The Effect of a Quality Improvement Collaborative to Improve Antimicrobial Prophylaxis in Surgical Patients: A Randomized Trial
Abstract
BACKGROUND: Quality improvement collaboratives are used to improve health care quality, but their efficacy remains controversial. OBJECTIVE: To assess the effects of a quality improvement collaborative on preoperative antimicrobial prophylaxis. DESIGN: Longitudinal cluster randomized trial, with the quality improvement collaborative as the intervention. SETTING: United States. PARTICIPANTS: 44 acute care hospitals, each of which randomly sampled approximately 100 selected surgical cases (cardiac, hip or knee replacement, and hysterectomy) at both the baseline and remeasurement phases. INTERVENTION: All hospitals received a comparative feedback report. Hospitals randomly assigned to the intervention group (n = 22) participated in a quality improvement collaborative comprising 2 in-person meetings led by experts, monthly teleconferences, and receipt of supplemental materials over 9 months. MEASUREMENTS: Change in the proportion of patients receiving at least 1 antibiotic dose within 60 minutes of surgery (primary outcome) and change in the proportions of patients given any antibiotics, given antibiotics for 24 hours or less, given an appropriate drug, and given a single preoperative dose and receipt of any of the 5 measures (secondary outcome). RESULTS: The groups did not differ in the change in proportion of patients who received a properly timed antimicrobial prophylaxis dose (-3.8 percentage points [95% CI, -13.9 to 6.2 percentage points]) after adjustment for region, hospital size, and surgery type. Similarly, the groups did not differ in individual measures of antibiotic duration; use of appropriate drug; receipt of a single preoperative dose; or an all-or-none measure combining timing, duration, and selection. LIMITATIONS: Hospitals volunteered for the effort, thereby resulting in selection for participants who were motivated to change. Implementation of the surgical infection prevention measure reporting requirements by the Centers for Medicare & Medicaid Services and The Joint Commission may have motivated improvement in prophylaxis performance. CONCLUSION: At a time of heightened national attention toward measures of antimicrobial prophylaxis performance, the trial did not demonstrate a benefit of participation in a quality improvement collaborative over performance feedback for improvement of these measures.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Kritchevsky 2008 found that adding a quality improvement collaborative to feedback alone did not improve the utilisation of antibiotics within one hour prior to surgery (adjusted RD = -3.6%; absolute risk reduction (ARR) -3.8, 95% CI -13.9 to 6.2).
“Kritchevsky 2008 found that adding a quality improvement collaborative to feedback alone did not improve the utilisation of antibiotics within one hour prior to surgery (adjusted RD = ‐3.6%; absolute risk reduction (ARR) ‐3.8, 95% CI ‐13.9 to 6.2).”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Kritchevsky 2008
Cites
Davis, D., O'Brien, M. A. T., Freemantle, N., Wolf, F. M., Mazmanian, P., & Taylor-Vaisey, A. (1999) · JAMA · doi:10.1001/jama.282.9.867 · Cited by 2,364 · see citing works
The Timing of Prophylactic Administration of Antibiotics and the Risk of Surgical-Wound Infection
Classen, D. C., Evans, R. S., Pestotnik, S. L., Horn, S. D., Menlove, R. L., & Burke, J. P. (1992) · New England Journal of Medicine · doi:10.1056/nejm199201303260501 · Cited by 1,734 · see citing works
Self-citationBratzler, D. W., & Houck, P. M. (2005) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2005.01.015 · Cited by 1,168 · see citing works
Infection Control — A Problem for Patient Safety
Burke, J. P. (2003) · New England Journal of Medicine · doi:10.1056/nejmhpr020557 · Cited by 1,153 · see citing works
Self-citationFung, C. H., Lim, Y.-W., Mattke, S., Damberg, C. L., & Shekelle, P. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-148-2-200801150-00006 · Cited by 981 · see citing works
Dale, W., Peter, M. H., & Workgroup, F. T. S. I. P. G. W. (2004) · Clinical Infectious Diseases · doi:10.1086/421095 · Cited by 884 · see citing works
Evidence-Based Quality Improvement: The State Of The Science
Shojania, K. G., & Grimshaw, J. (2005) · Health Affairs · doi:10.1377/hlthaff.24.1.138 · Cited by 688 · see citing works
