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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/28749792/effect-of-socioeconomic-status-on-surgery-waiting-times-and-mortality-after-hip-fractures-in-italy
#1
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
#2
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
#3
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/28658092/healthcare-affiliation-networks-a-unique-quality-partnership-to-aid-in-making-communities-healthier
#4
Karen Frush, Harry Phillips, Cynthia Nordlund, Russell Holman
As the healthcare environment continues to evolve, many community hospitals of all sizes are finding it difficult to thrive and grow in the headwinds of increasing regulatory requirements, decreased reimbursements amidst healthcare reform efforts, increased requirements for efficiency, demands for improvement in the patient experience, and increasing penalties for lagging performance in patient safety and quality metrics. A unique partnership, involving an organization built upon expertise in operating community hospitals and an academic center with expertise in patient safety, quality, innovation, and care delivery, has provided a successful solution for a growing number of challenged community facilities...
July 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28658091/assessing-estimates-of-patient-safety-derived-from-coded-data
#5
Wazim Narain
The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSI) with the goal of detecting and preventing adverse events using administrative data. Use of PSIs to measure safety and quality of care raises questions since they rely heavily on coded data. The goal of this paper is to review literature on AHRQ PSIs, specifically their accuracy in detecting adverse events, and how recent coding changes affect the accuracy of these estimates. The Healthcare Utilization Project (HCUP) National Inpatient Sample (NIS) contains data on more than seven million hospital stays yearly...
July 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28658090/patient-needs-required-level-of-care-and-reasons-delaying-hospital-discharge-for-nonacute-patients-occupying-acute-hospital-beds
#6
Marc Afilalo, Xiaoqing Xue, Nathalie Soucy, Antoinette Colacone, Emmanuelle Jourdenais, Jean-François Boivin
This study aims to determine the proportion of nonacute patients occupying acute care beds and to describe their needs, the appropriate level of alternative care, and reasons preventing discharge. Data from 952 patients hospitalized in an acute care unit for 30 days were obtained from their medical charts and by consulting with the medical team at two tertiary teaching hospitals. Among them, 333 (35%) were determined nonacute on day 30 of hospitalization. According to the Appropriateness Evaluation Protocol (AEP), 55% had no medical, nursing, or patient needs...
July 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27811579/a-comprehensive-approach-to-pediatric-pneumonia-relationship-between-standardization-antimicrobial-stewardship-clinical-testing-and-cost
#7
Lori Rutman, Davene R Wright, James OʼCallaghan, Suzanne Spencer, K Casey Lion, Matthew P Kronman, Chuan Zhou, Rita Mangione-Smith
OBJECTIVE: In September 2012, our institution implemented an emergency department (ED) and inpatient pathway for community-acquired pneumonia (CAP) based on national guideline recommendations. The objective of this study was to determine the relationship between standardizing ED and inpatient care for CAP and antimicrobial stewardship, clinical testing, and cost. METHODS: We used descriptive statistics, statistical process control, and interrupted time series analysis to analyze measures 12 months before and after implementation...
July 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27631710/an-assessment-of-the-quality-oncology-practice-initiative-lessons-learned-from-a-detailed-assessment-of-a-well-established-profession-based-performance-measurement-program
#8
Constance M Barysauskas, Carole K Dalby, Paul J Catalano, Joseph O Jacobson
BACKGROUND: National performance measurement programs used to improve quality and/or accountability are prevalent. Professional society-based programs largely assess practice or provider performance. We tested the limitations of the Quality Oncology Practice Initiative (QOPI), a well-established program. METHODS: We investigated the potential limitations of the QOPI limited sampling strategy and end-of-life (EOL) metrics through a retrospective review of all decedents meeting the QOPI eligibility criteria at a large three-site community oncology practice...
