Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative

Autores
Jorro Barón, Facundo; Falaschi, Andrea; Bosio, Lía; Gibbons, Luz; Vitar, Emilse Mabel; Guglielmino, Marina; Negri, Erica; Peralta-Roca, María Belén; Rodriguez, Ana Paula; Suarez Anzorena, Inés; Alonso, Juan Pedro; Rodríguez, Viviana; Roberti, Javier Eugenio; Garcia Elorrio, Ezequiel
Año de publicación
2025
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Background: Primary care has been essential inensuring the continuity of health services for patientswith COVID-19and other conditions. We aimed toincrease the adoption of evidence-basedinterventionsto identify clinical deterioration in adult patients withconfirmed or suspected respiratory COVID-19at theprimary care level.Methods: We implemented specific interventions in ninePrimary Healthcare Centres (PHCC) through a qualityimprovement collaborative (QIC) with an interruptedtime-seriesdesign. Interventions included triage foracute respiratory symptoms, the National Early WarningScore 2 (NEWS2) scale, portable oximeters for selectedpatients and the provincial telehealth system. Additionalcomponents involved leadership commitment, teamworktools, reminders, audits, feedback and direct observation.A mixed-methodevaluation was conducted, with twolearning sessions and three action periods to test andimplement selected change ideas.Results: Six PHHCs completed the study. Over 48 weeks,data from 877 patients were gathered, 356 in the baselineperiod (BP) and 477 in the implementation period (IP).Eight hundred and sixty-twomedical consultations werereported, 367 for BP and 495 for IP. More COVID-19-confirmeddiagnoses were observed in the IP group (1.9%vs 15%, p<0.001).The bundle was implemented in 0% and 28.4% ofpatients in the BP and IP groups, respectively. Onevaluating the individual components of the bundle, wediscovered enhancements in the utilisation of triage,application of NEWS2 and utilisation of oximeters whenappropriate. A decrease in the number of follow-upcallswas observed at the end of the implementation.Patients rated the quality of care as positive in 66% of thecases in the BP and 76% in the IP group (p=0.023).Conclusion: We successfully implemented a triagealgorithm based on the NEWS2 score to identifyrespiratory deterioration in adult patients in primary carethrough a QIC. This intervention was perceived as animprovement in the quality of care by the patients.
Fil: Jorro Barón, Facundo. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Falaschi, Andrea. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Bosio, Lía. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Vitar, Emilse Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Guglielmino, Marina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Negri, Erica. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Peralta-Roca, María Belén. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Rodriguez, Ana Paula. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Suarez Anzorena, Inés. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Alonso, Juan Pedro. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Rodríguez, Viviana. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Materia
COVID-19
PRIMARY CARE
Quality improvement
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/291236
Acceder
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oai_identifier_str oai:ri.conicet.gov.ar:11336/291236
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborativeJorro Barón, FacundoFalaschi, AndreaBosio, LíaGibbons, LuzVitar, Emilse MabelGuglielmino, MarinaNegri, EricaPeralta-Roca, María BelénRodriguez, Ana PaulaSuarez Anzorena, InésAlonso, Juan PedroRodríguez, VivianaRoberti, Javier EugenioGarcia Elorrio, EzequielCOVID-19PRIMARY CAREQuality improvementhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: Primary care has been essential inensuring the continuity of health services for patientswith COVID-19and other conditions. We aimed toincrease the adoption of evidence-basedinterventionsto identify clinical deterioration in adult patients withconfirmed or suspected respiratory COVID-19at theprimary care level.Methods: We implemented specific interventions in ninePrimary Healthcare Centres (PHCC) through a qualityimprovement collaborative (QIC) with an interruptedtime-seriesdesign. Interventions included triage foracute respiratory symptoms, the National Early WarningScore 2 (NEWS2) scale, portable oximeters for selectedpatients and the provincial telehealth system. Additionalcomponents involved leadership commitment, teamworktools, reminders, audits, feedback and direct observation.A mixed-methodevaluation was conducted, with twolearning sessions and three action periods to test andimplement selected change ideas.Results: Six PHHCs completed the study. Over 48 weeks,data from 877 patients were gathered, 356 in the baselineperiod (BP) and 477 in the implementation period (IP).Eight hundred and sixty-twomedical consultations werereported, 367 for BP and 495 for IP. More COVID-19-confirmeddiagnoses were observed in the IP group (1.9%vs 15%, p<0.001).The bundle was implemented in 0% and 28.4% ofpatients in the BP and IP groups, respectively. Onevaluating the individual components of the bundle, wediscovered enhancements in the utilisation of triage,application of NEWS2 and utilisation of oximeters whenappropriate. A decrease in the number of follow-upcallswas observed at the end of the implementation.Patients rated the quality of care as positive in 66% of thecases in the BP and 76% in the IP group (p=0.023).Conclusion: We successfully implemented a triagealgorithm based on the NEWS2 score to identifyrespiratory deterioration in adult patients in primary carethrough a QIC. This intervention was perceived as animprovement in the quality of care by the patients.Fil: Jorro Barón, Facundo. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Falaschi, Andrea. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; ArgentinaFil: Bosio, Lía. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; ArgentinaFil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Vitar, Emilse Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Guglielmino, Marina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Negri, Erica. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; ArgentinaFil: Peralta-Roca, María Belén. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; ArgentinaFil: Rodriguez, Ana Paula. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Suarez Anzorena, Inés. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Alonso, Juan Pedro. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Rodríguez, Viviana. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaBMJ Publishing Group2025-07info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/291236Jorro Barón, Facundo; Falaschi, Andrea; Bosio, Lía; Gibbons, Luz; Vitar, Emilse Mabel; et al.; Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative; BMJ Publishing Group; BMJ Open Quality; 14; 3; 7-2025; 1-102399-6641CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://qir.bmj.com/lookup/doi/10.1136/bmjoq-2025-003390info:eu-repo/semantics/altIdentifier/doi/10.1136/bmjoq-2025-003390info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2026-08-25T14:54:18Zoai:ri.conicet.gov.ar:11336/291236instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982026-08-25 14:54:18.631CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative
title Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative
spellingShingle Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative
Jorro Barón, Facundo
COVID-19
PRIMARY CARE
Quality improvement
title_short Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative
title_full Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative
title_fullStr Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative
title_full_unstemmed Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative
title_sort Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative
dc.creator.none.fl_str_mv Jorro Barón, Facundo
Falaschi, Andrea
Bosio, Lía
Gibbons, Luz
Vitar, Emilse Mabel
Guglielmino, Marina
Negri, Erica
Peralta-Roca, María Belén
Rodriguez, Ana Paula
Suarez Anzorena, Inés
Alonso, Juan Pedro
Rodríguez, Viviana
Roberti, Javier Eugenio
Garcia Elorrio, Ezequiel
author Jorro Barón, Facundo
author_facet Jorro Barón, Facundo
Falaschi, Andrea
Bosio, Lía
Gibbons, Luz
Vitar, Emilse Mabel
Guglielmino, Marina
Negri, Erica
Peralta-Roca, María Belén
Rodriguez, Ana Paula
Suarez Anzorena, Inés
Alonso, Juan Pedro
Rodríguez, Viviana
Roberti, Javier Eugenio
Garcia Elorrio, Ezequiel
author_role author
author2 Falaschi, Andrea
Bosio, Lía
Gibbons, Luz
Vitar, Emilse Mabel
Guglielmino, Marina
Negri, Erica
Peralta-Roca, María Belén
Rodriguez, Ana Paula
Suarez Anzorena, Inés
Alonso, Juan Pedro
Rodríguez, Viviana
Roberti, Javier Eugenio
Garcia Elorrio, Ezequiel
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv COVID-19
PRIMARY CARE
Quality improvement
topic COVID-19
PRIMARY CARE
Quality improvement
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Background: Primary care has been essential inensuring the continuity of health services for patientswith COVID-19and other conditions. We aimed toincrease the adoption of evidence-basedinterventionsto identify clinical deterioration in adult patients withconfirmed or suspected respiratory COVID-19at theprimary care level.Methods: We implemented specific interventions in ninePrimary Healthcare Centres (PHCC) through a qualityimprovement collaborative (QIC) with an interruptedtime-seriesdesign. Interventions included triage foracute respiratory symptoms, the National Early WarningScore 2 (NEWS2) scale, portable oximeters for selectedpatients and the provincial telehealth system. Additionalcomponents involved leadership commitment, teamworktools, reminders, audits, feedback and direct observation.A mixed-methodevaluation was conducted, with twolearning sessions and three action periods to test andimplement selected change ideas.Results: Six PHHCs completed the study. Over 48 weeks,data from 877 patients were gathered, 356 in the baselineperiod (BP) and 477 in the implementation period (IP).Eight hundred and sixty-twomedical consultations werereported, 367 for BP and 495 for IP. More COVID-19-confirmeddiagnoses were observed in the IP group (1.9%vs 15%, p<0.001).The bundle was implemented in 0% and 28.4% ofpatients in the BP and IP groups, respectively. Onevaluating the individual components of the bundle, wediscovered enhancements in the utilisation of triage,application of NEWS2 and utilisation of oximeters whenappropriate. A decrease in the number of follow-upcallswas observed at the end of the implementation.Patients rated the quality of care as positive in 66% of thecases in the BP and 76% in the IP group (p=0.023).Conclusion: We successfully implemented a triagealgorithm based on the NEWS2 score to identifyrespiratory deterioration in adult patients in primary carethrough a QIC. This intervention was perceived as animprovement in the quality of care by the patients.