Bratzler, D. W., & Hunt, D. R. (2006) · Clinical Infectious Diseases · doi:10.1086/505220 · Cited by 583 · see citing works
Use of Antimicrobial Prophylaxis for Major Surgery
Bratzler, D. W. (2005) · Archives of Surgery · doi:10.1001/archsurg.140.2.174 · Cited by 578 · see citing works
Quality collaboratives: lessons from research
Øvretveit, J. (2002) · BMJ Quality & Safety · doi:10.1136/qhc.11.4.345 · Cited by 572 · see citing works
A Framework for Collaborative Improvement
Kilo, C. M. (1998) · Quality Management in Health Care · doi:10.1097/00019514-199806040-00001 · Cited by 482 · see citing works
Soumerai, S. B., McLaughlin, T. J., Gurwitz, J. H., Guadagnoli, E., Hauptman, P. J., Borbas, C., Morris, N., McLaughlin, B., Gao, X., Willison, D. J., et al. (1998) · JAMA · doi:10.1001/jama.279.17.1358 · Cited by 479 · see citing works
Microsystems in Health Care: Part 1. Learning from High-Performing Front-Line Clinical Units
Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., & Wasson, J. H. (2002) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(02)28051-7 · Cited by 451 · see citing works
Quality of Care in U.S. Hospitals as Reflected by Standardized Measures, 2002–2004
Williams, S. C., Schmaltz, S. P., Morton, D. J., Koss, R. G., & Loeb, J. M. (2005) · New England Journal of Medicine · doi:10.1056/nejmsa043778 · Cited by 421 · see citing works
Evidence-Based Implementation of Evidence-Based Medicine
Grol, R., & Grimshaw, J. (1999) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(16)30464-3 · Cited by 421 · see citing works
Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O'Brien, M. A., & Oxman, A. D. (2006) · BMJ Quality & Safety · doi:10.1136/qshc.2006.018549 · Cited by 364 · see citing works
Hospitals collaborate to decrease surgical site infections
Dellinger, E. P., Hausmann, S. M., Bratzler, D. W., Johnson, R. M., Daniel, D. M., Bunt, K. M., Baumgardner, G. A., & Sugarman, J. R. (2005) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2004.12.001 · Cited by 310 · see citing works
Improving the Management of Chronic Disease at Community Health Centers
Landon, B. E., Hicks, L. S., O’Malley, A. J., Lieu, T. A., Keegan, T., McNeil, B. J., & Guadagnoli, E. (2007) · New England Journal of Medicine · doi:10.1056/nejmsa062860 · Cited by 280 · see citing works
Creating the Evidence Base for Quality Improvement Collaboratives
Mittman, B. S. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-11-200406010-00011 · Cited by 279 · see citing works
What Do Collaborative Improvement Projects Do? Experience from Seven Countries
Wilson, T., Berwick, D. M., & Cleary, P. D. (2003) · The Joint Commission Journal on Quality and Safety · doi:10.1016/s1549-3741(03)29011-0 · Cited by 210 · see citing works
Ferguson, T. B., Peterson, E. D., Coombs, L. P., Eiken, M. C., Carey, M. L., Grover, F. L., DeLong, E. R., & for the Society of Thoracic Surgeons and the National Cardiac Database (2003) · JAMA · doi:10.1001/jama.290.1.49 · Cited by 201 · see citing works
Data feedback efforts in quality improvement: lessons learned from US hospitals
Bradley, E. H. (2004) · BMJ Quality & Safety · doi:10.1136/qhc.13.1.26 · Cited by 197 · see citing works
Goldberg, H. I., Wagner, E. H., Fihn, S. D., Martin, D. P., Horowitz, C. R., Christensen, D. B., Cheadle, A. D., Diehr, P. H., & Simon, G. (1998) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(16)30367-4 · Cited by 180 · see citing works
Landon, B. E., Wilson, I. B., McInnes, D. K., Landrum, M. B., Hirschhorn, L. R., Marsden, P. V., Gustafson, D. H., & Cleary, P. D. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-11-200406010-00010 · Cited by 173 · see citing works
Ornstein, S., Jenkins, R. G., Nietert, P. J., Feifer, C., Roylance, L. F., Nemeth, L., Corley, S., Dickerson, L., Bradford, W. D., & Litvin, C. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-141-7-200410050-00008 · Cited by 125 · see citing works
Administrative Data Feedback for Effective Cardiac Treatment
Beck, C. A., Richard, H., Tu, J. V., & Pilote, L. (2005) · JAMA · doi:10.1001/jama.294.3.309 · Cited by 60 · see citing works
Evidence-Based Practice to Reduce Central Line Infections
Render, M. L., Brungs, S. M., Kotagal, U. R., et al. (2006) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(06)32033-8 · Cited by 57 · see citing works
If You've Seen One Quality Improvement Collaborative ...
