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https://www.readbyqxmd.com/read/28325207/using-a-systematic-framework-of-interventions-to-improve-early-discharges
#1
Hemali Patel, Sasha Morduchowicz, Michelle Mourad
BACKGROUND: Late-afternoon hospital discharges can lead to admission bottlenecks and negatively affect the flow of patients needing hospital admission. Delays in discharge are a prevalent health care problem and have been linked to increased length of stay, lower patient satisfaction scores, and adverse outcomes. As a result, hospitals are placing a renewed emphasis on early discharge as a way to reduce admission delays and achieve optimal patient flow. This study shows that the Model for Improvement (MFI) is an effective approach for complex improvement efforts...
April 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28300990/analysis-of-the-attributes-of-primary-health-care-using-the-electronic-medical-records-in-the-city-of-rio-de-janeiro
#2
Daniel Soranz, Luiz Felipe Pinto, Luiz Antonio Bastos Camacho
Epidemiology plays a strategic role at this stage of the policy cycle, contributing to goal setting, resource allocation and use of information systems. In 2009, the Municipal Health Secretariat of Rio de Janeiro initiated a reform of the health care model under the main influence the Primary Health Care concept. This study evaluates the trend of selected pay-for-performance indicators that measure the health care process in the city's PHC. This a study on repeated panels, from the administrative and clinical records of electronic medical records in the period from 2012 to 2016...
March 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28274985/role-of-postgraduate-year-2-pharmacy-residents-in-providing-weekend-antimicrobial-stewardship-coverage-in-an-academic-medical-center
#3
Justin Siegfried, Cristian Merchan, Marco R Scipione, John Papadopoulos, Arash Dabestani, Yanina Dubrovskaya
PURPOSE: The integration of pharmacy residents into an antimicrobial stewardship program (ASP) is described, and data on the residents' ASP interventions and outcomes are reported. SUMMARY: ASP coverage of nighttime, holiday, and weekend shifts is often provided by infectious diseases (ID) medical fellows and staff pharmacists, potentially leading to inconsistent stewardship practices. As part of an initiative by a large urban hospital to provide around-the-clock, comprehensive ASP services 7 days a week, postgraduate year 2 (PGY2) pharmacy residents in ID or critical care were assigned to provide ASP coverage on weekends...
March 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28270725/a-centrally-generated-primary-care-physician-audit-report-does-not-improve-colonoscopy-uptake-after-a-positive-result-on-a-fecal-occult-blood-test-in-ontario-s-coloncancercheck-program
#4
D Stock, L Rabeneck, N N Baxter, L F Paszat, R Sutradhar, L Yun, J Tinmouth
BACKGROUND: Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. In the present study, we evaluated the effectiveness of centrally generated, physician-targeted audit and feedback to improve colonoscopy uptake after a positive fecal occult blood test (fobt) result within Ontario's population-wide ColonCancerCheck Program. METHODS: This prospective cohort study used data sets from Ontario's ColonCancerCheck Program (2008-2011) that were linked to provincial administrative health databases...
February 2017: Current Oncology
https://www.readbyqxmd.com/read/28260280/teaching-rational-prescribing-to-general-practice-registrars-a-guide-for-supervisors
#5
Simon Morgan
BACKGROUND: Pharmaceuticals play an important role in modern day healthcare, and prescribing is a very common activity in Australian general practice. However, there are significant harms associated with medicine use. Vocational training is a critical period in the development of clinical practice patterns for the future general practitioner (GP), including prescribing behaviour. The general practice supervisor, therefore, has a key role to play in educating registrars about rational prescribing...
March 2017: Australian Family Physician
https://www.readbyqxmd.com/read/28244494/do-primary-care-provider-strategies-improve-patient-participation-in-colorectal-cancer-screening
#6
Nancy N Baxter, Rinku Sutradhar, Qing Li, Corinne Daly, Gladys N Honein-AbouHaidar, Devon P Richardson, Lisa Del Giudice, Jill Tinmouth, Lawrence Paszat, Linda Rabeneck
OBJECTIVES: Screening rates for colorectal cancer (CRC) remain suboptimal. The impact of provider strategies to enhance screening participation in the population is uncertain. The objective of this study was to determine the effect of provider strategies to increase screening in a single-payer system. METHODS: A population-based survey was conducted in primary care providers (PCPs) linked to patients using administrative data in Ontario, Canada. Patients were due for CRC screening from April 2012 to March 2013...