Fil: Jorro Barón, Facundo. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Falaschi, Andrea. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Bosio, Lía. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Vitar, Emilse Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Guglielmino, Marina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Negri, Erica. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Peralta-Roca, María Belén. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Rodriguez, Ana Paula. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Suarez Anzorena, Inés. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Alonso, Juan Pedro. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Rodríguez, Viviana. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Roberti, Javier Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
description Background: Primary care has been essential inensuring the continuity of health services for patientswith COVID-19and other conditions. We aimed toincrease the adoption of evidence-basedinterventionsto identify clinical deterioration in adult patients withconfirmed or suspected respiratory COVID-19at theprimary care level.Methods: We implemented specific interventions in ninePrimary Healthcare Centres (PHCC) through a qualityimprovement collaborative (QIC) with an interruptedtime-seriesdesign. Interventions included triage foracute respiratory symptoms, the National Early WarningScore 2 (NEWS2) scale, portable oximeters for selectedpatients and the provincial telehealth system. Additionalcomponents involved leadership commitment, teamworktools, reminders, audits, feedback and direct observation.A mixed-methodevaluation was conducted, with twolearning sessions and three action periods to test andimplement selected change ideas.Results: Six PHHCs completed the study. Over 48 weeks,data from 877 patients were gathered, 356 in the baselineperiod (BP) and 477 in the implementation period (IP).Eight hundred and sixty-twomedical consultations werereported, 367 for BP and 495 for IP. More COVID-19-confirmeddiagnoses were observed in the IP group (1.9%vs 15%, p<0.001).The bundle was implemented in 0% and 28.4% ofpatients in the BP and IP groups, respectively. Onevaluating the individual components of the bundle, wediscovered enhancements in the utilisation of triage,application of NEWS2 and utilisation of oximeters whenappropriate. A decrease in the number of follow-upcallswas observed at the end of the implementation.Patients rated the quality of care as positive in 66% of thecases in the BP and 76% in the IP group (p=0.023).Conclusion: We successfully implemented a triagealgorithm based on the NEWS2 score to identifyrespiratory deterioration in adult patients in primary carethrough a QIC. This intervention was perceived as animprovement in the quality of care by the patients.
publishDate 2025
dc.date.none.fl_str_mv 2025-07
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/291236
Jorro Barón, Facundo; Falaschi, Andrea; Bosio, Lía; Gibbons, Luz; Vitar, Emilse Mabel; et al.; Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative; BMJ Publishing Group; BMJ Open Quality; 14; 3; 7-2025; 1-10
2399-6641
CONICET Digital
CONICET
url http://hdl.handle.net/11336/291236
identifier_str_mv Jorro Barón, Facundo; Falaschi, Andrea; Bosio, Lía; Gibbons, Luz; Vitar, Emilse Mabel; et al.; Timely identification of deteriorating patients from acute respiratory infections at the primary care level in the COVID-19 era: quality improvement collaborative; BMJ Publishing Group; BMJ Open Quality; 14; 3; 7-2025; 1-10
2399-6641
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://qir.bmj.com/lookup/doi/10.1136/bmjoq-2025-003390
info:eu-repo/semantics/altIdentifier/doi/10.1136/bmjoq-2025-003390
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
application/pdf
dc.publisher.none.fl_str_mv BMJ Publishing Group
publisher.none.fl_str_mv BMJ Publishing Group
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 13.265058

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