July 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27348430/intraoperative-handoffs-and-postoperative-complications-among-patients-undergoing-gynecologic-oncology-operations
#9
Kemi M Doll, Jessica A Lavery, Anna C Snavely, Paola A Gehrig
There is evidence that systems-based factors influence surgical outcomes of intraoperative and postoperative morbidity. The goal of this study was to provide an exploratory analysis of systems-based variables and their associations with surgical outcomes in gynecologic oncology patients. We merged electronic records from operating room software with billing claims from major surgeries performed from 2011 to 2013, at a tertiary care academic medical center. Univariate and bivariate analyses were performed to evaluate the relationship between baseline demographic and clinical covariates (age, comorbidity, procedure type, and surgeon volume), the main exposure variables (case start time, case order, and personnel handoffs), and the primary outcome of 30-day postoperative complications...
July 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27322930/communication-access-for-deaf-people-in-healthcare-settings-understanding-the-work-of-american-sign-language-interpreters
#10
Andrea M Olson, Laurie Swabey
Despite federal laws that mandate equal access and communication in all healthcare settings for deaf people, consistent provision of quality interpreting in healthcare settings is still not a reality, as recognized by deaf people and American Sign Language (ASL)-English interpreters. The purpose of this study was to better understand the work of ASL interpreters employed in healthcare settings, which can then inform on training and credentialing of interpreters, with the ultimate aim of improving the quality of healthcare and communication access for deaf people...
July 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27183172/collection-of-patients-disability-status-by-healthcare-organizations-patients-perceptions-and-attitudes
#11
Megan A Morris, Megan Schliep, Juliette Liesinger, Kenzie A Cameron
Recent policies call for healthcare organizations to consistently document patients' disability status for the purpose of tracking the quality of care experienced by patients with disabilities. The purpose of the study was to explore patients' attitudes toward healthcare organizations collecting disability status. We surveyed a convenience sample of patients in three outpatient clinics, including primary care and rehabilitation clinics. A total of 303 patients participated; 49% self-identified as disabled, 59% were female and the mean age was 52 years...
July 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/26566237/attitudes-and-beliefs-regarding-the-utility-of-robotically-assisted-gynecologic-surgery-among-practicing-gynecologists
#12
Jason D Wright, Greta B Raglan, Jay Schulkin, Michael F Fialkow
While use of robotic-assisted surgery has increased rapidly, little is known about the attitudes and beliefs of practicing gynecologists regarding the utility of the technology. We surveyed a large sample of gynecologists to examine their attitudes and beliefs about the benefits, utility, and factors driving use of robotic-assisted gynecologic surgery. A 51-item survey was mailed to 600 fellows or junior fellows of the American College of Obstetricians and Gynecologists. The survey included questions on use of robotic surgery, decision-making, and beliefs regarding the technology...
July 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28481845/did-we-have-an-impact-changes-in-racial-and-ethnic-composition-of-patient-populations-following-implementation-of-a-pilot-program
#13
Pamela S Webster, Swathi Sampangi
High-quality data are necessary to eliminate health disparities, and are necessary in cancer prevention and control. A pilot project to improve the collection of race and ethnicity data was undertaken. The approach included train-the-trainer and staff training, and racial and ethnic categories were expanded to include "granular ethnicity" or ancestry terms in the patient registration system at five acute care hospitals in Rhode Island. The self-reported racial and ethnic distribution of the patient population was examined for each pilot hospital...
May 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28481844/transformational-leadership-the-chief-nursing-officer-role-in-leading-quality-and-patient-safety
#14
Pam Jones, Shea Polancich, Robin Steaban, Nancye Feistritzer, Terri Poe
This department column highlights leadership perspectives of quality and patient safety practice. The purpose of this article is to provide strategic direction for transformational quality and safety leadership as the chief nursing officer (CNO) within the academic medical center environment.
May 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28481843/vha-patient-centered-medical-home-associated-with-lower-rate-of-hospitalizations-and-specialty-care-among-veterans-with-posttraumatic-stress-disorder
#15
Ian Randall, David C Mohr, Charles Maynard
OBJECTIVE: The Veterans Health Administration (VHA) implemented a patient-centered medical home (PCMH) model, termed Patient Aligned Care Teams (PACT), in 2010. We assessed the association between PACT and the use of health services among U.S. veterans with posttraumatic stress disorder (PTSD). METHODS: VHA clinical and administrative data were obtained for the pre-PACT period of April 1, 2009 to March 31, 2010 and post-PACT period of June 1, 2011 to May 31, 2012...
