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Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality

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https://www.readbyqxmd.com/read/30383558/impact-of-a-resident-centered-interprofessional-quality-improvement-intervention-on-acute-care-length-of-stay
#1
Megan Walker, Lindsey Gay, Glynda Raynaldo, Hans Von Marensdorff, Jeffrey T Bates, Joan A Friedland, Jung Hyun Park, Ekaterina Kehl, Bryan Sowers, Sivasubramanium Bhavani, Charlie Lan, Biykem Bozkurt, Diana E Stewart, Molly J Horstman
Competency in interprofessional quality improvement and performance measurement is required by the Accreditation Council for Graduate Medical Education. We implemented an interprofessional quality improvement project to support trainee involvement in systems-level improvement to reduce hospital length of stay and engage trainees in efforts to improve the validity and reliability of clinical documentation contributing to risk-adjusted performance measures. The intervention had three components: daily interprofessional disposition huddles to discuss discharge needs, medical documentation curriculum to improve clinical data accuracy, and scheduled coding huddles to provide real-time feedback on documentation...
October 26, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30358635/narcotic-pain-control-for-ureterolithiasis-is-associated-with-unnecessary-repeat-imaging-in-the-emergency-department
#2
Kyle Garcia, Hannah Pham, Pranav Sharma
A subset of patients with ureteral stones who present to the emergency department (ED) will return with recurring symptoms and will receive unnecessary repeat imaging. We retrospectively identified 112 patients from 2012 to 2016 diagnosed with at least one ureteral stone on computerized tomography (CT) at our institution who returned to the ED within 30 days. Patients were stratified based on the presence or absence of repeat CT scan imaging. Mean values were compared with independent t-test and proportions with chi-square analysis...
October 24, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30358634/consumers-association-of-hospital-reputation-with-healthcare-quality
#3
Justin B Ziemba, Steven Arenberg, Holly Reustle, Mohamad E Allaf, Dalal Haldeman
Why consumers consistently rank hospital reputation as one of the most important factors when selecting health care services remains unknown. We hypothesized that this is explained by consumers associating reputation with objective quality. We performed a cross-sectional, US population-based survey of consumers (N = 23,410) exploring this association. A Spearman rank order correlation was used to measure the strength of this relationship. Subgroups of consumers more likely to associate the two was explored with multivariable logistic regression...
October 24, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30362997/readmission-of-high-risk-discharged-patients-at-a-tertiary-hospital-in-korea
#4
Young Man Kim, Taehee Lee, Hyun Joo Lee, You Lee Yang, Eui Geum Oh
This study aims to investigate the readmission rates of major disease groups as stated by the Centers for Medicare and Medicaid Services and to identify risk factors related to readmission in Korea. We studied 2,973 patients discharged from a 2,200-bed tertiary referral hospital in South Korea, from April 1, 2016, to March 31, 2017. Using electronic medical records, we calculated the 30-day readmission rates of seven diseases: acute myocardial infarction, chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia, stroke, coronary artery bypass graft (CABG), and total hip arthroplasty/total knee arthroplasty...
October 22, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30303883/development-of-a-multistep-hypertension-quality-improvement-program-in-an-academic-general-medicine-practice
#5
Mai-Khanh Bui-Duy, Shirley Wong, Rosemary Lam, Leah S Karliner
Hypertension is a common problem and a major risk factor for cardiovascular disease. It is unclear whether efforts to control blood pressure (BP) known to be effective in integrated healthcare systems can be successfully implemented in an academic setting. We describe our experience implementing a multistep quality improvement program within an academic general medicine practice aimed at improving BP among patients with uncontrolled hypertension. Ensuring medical assistants were correctly measuring BP provided the basis for accurate data entry into the electronic medical record (EMR); our EMR-based registry data allowed us to feedback primary care provider (PCP) level data on BP control for panel management, which resulted in improvements in BP for a substantial proportion of patients, particularly for those with more practice visits...
October 8, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30239473/predictors-of-30-day-postdischarge-readmission-to-a-multistate-national-sample-of-state-psychiatric-hospitals
#6
Glorimar Ortiz
BACKGROUND: Early discharge from psychiatric inpatient care may pose challenges for the patient's recovery and may incite a rapid return to the hospital. This study identified demographic, clinical, and the continuing of care characteristics associated with rapid readmission into a sample of psychiatric inpatient hospitals. METHODS: Cross-sectional analysis of 60,254 discharges from state psychiatric hospitals. Logistic regression explored the relationship between predictors of rapid readmission...
