Using a logic model to design and evaluate quality and patient safety improvement programs

Goeschel, C. A.; Weiss, W. M.; Pronovost, P. J.

doi:10.1093/intqhc/mzs029

Cited by 58Healthcare Quality and ManagementHealth Policy Implementation ScienceCentral Venous Catheters and Hemodialysis

Using a logic model to design and evaluate quality and patient safety improvement programs

Goeschel, C. A., Weiss, W. M., Pronovost, P. J.·2012·International Journal for Quality in Health Care

DOI 10.1093/intqhc/mzs029

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Abstract

Quality improvement programs often pose unique project management challenges, including multi-faceted interventions that evolve over time and teams with few resources for data collection. Thus, it is difficult to report methods and results. We developed a program to reduce central line-associated bloodstream infections (CLABSIs) and improve safety culture in intensive care units (ICUs). As previously reported, we worked with 103 Michigan ICUs to implement this program, and they achieved a 66% reduction in the median CLABSI rate and sustained the reduction. This success prompted the spread of this program to Spain, England, Peru and across the USA. We developed a logical framework approach (LFA) to guide project management; to incorporate the cultural, clinical and capacity variations among countries; and to ensure early alignment of the project's design and evaluation. In this paper, we describe the use of the LFA to systematically design, implement and evaluate large-scale, multi-faceted, quality improvement programs.

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An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU
Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., Sexton, B., Hyzy, R., Welsh, R., Roth, G., et al. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa061115 · Cited by 4,387 · see citing works
Self-citation
Translating evidence into practice: a model for large scale knowledge translation
Pronovost, P. J., Berenholtz, S. M., & Needham, D. M. (2008) · BMJ · doi:10.1136/bmj.a1714 · Cited by 577 · see citing works
Self-citation
Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study
Pronovost, P. J., Goeschel, C. A., Colantuoni, E., Watson, S., Lubomski, L. H., Berenholtz, S. M., Thompson, D. A., Sinopoli, D. J., Cosgrove, S. E., Sexton, J. B., et al. (2010) · BMJ · doi:10.1136/bmj.c309 · Cited by 519 · see citing works
Self-citation
Heterogeneity Is Not Always Noise
Davidoff, F. (2009) · JAMA · doi:10.1001/jama.2009.1845 · Cited by 114 · see citing works
The Elephant of Patient Safety: What You See Depends on How You Look
Shojania, K. G. (2010) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(10)36058-2 · Cited by 76 · see citing works
THE COMMONWEALTH FUND Commission on a High Performance Health System
Mongan, J. J., Bisognano, M. A., Cassel, C. K., Chernew, M. E., & Gabow, P. A. (2005) · Cited by 75 · see citing works
Improving data quality control in quality improvement projects
Needham, D. M., Sinopoli, D. J., Dinglas, V. D., Berenholtz, S. M., Korupolu, R., Watson, S. R., Lubomski, L. H., Goeschel, C. A., & Pronovost, P. J. (2009) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzp005 · Cited by 63 · see citing works
Self-citation
A Logical Framework
Nancholas, S. (1998) · Health Policy and Planning · doi:10.1093/heapol/13.2.189 · Cited by 58 · see citing works
The Logical Framework Approach
Riznic, J. R. (2009) · Cited by 44 · see citing works
Health planning for effective management
Reinke, W. A. (1988) · Cited by 30 · see citing works
Alcohol accounts for 6% of all admissions to English hospitals
O'Dowd, A. (2008) · BMJ · doi:10.1136/bmj.a963 · Cited by 22 · see citing works
Developing a Monitoring and Evaluating Capability for the U.S. Department of Defense Humanitarian Assistance Program
Licina, D. J., & Schor, K. W. (2007) · Military Medicine · doi:10.7205/milmed.172.4.339 · Cited by 12 · see citing works

