The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff

Abstract

Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was ‘average’ in complexity, with variation depending on participant’s role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Andreatta, P., & Marzano, D. (2012). Healthcare management strategies: Interdisciplinary team factors. Current Opinion in Obstetrics and Gynecology, 24(6), 445–452. doi:10.1097/GCO.0b013e328359f007.

    Article  PubMed  Google Scholar 

  2. 2.

    Armstrong, C. E., Lange, I. L., Magoma, M., Ferla, C., Filippi, V., & Ronsmans, C. (2014). Strengths and weaknesses in the implementation of maternal and perinatal death reviews in Tanzania: Perceptions, processes and practice. Tropical Medicine and International Health, 19(9), 1087–1095. doi:10.1111/tmi.12353.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Belizan, J. M., Salaria, N., Valanzasca, P., & Mbizvo, M. (2014). How can we improve the use of essential evidence-based interventions? Reproductive Health, 11, 69. doi:10.1186/1742-4755-11-69.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Bingham, D., & Jones, R. (2012). Maternal death from obstetric hemorrhage. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 41(4), 531–539. doi:10.1111/j.1552-6909.2012.01372.x.

    Article  PubMed  Google Scholar 

  5. 5.

    Bingham, D., Lyndon, A., Lagrew, D., & Main, E. K. (2011). A state-wide obstetric hemorrhage quality improvement initiative. MCN The American Journal of Maternal Child Nursing, 36(5), 297–304. doi:10.1097/NMC.0b013e318227c75f.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Coding Analysis Toolkit. (2007–2015). Qualitative data analysis program. University Center for Social and Urban Research, University of Pittsburgh, Qualitative Data Analysis Program, College of Social and Behavioral Sciences, University of Massachusetts Amherst. Retrieved July 26, 2015 from http://cat.ucsur.pitt.edu/.

  7. 7.

    Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, F. C., & Callaghan, W. M. (2015). Pregnancy-related mortality in the United States, 2006–2010. Obstetrics and Gynecology, 125(1), 5–12.

    Article  PubMed  Google Scholar 

  8. 8.

    Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, 50. doi:10.1186/1748-5908-4-50.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Damschroder, L. J., & Hagedorn, H. J. (2011). A guiding framework and approach for implementation research in substance use disorders treatment. Psychology of Addictive Behaviors, 25(2), 194–205. doi:10.1037/a0022284.

    Article  PubMed  Google Scholar 

  10. 10.

    Florida Perinatal Quality Collaborative. (2014). Florida obstetric hemorrhage initiative toolkit: A quality improvement initiative for obstetric hemorrhage management.

  11. 11.

    Hartzler, B., Lash, S. J., & Roll, J. M. (2012). Contingency management in substance abuse treatment: A structured review of the evidence for its transportability. Drug and Alcohol Dependence, 122(1–2), 1–10. doi:10.1016/j.drugalcdep.2011.11.011.

    Article  PubMed  Google Scholar 

  12. 12.

    Kennedy, C., Finkelstein, N., Hutchins, E., & Mahoney, J. (2004). Improving screening for alcohol use during pregnancy: The Massachusetts ASAP program. Maternal and Child Health Journal, 8(3), 137–147.

    Article  PubMed  Google Scholar 

  13. 13.

    Lash, S. J., Timko, C., Curran, G. M., McKay, J. R., & Burden, J. L. (2011). Implementation of evidence-based substance use disorder continuing care interventions. Psychology of Addictive Behaviors, 25(2), 238–251. doi:10.1037/a0022608.

    Article  PubMed  Google Scholar 

  14. 14.

    Lee, H. C., Powers, R. J., Bennett, M. V., Finer, N. N., Halamek, L. P., Nisbet, C., & Sharek, P. J. (2014). Implementation methods for delivery room management: A quality improvement comparison study. Pediatrics, 134(5), e1378–e1386. doi:10.1542/peds.2014-0863.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Levison, J., Williams, L. T., Moore, A., McFarlane, J., & Davila, J. A. (2011). Increasing use of rapid HIV testing in labor and delivery among women with no prenatal care: A local initiative. Maternal and Child Health Journal, 15(6), 822–826. doi:10.1007/s10995-010-0636-1.

