Table 6.
Champions’ effectiveness on patient, provider and system/facility’s outcomes
| Subcategory (# of studies) | First author, year | Study Design | Champion operationalization | Outcome extracted from included study | Statistical analysis/approach | Test statistic (measure of magnitude) | p-value |
|---|---|---|---|---|---|---|---|
|
Patient Outcomes (n = 6) Conclusion: Across six studies, there are mixed findings pertaining to use of champions and improvement in patients’ outcomes related to innovation use | |||||||
|
Improvement in patient’s health outcomes (n = 4) |
Ben-David, 2019 [51] | Cross-sectional study |
Presence of ward infection control champions (survey item asking if a nurse or/and physician champion was present) |
Monthly incidence rates of central-line-associated bloodstream infection | Negative binomial regression | Incidence rate ratio (95% CI) = 0.47 (0.31–0.71) | < .001 |
| Bradley, 2012 [53] | Cross-sectional study |
Presence of one or more physician/nurse/ both/no champions (two “Yes/No” survey items asking the presence of physician/nurse champions) |
30 days risk-standardized mortality rate post acute myocardial infarction in hospitals | Multivariate linear regression |
β (95% CI) = − 0.695 (− 1.253 to − 0.137) (No champion vs nurse champion only)a |
.015 | |
|
β (95% CI) = − 0.731 (− 1.404 to − 0.059) (Physician champions vs nurse champion only) |
.033 | ||||||
|
β (95% CI) = − 0.880 (− 1.442 to − 0.318) (Both physician and nurse champions vs nurse champion only) |
.002 | ||||||
| Ward, 2004 [76] | Cross-sectional study |
Presence of champion (single item rated on a 5-point Likert scale) |
Patient outcome measures relative to guideline-based diabetes management | Single predictor generalized estimating equations | β (SE) = − 0.38 (0.39) | .3202 | |
| Whitebird, 2014 [41] | Prospective cohort |
Presence of a strong primary care provider champion (“Yes/No” extracted from quality improvement narrative reports) |
Average monthly remission rates at 6 months (number of patients with a score of < 5 on the PHQ-9) | Pearson's correlation coefficient | r (95 CI) = 0.40 (− 0.16 to 0.77) | > .05 | |
| Quality of life (n = 1) | Hung, 2008 [60] | Cross-sectional study | Presence of practice (health promotion) champions (single item rated on a 5-point Likert scale) | Fewer numbers of unhealthy days in the past 30 days | Hierarchal generalized linear modelling |
β (SE): 0.34 (0.07) OR (95 CI) = 1.41 (1.22–1.64) |
< .001 |
| Fewer numbers of limiting days in the past 30 days |
β (SE): 0.53 (0.19) OR (95 CI) = 1.71 (1.16–2.53) |
< .01 | |||||
| General health status |
β (SE): 0.38 (0.09) OR (95 CI) = 1.47 (1.20–1.79) |
< .001 | |||||
|
Patient Experience (n = 1) |
Goff, 2019 [57] | Cross-sectional study |
Presence of a designated quality champion (“Yes/No” survey item) |
Average patient experience scores of clinics that are part of the Massachusetts Health Quality Partners (MHQP) | ANOVA | Test statistics not reported (Mean difference = 0.09 favouring presence of a champion) | .29 |
|
Provider Outcomes (n = 1) Conclusion: There is a single study suggesting that the use champions is related to improvements in provider outcomes related to innovation use | |||||||
| Satisfaction with practice (n = 1) |
One study, two reports: |
Interrupted time series | Endorsed by champions (three items rated at a 6-point Likert scale based on Mullins et al. [98] | Reported ergonomic advantage 1-month post-introduction of transfer boards | Structural equation model using a maximum likelihood method | Path coefficients (95 CI) = 0.63 (.0664–1.1936) | < 0.05b |
|
System/Facility Outcomes (n = 3) Conclusion: Across three studies, there is a trend suggesting that use of champions is related to improvement in system/facility outcomes related to innovation use | |||||||
|
Hospital quality of care indicators (n = 1) |
Foster, 2017 [56] | Non-controlled before and after study | An average of 0.1 champion fellows in 1160 hospitals (number of champion fellows) | Weighted composite score of quality of care—occurrence of 10 harm topics (e.g. readmissions) for 1 month | Multivariate linear regression | Adjusted effect over time: β = − 0.9 (negative β = more effective in this study) | .008 |
|
Access to training for alcohol cessation screening and advice (n = 1) |
Patton, 2013 [69] | Cross-sectional study | Presence of champion (“Yes/No” survey item) | Emergency staff’s access to training for screening for alcohol consumption | Chi square | χ2 = 36.64 | < 0.001 |
| Emergency staff’s access to training for providing brief advice regarding alcohol consumption | χ2 = 29.93 | < 0.001 | |||||
|
Compatibility and sustainability of in-house pharmacy immunization services (n = 1) |
Westrick, 2009 [79] | Cross-sectional study |
Strategic champion effectiveness (4-item scale on champion’s commitment, advocacy and ability to manage and acquire resources) adapted from Hays et al. [99] |
Compatibility between immunization services and host pharmacy | Multivariable linear regression | β = 0.12 | .300 |
| Sustainability of in-house pharmacy immunization services | β = 0.00 | .978 | |||||
| Operational champion effectiveness (4-item scale on champion’s knowledge, ability to manage an in-house immunization service, and to resolve conflicts) adapted from Hays et al. [99] | Compatibility between immunization services and host pharmacy | Multivariable linear regression | β = 0.31 | .005 | |||
| Sustainability of in-house pharmacy immunization services | β = 0.09 | .419 | |||||
| Other Outcomes (n = 1)c | |||||||
|
Adaptation and evaluation of in-house pharmacy immunization services (n = 1) |
Westrick, 2009 [79] | Cross-sectional study |
Strategic champion effectiveness (4-item scale on champion’s commitment, advocacy and ability to manage and acquire resources) adapted from Hays et al. [99] |
Degree of modifications made to in-house pharmacy immunization services | Multivariable linear regression | β = 0.05 | .705 |
| Formal evaluation of in-house pharmacy immunization services | β = 0.26 | .038 | |||||
| Operational champion effectiveness (4-item scale on champion’s knowledge, ability to manage an in-house immunization service, and to resolve conflicts) adapted from Hays et al. [99] | Degree of modifications made to in-house pharmacy immunization services | Multivariable linear regression | β = 0.05 | .698 | |||
| Formal evaluation of in-house pharmacy immunization services | β = 0.09 | .419 | |||||
aIn this study, groups exposed to only nurse champions had the highest risk-standardized mortality rate (RSMR; RSMR = 16.2); hence, it was the reference variable
bThe authors reported a path coefficient that they stated is significant at a p-value of 0.1. Manual calculation of the 95% CI was done by JES to determine significance of both ergonomic advantage and intention to use at a p-value of .05
cOther outcomes were not considered in analysis