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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/28933709/evidence-for-misspecification-of-a-nationally-used-quality-measure-for-substance-use-treatment
#1
Soeren Mattke, Zachary Predmore, Elizabeth Sloss, Asa Wilks, Katherine E Watkins
OBJECTIVES: The National Committee for Quality Assurance's (NCQA) measure "Initiation and Engagement of Alcohol and Other Drug Dependence Treatment" captures the proportion of substance use patients with (1) treatment initiation within 14 days and (2) treatment engagement within 30 days thereafter. The definition of treatment considers only counseling but not medication-assisted treatment (MAT), although MAT is supported by current guidelines. Our research question is whether this omission results in meaningful measurement error...
September 4, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28933708/statewide-longitudinal-progression-of-the-whole-patient-measure-of-safety-in-south-carolina
#2
Christine B Turley, Jordan Brittingham, Aunyika Moonan, Dianne Davis, Hrishikesh Chakraborty
Meaningful improvement in patient safety encompasses a vast number of quality metrics, but a single measure to represent the overall level of safety is challenging to produce. Recently, Perla et al. established the Whole-Person Measure of Safety (WPMoS) to reflect the concept of global risk assessment at the patient level. We evaluated the WPMoS across an entire state to understand the impact of urban/rural setting, academic status, and hospital size on patient safety outcomes. The population included all South Carolina (SC) inpatient discharges from January 1, 2008, through to December 31, 2013, and was evaluated using established definitions of highly undesirable events (HUEs)...
September 4, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28885241/technology-solutions-to-support-care-continuity-in-home-care-a-focus-group-study
#3
Dawn W Dowding, David Russell, Nicole Onorato, Jacqueline A Merrill
BACKGROUND: Elevated hospital readmission rates from home care are an indicator of poor care quality, and rates are particularly high for patients with heart failure. Readmissions may be avoided by optimizing continuity of care. PURPOSE: To explore perceptions among home care clinicians of the barriers they face and the information they need to improve care continuity for patients with heart failure. METHODS: Focus groups were conducted with teams of home care clinicians at a large certified home healthcare agency in the Northeastern United states...
September 1, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28885240/advancing-value-based-population-health-management-through-payer-provider-partnerships-improving-outcomes-for-children-with-complex-conditions
#4
Pamela Peele, Donna Keyser, John Lovelace, Deborah Moss
Population health management (PHM) approaches to improve cost and quality remain limited. To address this gap, stakeholders within an integrated delivery and financing system in Western Pennsylvania designed, implemented, and tested a value-based care model for children with medically complex conditions that could be scaled across the broader pediatric population. The model included: (1) a multilevel, interdisciplinary infrastructure; (2) actionable analytics reports to guide continuous quality improvement; (3) alternative provider payments; (4) consumer-directed spending accounts; and (5) shared savings with practices...
September 1, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28885239/opioid-use-in-children-and-adolescents-after-anterior-cruciate-ligament-repair
#5
Nicole Taylor, Shannon Frick, Samantha Killilea, Teri Dugan-Frost, Jean Solodiuk
Opioid overdose is a leading cause of death from unintentional injury in the United States. When more opioids are prescribed than needed, leftover opioids may be misused if not properly disposed. The purpose of this study is to describe the opioid use of subjects (aged 13-21 years) after an anterior cruciate ligament (ACL) repair. After obtaining IRB approval, we obtained consent from 100 subjects (over an 8-month period) undergoing ACL reconstructions performed by five sports medicine surgeons. The mean age of enrolled subjects was 16 years, most were female (60%) and white (72%)...
September 1, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28885238/improving-the-implementation-of-lung-cancer-screening-guidelines-at-an-academic-primary-care-practice
#6
Alison T Brenner, Laura Cubillos, Katherine Birchard, Caleb Doyle-Burr, John Eick, Louise Henderson, Laura Jones, Michael Massaro, Bailey Minish, Paul Molina, Michael Pignone, Shana Ratner, Maria Patricia Rivera, Daniel S Reuland
Expert groups recommend annual chest computed tomography for lung cancer screening (LCS) in high-risk patients. Lung cancer screening in primary care is a complex process that includes identification of the at-risk population, comorbidity assessment, and shared decision making. We identified three key processes required for high-quality screening implementation in our academic primary care practice: (1) systematic collection of lifetime cumulative smoking history to identify potentially eligible patients; (2) visit-based clinical reminders and order sets embedded in the electronic health record (EHR); and (3) tools to facilitate shared decision making and appropriate test ordering...
September 1, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28885237/exploring-the-perceived-value-of-a-personalized-informatics-tool-to-anticipate-and-mitigate-patient-risk
#7
Michael D Kneeland, Catherine H Ivory, Phebe Bloomingburg, Neesha N Choma
Health care systems are implementing a myriad of strategies to improve patient outcomes and reduce both adverse events and unplanned readmissions. These approaches include interventions related to people, processes, and technology. This article describes the development of a technology-based model in the form of an actionable risk profile, which was used by one inpatient surgical unit (people) during a daily care team briefing (process). The risk profile was evaluated for its perceived value to the care team as a method of organizing care and anticipating patients' needs...
