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BMJ Quality & Safety

Roman Kislov
No abstract text is available yet for this article.
November 14, 2018: BMJ Quality & Safety
Helen Snooks, Kerry Bailey-Jones, Deborah Burge-Jones, Jeremy Dale, Jan Davies, Bridie Angela Evans, Angela Farr, Deborah Fitzsimmons, Martin Heaven, Helen Howson, Hayley Hutchings, Gareth John, Mark Kingston, Leo Lewis, Ceri Phillips, Alison Porter, Bernadette Sewell, Daniel Warm, Alan Watkins, Shirley Whitman, Victoria Williams, Ian Russell
AIM: We evaluated the introduction of a predictive risk stratification model (PRISM) into primary care. Contemporaneously National Health Service (NHS) Wales introduced Quality and Outcomes Framework payments to general practices to focus care on those at highest risk of emergency admission to hospital. The aim of this study was to evaluate the costs and effects of introducing PRISM into primary care. METHODS: Randomised stepped wedge trial with 32 general practices in one Welsh health board...
November 5, 2018: BMJ Quality & Safety
Nora Jacobson, Roberta Johnson, Bri Deyo, Esra Alagoz, Andrew Quanbeck
BACKGROUND: In order to promote guideline-concordant opioid prescribing practices, a blended implementation strategy called systems consultation was pilot tested in four primary care clinics in one US health system. OBJECTIVES: To describe (1) how systems consultation worked during the pilot test and (2) the modifications necessary to adapt this implementation strategy to primary care. METHODS: A team of investigators conducted observations (n=24), focus groups (n=4) and interviews (n=2)...
October 31, 2018: BMJ Quality & Safety
Finlay McAlister, Carl van Walraven
OBJECTIVE: Frailty is an important prognostic factor in hospitalised patients but typically requires face-to-face assessment by trained observers to detect. Thus, frail patients are not readily apparent from a systems perspective for those interested in implementing quality improvement measures to optimise their outcomes. This study was designed to externally validate and compare two recently described tools using administrative data as potential markers for frailty: the Hospital Frailty Risk Score (HFRS) and the Hospital-patient One-year Mortality Risk (HOMR) Score...
October 31, 2018: BMJ Quality & Safety
Lorelei Jones, Linda Pomeroy, Glenn Robert, Susan Burnett, Janet E Anderson, Stephen Morris, Estela Capelas Barbosa, Naomi J Fulop
BACKGROUND: Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis' typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England. METHODS: We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England...
October 31, 2018: BMJ Quality & Safety
Daniel Cornejo-Palma, David R Urbach
No abstract text is available yet for this article.
October 31, 2018: BMJ Quality & Safety
Tara Kiran, Noor Ramji, Mary Beth Derocher, Girdhari Rajesh, Samantha Davie, Margarita Lam-Antoniades
Embracing practice-based quality improvement (QI) represents one way for clinicians to improve the care they provide to patients while also improving their own professional satisfaction. But engaging in care redesign is challenging for clinicians. In this article, we describe our experience over the last 7  years transforming the care delivered in our large primary care practice. We reflect on our journey and offer 10 tips to healthcare leaders seeking to advance a culture of improvement. Our organisation has developed a cadre of QI leaders, tracks a range of performance measures and has demonstrated sustained improvements in important areas of patient care...
October 31, 2018: BMJ Quality & Safety
Skerdi Haviari, François Chollet, Stéphanie Polazzi, Cecile Payet, Adrien Beauveil, Cyrille Colin, Antoine Duclos
BACKGROUND: Quality improvement and epidemiology studies often rely on database codes to measure performance or impact of adjusted risk factors, but how validity issues can bias those estimates is seldom quantified. OBJECTIVES: To evaluate whether and how much interhospital administrative coding variations influence a typical performance measure (adjusted mortality) and potential incentives based on it. DESIGN: National cross-sectional study comparing hospital mortality ranking and simulated pay-for-performance incentives before/after recoding discharge abstracts using medical records...
October 26, 2018: BMJ Quality & Safety
Edward Etchells, Olavo Fernandes
No abstract text is available yet for this article.
October 24, 2018: BMJ Quality & Safety
Sally J Giles, Sahdia Parveen, Andrea L Hernan
BACKGROUND: The Primary Care Patient Measure of Safety (PC PMOS) is designed to capture patient feedback about the contributing factors to patient safety incidents in primary care. It required further reliability and validity testing to produce a robust tool intended to improve safety in practice. METHOD: 490 adult patients in nine primary care practices in Greater Manchester, UK, completed the PC PMOS. Practice staff (n = 81) completed a survey on patient safety culture to assess convergent validity...