Solberg, L. I. (2005) · The Annals of Family Medicine · doi:10.1370/afm.304 · Cited by 45 · see citing works
Quality Improvement Interventions: What Works?
Strom, K. L. (2001) · Journal for Healthcare Quality · doi:10.1111/j.1945-1474.2001.tb00368.x · Cited by 21 · see citing works
Kritchevsky, S. B., SIMMONS, B. P., & Braun, B. I. (1995) · Infection Control and Hospital Epidemiology · doi:10.1086/647000 · Cited by 13 · see citing works
Self-citationKritchevsky, S. B., SIMMONS, B. P., & Braun, B. I. (1995) · Infection Control and Hospital Epidemiology · doi:10.2307/30140999 · Cited by 6 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Audit and feedback: effects on professional practice and healthcare outcomes
Ivers, N., Jamtvedt, G., Flottorp, S., Young, J. M., Odgaard-Jensen, J., French, S. D., O'Brien, M. A., Johansen, M., Grimshaw, J., & Oxman, A. D. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000259.pub3 · Cited by 5,485 · see citing works
Understanding the Components of Quality Improvement Collaboratives: A Systematic Literature Review
NADEEM, E., OLIN, S. S., HILL, L. C., HOAGWOOD, K. E., & HORWITZ, S. M. (2013) · The Milbank Quarterly · doi:10.1111/milq.12016 · Cited by 332 · see citing works
Understanding antibiotic decision making in surgery—a qualitative analysis
Charani, E., Tarrant, C., Moorthy, K., Sevdalis, N., Brennan, L., & Holmes, A. H. (2017) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2017.03.013 · Cited by 101 · see citing works
- Authors
- Kritchevsky, S. B., Braun, B. I., Bush, A. J., Bozikis, M. R., Kusek, L., Burke, J. P., Wong, E. S., Jernigan, J., Davis, C. C., Simmons, B., & for the TRAPE Study Group*
- Affiliations
- Centers for Disease Control and Prevention (US)
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2008-10-07
- Volume
- 149
- Issue
- 7
- Pages
- 472-480
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2091269080
- Cited by
- 61
- References
- 31
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 6 · 2020: 2 · 2019: 6 · 2017: 5 · 2016: 2 · 2015: 3 · 2014: 3 · 2013: 10 · 2012: 2
- FWCI
- 5.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01 HS11331-01A1)
- Topics
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Keywords
- quality improvement collaborative, surgical site infection prevention, performance feedback, hospital quality improvement, antibiotic duration, timing of antibiotic administration, cardiac surgery, hip and knee replacement, hysterectomy, Joint Commission
- MeSH terms
- Cooperative Behavior, Feedback, Hospitals, Humans, Surgical Wound Infection, United States, Antibiotic Prophylaxis, Quality Indicators, Health Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
