title: Implementation of Departmental Quality Strategies Is Positively Associated with Clinical Practice: Results of a Multicenter Study in 73 Hospitals in 7 European Countries.
abstract: BACKGROUND
  Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness.
  
  
  OBJECTIVE
  To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems.
  
  
  METHODS
  Multicenter, multilevel cross-sectional study.
  
  
  METHODS
  Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries.
  
  
  METHODS
  None.
  
  
  METHODS
  Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding.
  
  
  CONCLUSIONS
  Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities.
  
  
  CONCLUSIONS
  There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly associated with good clinical practice. Further research should aim to develop clinically relevant quality standards for hospital departments, which appear to be more effective than generic hospital-wide quality systems.
authors.affiliation: Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain.|Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Sunol
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.|Department of Public and Occupational Health,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, United States of America.
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
authors.affiliation: Danish Clinical Registries, Aarhus, Denmark.|Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Solvejg
authors.initials: S
authors.lastname: Kristensen
authors.affiliation: Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany.|Center for Health Services Research Cologne, University of Cologne, Cologne, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Niek
authors.initials: N
authors.lastname: Klazinga
authors.affiliation: Palo Alto Medical Foundation Research Institute (PAMFRI), Palo Alto, California, United States of America.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Thompson
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, United States of America.
authors.forename: Aolin
authors.initials: A
authors.lastname: Wang
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, United States of America.
authors.forename: Maral
authors.initials: M
authors.lastname: DerSarkissian
authors.affiliation: Danish Clinical Registries, Aarhus, Denmark.|Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Paul
authors.initials: P
authors.lastname: Bartels
authors.affiliation: Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Michel
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Oliver
authors.initials: O
authors.lastname: Groene
mesh_terms: D036861:Delivery, Obstetric; D005060:Europe; D006620:Hip Fractures / Q000453:epidemiology; D006761:Hospitals / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D059039:Standard of Care; D020521:Stroke / Q000453:epidemiology