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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/29634594/pilot-teledermatology-service-for-assessing-solitary-skin-lesions-in-a-tertiary-london-dermatology-center
#1
Chung-Mei Maggie Cheung, Kayria Muttardi, Suchitra Chinthapalli, Ferina Ismail
BACKGROUND: Efficient clinical pathways are needed to meet the growing pressures in dermatology due to the significant rise in the number of suspected skin cancer referrals. Our hospital serves a wide geographical area and receives a large number of 2-week-wait (2WW) suspected skin cancer referrals. In the United Kingdom, approximately 10-12% of 2WW referrals are diagnosed as skin cancers fulfilling the 2WW criteria. PURPOSE: We sought to assess the role of teledermatology in reducing hospital consultations for patients referred via the dermatology 2WW pathway...
April 9, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29634593/oral-care-clinical-trial-to-reduce-non-intensive-care-unit-hospital-acquired-pneumonia-lessons-for-future-research
#2
Edel McNally, Gintas P Krisciunas, Susan E Langmore, Janet T Crimlisk, Jessica M Pisegna, Joseph Massaro
Hospital-acquired pneumonia (HAP) contributes greatly to patient mortality and healthcare costs. Studies have shown that aggressive oral care in intensive care units (ICUs) can significantly reduce pneumonia rates, and hospitals have implemented stringent protocols in this setting. However, little is known about the effectiveness of aggressive oral care in reducing HAP in non-intensive care wards, prompting us to conduct a nonrandomized controlled clinical trial. A structured toothbrushing program was provided to an experimental cohort of patients...
April 9, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29553966/subsequent-fracture-prevention-in-patients-50-years-and-older-with-fragility-fractures-a-quality-improvement-initiative
#3
Patricia A Mackey, Laura D Rosenthal, Lanyu Mi, Michael D Whitaker
Because of osteoporosis, patients older than 50 years with fragility fractures are at risk of further fractures. We developed a quality improvement initiative based on an evidence-based Fracture Liaison Service (FLS) model of care to help prevent subsequent fractures. Previous to the implemented FLS model, less than 13% of patients with fragility fractures were assessed for osteoporosis at our institution. We created a registry tool to identify patients with fractures who were older than 50 years. Our interventions focused on identifying, contacting, and educating patients; and coordinating screening tests and an outpatient follow-up visit with an endocrinologist...
March 16, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29734270/managing-what-is-measured-a-rural-hospital-s-experience-in-reducing-patient-harm
#4
Lucretia F Stargell, Stephen L Heatherly
Effecting improvement in the small, rural hospital setting is often challenging. Harris Regional Hospital (HRH) is a small, acute care hospital in rural western North Carolina acquired by Duke LifePoint Healthcare in August, 2014. Since that time, HRH has been on a quality journey characterized by a data-driven approach to reducing patient harm events. Using a framework that comprised leadership, performance improvement, and cultural development to cultivate an environment of mutual respect and trust, HRH has demonstrated sustained improvement in patient harm events over a 29-month period from January 2015 to June 2017...
May 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29734269/improving-patient-compliance-with-mechanical-venous-thromboembolism-prophylaxis
#5
Deepti Nahar, Aaron Nizam, Monique Farrow, Andrea Restifo, Michael Nimaroff
Venous thromboembolic events (VTE) occurring in the postoperative period are serious yet preventable conditions. Multiple studies have demonstrated that the risk of postoperative VTE can be successfully reduced with mechanical prophylaxis and/or chemoprophylaxis. Patients are often noncompliant with mechanical prophylaxis in the postoperative period. We performed a prospective nonrandomized controlled study to determine if providing an educational pamphlet would increase knowledge and compliance with mechanical VTE prophylaxis...
May 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29734268/nahq-is-on-the-move
#6
Stephanie Mercado
No abstract text is available yet for this article.
May 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29509610/pediatric-quality-and-safety-come-of-age
#7
Richard J Brilli, John Terrance Davis
No abstract text is available yet for this article.