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Powell, B. J., Beidas, R. S., Lewis, C. C., Aarons, G. A., McMillen, J. C., Proctor, E. K., & Mandell, D. S. (2017) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-015-9475-6 · Cited by 967 · see citing works
Demystifying theory and its use in improvement
Davidoff, F., Dixon-Woods, M., Leviton, L., & Michie, S. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003627 · Cited by 714 · see citing works
“28 Second, they offer what the evaluation scientist Carol Weiss 27 describes as a programme ’ s ‘ theory of change ’ , by which she means the rationale and assumptions about mechanisms that link a programme ’ s processes and inputs to outcomes — both intended and unintended, as well as specifying…”
Background
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Proctor, E. K., Powell, B. J., Baumann, A. A., Hamilton, A. M., & Santens, R. L. (2012) · Implementation Science · doi:10.1186/1748-5908-7-96 · Cited by 169 · see citing works
Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts
Powell, B. J., Beidas, R. S., Rubin, R. M., Stewart, R. E., Wolk, C. B., Matlin, S. L., Weaver, S., Hurford, M. O., Evans, A. C., Hadley, T. R., et al. (2016) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-016-0733-6 · Cited by 82 · see citing works
The biopsychosociotechnical model: a systems-based framework for human-centered health improvement
Card, A. J. (2022) · Health Systems · doi:10.1080/20476965.2022.2029584 · Cited by 66 · see citing works
Using implementation tools to design and conduct quality improvement projects for faster and more effective improvement
Øvretveit, J., Mittman, B. S., Rubenstein, L. V., & Ganz, D. A. (2017) · International Journal of Health Care Quality Assurance · doi:10.1108/ijhcqa-01-2017-0019 · Cited by 46 · see citing works
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Tackling the wicked problem of health networks: the design of an evaluation framework
Cunningham, F. C., Ranmuthugala, G., Westbrook, J. I., & Braithwaite, J. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-024231 · Cited by 33 · see citing works
A qualitative study of design stakeholders’ views of developing and implementing a registry-based learning health system
Dixon‐Woods, M., Campbell, A., Chang, T. E., Martin, G. P., Georgiadis, A., Heney, V., Chew, S., Citters, A. D. V., Sabadosa, K. A., & Nelson, E. C. (2020) · Implementation Science · doi:10.1186/s13012-020-0976-1 · Cited by 30 · see citing works
Long-Term Residential Care Policy Guidance for Staff to Support Resident Quality of Life
Hande, M. J., Keefe, J. M., & Taylor, D. (2020) · The Gerontologist · doi:10.1093/geront/gnaa176 · Cited by 26 · see citing works
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Weber, N., Patrick, M., Hayter, A. K. M., Martinsen, A. L., & Gelting, R. (2019) · Journal of Water Sanitation and Hygiene for Development · doi:10.2166/washdev.2019.090 · Cited by 25 · see citing works
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Blettner, M., Dierks, M., Donner‐Banzhoff, N., Hertrampf, K., Klusen, N., Köpke, S., Masanneck, M., Pfaff, H., Richter, R., & Sundmacher, L. (2018) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2018.01.004 · Cited by 24 · see citing works
To RCT or not to RCT? The ongoing saga of randomised trials in quality improvement
Parry, G. J., & Power, M. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004862 · Cited by 22 · see citing works
Practical recommendations for the evaluation of improvement initiatives
Parry, G. J., Coly, A., Goldmann, D. A., Rowe, A. K., Chattu, V. K., Logiudice, D., Rabrenović, M., & Nambiar, B. (2018) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzy021 · Cited by 21 · see citing works
Patient involvement in diagnosing cancer in primary care: a systematic review of current interventions
Heyhoe, J., Reynolds, C., Dunning, A., Johnson, O., Howat, A., & Lawton, R. (2018) · British Journal of General Practice · doi:10.3399/bjgp18x695045 · Cited by 19 · see citing works
Queensland Youth Cancer Service: A Partnership Model to Facilitate Access to Quality Care for Young People Diagnosed with Cancer
Bradford, N., Henney, R., Walker, R., Walpole, E. T., Kennedy, G., Nicholls, W., & Pinkerton, C. (2018) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2017.0080 · Cited by 17 · see citing works
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Øvretveit, J., Garofalo, L., & Mittman, B. S. (2017) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzx147 · Cited by 17 · see citing works
Central line associated blood stream infection rate after intervention and comparing outcome with national healthcare safety network and international nosocomial infection control consortium data
Bukhari, S., Banjar, A., Baghdadi, S., Baltow, B., Ashshi, A. M., & Hussain, W. (2014) · Annals of Medical and Health Sciences Research · doi:10.4103/2141-9248.141499 · Cited by 16 · see citing works
Evidence-Based Programs in “Real World” Settings: Finding the Best Fit
Powell, B. J., Bosk, E. A., Wilen, J. S., Danko, C. M., Scoyoc, A. V., & Banman, A. (2015) · Child maltreatment · doi:10.1007/978-3-319-16327-7_7 · Cited by 14 · see citing works
Using a Logic Model to Direct Backward Design of Curriculum
Loberti, A. M., & Dewsbury, B. M. (2018) · Journal of Microbiology and Biology Education · doi:10.1128/jmbe.v19i3.1638 · Cited by 13 · see citing works
Theory and context: putting the science into improvement
Moonesinghe, R., & Peden, C. J. (2017) · British Journal of Anaesthesia · doi:10.1093/bja/aew469 · Cited by 12 · see citing works
Improvement Science in Anaesthesia
