Reducing Ileostomy Readmissions: Using Implementation Science to Evaluate the Adoption of a Quality Improvement...

Area of Science:

• Implementation science
• Quality improvement initiatives
• Clinical practice adoption

Background:

• Translating evidence into practice for new ileostomy patients is challenging.
• Oral rehydration solutions show benefits but have low adoption rates.
• Causes for low uptake are multifactorial.

Purpose of the Study:

• Identify barriers and facilitators to adopting oral rehydration solutions for new ileostomy patients.
• Utilize the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
• Decrease emergency department visits and hospital readmissions due to dehydration.

Main Methods:

• Qualitative interviews with 25 key stakeholders across 12 Michigan hospitals.
• Stakeholders included nurses, surgeons, physician assistants, and data abstractors.
• Analysis used the RE-AIM framework domains.

Main Results:

• Provider-level factors for adoption include selecting and coaching champions.
• Broadening multidisciplinary teams and performing structured patient follow-up are crucial.
• Addressing long-term sustainability concerns regarding cost and equity is essential.

Conclusions:

• Implementation science frameworks can rigorously study quality improvement initiatives.
• Identifying determinants is key to widespread adoption of evidence-based practices.
• This study highlights factors for successful implementation of oral rehydration solutions.