A Quality Improvement Process to Support Delivery of Cardiovascular Care in Community Mental Health Organizations

A Quality Improvement Process to Support Delivery of Cardiovascular Care in Community Mental Health Organizations

Using an Innovative Quality Improvement Process to Increase Delivery of Evidence-based Cardiovascular Risk Factor Care in Community Mental Health Organizations

This pilot study will examine whether an implementation strategy will improve delivery of evidence-based care for cardiovascular risk factors for people with serious mental illness.

In this pilot study, the investigators will work with health home programs and pilot test an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy to improve mental health providers' delivery of evidence-based cardiovascular risk factor care for hypertension, dyslipidemia and diabetes for individuals with serious mental illness. The project will also characterize implementation processes, organizational and provider-level factors, and cardiovascular disease risk factor care and control.

CUSP is a quality improvement strategy developed by the Johns Hopkins University Armstrong Institute for Patient Safety and Quality that is used to improve care delivery.

CUSP is a quality improvement strategy developed by the Johns Hopkins University Armstrong Institute for Patient Safety and Quality that is used to improve care delivery.

Change in quality improvement culture as assessed by the modified version of the validated Survey on Patient Safety

Each of the 34 items in the modified survey is scored individually on 1-5 Likert scales. An average score is calculated by summing responses across all 34 items and dividing by the total number of items. The average score ranges from 1-5. A higher average score signifies an organizational culture that is more supportive of quality improvement.

Change in self-efficacy as assessed by an adapted version of Compeau & Higgins' task-focused self-efficacy scale

Each of the nine items is scored individually on a 1-10 Likert scale, where 1=not at all confident and 10=totally confident. An average score is calculated by summing responses across all 9 items and dividing by the total number of items. The average score ranges from 1-10. A higher score signifies greater self-efficacy.

We will use a validated 4-item instrument measuring intervention acceptability, using the Acceptability of Intervention Measure. Each of the 4 items will be measured on a 5-point Likert scale, where 1=completely disagree and 5=completely agree. An average score is calculated by summing responses across all four items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies greater acceptability.

We will use a validated 4-item instrument measuring intervention appropriateness, using the Intervention Appropriateness Measure. Each of the 4 items will be measured on a 5-point Likert scale, where 1=completely disagree and 5= completely agree. An average score is calculated by summing responses across all four items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies greater appropriateness.

We will use a validated 4-item instrument measuring intervention feasibility, using the Feasibility of Intervention Measure. Each of the 4 items will be measured on a 5-point Likert scale, where 1=completely disagree and 5=completely agree. An average score is calculated by summing responses across all four items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies greater feasibility.

Measured with cholesterol readings (controlled dyslipidemia defined as total cholesterol <200 mg/dL and low-density lipoprotein (LDL) <130 mg/dL).

Change in the percent of individuals diagnosed with diabetes mellitus who received a dilated eye exam

Change in teamwork within units as assessed by the modified version of the validated Survey on Patient Safety

We will use 4 items measuring teamwork. Each of the 4 items will be measured on a 5-point Likert scale, where 1=strongly disagree and 5=strongly agree. An average score is calculated by summing responses across items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies better teamwork within units.

Change in supervisor promotion of quality improvement as assessed by the modified version of the validated Survey on Patient Safety

We will use 4 items measuring the degree to which a provider's supervisor promotes quality improvement. Each of the 4 items will be measured on a 5-point Likert scale, where 1=strongly disagree and 5=strongly agree. An average score is calculated by summing responses across items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies greater promotion of quality improvement.

Change in organizational learning as assessed by the modified version of the validated Survey on Patient Safety

We will use 3 items measuring organizational learning environment. Each of the 3 items will be measured on a 5-point Likert scale, where 1=strongly disagree and 5=strongly agree. An average score is calculated by summing responses across items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies greater organizational learning.

Change in management support for quality improvement as assessed by the modified version of the validated Survey on Patient Safety

We will use 3 items measuring the degree to which organization management supports quality improvement. Each of the 3 items will be measured on a 5-point Likert scale, where 1=strongly disagree and 5=strongly agree. An average score is calculated by summing responses across items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies greater management support for quality improvement.

Change in overall perceptions of quality improvement culture as assessed by the modified version of the validated Survey on Patient Safety

We will use 3 items measuring the perception's of the organization's quality improvement culture. Each of the 3 items will be measured on a 5-point Likert scale, where 1=strongly disagree and 5=strongly agree. An average score is calculated by summing responses across items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies better quality improvement culture.

Change in feedback and communication as assessed by the modified version of the validated Survey on Patient Safety

We will use 3 items measuring feedback and communication about quality improvement. Each of the 3 items will be measured on a 5-point Likert scale, where 1=never and 5=always. An average score is calculated by summing responses across items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies better feedback and communication.

Change in communication openness as assessed by the modified version of the validated Survey on Patient Safety

We will use 3 items measuring perceptions of communication openness in the organization. Each of the 3 items will be measured on a 5-point Likert scale, where 1=never and 5=always. An average score is calculated by summing responses across items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies better communication openness.

Change in mistake reporting as assessed by the modified version of the validated Survey on Patient Safety

We will use 3 items assessing the degree to which mistakes are reported at the organization. Each of the 3 items will be measured on a 5-point Likert scale, where 1=never and 5=always. An average score is calculated by summing responses across items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies more frequent mistake reporting.

Change in teamwork across units as assessed by the modified version of the validated Survey on Patient Safety

We will use 4 items assessing teamwork across units. Each of the 4 items will be measured on a 5-point Likert scale, where 1=strongly disagree and 5=strongly agree. An average score is calculated by summing responses across items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies better teamwork across units.

Change in staffing capacity as assessed by the modified version of the validated Survey on Patient Safety

We will use 2 items assessing staffing capacity. Each of the 2 items will be measured on a 5-point Likert scale, where 1=strongly disagree and 5=strongly agree. An average score is calculated by summing responses across items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies better staffing capacity.

Change in the percent of individuals with systolic blood pressure with poorly controlled hypertension who had a blood pressure measurement

Change in the percent of individuals diagnosed with diabetes mellitus who received a urine-protein-creatinine test

Change in the percent of individuals diagnosed with diabetes mellitus who received lifestyle counseling

Inclusion Criteria: Study population 1: Psychiatric rehabilitation program and health home team staff, including providers and leadership are those employed by the psychiatric rehabilitation program or health home program. English-speaking. Study population 2: People with serious mental illness participating in psychiatric rehabilitation health home programs. English-speaking Exclusion Criteria: None

McGinty EE, Thompson D, Murphy KA, Stuart EA, Wang NY, Dalcin A, Mace E, Gennusa JV 3rd, Daumit GL. Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study. Implement Sci Commun. 2021 Mar 4;2(1):26. doi: 10.1186/s43058-021-00129-6.