September 1, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28846551/highlighting-a-common-quality-of-care-delivery-problem-overuse-of-low-value-healthcare-services
#8
Stephanie MacLeod, Shirley Musich, Kevin Hawkins, Kay Schwebke
BACKGROUND: Low-value healthcare services (LVHS) are defined as procedures delivered that provide little or no clinical benefit. Overuse of LVHS, or delivery when the risks exceed the benefits, contributes to excessive spending without improved outcomes. Furthermore, overuse contributes to healthcare waste. PURPOSE: The primary purpose of this commentary is to (1) examine the problem of LVHS overuse and its impacts on quality care delivery and (2) propose factors to consider in developing quality measures to help reduce overuse and waste and thus improve patient outcomes...
August 25, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28857931/comparison-of-machine-learning-algorithms-for-the-prediction-of-preventable-hospital-readmissions
#9
Andres Garcia-Arce, Florentino Rico, José L Zayas-Castro
A diverse universe of statistical models in the literature aim to help hospitals understand the risk factors of their preventable readmissions. However, these models are usually not necessarily applicable in other contexts, fail to achieve good discriminatory power, or cannot be compared with other models. We built and compared predictive models based on machine learning algorithms for 30-day preventable hospital readmissions of Medicare patients. This work used the same inclusion/exclusion criteria for diseases used by the Centers for Medicare and Medicaid Services...
August 24, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28837450/identifying-persistent-asthma-in-children-a-comparison-of-healthcare-effectiveness-data-and-information-set-criteria-and-national-heart-lung-and-blood-institute-guidelines
#10
Ashleigh Hall, Carol Smolij, Beth Moughan, Amer Kechli, Stephen Aronoff
Persistent asthma requires a daily controller medication. National Heart, Lung, and Blood Institute (NHLBI) guidelines and Healthcare Effectiveness Data and Information Set (HEDIS) quality measures are used to identify persistent asthma, the former method used by clinicians, and the latter by managed care organizations (MCOs). This study aims to determine the degree of agreement between these criteria in classifying pediatric persistent asthma. Asthmatic patients aged 5-18 years old in a university pediatric practice who were continuously enrolled with one MCO from January 1, 2012 to December 31, 2013 (Cohort 1: 329 patients) and January 1, 2013 to December 31, 2014 (Cohort 2: 212 patients) were identified...
August 22, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28837449/uses-and-limitations-of-claims-based-performance-feedback-reports-lessons-from-the-comprehensive-primary-care-initiative
#11
Margaret Gerteis, Deborah Peikes, Arkadipta Ghosh, Lori Timmins, Ann S OʼMalley, Michael Barna, Erin F Taylor, Timothy J Day, Kaylyn Swankoski, Perry W Payne, Randall Brown
BACKGROUND: Performance feedback is central to data-driven models of quality improvement, but the use of claims-based data for feedback has received little attention. PURPOSE: To examine the challenges, uses, and limitations of quarterly Medicare claims-based performance feedback reports generated for practices participating in the Comprehensive Primary Care (CPC) initiative from 2012 to 2015. METHODS: Mixed methods study of nearly 500 CPC practices in seven regions, combining pilot testing; systematic monitoring; surveys; in-depth interviews; user feedback; and input from data feedback team...
August 22, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28837451/within-hospital-variation-in-30-day-adverse-events-implications-for-measuring-quality
#12
Robert E Burke, Thomas Glorioso, Anna K Barón, Peter J Kaboli, P Michael Ho
Novel measures of hospital quality are needed. Because quality improvement efforts seek to reduce variability in processes and outcomes, hospitals with higher variability in adverse events may be delivering poorer quality care. We sought to evaluate whether within-hospital variability in adverse events after a procedure might function as a quality metric that is correlated with facility-level mortality rates. We analyzed all percutaneous coronary interventions (PCIs) performed in the Veterans Health Administration (VHA) system from 2007 to 2013 to evaluate the correlation between within-hospital variability in 30-day postdischarge adverse events (readmission, emergency department visit, and repeat revascularization), and facility-level mortality rates, after adjustment for patient demographics, comorbidities, PCI indication, and PCI urgency...
August 21, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28786846/hospital-readmission-from-the-perspective-of-medicaid-and-uninsured-patients
#13
Gregory J Misky, Robert E Burke, Teresa Johnson, Amira Del Pino Jones, Janice L Hanson, Mark B Reid
BACKGROUND: Patients with little or no health insurance are frequently readmitted to the hospital, yet few previous studies have listened to patients' explanations of why they returned to the hospital after discharge. Enhanced understanding of patient perspectives may facilitate targeted services and improve care. METHODS: We enrolled 18 patients with Medicaid or no insurance during a hospital readmission within 30 days in a major metropolitan area, and conducted semi-structured qualitative interviews to explore the impact of patients' experiences around readmission using a grounded theory approach...
