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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/30649004/alerting-wisely-reducing-inappropriate-blood-chemistry-panel-orders-using-a-clinical-decision-support-tool
#1
Jonathan W Anderson, Mark R Greenwood, Gisele G Borsato, Kathryn G Kuttler
The Choosing Wisely (CW) initiative provides recommendations for healthcare providers, aimed at reducing unnecessary or inappropriate tests and procedures. A clinical decision support (CDS) alert in the electronic health record was developed to reflect organizational CW guidelines regarding blood chemistry panel ordering in the primary care setting. An interrupted time series design was used to analyze the weekly proportion of inappropriate blood chemistry panel orders prior to and after implementation of the CDS alert in treatment and control groups...
January 3, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30649003/falls-in-hospital-causing-injury
#2
Lieu Thi Thuy Trinh, Hassan Assareh, Michael Wood, Cathleen Addison-Wilson, Yasoda Sathiyaseelan
AIMS: To describe falls causing injury, types of injuries, and the reporting of these falls. METHODS: Administrative and incident reporting datasets between July 2012 and June 2017 were analyzed. RESULTS: Using both datasets, 5,653 falls were identified (3.7 per 1,000 bed-days). Administrative and incident datasets accounted for 40.8% (2,299) and 84.4% (4,752) of falls, respectively. More than half the falls in the administrative data required only observation/examination (1,221 falls; 53...
January 3, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30649002/7-is-the-new-8-improving-adherence-to-restrictive-prbc-transfusions-in-the-pediatric-icu
#3
Colleen M Badke, Julie A Borrowman, Shannon Haymond, Karen Rychlik, Marcelo R Malakooti
Up to 30%-40% of children admitted to the pediatric intensive care unit (PICU) have anemia, and approximately 15% receive packed red blood cell (pRBC) transfusions. Current literature supports a pRBC transfusion threshold of hemoglobin less than or equal to seven for most PICU patients. Our objective was to determine pRBC transfusion rates, assess compliance with transfusion guidelines, understand patient-level variables that affect transfusion practices, and use cross-industry innovation to implement a practice strategy...
January 3, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30649001/a-student-led-multifaceted-intervention-to-decrease-unnecessary-folate-ordering-in-the-inpatient-setting
#4
Celine Goetz, John Di Capua, Irene Lee, Rena Mei, Sukrit Narula, Sarah Zarrin, Jashvant Poeran, Hyung J Cho
To reduce unnecessary laboratory testing, a three-phase intervention was designed by students to decrease serum folate laboratory testing in the inpatient setting. These included an educational phase, a personalized feedback phase, and the uncoupling of orders in the electronic medical record. Average monthly serum folate ordering decreased by 87% over the course of the intervention, from 98.4 orders per month at baseline to 12.7 per month in the last phase of the intervention. In the segmented regression analysis, joint ordering of folate and vitamin B12 significantly decreased during the intervention ([INCREMENT]slope = -4...
January 3, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30649000/quality-of-care-and-preventive-screening-use-in-the-carefirst-patient-centered-medical-home-program
#5
Iwona M Kicinger, Alison Cuellar, Lorens A Helmchen, Gilbert Gimm, Jay Want, Bradley J Kells, Len M Nichols
Despite their value, comprehensive diabetes care and screening for common cancers remain underutilized. We examined the association between participation in a patient-centered medical home (PCMH) program with strong financial incentives and receipt of preventive care in the first 5 years after program launch. Using multivariate regression analysis, we compared outcomes for adults under the care of participating primary care providers (PCPs) with adults under the care of nonparticipating PCPs. Outcomes were breast, cervical and colorectal cancer screenings, and elements of diabetes care...
January 3, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30648999/improving-colorectal-cancer-screening-rates-in-patients-referred-to-a-gastroenterology-clinic
#6
Benjamin L Bick, Mustapha El-Halabi, Keaton R Jones, Charles J Kahi, Nabil F Fayad
Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related death in the United States. Colonoscopy and fecal immunochemistry testing (FIT) are the primary recommended CRC screening modalities. The purpose of this study is to improve rates of CRC screening in Veterans and County hospital patients referred to gastroenterology fellow's clinics. A total of 717 patients between ages of 49 and 75 years were seen. Previous CRC screening was not performed in 109 patients (15...
January 3, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30648998/improving-nonvocal-critical-care-patients-ease-of-communication-using-a-modified-speacs-2-program
#7
Rebecca L Trotta, Robin M Hermann, Rosemary C Polomano, Mary Beth Happ
OBJECTIVE: To evaluate the feasibility and impact of implementing the "study of patient-nurse effectiveness with assisted communication strategies-2" (SPEACS-2); a program to facilitate communication with nonvocal patients. STUDY DESIGN: The plan-do-study-act quality improvement methodology guided the implementation of a modified SPEACS-2 program within a pre and posttest design. The Ease of Communication Scale (ECS) measured patients' communication difficulty, and care processes measured the program's success...
January 3, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30418300/multidisciplinary-approach-to-improve-sepsis-outcomes
#8
Andrew MacMillan, David Rudinsky, Gena Han, John O Elliott, Kim Jordan
Severe sepsis and septic shock cause significant morbidity and mortality with health care costs approximating $17 billion annually. The Surviving Sepsis Campaign 2012 recommended time-sensitive care bundles to improve outcomes for patients with sepsis. At our community teaching hospital, a review of sepsis management for patients admitted to a medical intensive care unit (ICU) between December 2015 and March 2016 found 70.8% compliance with timing of lactate draw, 65.3% compliance for blood cultures, and 51...
November 2, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30383558/impact-of-a-resident-centered-interprofessional-quality-improvement-intervention-on-acute-care-length-of-stay
#9
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
#10
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
#11
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/30614929/human-centered-design-of-a-low-molecular-weight-heparin-order-set-to-reduce-medication-errors
#12
Anishka DʼSouza, Phillis Wu, Laura Jung, Karla Nungaray, Mark Richman
Inpatient anticoagulation medication errors for venous thromboembolism (VTE) therapy are common. Our VTE Team identified frequent dosing and duplicate order errors for therapeutic-dose low molecular weight heparin, which (lacking computerized physician order entry) was ordered using blank forms. To decrease such errors, a nonmandatory order form with weight-based dosing and prechecked orders discontinuing existing injectable anticoagulation was developed using human-centered design innovation principles/processes emphasizing end-user engagement in all phases: observation, exploring solutions, and rapid prototyping/feedback...
January 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30614928/decreasing-adverse-events-in-pediatric-patients-with-end-stage-renal-disease
#13
Gwendolyn D Childs, Rebekah Sims
Children with end-stage renal disease (ESRD) are at a higher risk of adverse events when they live at a distance from a pediatric facility with specialty services specific to the disease process. At a children's hospital in the southeast, a dialysis unit provides care for 27 patients with chronic ESRD. Nineteen of the 27 patients live more than 1 hour away from the children's hospital. Over the past 3 years, adverse events have occurred in patients being treated at another hospital. These adverse events included sepsis, bacterial and fungal infections, and compromised residual glomerular filtration rate because of the administration of nephrotoxic medications...
January 2019: 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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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