The effect of a quality improvement collaborative to improve antimicrobial prophylaxis in surgical patients: a randomized trial.
BACKGROUND
Quality improvement collaboratives are used to improve health care quality, but their efficacy remains controversial.


OBJECTIVE
To assess the effects of a quality improvement collaborative on preoperative antimicrobial prophylaxis.


METHODS
Longitudinal cluster randomized trial, with the quality improvement collaborative as the intervention.


METHODS
United States.


METHODS
44 acute care hospitals, each of which randomly sampled approximately 100 selected surgical cases (cardiac, hip or knee replacement, and hysterectomy) at both the baseline and remeasurement phases.


METHODS
All hospitals received a comparative feedback report. Hospitals randomly assigned to the intervention group (n = 22) participated in a quality improvement collaborative comprising 2 in-person meetings led by experts, monthly teleconferences, and receipt of supplemental materials over 9 months.


METHODS
Change in the proportion of patients receiving at least 1 antibiotic dose within 60 minutes of surgery (primary outcome) and change in the proportions of patients given any antibiotics, given antibiotics for 24 hours or less, given an appropriate drug, and given a single preoperative dose and receipt of any of the 5 measures (secondary outcome).


RESULTS
The groups did not differ in the change in proportion of patients who received a properly timed antimicrobial prophylaxis dose (-3.8 percentage points [95% CI, -13.9 to 6.2 percentage points]) after adjustment for region, hospital size, and surgery type. Similarly, the groups did not differ in individual measures of antibiotic duration; use of appropriate drug; receipt of a single preoperative dose; or an all-or-none measure combining timing, duration, and selection.


CONCLUSIONS
Hospitals volunteered for the effort, thereby resulting in selection for participants who were motivated to change. Implementation of the surgical infection prevention measure reporting requirements by the Centers for Medicare & Medicaid Services and The Joint Commission may have motivated improvement in prophylaxis performance.


CONCLUSIONS
At a time of heightened national attention toward measures of antimicrobial prophylaxis performance, the trial did not demonstrate a benefit of participation in a quality improvement collaborative over performance feedback for improvement of these measures.
Kritchevsky
Stephen B
SB
Wake Forest University School of Medicine and J. Paul Sticht Center on Aging, Winston-Salem, North Carolina.
Braun
Barbara I
BI
Bush
Andrew J
AJ
Bozikis
Michele R
MR
Kusek
Linda
L
Burke
John P
JP
Wong
Edward S
ES
Jernigan
John
J
Davis
Cralen C
CC
Simmons
Bryan
B
D019072:Antibiotic Prophylaxis / Q000592:standards*; D003299:Cooperative Behavior; D005246:Feedback; D006761:Hospitals / Q000592:standards*; D006801:Humans; D019984:Quality Indicators, Health Care; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014481:United States