May 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28481842/electronic-health-record-adoption-among-obstetrician-gynecologists-in-the-united-states-physician-practices-and-satisfaction
#16
Greta B Raglan, Benyamin Margolis, Ronald A Paulus, Jay Schulkin
Implementation of electronic health records (EHRs) has historically been lower among obstetrician-gynecologists (ob-gyns) than many physician groups. This study described ob-gyns' adoption and use of EHR systems in practice, as well as barriers and benefits to implementation. Surveys asking about the physicians' use of EHR, satisfaction with systems, and what features they found most or least helpful were mailed to 1,200 ob-gyns. An overall response rate of 57.4% was achieved, with 559 returning completed surveys...
May 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28481841/a-system-wide-enhanced-recovery-program-focusing-on-two-key-process-steps-reduces-complications-and-readmissions-in-patients-undergoing-bowel-surgery
#17
Terrence J Loftus, Susan Stelton, Brett W Efaw, Joshua Bloomstone
Enhanced recovery programs (ERPs) can improve outcomes following bowel surgery, but implementing an ERP across a large healthcare system remains challenging. In this study, a simplified ERP that focused on two process steps, early and frequent ambulation and early alimentation, was evaluated to determine its impact on outcomes. Data were collected on 5,000 adult patients undergoing elective small and large bowel operations over a 3-year period. Complication, readmission, and mortality rates were evaluated before and after ERP implementation...
May 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/28166113/using-a-mixed-methods-approach-to-examine-practice-characteristics-associated-with-implementation-of-an-adult-immunization-intervention-using-the-4-pillars-practice-transformation-program
#18
Mary Hawk, Mary Patricia Nowalk, Krissy K Moehling, Valory Pavlik, Jonathan M Raviotta, Anthony E Brown, Richard K Zimmerman, Edmund M Ricci
Adult immunization rates are consistently suboptimal, exacting significant human and financial burden of preventable disease. Practice-level interventions to improve immunization rates have produced mixed results. The context of change critically affects implementation of evidence-based interventions. We conducted a randomized controlled cluster trial of the 4 Pillars Practice Transformation Program to increase adult vaccination rates in primary care practices and used qualitative methods to test intervention effects and understand practice characteristics associated with implementation success...
May 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/26087024/an-interdisciplinary-education-initiative-to-promote-blood-conservation-in-cardiac-surgery
#19
Tamara S Goda, Brad Sherrod, Linda Kindell
Transfusion practices vary extensively for patients undergoing cardiac surgical procedures, leading to high utilization of blood products despite evidence that transfusions negatively impact outcomes. An important factor affecting transfusion practice is recognition of the importance of teams in cardiac surgery care delivery. This article reports an evidenced-based practice (EBP) initiative constructed using the Society of Thoracic Surgery (STS) 2011 Blood Conservation Clinical Practice Guidelines (CPGs) to standardize transfusion practice across the cardiac surgery team at a large academic medical center...
May 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/26042755/quality-of-interhospital-transfer-communication-practices-and-association-with-adverse-events-on-an-internal-medicine-hospitalist-service
#20
Jennifer S Borofsky, Jason C Bartsch, Alan B Howard, Allen B Repp
Communication practices around interhospital transfer have not been rigorously assessed in adult medicine patients. Furthermore, the clinical implications of such practices have not been reported. This case-control study was designed to assess the quality of communication between clinicians during interhospital transfer and to determine if posttransfer adverse events (PTAEs) are associated with suboptimal communication. Cases included patients transferred to a Medicine Hospitalist Service from an outside hospital who subsequently experienced a PTAE, defined as unplanned transfer to an intensive care unit or death within 24 hours of transfer...
May 2017: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
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