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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/27902532/lean-six-sigma-to-reduce-intensive-care-unit-length-of-stay-and-costs-in-prolonged-mechanical-ventilation
#1
Stephen Trzeciak, Michael Mercincavage, Cory Angelini, William Cogliano, Emily Damuth, Brian W Roberts, Sergio Zanotti, Anthony J Mazzarelli
OBJECTIVE: Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. DESIGN: Before-and-after cohort study. SETTING: Multidisciplinary intensive care unit (ICU) in an academic medical center...
November 29, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27820712/improved-resident-adherence-to-aaa-screening-guidelines-via-an-electronic-reminder
#2
David Sypert, Kenneth Van Dyke, Namrata Dhillon, John O Elliott, Kim Jordan
The 2014 United States Preventive Services Task Force systematic review found abdominal aortic aneurysm (AAA) screening decreased related mortality by close to half. Despite the simplicity of screening, research suggests poor adherence to the recommended AAA screening guidelines. Using the quality improvement plan-study-do-act cycle, we retrospectively established poor adherence to AAA screening and poor documentation of smoking history in our resident clinic. An electronic reminder was prospectively implemented into our electronic medical record (EMR) with the goal of improving screening rates...
November 4, 2016: 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
#3
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...
November 1, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27811578/process-mapping-and-time-study-to-improve-efficiency-of-new-procedure-implementation-for-high-dose-rate-prostate-brachytherapy
#4
Laura A Doyle, Menachem Yondorf, Cheng Peng, Amy S Harrison, Robert B Den
New technologies and procedures have the potential to improve outcomes; however, initial implementation is often associated with a steep learning curve, decreased efficiency, and patient safety implications. Implementation of a real-time, ultrasound-based prostate high-dose rate brachytherapy procedure involved a multidisciplinary team composed of approximately 6-8 team members and numerous complex tasks. To characterize time spent on various aspects of the procedure and improve efficiency, the team developed a detailed process map, time study, and team debriefings...
November 1, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27811577/exploring-the-validity-of-developing-an-interdisciplinarity-score-of-a-patient-s-needs-care-coordination-patient-complexity-and-patient-safety-indicators
#5
Ashley Hodgson, Lacey Etzkorn, Alexander Everhart, Nicholas Nooney, Jessica Bestrashniy
Despite the Affordable Care Act's push to improve the coordination of care for patients with multiple chronic conditions, most measures of coordination quality focus on a specific moment in the care process (e.g., medication errors or transfer between facilities), rather than patient outcomes. One possible supplementary way of measuring the care coordination quality of a facility would be to identify the patients needing the most coordination, and to look at outcomes for that group. This paper lays the groundwork for a new measure of care coordination quality by outlining a conceptual framework that considers the interaction between a patient's interdisciplinarity, biological susceptibility, and procedural intensity...
November 1, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27631713/meta-analysis-of-clinical-trials-that-evaluate-the-effectiveness-of-hospital-initiated-postdischarge-interventions-on-hospital-readmission
#6
Patricia M Branowicki, Judith A Vessey, Dionne A Graham, Margaret A McCabe, Alison L Clapp, Kevin Blaine, Margaret R OʼNeill, Julie A Gouthro, Colleen K Snydeman, Nancy E Kline, Vincent W Chiang, Courtney Cannon, Jay G Berry
Under pressure to avoid readmissions, hospitals are increasingly employing hospital-initiated postdischarge interventions (HiPDI), such as home visits and follow-up phone calls, to help patients after discharge. This study was conducted to assess the effectiveness of HiPDI on reducing hospital readmissions using a systematic review of clinical trials published between 1990 and 2014. We analyzed twenty articles on HiPDI (from 503 reviewed abstracts) containing 7,952 index hospitalizations followed for a median 3 months (range 1-24) after discharge for readmission...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27631712/collaborative-learning-in-the-texas-medicaid-1115-waiver-program
#7
Lee Revere, Adele Semaan, Nicole Lievsay, Jessica Hall, Zheng M Wang, Charles Begley
The Texas Medicaid 1115 Transformation Waiver reforms the state's safety net systems by creating a Delivery System Reform Incentive Payment incentive pool for innovative healthcare delivery. The Waiver supports the design and implementation of transformative projects. As part of the Waiver requirements, regions created Learning Collaboratives to collaborate on project implementation and outcomes. This paper describes the experience of one region in adapting the Institute for Healthcare Improvement Breakthrough Series (IHI BTS) model, as a framework for their Learning Collaborative...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27631711/can-clinicians-predict-readmissions-a-prospective-cohort-study
#8
Matthew Wetherell, Megan Sweeney, Saul N Weingart
BACKGROUND: Current risk-stratification models insufficiently identify readmission risk. SETTING: Academic medical center in Boston, MA. PATIENTS: One hundred seventy-seven medicine inpatients. METHODS: We prospectively interviewed clinicians about whether they would be surprised if patients scheduled for discharge were readmitted within 30 days and to identify one patient at the highest risk. Multivariate models examined the impact of clinicians' judgment on readmission...