September 19, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30180043/patients-perspectives-on-reasons-for-unplanned-readmissions
#7
Amy M LeClair, Megan Sweeney, Grace H Yoon, Jana C Leary, Saul N Weingart, Karen M Freund
Massachusetts has one of the highest rates of 30-day readmissions in the country. To identify patient-reported factors that may contribute to readmissions, we conducted semi-structured interviews with patients with unplanned readmissions within 30 days of inpatient discharge from the medicine services at an urban medical center between June and August 2016. Interviews with patients and/or proxies were conducted in English, Spanish, Mandarin, or Cantonese, then translated to English if necessary, transcribed verbatim, and deidentified...
August 30, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30180042/how-measurement-variability-affects-reporting-of-a-single-readmission-metric
#8
Mark S Brittan, Elizabeth J Campagna, David Keller, Allison Kempe
Readmissions are an important quality measure for public reporting, payment, and collaborative research. Lack of measure standardization may lead to inconsistent reporting of outcomes across study sites. In this study, we examined the impact of measurement variability on reporting of a single readmission metric, 30-day all-condition readmission rates (ARRs). We conducted a secondary database analysis of 2006-2008 Medicaid Analytic eXtract data merged from four states of children younger than 21 years. We calculated 30-day ARRs for this cohort using three previously described models varying in their inclusions and exclusions of index hospitalizations and readmissions...
August 30, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30180041/reducing-phlebotomy-utilization-with-education-and-changes-to-computerized-provider-order-entry
#9
Christopher Breen, Kevin Maguire, Amit Bansal, Stanley Russin, Sara West, Anju Dayal, Andrea Berger, Jordan Olson, Benjamin Hohmuth
INTRODUCTION: Daily phlebotomy is often a standard procedure in hospitalized patients. Recently, this practice has begun receiving attention as a potential target for efforts focused on eliminating overuse. Several organizations have published their efforts in this arena. Interventions have included education, feedback, and changes to computerized provider order entry (CPOE) but have yielded mixed results. METHODS: A quality improvement initiative to reduce the utilization of daily phlebotomy was conducted at a 505-bed Academic Medical Center...
August 30, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30180040/improving-the-transition-of-care-process-for-veterans-hospitalized-at-non-vha-facilities
#10
James V Libbon, Carrie Meg Austin, Leta C Gill-Scott, Robert E Burke
Veterans receiving primary care through the Veterans Health Administration (VHA) are at increased risk of adverse outcomes when transitioning from a non-VHA hospitalization to VHA primary care. We intervened to improve these care transitions through identifying Veterans at a partnered community hospital, use of a multidisciplinary patient-structured discharge information sheet for community case managers to effectively communicate with VHA clinics, and implementation of a VHA site process for receiving information...
August 30, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30124565/-think-before-you-order-multidisciplinary-initiative-to-reduce-unnecessary-lab-testing
#11
Masih Shinwa, Adam Bossert, Iris Chen, Anna Cushing, Andrew S Dunn, Jashvant Poeran, Sally Weinstein, Hyung J Cho
Inappropriate daily lab testing can have adverse effects on patients, including anemia, pain, and interruption of sleep. We implemented a student-led, multifaceted intervention featuring clinician education, publicity campaign, gamification, and system changes, including a novel nurse-driven protocol to reduce unnecessary daily lab testing in a teaching hospital. We applied a quasi-experimental interrupted time series design with a segmented regression analysis to estimate changes before and after our 14-month intervention with a comparison to a control surgical unit...
August 17, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30399033/understanding-quality-of-care-and-satisfaction-with-sexual-and-reproductive-healthcare-among-young-men
#12
Nanlesta Pilgrim, Jacky M Jennings, Renata Sanders, Kathleen R Page, Penny S Loosier, Patricia J Dittus, Arik V Marcell
OBJECTIVE: Sexual and reproductive healthcare (SRHC) guidelines recommend the delivery of quality preventive SRHC to males beginning in adolescence. A quality of care (QOC) framework was used to examine factors associated with young male's perceptions of QOC and satisfaction with care, which can influence their engagement and use of SRHC. METHODS: Cross-sectional surveys were conducted from August 2014 to September 2016 with 385 male patients aged 15-24 years, recruited from primary care and sexually transmitted disease (STD) clinics...
November 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30362998/preventing-central-line-associated-bloodstream-infections-in-the-intensive-care-unit-application-of-high-reliability-principles
#13
Beth McCraw, Terri Crutcher, Shea Polancich, Pam Jones
This department column highlights translation of research into healthcare quality practice. Achieving the highest quality in healthcare requires organizations to understand care delivery and to proactively mitigate risks in care delivery processes. The purpose of this article is to describe a quality initiative that used principles of high reliability to develop a zero tolerance culture for central line-associated bloodstream infections in an intensive care unit at an independent, nonprofit acute care community hospital...