Wagstaff, D., Bedford, J., & Moonesinghe, R. (2017) · Current anesthesiology reports · doi:10.1007/s40140-017-0234-5 · Cited by 10 · see citing works
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Sanctis, T. D., Etiebet, M.-A. A., Janssens, W., van der Graaf, M. H., van Montfort, C., Waiyaiya, E., & Spieker, N. (2022) · Global Health Science and Practice · doi:10.9745/ghsp-d-21-00665 · Cited by 11 · see citing works
Perspectives: answering questions about quality improvement: suggestions for investigators
Øvretveit, J. (2016) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzw136 · Cited by 10 · see citing works
Patients’ Satisfaction With the Health Care Systemin the Age of Globalization: The Case of Romania
Burcea, M., Toma, S.-G., & Papuc, R. M. (2014) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 9 · see citing works
Framework for Critical Care in Obstetrics
Baird, S. M., & Martin, S. L. (2018) · The Journal of Perinatal & Neonatal Nursing · doi:10.1097/jpn.0000000000000348 · Cited by 7 · see citing works
Development and design of the first structured clinic-based program in lower resource settings to transition emerging adults with type 1 diabetes from pediatric to adult care
Sarteau, A. C., Peerzada, A., Goyal, A., Praveen, P. A., & Tandon, N. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000665 · Cited by 5 · see citing works
Evaluating an oral health programme for the prevention of dental decay among school-aged children in China: protocol for a mixed-methods study based on the RE-AIM framework
Wang, L., Liu, H., Wang, L., Zhang, Y., Guo, W., Wu, P., Chang, X., Wang, L., Xu, W., & Zhao, L. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-061601 · Cited by 5 · see citing works
A remote monitoring program evaluation: a retrospective study
Williams, C., & Wan, T. T. H. (2016) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12577 · Cited by 5 · see citing works
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Yang, J. T., Kurdyak, P. A., & Guttmann, A. (2016) · Healthcare Quarterly · doi:10.12927/hcq.2016.24865 · Cited by 5 · see citing works
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Hyland, S. J., & Musch, K. L. E. (2022) · JACCP JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY · doi:10.1002/jac5.1738 · Cited by 4 · see citing works
Wie kann die Implementierung von Patientensicherheitsprogrammen gelingen? Ein Beispiel aus der Schweiz
Kobler, I., Mascherek, A., & Bezzola, P. (2015) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2015.03.002 · Cited by 4 · see citing works
Lessons Learned Using Logic Models to Design and Guide DNP Projects
Idzik, S. R., Buckley, K. M., Bindon, S. L., Gorschboth, S., Hammersla, M., Windemuth, B., & Bingham, D. (2021) · Nurse Educator · doi:10.1097/nne.0000000000001025 · Cited by 4 · see citing works
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Choong, K. L. M. (2016) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000000992 · Cited by 4 · see citing works
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Ehteram, H., & Sharif-Alhoseini, M. (2013) · PubMed · Cited by 3 · see citing works
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Øvretveit, J. (2018) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzy015 · Cited by 2 · see citing works
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Baylis, J. B., Innes, K., Roos, J., McFetridge, C., McSweeney, C., & Holm, N. (2020) · BMJ Simulation & Technology Enhanced Learning · doi:10.1136/bmjstel-2019-000573 · Cited by 1 · see citing works
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Buelow, J. M. (2013) · PubMed · Cited by 1 · see citing works
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González, R., Rodríguez, I. A., & García, J. C. (2015) · Revista Habanera de Ciencias Médicas
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Jeffery, C. (2016) · University Library - University of Saskatchewan (University of Saskatchewan)
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Labella, B., Blasi, R. D., Raho, V., Matteis, G. D., Tozzi, Q., & Caracci, G. (2017) · InTech eBooks · doi:10.5772/intechopen.69652
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Authors: Goeschel, C. A., Weiss, W. M., & Pronovost, P. J.
Affiliations: Johns Hopkins University (US)
Corresponding author: Goeschel, C. A.
ORCID: Weiss, W. M.
Pronovost, P. J.
Venue: International Journal for Quality in Health Care
Publisher: Oxford University Press (OUP)
Published: 2012-06-27
Volume: 24
Issue: 4
Pages: 330-337
ISSN: 1353-4505 (ISSN-L)
1464-3677
DOI: 10.1093/intqhc/mzs029
OpenAlex: W2166271693
Cited by: 58
References: 12
Citations by year: 2026: 1 · 2025: 2 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 10 · 2017: 6 · 2016: 6 · 2015: 6 · 2014: 2 · 2013: 5 · 2012: 1
FWCI: 7.27
Type: journal article
Language: en
Open access: closed
Locations: International Journal for Quality in Health Care (publishedVersion)
PubMed (publishedVersion)
Funders: Agency for Healthcare Research and Quality (1 UC1 HS14246-01)
Topics: Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
Keywords: logic model, patient safety, central line-associated bloodstream infection, intensive care unit, safety culture, program evaluation, project management, multi-faceted intervention, infection control
MeSH terms: Humans, Intensive Care Units, Logistic Models, Catheter-Related Infections, Quality Improvement, Patient Safety

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Using a logic model to design and evaluate quality and patient safety improvement programs

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