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

Johns Hopkins University85 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Diabetes Mellitus Hypertension Dyslipidemias

Interventions

Comprehensive Unit Based Safety Program (CUSP)OTHER

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.

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

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

Locations (1)

Johns Hopkins Adult Psychiatric Rehabilitation Program

Baltimore, Maryland, United States

Outcomes

Primary Outcomes

Quality Improvement Culture as Assessed by the Modified Version of the Validated Survey on Patient Safety

Each of the items in the modified survey is scored individually on 1-5 Likert scales. An average score is calculated by summing responses across all 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.

Time frame: Baseline, 12 Months

Self-efficacy as Assessed by an Adapted Version of Compeau & Higgins' Task-focused Self-efficacy Scale

Each of the items (Hypertension, Dyslipidemia, Diabetes) are 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 items and dividing by the total number of items. The average score ranges from 1-10. A higher score signifies greater self-efficacy.

Time frame: Baseline, 12 Months

Secondary Outcomes

Acceptability as Assessed by the Acceptability of Intervention Measure

Validated 4-item instrument measuring intervention acceptability of the Evidence based practice and CUSP strategy using the Acceptability of Intervention Measure. Each of the 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 items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies greater acceptability.

Time frame: Baseline, 12 Months

Appropriateness as Assessed by the Intervention Appropriateness Measure

Four item instrument measuring intervention appropriateness of Evidence based practice and CUSP strategy using the Intervention Appropriateness Measure. Each of the 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 items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies greater appropriateness.

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.

Time frame: Baseline, 12 Months

Feasibility as Assessed by the Feasibility of Intervention Measure

Four item instrument measuring intervention feasibility of Evidence based practice and CUSP strategy using the Feasibility of Intervention Measure. Each of the 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 items and dividing by the total number of items. The average score ranges from 1-5. A higher score signifies greater feasibility.

Time frame: Baseline, 12 Months

Clients With Hypertension Control

Measured with blood pressure (BP) readings reported by staff . Clients with control defined as a BP \<130/80 mmHg.

Time frame: Baseline and 12 Months

Clients With Dyslipidemia Control

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

Time frame: Baseline and 12 Months

Clients With Diabetes Control

Measured using HbA1c tests reported by staff . Clients with controlled diabetes defined as HbA1c\<7.0.

Time frame: Baseline and 12 Months

Clients Diagnosed With Diabetes Mellitus Who Received HBA1c Measurement

The number of clients who have a HBA1c measurement reported by the participating staff.

Time frame: Baseline and 12 Months

Change in the Percent of Individuals Diagnosed With Diabetes Mellitus Who Received a Lipid Panel

Time frame: Baseline, 6 and 12 months

Change in the Percent of Individuals Diagnosed With Diabetes Mellitus Who Received Statin Therapy

Time frame: Baseline, 6 and 12 months

Change in the Percent of Individuals Diagnosed With Diabetes Mellitus Who Received a Dilated Eye Exam

Time frame: Baseline, 6 and 12 months

Change in the Percent of Individuals Diagnosed With Diabetes Mellitus Who Received a Foot Exam

Time frame: Baseline, 6 and 12 months

Clients Diagnosed With Dyslipidemia Who Received a Lipid Panel

The number of clients who have a lipid panel reported by the participating staff.

Time frame: Baseline and 12 Months

Teamwork Within Teams as Assessed by the Implementation Climate Scale

Four items measuring teamwork. Each of the 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.

Time frame: Baseline, 12 Months

Supervisor/Manager Expectations and Actions Promoting Quality as Assessed by the Implementation Climate Scale

Four items measuring the degree to which a provider's supervisor promotes quality improvement. Each of the 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.

Time frame: Baseline, 12 Months

Organizational Learning Assessed by the Implementation Climate Scale

Three items measuring organizational learning environment. Each of the 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.

Time frame: Baseline, 12 Months

Management Support for Patient Safety as Assessed by the Implementation Climate Scale

Three items measuring the degree to which organization management supports quality improvement. Each of the 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.

Time frame: Baseline, 12 Months

Overall Perceptions of Quality Improvement Culture as Assessed by the Implementation Climate Scale

Three items measuring the perception's of the organization's quality improvement culture. Each of the 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.

Time frame: Baseline, 12 Months

Feedback and Communication About Error as Assessed by the Implementation Climate Scale

Three items measuring feedback and communication about quality improvement. Each of the 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.

Time frame: Baseline, 12 Months

Communication Openness as Assessed by the Implementation Climate Scale

Three items measuring perceptions of communication openness in the organization. Each of the 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.

Time frame: Baseline, 12 Months

Frequency of Events Reported as Assessed by the Implementation Climate Scale

Three items assessing the degree to which mistakes are reported at the organization. Each of the 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.

Time frame: Baseline, 12 Months

Teamwork Across Teams as Assessed by the Implementation Climate Scale

Four items assessing teamwork across units. Each of the 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.

Time frame: Baseline, 12 Months

Staffing as Assessed by the Implementation Climate Scale

Two items assessing staffing capacity. Each of the 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.

Time frame: Baseline, 12 Months

Clients With Hypertension Who Had a Blood Pressure Measurement

The number of clients who have a blood pressure measurement reported by the participating staff.

Time frame: Baseline and 12 Months

Change in the Percent of Individuals Diagnosed With Diabetes Mellitus Who Received a Urine-protein-creatinine Test

Time frame: Baseline, 6 and 12 months

Change in the Percent of Individuals Diagnosed With Dyslipidemia Who Are on a Statin Medication

Time frame: Baseline, 6 and 12 months

Change in the Percent of Individuals Diagnosed With Hypertension Who Received Lifestyle Counseling

Time frame: Baseline, 6 and 12 months

Change in the Percent of Individuals Diagnosed With Diabetes Mellitus Who Received Lifestyle Counseling

Time frame: Baseline, 6 and 12 months

Change in the Percent of Individuals Diagnosed With Dyslipidemia Who Received Lifestyle Counseling

Time frame: Baseline, 6 and 12 months