title: Challenges in conducting a hospital-randomized trial of an educational quality improvement intervention in rural and small community hospitals.
abstract: The study design for this hospital-randomized controlled trial of an educational quality improvement intervention in rural and small community hospitals, following the implementation of a Web-based quality benchmarking and case review tool, specified a control group and a rapid-cycle quality improvement education group of >or= 30 hospitals each. Of the 64 hospitals initially interested in participating, 7 could not produce the required quality data and 10 refused consent to randomization. Of the 23 hospitals randomized to the educational intervention, 16 completed the educational program, 1 attended the didactic sessions but did not complete the required quality improvement project, 3 enrolled in "make-up" sessions, and 3 were unable to attend. Of the 42 individuals who attended educational sessions, 5 (12%) have left their positions. Quality improvement interventions require several different approaches to engage participating organizations and should include plans to train new staff given the high turnover of health care quality improvement personnel.
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas 75206, USA.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filardo
authors.forename: David
authors.initials: D
authors.lastname: Nicewander
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Percy
authors.initials: P
authors.lastname: Galimbertti
authors.forename: Mari
authors.initials: M
authors.lastname: Tietze
authors.forename: Susan
authors.initials: S
authors.lastname: McBride
authors.forename: Julie
authors.initials: J
authors.lastname: Gunderson
authors.forename: Ashley
authors.initials: A
authors.lastname: Collinsworth
authors.forename: Ziad
authors.initials: Z
authors.lastname: Haydar
authors.forename: Josie
authors.initials: J
authors.lastname: Williams
authors.forename: David J
authors.initials: DJ
authors.lastname: Ballard
mesh_terms: D019985:Benchmarking / Q000379:methods*; D003258:Consumer Behavior; D006740:Hospital Administrators / Q000193:education*; D006764:Hospitals, Community / Q000592:standards*; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D011786:Quality Control; D013781:Texas