November 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30113366/developing-a-quality-measurement-strategy-in-an-academic-primary-care-setting-an-environmental-scan
#14
Alexandra F Dalton, Corey Lyon, Bennett Parnes, Douglas Fernald, Carmen L Lewis
PURPOSE: The purpose of this project was to: (1) develop a strategy for primary care quality measurement using an environmental scan and interviews to identify best practices and candidate measures; (2) present recommendations to facilitate successful measurement. METHODS: Following stakeholder interviews and review of existing measures, we created a three-tiered recommendation system for selecting and implementing measures. We also developed a framework for reviewing and prioritizing measures and prepared a detailed project report...
November 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29474313/perception-of-patient-safety-culture-in-pediatric-long-term-care-settings
#15
Amanda J Hessels, Meghan T Murray, Bevin Cohen, Elaine L Larson
INTRODUCTION: Patient safety culture (PSC) is an emerging construct in adult long-term care settings. No measures are validated to quantify PSC in pediatric long-term care (pLTC) settings despite the importance of safety for this vulnerable population. The study purposes are to (1) describe PSC in pLTC, (2) assess the relationship of PSC to facility recommendation and overall safety rating, and (3) test the stability and reliability of the PSC survey over time. METHODS: A modified Nursing Home PSC (NHSPSC) survey was administered to employees at three pLTC facilities over 3 years; data were summarized and compared over time...
November 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29474312/benchmarking-implications-analysis-of-medicare-accountable-care-organizations-spending-level-and-quality-of-care
#16
Young-Rock Hong, Frederick Kates, Soon Ju Song, Nayoung Lee, R Paul Duncan, Nicole M Marlow
Early evidence has shown that Accountable Care Organizations (ACOs) have achieved some success in improving the quality of care and reducing Medicare costs. However, it has been argued that the ACO rewarding model may disproportionately affect relatively low-spending (LS; considered as efficient) organizations that have fewer options to cut unnecessary services compared with high-spending (HS; inefficient) organizations. We conducted a cross-sectional retrospective study to compare ACO financial and quality of care performance between HS-ACO and LS-ACO...
November 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29474311/identifying-poor-performing-hospitals-in-the-medicare-hospital-acquired-condition-reduction-program-an-assessment-of-reliability
#17
Samuel Soltoff, Lane Koenig, Akinluwa A Demehin, Nancy E Foster, Christopher Vaz
Centers for Medicare and Medicaid Services (CMS) estimated that Medicare's Hospital-Acquired Condition Reduction Program (HAC-RP) would reduce hospital payments by $364 million in fiscal year 2016. Although observers have questioned the validity of certain HAC-RP measures, less attention has been paid to the determination of low-performing hospitals (bottom quartile) and the reliability of penalty assignment. This study used publicly available data from CMS's Hospital Compare to simulate the consistency of hospitals' scores and the assignment of penalties under repeated measurement with no change in each hospital's underlying quality...
November 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29315153/overall-emergency-department-rating-identifying-the-factors-that-matter-most-to-patient-experience
#18
Emily L Aaronson, Elizabeth Mort, Jonathan D Sonis, Yuchiao Chang, Benjamin A White
BACKGROUND: Patient experience is becoming an area of interest in Emergency Medicine as more is understood about its impact on outcomes and the expectation that it will soon be tied to reimbursement. No study has investigated the predictors of emergency department (ED) patient satisfaction in over a decade. As the care environment, access to information, and consumer interests change, determinants of satisfaction have likely evolved. Our objective was to examine the factors that were most predictive of ED satisfaction...
November 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29315151/factors-associated-with-delayed-discharge-on-general-medicine-service-at-an-academic-medical-center
#19
Nidhi Rohatgi, Marlena Kane, Marcy Winget, Farnoosh Haji-Sheikhi, Neera Ahuja
Lack of collaboration between care teams and patients/families has been associated with delayed discharge from the hospital. In this study, we determine whether patients' awareness of the estimated date of discharge (EDD) was associated with a decrease in delayed discharge, and determine the factors associated with a delayed discharge. A total of 221 patients admitted to the General Medicine service between July and September 2014 were included in the study. Estimated date of discharge was identified within 36 hours of admission...
November 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29315150/meeting-management-standards-and-improvement-in-clinical-outcomes-among-patients-with-hip-fractures
#20
Lieu Thi Thuy Trinh, Helen Achat, Sze Ming Loh, Robert Pascoe, Hassan Asarreh, Joanne Stubbs
OBJECTIVES: To determine the association between management standards and clinical outcomes among patients with hip fracture (HF). METHODS: Data from a prospective cohort study were linked with hospital administration data. RESULTS: In 2014 and 2015, 493 patients had surgery for HF. The proportion of patients meeting care standards ranged from 69% for surgery within 48 hours to 96% for being seen by a geriatrician. Thirty-nine per cent of patients received all the standards...
November 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
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