September 13, 2016: 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
#9
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...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27631709/automated-detection-of-sepsis-using-electronic-medical-record-data-a-systematic-review
#10
Laurel A Despins
Severe sepsis and septic shock are global issues with high mortality rates. Early recognition and intervention are essential to optimize patient outcomes. Automated detection using electronic medical record (EMR) data can assist this process. This review describes automated sepsis detection using EMR data. PubMed retrieved publications between January 1, 2005 and January 31, 2015. Thirteen studies met study criteria: described an automated detection approach with the potential to detect sepsis or sepsis-related deterioration in real or near-real time; focused on emergency department and hospitalized neonatal, pediatric, or adult patients; and provided performance measures or results indicating the impact of automated sepsis detection...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27631708/low-rate-of-adverse-events-associated-with-inpatient-parenteral-prostacyclins
#11
Rana L Awdish, Michael P Mendez, Nancy MacDonald, Lenar Yessayan, Jeffrey H Jennings, Kamelia Albujoq, Sara Hegab, Hector F Cajigas
Parenteral prostacyclin is the most-effective therapy for patients with pulmonary arterial hypertension. Administration is complex, and administration errors are potentially life threatening. Hospital policies to minimize the risk to patients are necessary, but their effectiveness has not been well studied. We quantified the adverse event incident rate per at-risk patient day in a tertiary care hospital with an established parenteral prostacyclin policy. Patients on parenteral prostacyclin including new initiations from January 2003 to January 2013 were identified, encompassing 386 discrete admissions...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27631707/negative-association-of-hospital-efficiency-under-increasing-geographic-elevation-on-acute-myocardial-infarction-in-patient-mortality
#12
Srikant Devaraj, Pankaj C Patel
Although variation in-patient outcomes based on hospitals' geographic location has been studied, altitude of hospitals above sea level may also affect patient outcomes. Possibly, because of negative physical and psychological effects of altitude on hospital employees, hospital efficiency may decline at higher altitudes. Greater focus on hospital efficiency, despite decreasing efficiency at higher altitudes, could increase demands on hospital employees and further deteriorate patient outcomes. Using data envelopment analysis on a sample of 840 hospital-year observations representing 95,504 patients with acute myocardial infarction (AMI) in the United States, and controlling for patient, hospital, and county characteristics and controlling for hospital, state, and year fixed effects, we find support for the negative association between hospital altitude and efficiency; for 1 percentage point increase in efficiency and every 1,000 feet increase in altitude above the sea level, the mortality of patients with AMI increases by 0...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27631706/using-nurse-practitioner-comanagement-to-reduce-hospitalizations-and-readmissions-within-a-home-based-primary-care-program
#13
Masha G Jones, Linda V DeCherrie, Yasmin S Meah, Cameron R Hernandez, Eric J Lee, David M Skovran, Theresa A Soriano, Katherine A Ornstein
Nurse practitioner (NP) comanagement involves an NP and physician sharing responsibility for the care of a patient. This study evaluates the impact of NP comanagement for clinically complex patients in a home-based primary care program on hospitalizations, 30-day hospital readmissions, and provider satisfaction. We compared preenrollment and postenrollment hospitalization and 30-day readmission rates of home-bound patients active in the Nurse Practitioner Co-Management Program within the Mount Sinai Visiting Doctors Program (MSVD) (n = 87) between January 1, 2012, and July 1, 2013...
September 13, 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27584696/how-quality-improvement-practice-evidence-can-advance-the-knowledge-base
#14
Hannah M OʼRourke, Kimberly D Fraser
Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research...
