title: Quality improvement projects targeting health care-associated infections: comparing Virtual Collaborative and Toolkit approaches.
abstract: BACKGROUND
  Collaborative and toolkit approaches have gained traction for improving quality in health care.
  
  
  OBJECTIVE
  To determine if a quality improvement virtual collaborative intervention would perform better than a toolkit-only approach at preventing central line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonias (VAPs).
  
  
  METHODS
  Cluster randomized trial with the Intensive Care Units (ICUs) of 60 hospitals assigned to the Toolkit (n=29) or Virtual Collaborative (n=31) group from January 2006 through September 2007.
  
  
  METHODS
  CLABSI and VAP rates. Follow-up survey on improvement interventions, toolkit utilization, and strategies for implementing improvement.
  
  
  RESULTS
  A total of 83% of the Collaborative ICUs implemented all CLABSI interventions compared to 64% of those in the Toolkit group (P = 0.13), implemented daily catheter reviews more often (P = 0.04), and began this intervention sooner (P < 0.01). Eighty-six percent of the Collaborative group implemented the VAP bundle compared to 64% of the Toolkit group (P = 0.06). The CLABSI rate was 2.42 infections per 1000 catheter days at baseline and 2.73 at 18 months (P = 0.59). The VAP rate was 3.97 per 1000 ventilator days at baseline and 4.61 at 18 months (P = 0.50). Neither group improved outcomes over time; there was no differential performance between the 2 groups for either CLABSI rates (P = 0.71) or VAP rates (P = 0.80).
  
  
  CONCLUSIONS
  The intensive collaborative approach outpaced the simpler toolkit approach in changing processes of care, but neither approach improved outcomes. Incorporating quality improvement methods, such as ICU checklists, into routine care processes is complex, highly context-dependent, and may take longer than 18 months to achieve.
authors.affiliation: Geriatric Research, Education, and Clinical Center (GRECC) and Center for Health Services Research, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA. ted.speroff@vanderbilt.edu
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
authors.forename: E Wes
authors.initials: EW
authors.lastname: Ely
authors.forename: Robert
authors.initials: R
authors.lastname: Greevy
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Weinger
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Talbot
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wall
authors.forename: Jayant K
authors.initials: JK
authors.lastname: Deshpande
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: France
authors.forename: Sam
authors.initials: S
authors.lastname: Nwosu
authors.forename: Hayley
authors.initials: H
authors.lastname: Burgess
authors.forename: Jane
authors.initials: J
authors.lastname: Englebright
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
mesh_terms: D016000:Cluster Analysis; D003299:Cooperative Behavior; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D058996:Quality Improvement / Q000639:trends*; D014584:User-Computer Interface