March 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29329135/clinician-perceptions-of-the-importance-of-hospital-discharge-components-for-children
#8
Kevin Blaine, Jayne Rogers, Margaret R OʼNeill, Sarah McBride, Jennifer Faerber, Chris Feudtner, Jay G Berry
BACKGROUND: Discharging hospitalized children involves several different components, but their relative value is unknown. We assessed which discharge components are perceived as most and least important by clinicians. METHODS: March and June of 2014, we conducted an online discrete choice experiment (DCE) among national societies representing 704 nursing, physician, case management, and social work professionals from 46 states. The DCE consisted of 14 discharge care components randomly presented two at a time for a total of 28 choice tasks...
March 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29271801/simulation-of-the-emergency-department-care-process-for-pediatric-traumatic-brain-injury
#9
Ali Ajdari, Linda Ng Boyle, Nithya Kannan, Jin Wang, Frederick P Rivara, Monica S Vavilala
The treatment of patients in the emergency department (ED) with severe pediatric traumatic brain injury (TBI) is challenging, and treatment process strategies that facilitate good outcomes are not well documented. The overall objective of this study was to identify factors that can affect the care process associated with pediatric TBI. This objective was achieved using a discrete-event simulation model of patients with TBI as they progress through the ED treatment process of a Level I trauma center. This model was used to identify areas where the ED length of stay can be reduced...
March 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29271800/pediatric-adverse-event-rates-associated-with-inexperience-in-teaching-hospitals-a-multilevel-analysis
#10
Linda Dynan, Anthony Goudie, Patrick W Brady
High adverse event rates are a signal of potentially low-quality care that imposes burdens on patients, families, and hospitals. In this article, we examine the relationship between the distinct characteristics of teaching hospitals with adverse event rates among pediatric patients, controlling for patient complexity and severity using 2009-2011 Nationwide Inpatient Sample data from the Agency for Healthcare Research and Quality. We hypothesize that adverse event rates increase with the availability of more complex services and technologies (transplantation and pediatric open-heart surgery); increase as experience of providers decreases (July effect); and increase with residents per bed, a measure of both average provider inexperience and congestion...
March 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29016408/family-initiated-pediatric-rapid-response-characteristics-impetus-and-outcomes
#11
Aarti C Bavare, Jenilea K Thomas, Elizabeth P Elliott, Angela C Morgan, Jeanine M Graf
BRIEF DESCRIPTION: Family-initiated rapid response (FIRR) empowers families to express concern and seek care from specialized response teams. We studied FIRRs that occurred in a pediatric tertiary hospital over a 3-year period. The main aims were to describe the characteristics and outcomes of FIRRs and compare them with clinician-activated RRs (C-RRs). Of the 1,906 RRs events reviewed, 49 (2.6%) were FIRRs. All FIRRs had appropriate clinical triggers with the most common being uncontrolled pain...
March 2018: 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
#12
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...
March 2018: 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
#13
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%)...
March 2018: 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
#14
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...
March 2018: 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
#15
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...
March 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29474314/severity-of-illness-measures-for-pediatric-inpatients
#16
Amanda J Hessels, Jianfang Liu, Bevin Cohen, Jingjing Shang, Elaine L Larson
INTRODUCTION: Severity of illness (SOI) measures are commonly used in adults for comparison of treatment and outcomes in similar populations. Less is known about the psychometric properties of measures available to providers and healthcare systems caring for pediatric patients. The purpose of this study was to (1) identify SOI measures used for pediatric patients admitted to acute care hospitals and (2) compare the ability of two SOI measures to predict mortality and length of stay (LOS)...
February 16, 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...
February 16, 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...
February 16, 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...
February 16, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29474310/relationship-between-accountable-care-organization-status-and-30-day-hospital-wide-readmissions-are-all-accountable-care-organizations-created-equal
#20
Andrew Mask, Omolola E Adepoju
OBJECTIVE: We compare hospital readmission rates by accountable care organization (ACO) status with national readmission averages, to determine whether ACO affiliation influences 30-day hospital-wide readmission rates. METHODS: Data from the 2015 American Hospital Association Survey of Care Systems and Payment database were merged with Centers for Medicare and Medicaid's 2015 Hospital Compare Deaths and Readmissions data set. A multinomial logistic regression model is used to examine readmission rates, categorized as better, no different, or worse, in comparison to national averages, by ACO status...
February 16, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
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