Assessing long-term sustainability of a large-scale infection prevention and control routine practice improvement initiative in ambulatory care units located at cancer care centres and acute care hospitals
Bibliographic record
Abstract
Background: Alberta Health Services’ provincial Infection Prevention and Control (IPAC) program implemented a quality improvement initiative to promote the use of routine practices and discontinue use of contact precautions for patients with an antimicrobial-resistant organism. The initiative was implemented in two phases: Phase 1 in ambulatory care areas at cancer care centres in 2016, and Phase 2 ambulatory care areas at acute care hospitals in 2017. The aim of this evaluation was to assess long-term sustainability of the initiative and document lessons learned. Methods: One-on-one, structured interviews with frontline staff from a sample of initiative areas were performed by IPAC staff. A focus group interview with those IPAC staff was also performed. Responses were independently reviewed by two IPAC staff not involved in the initiative and coded using thematic analysis. Results: Interviews were performed with 115 frontline staff representing 67 initiative areas. The initiative was sustained in 42% (28/67) of the areas sampled, with sustainability higher for Phase 1 areas (67%, 8/12) than Phase 2 areas (36%, 20/55). Identified themes included differences between Phase 1 and Phase 2 planning and implementation, importance of engagement at various levels, resource issues, process issues, and the use of champions and educators. Conclusions: The themes from this evaluation suggest factors that affect the sustainability of routine practices in ambulatory care settings and highlights the crucial role of project planning in the roll out of such large-scale initiatives. Collaboration between IPAC and area leadership also improved sustainability and was increasingly important as the complexity of the initiative increased.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.043 | 0.053 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".