October 18, 2018: BMJ Quality & Safety
Patricia Trbovich, Charles Vincent
No abstract text is available yet for this article.
October 18, 2018: BMJ Quality & Safety
Karen Pellegrin, Alicia Lozano, Jill Miyamura, Joanne Lynn, Les Krenk, Sheena Jolson-Oakes, Anita Ciarleglio, Terry McInnis, Alistair Bairos, Lara Gomez, Mercedes Benitez-McCrary, Alexandra Hanlon
BACKGROUND: We previously reported reduction in the rate of hospitalisations with medication harm among older adults with our 'Pharm2Pharm' intervention, a pharmacist-led care transition and care coordination model focused on best practices in medication management. The objectives of the current study are to determine the extent to which medication harm among older inpatients is 'community acquired' versus 'hospital acquired' and to assess the effectiveness of the Pharm2Pharm model with each type...
October 18, 2018: BMJ Quality & Safety
Anna Schneider, Markus Wehler, Matthias Weigl
BACKGROUND: Interruptions are endemic in healthcare work environments. Yet, they can have positive effects in some instances and negative in others, with their net effect on quality of care still poorly understood. We aimed to distinguish beneficial and detrimental forms of interruptions of emergency department (ED) providers using patients' perceptions of ED care as a quality measure. METHODS: An observational design was established. The study setting was an interdisciplinary ED of an academic tertiary referral hospital...
October 18, 2018: BMJ Quality & Safety
Brenda Lynch, Anthony P Fitzgerald, Paul Corcoran, Claire Buckley, Orla Healy, John Browne
BACKGROUND: Many emergency admissions are deemed to be potentially avoidable in a well-performing health system. OBJECTIVE: To measure the impact of population and health system factors on county-level variation in potentially avoidable emergency admissions in Ireland over the period 2014-2016. METHODS: Admissions data were used to calculate 2014-2016 age-adjusted emergency admission rates for selected conditions by county of residence. Negative binomial regression was used to identify which a priori factors were significantly associated with emergency admissions for these conditions and whether these factors were also associated with total/other emergency admissions...
October 12, 2018: BMJ Quality & Safety
Karla Hemming
No abstract text is available yet for this article.
October 12, 2018: BMJ Quality & Safety
Karl Y Bilimoria, Jeanette W Chung, Larry V Hedges
No abstract text is available yet for this article.
October 12, 2018: BMJ Quality & Safety
Stephanie P Schwartz, Kathryn C Adair, Jonathan Bae, Kyle J Rehder, Tait D Shanafelt, Jochen Profit, J Bryan Sexton
BACKGROUND: Healthcare is approaching a tipping point as burnout and dissatisfaction with work-life integration (WLI) in healthcare workers continue to increase. A scale evaluating common behaviours as actionable examples of WLI was introduced to measure work-life balance. OBJECTIVES: (1) Explore differences in WLI behaviours by role, specialty and other respondent demographics in a large healthcare system. (2) Evaluate the psychometric properties of the work-life climate scale, and the extent to which it acts like a climate, or group-level norm when used at the work setting level...
October 11, 2018: BMJ Quality & Safety
Rick Iedema
No abstract text is available yet for this article.
October 11, 2018: BMJ Quality & Safety
Sylvain Boet, Nicole Etherington, Sarah Larrigan, Li Yin, Hira Khan, Katrina Sullivan, James J Jung, Teodor P Grantcharov
BACKGROUND: Educational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement properties in order to identify the most robust tool for measuring the teamwork performance of teams in crisis situations. METHODS: Searches were conducted in Embase (via OVID), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Medline and Medline In-Process (via OVID) (through 12 January 2017)...
October 11, 2018: BMJ Quality & Safety
Claudia Caroline Dobler, Manuel Sanchez, Michael R Gionfriddo, Neri A Alvarez-Villalobos, Naykky Singh Ospina, Gabriela Spencer-Bonilla, Bjorg Thorsteinsdottir, Raed Benkhadra, Patricia J Erwin, Colin P West, Juan P Brito, Mohammad Hassan Murad, Victor M Montori
BACKGROUND: Clinicians' satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes. METHODS: We searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion...
October 9, 2018: BMJ Quality & Safety
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