Christiana Care Value Institute

Who We Are

The Value Institute at Christiana Care is a diverse team of experts collaborating in the discovery and delivery of value-centered knowledge to improve health.

Who We Serve

To develop, deliver and evaluate innovative solutions impacting population health, patient experience, system performance and policy development.

How We Work

The Value Institute leads the way in conducting real-world research on today’s most pressing health care issues, helping to deliver better health, better care and better value for our neighbors.

Publications

Carrots and Sticks: Achieving High Healthcare Personnel Influenza Vaccination Rates without a Mandate
Carrots and Sticks: Achieving High Healthcare Personnel Influenza Vaccination Rates without a Mandate
Drees M, Wroten K, Smedley M, Mase T, Schwartz JS

Infect Control Hosp Epidemiol 2015 Jun;36(6):717-24

PMID: 25721404

Abstract

OBJECTIVE Achieving high healthcare personnel (HCP) influenza vaccination rates has typically required mandating vaccination, which is often challenging to implement. Our objective was to achieve >90% employee influenza vaccination without a mandate. DESIGN Prospective quality improvement initiative SETTING AND PARTICIPANTS All employees of a 2-hospital, 1,100-bed, community-based academic healthcare system. METHODS The multimodal HCP vaccination campaign consisted of a mandatory declination policy, mask-wearing for non-vaccinated HCP, highly visible "I'm vaccinated" hanging badges, improved vaccination tracking, weekly compliance reports to managers and vice presidents, disciplinary measures for noncompliant HCP, vaccination stations at facility entrances, and inclusion of a target employee vaccination rate (>75%) metric in the annual employee bonus program. The campaign was implemented in the 2011-2012 influenza season and continued throughout the 2012-2013 through 2014-2015 influenza seasons. Employee compliance, vaccination, exemption and declination rates were calculated and compared with those of the seasons prior to the intervention. RESULTS Compared with vaccination rates of 57%-72% in the 3 years preceding the intervention, employee influenza vaccination increased to 92% in year 1 and 93% in years 2-4 (P<.001). The proportion of employees declaring medical/religious exemptions or declining vaccination decreased during the 4 years of the program (respectively, 1.2% to 0.5%, P<.001; 4.4% to 3.8%, P=.001). CONCLUSIONS An integrated multimodal approach incorporating peer pressure, accountability, and financial incentives was associated with increased employee vaccination rate from ≤72% to ≥92%, which has been sustained for 4 influenza seasons. Such programs may provide a model for behavioral change within healthcare organizations. Infect Control Hosp Epidemiol 2015;00(0): 1-8.
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Efficacy of ultrasound-indicated cerclage in twin pregnancies
Efficacy of ultrasound-indicated cerclage in twin pregnancies
Roman A, Rochelson B, Fox NS, Hoffman M, Berghella V, Patel V, Calluzzo I, Saccone G, Fleischer A

Am. J. Obstet. Gynecol. 2015 Jun;212(6):788.e1-6

PMID: 25637840

Abstract

OBJECTIVE: We sought to compare the perinatal outcomes in twin pregnancies with short cervical length (CL) with ultrasound-indicated cerclage (UIC) vs no cerclage (control).
STUDY DESIGN: This was a retrospective cohort study of asymptomatic twin pregnancies with transvaginal ultrasound (TVU) CL ≤25 mm at 16-24 weeks from 1995 through 2012 at 4 separate institutions. Exclusion criteria were: genetic or major fetal anomaly, multifetal reduction >14 weeks, monochorionic-monoamniotic placentation, or medically indicated preterm birth (PTB). Primary outcome was spontaneous PTB (SPTB) <34 weeks. Secondary outcome was SPTB <28, <32, and <37 weeks. We also planned to evaluate primary and secondary outcome for the subgroup of twin pregnancies with CL ≤15 mm.
RESULTS: In all, 140 women with twin pregnancy and TVU-CL ≤25 mm were managed with either UIC (n = 57) or no cerclage (n = 83). Demographic characteristics were not significantly different except women who underwent UIC presented at an earlier gestational age (GA) at diagnosis of short CL. After adjusting for GA at presentation, there were no differences in GA at delivery or SPTB <28 weeks: 12 (21.2%) vs 20 (24.1%) (adjusted odds ratio [aOR], 0.3; 95% confidence interval [CI], 0.68-1.37), <32 weeks: 22 (38.6%) vs 36 (43.4%) aOR, 0.34; 95% CI, 0.1-1.13), or <34 weeks: 29 (50.9%) vs 53 (63.9%) (aOR, 0.37; 95% CI, 0.16-1.1). In the subgroup of women with CL ≤15 mm (32 with UIC and 39 controls) the interval between diagnosis to delivery was significantly prolonged by 12.5 ± 4.5 vs 8.8 ± 4.6 weeks (P < .001); SPTB <34 weeks was significantly decreased: 16 (50%) vs 31 (79.5%) (aOR, 0.51; 95% CI, 0.31-0.83) as was admission to neonatal intensive care unit: 38/58 (65.5%) vs 63/76 (82.9%) (aOR, 0.42; 95% CI, 0.24-0.81) when the UIC group was compared with the control group, respectively.
CONCLUSION: UIC in asymptomatic twin pregnancies with TVU-CL ≤25 mm was not associated with significant effects on perinatal outcomes compared to controls. However, in the planned subgroup analysis of asymptomatic twin pregnancies with TVU-CL ≤15 mm before 24 weeks, UIC was associated with a significant prolongation of pregnancy by almost 4 more weeks, significantly decreased SPTB <34 weeks by 49%, and admission to neonatal intensive care unit by 58% compared with controls.
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Barriers to and facilitators of interprofessional-interdepartmental interventions: unearthing departmental culture
Barriers to and facilitators of interprofessional-interdepartmental interventions: unearthing departmental culture
Michalec B, Reinhold N, Dressler R, Laskowski-Jones L, Adarve L, Elliott D

Am J Med Qual 2015 Mar;30(2):126-34

PMID: 24443319

Abstract

This study evaluates how emergency department (ED) and medical intensive care unit (MICU) providers interact in the setting of a quality improvement project designed to enhance transport/care for patients from the ED to the MICU. Focus groups were conducted with nurses, residents, physician assistants, and physicians from the ED and MICU at baseline and 6 months regarding their thoughts on and perspectives of the intervention and working with colleagues from another department. Data were then analyzed utilizing a multistep coding scheme that identified key barriers to and facilitators of the interprofessional-interdepartmental intervention. Analysis also showed, however, that variances in departmental culture play a significant role in the willingness and ability of providers to practice interdepartmental team-based care. It is argued that anticipating and acknowledging these differences and designing systems to address them prior to launch will be essential to the development and implementation of effective interdepartmental quality improvement interventions.
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