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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/30180043/patients-perspectives-on-reasons-for-unplanned-readmissions
#1
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
#2
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
#3
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
#4
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
#5
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/30113366/developing-a-quality-measurement-strategy-in-an-academic-primary-care-setting-an-environmental-scan
#6
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...
August 14, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30085952/using-charlson-comorbidity-index-to-predict-short-term-clinical-outcomes-in-hospitalized-older-adults
#7
Liron Sinvani, Roshini Kuriakose, Sara Tariq, Andrzej Kozikowski, Vidhi Patel, Christopher Smilios, Meredith Akerman, Guang Qiu, Alex Makhnevich, Jessica Cohen, Gisele Wolf-Klein, Renee Pekmezaris
This study examined the prognostic value of the Charlson Comorbidity Index (CCI) in predicting short-term clinical outcomes in hospitalized older adults. We conducted a retrospective cohort study of patients, older than 75 years, admitted to the medicine service at a large tertiary hospital (New York). We used the Enhanced International Classification of Disease, 9th Revision, Clinical Modification adaptation to abstract the CCI from electronic medical records. The CCI scores were compared, using the standard Deyo version and the Schneeweiss version...
July 30, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30169442/designing-large-scale-improvement-using-an-academic-practice-partnership-to-enhance-care-transitions
#8
Shea Polancich, Cynthia S Selleck, Terri Poe, Rebecca Miltner, Maria R Shirey
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 develop and design process efficiencies. The improvement process may be enhanced through a partnership between the healthcare facility and an affiliated school of nursing. The purpose of this article was to describe the process for developing a large-scale improvement project focused on enhancing care transitions within an academic medical center using an academic-practice partnership model...
September 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/30169441/strategically-applying-new-criteria-for-use-improves-management-of-peripheral-intravenous-catheters
#9
Ryan A Loudermilk, Layne E Steffen, Jeremy S McGarvey
Peripheral intravenous catheters (PIVCs) are common devices used across many healthcare settings. This quality improvement project aims to proactively remove PIVCs as soon as possible by empowering nurses and providers to clinically evaluate the necessity of every PIVC on a daily basis on a general hospital medical unit. Specific criteria were established to assess PIVC necessity. Cases of PIVCs not meeting established criteria are escalated to providers for a decision point. The PIVC removal times documented within the electronic medical record were analyzed to compare precriteria PIVC dwell times to postcriteria dwell times...
September 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
#10
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)...
September 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29280778/perceptions-of-integration-of-the-clinical-pharmacist-into-the-patient-care-medical-home-model
#11
M Shawn McFarland, Kristen Lamb, Jonathan Hughes, Ashley Thomas, Justin Gatwood, Jacob Hathaway
INTRODUCTION: The patient-centered medical home (PCMH) model is a multidisciplinary, team-based approach to healthcare that focuses on actively involving the patient in clinical decision making. The Veterans Health Administration (VA), while desiring to be a national leader in the delivery of primary care services, used the principles of the PCMH model to design the patient-aligned care team (PACT). The purpose of this study, was to explore the perception of the PACT members after integration of a clinical pharmacist to the PACT...
September 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29280777/secure-provider-to-provider-communication-with-electronic-health-record-messaging-an-educational-outreach-study
#12
Kathleen E Walsh, Jessica L Secor, Jon S Matsumura, Margaret L Schwarze, Beth E Potter, Peter Newcomer, Michael K Kim, Christie M Bartels
INTRODUCTION: With increasing electronic health record (EHR) use, providers are talking less with one another. Now, many rely on EHRs, informal emails, or texts, introducing fragmentation and new data security challenges with new communication strategies. We aimed to examine the impact of a physician champion educational outreach intervention to promote electronic provider-to-provider communication in a large academic multispecialty group. METHODS: Physician champions provided educational outreach to 16 academic departments, using 10-minute case-based presentations...
September 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29252871/differences-in-patient-experience-between-hispanic-and-non-hispanic-white-patients-across-u-s-hospitals
#13
Jose F Figueroa, Kimberly E Reimold, Jie Zheng, Endel John Orav
INTRODUCTION: Despite the increased emphasis on patient experience, little is known about whether there are meaningful differences in hospital satisfaction between Hispanic and non-Hispanic whites. METHODS: To determine if satisfaction differs, we used Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data (2009-2010) reported by hospitals to compare responses between Hispanic and non-Hispanic white patients. Clustered logistic regression models identified within-hospital and between-hospital differences in satisfaction...
