Why It Matters
An independent review of Project JOINTS supports the use of campaign-style approaches to accelerate the adoption of simple, evidence-based practices to reduce surgical site infections.
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QI Methods Aid Adoption of Evidence-Based Practices to Reduce Hip and Knee SSIs

By Kimberly Mitchell | Tuesday, November 11, 2014

In this blog post, Kate DeBartolo, IHI National Field Manager, and Gareth Parry, PhD, IHI Senior Scientist, briefly describe a newly published article that reports on findings about factors that affect the adoption of evidence-based practices to reduce surgical site infections after orthopedic surgery.

KateDebartolo   GarethParry
Kate DeBartolo                  Gareth Parry


The IHI-led Project JOINTS initiative, funded by the US Department of Health and Human Services, aimed to increase the uptake of three evidence-based surgical site infection (SSI) reduction practices in hip and knee replacements. IHI based the approach on what we learned during the 100,000 Lives and 5 Million Lives Campaigns, and used the infrastructure IHI developed for these Campaigns in the Project JOINTS initiative.

An article published this week in the British Medical Journal Quality & Safety, co-authored by Kate DeBartolo, IHI National Field Manager, describes the factors found by RAND to have increased adoption of the Project JOINTS interventions across participating US states and hospitals.

Like many studies of improvement initiatives, participants reported value in being able to learn from one another, particularly through listservs and webinars. Also, like many other initiatives, the more complex components were most challenging to implement. Importantly, however, the authors found that adherence to quality improvement (QI) methods was a strong predictor of adoption of the SSI reduction practices.

The authors concluded that: “This association between adoption of evidence-based practices and QI methods adherence (developing a plan, forming an implementation team, and conducting small-scale tests of change) is consistent with prior literature suggesting that basing a campaign on systematic use of QI methods is an important pathway towards its effectiveness.”

This study provides a great example of the importance of listening to the perspective of those working to improve health care on an hour-by-hour basis to understand what is of value to them. Moreover, it supports the use of campaign-style approaches to accelerate the adoption of simple, evidence-based practices. For more complex practices, IHI and the improvement field will continue to partner and test innovative approaches, and commit to sharing what we learn.

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