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Challenges in Conducting a Hospital-Randomized Trial of an Educational Quality Improvement Intervention in Rural and Small Community Hospitals

Institute for Health Care Research and Improvement, Baylor Health Care System, Department of Statistical Science, Southern Methodist University, Dallas, Texas

David Nicewander, MS

Institute for Health Care Research and Improvement, Baylor Health Care System

Jeph Herrin, PhD

Flying Buttress Associates, Charlottesville, Virginia

Percy Galimbertti, MD, PhD

Community Health Institute, Texas A&M University Health Science Center, College Station, Texas

Mari Tietze, PhD, RN

Dallas-Fort Worth Hospitals Council, Dallas, Texas

Susan McBride, PhD, RN

Dallas-Fort Worth Hospitals Council, Dallas, Texas

Julie Gunderson, RN, MM, CPHQ

Institute for Health Care Research and Improvement, Baylor Health Care System

Ashley Collinsworth, MPH, ELS

Institute for Health Care Research and Improvement, Baylor Health Care System

Ziad Haydar, MD

Institute for Health Care Research and Improvement, Baylor Health Care System, Charlottesville, Virginia

Josie Williams, MD, MMM

Community Health Institute, Texas A&M University Health Science Center, College Station, Texas

David J. Ballard, MD, MSPH, PhD

Institute for Health Care Research and Improvement, Baylor Health Care System, dj.ballard{at}baylorhealth.edu

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 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. (Am J Med Qual 2008;23: 440-447)

Key Words: quality of care • rural hospitals • education • rapid-cycle quality improvement

This version was published on November 1, 2008

American Journal of Medical Quality, Vol. 23, No. 6, 440-447 (2008)
DOI: 10.1177/1062860608324546


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