Karen E. Fowler, MPH; Jane Forman, ScD; Jessica M. Ameling, MPH; Andrew J. Rolle, MPH; Deborah Bohr, MPH; Brittany Schwartz, MPH; Sue Collier, MSN, RN; Vineet Chopra, MD, MSc; Jennifer Meddings, MD, MSc
Disclaimer: The findings and conclusions in this report are those of the authors and do not represent the official position of the CDC, the American Hospital Association, or the Department of Veterans Affairs.
Acknowledgment: The authors thank the Health Research & Educational Trust (HRET) Health Care-Associated Infection team, as well as the National Program Team and all members of the CDC STRIVE collaborative.
Financial Support: Dr. Meddings' work was partially funded by concurrent support from Agency for Healthcare Research and Quality (AHRQ) (K08 HS19767).
Disclosures: Ms. Fowler, Dr. Forman, Ms. Ameling, Dr. Chopra, and Dr. Meddings report a CDC contract with the HRET, which subcontracted with the University of Michigan to support faculty/staff effort for this contract, during the conduct of the study. Mr. Rolle, Ms. Schwartz, and Ms. Collier report a CDC contract with the HRET during the conduct of the study. Ms. Bohr reports personal fees from the CDC contract with the HRET, which subcontracted with her to support interviews conducted by the University of Michigan faculty/staff effort for this contract. Dr. Meddings also reports an AHRQ K08 grant during the conduct of the study; employment by the University of Michigan Medical School (Michigan Medicine), VA Ann Arbor Healthcare System, and the Center for Clinical Management Research; being an investigator on an AHRQ contract with HRET; and receipt of honoraria for presentations from various professional and nonprofit organizations and QuantiaMD outside the submitted work. In addition, Dr. Meddings' research involves development of products to improve patient safety by reducing hospital-acquired complications, and her team has a provisional patent involving one of these products (US20180339133A1). She has no associations with any companies or manufacturers, has no ownership in a commercial entity, and receives no royalties. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3477.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement: Study protocol and statistical code: Not applicable. Data set: Not available. Interview Guide and Qualitative Codebook: Included in the Supplement.
Corresponding Author: Karen E. Fowler, MPH, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113-0170; e-mail, Karen.Fowler@va.gov.
Current Author Addresses: Ms. Fowler and Dr. Forman: Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113-0170.
Ms. Ameling and Drs. Chopra and Meddings: University of Michigan Department of Internal Medicine, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800.
Mr. Rolle and Ms. Schwartz: Health Research & Educational Trust, American Hospital Association, 155 North Upper Wacker Drive, #400, Chicago, IL 60606.
Ms. Collier: North Carolina Healthcare Foundation, 2400 Weston Parkway, Cary, NC 27513.
Ms. Bohr: 532 West 111th Street, #5, New York, NY 10025.
Author Contributions: Conception and design: K.E. Fowler, J. Forman, J.M. Ameling, A.J. Rolle, S. Collier, V. Chopra, J. Meddings.
Analysis and interpretation of the data: K.E. Fowler, J. Forman, J.M. Ameling, V. Chopra, J. Meddings.
Drafting of the article: K.E. Fowler, J. Forman, J.M. Ameling, D. Bohr, B. Schwartz, V. Chopra.
Critical revision of the article for important intellectual content: K. Fowler, J. Forman, J.M. Ameling, A.J. Rolle, S. Collier, V. Chopra, J. Meddings.
Final approval of the article: K.E. Fowler, J. Forman, J.M. Ameling, A.J. Rolle, D. Bohr, B. Schwartz, S. Collier, V. Chopra, J. Meddings.
Provision of study materials or patients: A.J. Rolle.
Obtaining of funding: S. Collier.
Administrative, technical, or logistic support: K.E. Fowler, D. Bohr, B. Schwartz, S. Collier.
Collection and assembly of data: K.E. Fowler, J. Forman, J.M. Ameling, D. Bohr, B. Schwartz, V. Chopra.
The Centers for Disease Control and Prevention (CDC) funded a 3-year national collaborative focused on facilitating relationships between health care–associated infection (HAI) prevention stakeholders within states and improving HAI prevention activities within hospitals. This program—STRIVE (States Targeting Reduction in Infections via Engagement)—targeted hospitals with elevated rates of common HAIs.
To use qualitative methods to better understand STRIVE's effect on state partner relationships and HAI prevention efforts by hospitals.
Qualitative case study, by U.S. state.
7 of 22 eligible STRIVE state partnerships.
Representatives from state hospital associations, state health departments, and other participating organizations (for example, Quality Innovation Networks–Quality Improvement Organizations), referred to as “state partners.”
Phone interviews (n = 17) with each organization were conducted, recorded, and transcribed.
State partners reported that relationships with each other and with participating hospitals improved through STRIVE participation. The partners saw improvements in hospital-level HAI prevention activities, such as improved auditing and feedback practices and inclusion of environmental services in prevention efforts; however, some noted those improvements may not be reflected in HAI rates. Many partners outlined plans to sustain their partner relationships by working on future state-level initiatives, such as opioid abuse prevention and antimicrobial stewardship.
Only 7 participating states were included; direct feedback from participating hospitals was not available.
Although there were no substantial changes in aggregate HAI rates, STRIVE achieved its goal of improving state partner relationships and coordination. This improved collaboration may lead to a more streamlined response to future HAI outbreaks and public health emergencies.
Centers for Disease Control and Prevention.
STRIVE implementation design and intervention components.
ICAR = Infection Control Assessment and Response; LAF = Learning Action Forum; PCA = Practice Change Assessment; QIN-QIO = Quality Innovation Network–Quality Improvement Organization; SHA = state hospital association; SHD = state health department; STRIVE = States Targeting Reduction in Infections via Engagement.
Table. Characteristics of States Selected for State Partner Interviews
STRIVE state partner roles identified in interviews.
ICAR = Infection Control Assessment and Response; QIN-QIOs = Quality Innovation Network–Quality Improvement Organization; SHA = state hospital association; SHD = state health department; STRIVE = States Targeting Reduction in Infections via Engagment.
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Fowler KE, Forman J, Ameling JM, et al. Qualitative Assessment of a State Partner–Facilitated Health Care–Associated Infection Prevention National Collaborative. Ann Intern Med. 2019;171:S75–S80. doi: 10.7326/M18-3477
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Published: Ann Intern Med. 2019;171(7_Supplement):S75-S80.
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