    Article  PubMed  Google Scholar 

  16. 16.

    McHugh, M. L. (2012). Interrater reliability: The kappa statistic. Biochemia medica (Zagreb), 22(3), 276–282.

    Article  Google Scholar 

  17. 17.

    Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510–520. doi:10.1258/jrsm.2011.110180.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Nikolopoulos, H., Farmer, A., Berry, T. R., McCargar, L. J., & Mager, D. R. (2015). Perceptions of the characteristics of the Alberta Nutrition Guidelines for Children and Youth by child care providers may influence early adoption of nutrition guidelines in child care centres. Maternal and Child Nutrition, 11(2), 271–282. doi:10.1111/j.1740-8709.2012.00460.x.

    Article  PubMed  Google Scholar 

  19. 19.

    Porter, K. J. (2013). Bringing nutrition education programs from outside sources into the classroom: The experience of New York City public elementary schools. (PhD), Columbia University, New York. Retrieved from http://search.proquest.com/docview/1372009019?accountid=14745. ProQuest Dissertations & Theses Full Text database database.

  20. 20.

    Rabin, B. A., Brownson, R. C., Haire-Joshu, D., Kreuter, M. W., & Weaver, N. L. (2008). A glossary for dissemination and implementation research in health. Journal of Public Health Management and Practice, 14(2), 117–123. doi:10.1097/01.PHH.0000311888.06252.bb.

    Article  PubMed  Google Scholar 

  21. 21.

    Robins, L. S., Jackson, J. E., Green, B. B., Korngiebel, D., Force, R. W., & Baldwin, L. M. (2013). Barriers and facilitators to evidence-based blood pressure control in community practice. The Journal of the American Board of Family Medicine, 26(5), 539–557. doi:10.3122/jabfm.2013.05.130060.

    Article  PubMed  Google Scholar 

  22. 22.

    Ryan, R. W., Harris, K. K., Mattox, L., Singh, O., Camp, M., & Shirey, M. R. (2015). Nursing leader collaboration to drive quality improvement and implementation science. Nursing Administration Quarterly, 39(3), 229–238. doi:10.1097/naq.0000000000000111.

    Article  PubMed  Google Scholar 

  23. 23.

    Saldaña, J. (2009). The coding manual for qualitative researchers. Thousand Oaks, CA: Sage.

    Google Scholar 

  24. 24.

    Segre, L. S., Brock, R. L., O’Hara, M. W., Gorman, L. L., & Engeldinger, J. (2011). Disseminating perinatal depression screening as a public health initiative: A train-the-trainer approach. Maternal and Child Health Journal, 15(6), 814–821. doi:10.1007/s10995-010-0644-1.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Serruya, S. J., Duran, P., Martinez, G., Romero, M., Caffe, S., Alonso, M., & Silveira, M. F. (2015). Maternal and congenital syphilis in selected Latin America and Caribbean countries: A multi-country analysis using data from the Perinatal Information System. Sexual Health. doi:10.1071/sh14191.

    PubMed  Google Scholar 

  26. 26.

    Shah, V., Warre, R., & Lee, S. K. (2013). Quality improvement initiatives in neonatal intensive care unit networks: Achievements and challenges. Academic Pediatric, 13(6 Suppl), S75–S83. doi:10.1016/j.acap.2013.04.014.

    Article  Google Scholar 

  27. 27.

    Sorensen, J. L., & Kosten, T. (2011). Developing the tools of implementation science in substance use disorders treatment: Applications of the consolidated framework for implementation research. Psychology of Addictive Behaviors, 25(2), 262–268. doi:10.1037/a0022765.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This project was supported by funds from the Florida Department of Health. We would like to thank all of the hospitals and multidisciplinary staff members who participated in this study for their time and willingness to share their candid experiences implementing this quality improvement initiative.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Cheryl A. Vamos.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vamos, C.A., Cantor, A., Thompson, E.L. et al. The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff. Matern Child Health J 20, 2003–2011 (2016). https://doi.org/10.1007/s10995-016-2020-2

Download citation

Keywords

  • Obstetric hemorrhage
  • Quality improvement
  • Implementation
  • Evaluation
  • Qualitative