August 2, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28786845/measuring-consumer-engagement-a-review-of-tools-and-findings
#14
Laurie M Jacobs, Claire D Brindis, Dana Hughes, Caitlin E Kennedy, Laura A Schmidt
Consumer engagement is increasingly emphasized in healthcare initiatives and has been a priority in healthcare reforms. Consumer engagement takes multiple forms, including increased involvement of consumers in their own care, in organizational design, and in broader policy decision-making processes. Determining the effectiveness of such involvement requires both effective measurement and empirical study, both of which have yet to be standardized or fully explored. In this review, we examine both existing measurement tools for consumer engagement and current empirical knowledge regarding the outcomes associated with each of three levels of consumer engagement...
August 2, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28749792/effect-of-socioeconomic-status-on-surgery-waiting-times-and-mortality-after-hip-fractures-in-italy
#15
Alessio Petrelli, Giuliana De Luca, Tania Landriscina, Giuseppe Costa, Roberto Gnavi
BACKGROUND: Reducing inequities is a main goal of the Italian healthcare system. We evaluated socioeconomic differences in delayed surgery and postoperative mortality after a hip replacement after a fracture in Piedmont Region (Italy). METHODS: Cohort study including all people aged ≥65 years hospitalized for a hip fracture in 2007-2010 (n = 21,432). Study outcomes were the following: (1) surgery waiting times >2 days; (2) 30-day, 90-day, and 1-year mortality from admission...
July 24, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28749791/enhanced-adherence-in-patients-using-an-automated-home-medication-dispenser
#16
Charles Hoffmann, Anne Schweighardt, Kelly M Conn, Dallas Nelson, Richard Barbano, Frederick Marshall, Jack Brown
BACKGROUND: Many factors contribute to medication nonadherence including psychological and memory disorders, aging, and pill burden. The Automated Home Medication Dispenser (AHMD) is a medication management system intended to help solve unintentional medication nonadherence. OBJECTIVE: The purpose of this study was to determine if use of the AHMD improved medication adherence. METHODS: We conducted a 6-month prospective, feasibility study assessing use of the AHMD in 21 patient-caregiver dyads...
July 24, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28671897/proactive-safety-management-in-trauma-care-applying-the-human-factors-analysis-and-classification-system
#17
Tara N Cohen, Jennifer S Cabrera, Tracy L Litzinger, Kevin A Captain, Michael A Fabian, Steven G Miles, Scott T Reeves, Scott A Shappell, Albert J Boquet
INTRODUCTION: This article examines the reliability of the Human Factors Analysis and Classification System (HFACS) for classifying observational human factors data collected prospectively in a trauma resuscitation center. METHODS: Three trained human factors analysts individually categorized 1,137 workflow disruptions identified in a previously collected data set involving 65 observed trauma care cases using the HFACS framework. RESULTS: Results revealed that the framework was substantially reliable overall (κ = 0...
June 30, 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28858966/using-technology-to-support-data-analytics-a-chief-nursing-officer-accountability-scorecard
#18
Shea Polancich, Terri Poe, Natalie Hackney, Jason Williamson
Accountability for health system improvement is a requirement for nursing leadership in practice. However, to be accountable for organizational goals, nurse leaders need the tools to identify gaps in their microsystems of care. The purpose of this article was to provide a case study example of chief nursing officer (CNO) leadership in using a technology solution to develop a CNO accountability scorecard. This project highlights the HQ Essential for data analytics using an innovative technological approach to drive improvement at the front line of clinical care...
September 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28858965/stepping-back-to-move-forward-evaluating-the-effectiveness-of-a-diabetes-prevention-program-within-a-large-integrated-healthcare-delivery-system
#19
Kimberly D Brunisholz, Elizabeth A Joy, Mia Hashibe, Lisa H Gren, Lucy A Savitz, Sharon Hamilton, Wayne Cannon, Kelly Huynh, Tonya A N Schafer, Laurel M Newman, Jodi Parker, Joilynne Musselman, Jaewhan Kim
OBJECTIVE: To evaluate the short-term effectiveness of the Intermountain Healthcare (IH) Diabetes Prevention Program (DPP) for patients with prediabetes (preDM) deployed within primary care clinics. STUDY DESIGN: A quasi-experimental study design was used to deploy the DPP within the IH system to identify patients with preDM and target a primary goal of a 5% weight loss within 6-12 months of enrollment. STUDY POPULATION: Adults (aged 18-75 years) who met the American Diabetes Association criteria for preDM were included for study...
September 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28858964/improvement-through-small-cycles-of-change-lessons-from-an-academic-medical-center-emergency-department
#20
Amit Arbune, Sarah Wackerbarth, Penne Allison, Joseph Conigliaro
This article describes the experiences of a quality improvement team that used small cycles of change to improve the emergency department (ED) of an academic medical center. The role of EDs in the provision of healthcare continues to increase in importance. ED bottlenecks contribute to long waits and diminished outcomes for ED patients as well as more system-wide issues, such as inefficiencies in inpatient admission processes. The purpose of this "ED Operational Efficiency Project" was to reduce lengths of stay (LOS) for low-acuity patients...
September 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
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