September 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/27442713/applying-the-new-institute-for-healthcare-improvement-inpatient-waste-tool-to-identify-waste-in-the-intensive-care-unit
#15
Khalid F Almoosa, Katharine Luther, Roger Resar, Bela Patel
Healthcare waste-the inappropriate use of healthcare resources that provides no benefit to patients yet contributes to cost and even harm-is a potentially significant contributor to high healthcare costs. This project aimed to apply a new locally modified Institute for Healthcare Improvement (IHI)-developed waste identification tool to measure the prevalence of and reason for the inappropriate use of intensive care unit (ICU) beds, one type of potential waste. Unnecessary days (i.e., waste) and their causes in a 16-bed "closed" medical ICU (MICU) and a 10-bed "semi-closed" transplant surgical ICU (TSICU) were identified by physicians over a 3-month period...
September 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/26562350/hospital-characteristics-and-the-agency-for-healthcare-research-and-quality-inpatient-quality-indicators-a-systematic-review
#16
Lilly D Engineer, Bradford D Winters, Christine M Weston, Allen Zhang, Ritu Sharma, Eric Bass, David Jones, Amy Rosen, Frank B Yoon, Ann Borzecki, Sydney M Dy
BACKGROUND: The Agency for Healthcare Research and Quality Inpatient Quality Indicators (IQIs) include inpatient mortality for selected procedures and medical conditions. They have assumed an increasingly prominent role in hospital comparisons. Healthcare delivery and policy-related decisions need to be driven by reliable research that shows associations between hospital characteristics and quality of inpatient care delivered. OBJECTIVES: To systematically review the literature on associations between hospital characteristics and IQIs...
September 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/26042758/using-lean-to-advance-quality-improvement-research
#17
Christopher Craig Blackmore, Barbara L Williams, Joan M Ching, Lynne A Chafetz, Gary S Kaplan
INTRODUCTION: Quality improvement research skills are not commonplace among quality improvement practitioners, and research on the effectiveness of quality improvement has not always kept pace with improvement innovation. However, the Lean tools applied to quality improvement should be equally relevant to the advancement of quality improvement research. METHODS: We applied the Lean methods to develop a simplified quality improvement publication pathway enabling a small research methodology group to increase quality improvement research throughout the institution...
September 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/26042756/improving-accuracy-and-relevance-of-race-ethnicity-data-results-of-a-statewide-collaboration-in-hawaii
#18
Karen L Pellegrin, Jill B Miyamura, Carolyn Ma, Ronald Taniguchi
Current race/ethnicity categories established by the U.S. Office of Management and Budget are neither reliable nor valid for understanding health disparities or for tracking improvements in this area. In Hawaii, statewide hospitals have collaborated to collect race/ethnicity data using a standardized method consistent with recommended practices that overcome the problems with the federal categories. The purpose of this observational study was to determine the impact of this collaboration on key measures of race/ethnicity documentation...
September 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/26042744/clostridium-difficile-infection-in-inflammatory-bowel-disease-a-nursing-based-quality-improvement-strategy
#19
Jordan E Axelrad, Brijen J Shah
OBJECTIVES: Patients with inflammatory bowel disease (IBD) have a higher prevalence of Clostridium difficile infection (CDI) and worse outcomes. Research has highlighted the inconsistent care that is provided to patients with IBD, and at our institution, the CDI testing rate was 41%. The present quality improvement intervention sought to increase CDI testing for inpatients with IBD with a flare. METHODS: Eighty-nine patients admitted to our gastrointestinal unit over a 9-month period with IBD flare were eligible for the study...
September 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://www.readbyqxmd.com/read/25155041/brief-report-on-obstetricians-gynecologists-distribution-of-scarce-resources
#20
Greta B Raglan, Joanna M Cain, Jay Schulkin
On a day-to-day basis, doctors must decide which treatments are most beneficial for their patients, and which make the most sense in terms of costs. In medical decision making, factors such as efficiency and cost-effectiveness can be particularly challenging to navigate because many of the most expensive procedures encountered in medical practice are also high-stake treatments for patients. One-hundred-six obstetricians-gynecologists (Obs/Gyns) completed a survey asking them to allocate the following resources in scenarios in which they are scarce: human papilloma virus (HPV) vaccinations, mammograms, and in vitro fertilization (IVF) treatments...
September 2016: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
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