September 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29189436/offering-econsult-to-family-physicians-with-patients-on-a-pain-clinic-wait-list-an-outreach-exercise
#14
Patricia A Poulin, Heather C Romanow, Jeannette Cheng, Clare Liddy, Erin J Keely, Catherine E Smyth
Wait times for many chronic pain programs in Canada range from 6 months to 2 years. This project sought to determine the interest of primary care providers (PCPs) in using an electronic consult system for patient(s) waiting for a pain consultation. This cross-sectional study was conducted at the pain clinic of a Canadian tertiary academic health sciences center. Participants were PCPs who had submitted a referral to this clinic. Referrals received between April 1, 2012, and March 31, 2014, were reviewed to determine their appropriateness for eConsult, and a letter providing information about eConsult and encouraging its use was sent to the referring PCP...
September 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29189435/investigating-physicians-views-on-soft-signals-in-the-context-of-their-peers-performance
#15
Myra van den Goor, Milou Silkens, Maas Jan Heineman, Kiki Lombarts
BACKGROUND: Physicians are responsible for delivering high quality of care. In cases of underperformance, hindsight knowledge indicates forewarning being potentially available in terms of concerns, signs, or signals. It is not known how the physicians involved perceive such signals. PURPOSE: To openly explore how physicians perceive soft signals and react on them. METHODS: In-depth interviews with 12 hospital-based physicians from various specialties and institutions following the interpretative phenomenological analysis approach...
September 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29166290/implementation-of-a-routine-health-literacy-assessment-at-an-academic-medical-center
#16
Carrie D Warring, Jacqueline R Pinkney, Elaine D Delvo-Favre, Michelle Robinson Rener, Jennifer A Lyon, Betty Jax, Irene Alexaitis, Kari Cassel, Kacy Ealy, Melanie Gross Hagen, Erin M Wright, Myron Chang, Nila S Radhakrishnan, Robert R Leverence
Limited health literacy is a common but often unrecognized problem associated with poor health outcomes. Well-validated screening tools are available to identify and provide the opportunity to intervene for at-risk patients in a resource-efficient manner. This is a multimethod study describing the implementation of a hospital-wide routine health literacy assessment at an academic medical center initiated by nurses in April 2014 and applied to all adult inpatients. Results were documented in the electronic health record, which then generated care plans and alerts for patients who screened positive...
September 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29095745/improving-quality-of-care-in-federally-qualified-health-centers-through-ambulatory-care-accreditation
#17
Suma Nair, Jie Chen
HRSA supported health centers have a long history of participating in ambulatory care accreditation; however, there is a dearth of information on the relationship between accreditation and quality of care. We conducted a cross-sectional study of 1,202 health centers, using multivariate regression to estimate the association between accreditation and 14 clinical quality measures, controlling for patient and organizational characteristics. We also predicted national estimates of accreditation-related improvement in quality...
September 2018: 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
#18
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 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29975672/-hot-seat-simulation-model-for-conflict-resolution-a-pilot-study
#19
Sara Kim, Elise Frans, Isaac Bohannon, Karen Barr, Elizabeth Buttrick, Ryan Fehr, Sarah E Shannon
BACKGROUND: Unresolved conflicts in health care threaten both clinician morale and quality of patient care. We piloted a training model that targeted clinicians' conflict resolution skills. METHODS: Sixty clinicians from local hospitals were randomized into an intervention group (n = 30), completing a 3-hour conflict resolution training session, and a control group (n = 30) without training. The training included facilitated practice with actors, coaching, and feedback...
July 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/29864070/reducing-readmissions-post-tonsillectomy-a-quality-improvement-study-on-intravenous-hydration
#20
Eileen Hession-Laband, Patrice Melvin, Herminia Shermont, Jane M Murphy, Bola Bukoye, Manali Amin
INTRODUCTION: Dehydration is a potentially preventable complication post-tonsillectomy and can result in an Emergency Department visit and/or readmission. Our objectives were to identify risk factors for dehydration readmissions and develop interventions to prevent them. METHODS: We used retrospective chart reviews to determine if increased intravenous (IV) hydration post-tonsillectomy prevented hospital readmissions for dehydration. All children aged 1-18 years who underwent tonsillectomy between July 1, 2007 and September 30, 2015 were included in this quality improvement study...
July 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
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