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Recorded Annual Meeting Presentations (RAMP) are now available for purchase.
Only $90 for presenters, $140 for registered attendees and $200 for non-attendees.

Online Program

333971
Exploring Factors Influencing the Implementation of the Obstetric Hemorrhage Initiative (OHI) in Florida


Tuesday, November 3, 2015 : 8:30 a.m. - 8:50 a.m.

Cheryl A. Vamos, PhD, MPH, Department of Community and Family Health, University of South Florida, College of Public Health, Tampa, FL
Allison Cantor, MA, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL
Linda A. Detman, PhD, Department of Community & Family Health, The Lawton and Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida, College of Public Health, Tampa, FL
Emily Bronson, MA, MPH, CPH, Florida Perinatal Quality Collaborative, Lawton and Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida, College of Public Health, Tampa, FL
Annette Phelps, ARNP, MSN, Florida Perinatal Quality Collaborative, Lawton and Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida, College of Public Health, Tampa, FL
Judette M. Louis, MD, MPH, Obstetrics & Gynecology, University of South Florida, College of Medicine, Tampa, FL
Anthony Gregg, MD, FACOG, Department of Obstetrics and Gynecology, University of Florida, College of Medicine, Gainesville, FL
John S. Curran, MD, University of South Florida, College of Medicine, Tampa, FL
William M. Sappenfield, MD MPH, Department of Community & Family Health, The Lawton and Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida, College of Public Health, Tampa, FL
Background:Hemorrhage is the leading, but most preventable cause of maternal mortality in Florida. The Florida Perinatal Quality Collaborative (FPQC) led a state-wide quality improvement (QI) project, Obstetric Hemorrhage Initiative (OHI), to assist hospitals in implementing best practices related to inter-professional efforts needed to prevent, identify, and manage hemorrhage cases. This study’s purpose was to explore the contextual factors influencing OHI implementation.

Methods:Purposive and snowball sampling were employed to recruit a diverse hospital (geographic area; hospital size; OHI preparedness; training hospital) and participant pool (leadership; physicians; nurses; blood bank staff; nurse educators; quality improvement staff), respectively. A semi-structured interview guide was developed based on the Consolidated Framework for Implementation Research (CFIR) and advisory board input. Interviews were audio-recorded, transcribed and uploaded into Atlas.ti for rigorous qualitative analysis.

Results: Data (50 participants across 12 hospitals) revealed numerous factors influencing implementation across CFIR domains: intervention characteristics; implementation processes; hospital setting; characteristics of individuals; and external factors. Common factors supporting implementation included: strength of OHI evidence; leadership engagement; flexibility; available resources; alignment with hospital’s culture/values; and technical assistance from FPQC. Common barriers included staff engagement and physician resistance; timelines; and competing priorities.

Conclusions: Factors influencing OHI implementation were identified and will be used to improve hospitals’ and staff’s abilities and experiences when integrating evidence-based practices. In addition, early lessons were captured and future recommendations were reported for stakeholder use. Furthermore, findings will guide innovative, consumer-driven implementation processes for other hospital-based QI projects, with the ultimate goal of improving maternal and infant health.

Learning Areas:

Administer health education strategies, interventions and programs
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Provision of health care to the public
Public health or related research

Learning Objectives:
Describe a theory-based assessment aimed to explore contextual factors experienced by hospitals and maternity staff during the implementation process of a quality improvement project. Discuss challenges and successes experienced by hospitals during the implementation process of a state-wide Obstetric Hemorrhage Initiative. Identify future recommendations to improve implementation processes regarding MCH quality improvement projects among hospital and staff.

Keyword(s): Maternal and Child Health, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the PI on this study that aimed to examine contextual factors influencing the implementation process of an Obstetric Hemorrhage Initiative. I have experience in study design, qualitative data collection/analysis, and disseminating findings to diverse stakeholders.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4050.0: Innovations in Maternity Services Oral Session