February 28, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28241909/reducing-unnecessary-postoperative-complete-blood-count-testing-in-the-pediatric-intensive-care-unit
#7
Maya Dewan, Jorge Galvez, Tracey Polsky, Genna Kreher, Blair Kraus, Luis Ahumada, John Mccloskey, Heather Wolfe
CONTEXT: Complete blood count (CBC) testing commonly occurs to determine the need for blood transfusions after surgical procedures. Many clinicians believe postoperative CBCs are "routine." OBJECTIVE: To decrease unnecessary routine CBC testing in a low-risk cohort of postoperative patients in the pediatric intensive care unit (PICU) at The Children's Hospital of Philadelphia by 50% in 6 months. DESIGN: Quality-improvement study. Data from our institution regarding frequency of ordering laboratory studies and transfusion requirements were collected for prior quality-improvement work demonstrating the safety and feasibility of avoiding routine postoperative CBCs in this cohort...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28225315/improving-glycemic-control-safely-in-critical-care-patients-a-collaborative-systems-approach-in-nine-hospitals
#8
Gregory A Maynard, Janet Holdych, Heather Kendall, Karen Harrison, Patricia A Montgomery, Kristen Kulasa
Objective Safely improve glycemic control in the critical care units of nine hospitals. Methods Critical care adult inpatients from nine hospitals with ≥ 4 point-of-care (POC) blood glucose (BG) readings over ≥ 2 days were targeted by collaborative improvement efforts to reduce hyper- and hypo-glycemia. Balanced glucometric goals for each hospital were set targeting improvement from baseline, or goals deemed desirable from Society of Hospital Medicine (SHM) benchmarking data. Collaborative interventions included standardized insulin infusion protocols, hypoglycemia prevention bundles, audit and feedback, education, and measure-vention (coupling measurement of patients "off protocol" with concurrent interventions to correct suboptimal care)...
February 22, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28223153/evaluations-of-implementation-at-early-adopting-lung-cancer-screening-programs-lessons-learned
#9
Yaron B Gesthalter, Elisa Koppelman, Rendelle Bolton, Christopher G Slatore, Sue H Yoon, Hilary C Cain, Nichole T Tanner, David H Au, Jack A Clark, Renda Soylemez Wiener
BACKGROUND: Guidelines recommend lung cancer screening and it is currently being adopted nationwide. The American College of Chest Physicians advises inclusion of specific programmatic components to ensure high-quality screening. However, little is known about how lung cancer screening has been implemented in practice. We sought to evaluate the experience of early-adopting programs, characterize barriers faced, and identify strategies to achieve successful implementation. METHODS: We performed qualitative evaluations of lung cancer screening implementation at three Veterans Health Administration facilities, conducting semi-structured interviews with key staff (n=29)...
February 18, 2017: Chest
https://www.readbyqxmd.com/read/28207841/barriers-and-enablers-to-the-implementation-of-the-6-pack-falls-prevention-program-a-pre-implementation-study-in-hospitals-participating-in-a-cluster-randomised-controlled-trial
#10
Darshini R Ayton, Anna L Barker, Renata T Morello, Caroline A Brand, Jason Talevski, Fiona S Landgren, Mayer M Melhem, Evelyn Bian, Sandra G Brauer, Keith D Hill, Patricia M Livingston, Mari Botti
Evidence for effective falls prevention interventions in acute wards is limited. One reason for this may be suboptimal program implementation. This study aimed to identify perceived barriers and enablers of the implementation of the 6-PACK falls prevention program to inform the implementation in a randomised controlled trial. Strategies to optimise successful implementation of 6-PACK were also sought. A mixed-methods approach was applied in 24 acute wards from 6 Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention...
2017: PloS One
https://www.readbyqxmd.com/read/28197223/a-multifaceted-approach-to-decrease-inappropriate-antibiotic-use-in-a-pediatric-outpatient-clinic
#11
Jaffar A Al-Tawfiq, Amel H Alawami
BACKGROUND: Inappropriate use of antimicrobial agents is the major cause for the development of resistance. Thus, it is important to include outpatient clinics in the development of antibiotic stewardship program. METHODS: We report a multifaceted approach to decrease inappropriate antibiotic use in upper respiratory tract infections (URTIs) in an outpatient pediatric clinic. The interventions included educational grand round, academic detailing, and prospective audit and feedback and peer comparison...
January 2017: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/28183346/study-protocol-improving-the-transition-of-care-from-a-non-network-hospital-back-to-the-patient-s-medical-home
#12
Roman A Ayele, Emily Lawrence, Marina McCreight, Kelty Fehling, Jamie Peterson, Russell E Glasgow, Borsika A Rabin, Robert Burke, Catherine Battaglia
BACKGROUND: The process of transitioning Veterans to primary care following a non-Veterans Affairs (VA) hospitalization can be challenging. Poor transitions result in medical complications and increased hospital readmissions. The goal of this transition of care quality improvement (QI) project is to identify gaps in the current transition process and implement an intervention that bridges the gap and improves the current transition of care process within the Eastern Colorado Health Care System (ECHCS)...
February 10, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28173823/effectiveness-of-a-clinical-practice-change-intervention-in-increasing-the-provision-of-nicotine-dependence-treatment-in-inpatient-psychiatric-facilities-an-implementation-trial
#13
Paula M Wye, Emily A Stockings, Jenny A Bowman, Chris Oldmeadow, John H Wiggers
BACKGROUND: Despite clinical practice guidelines recommending the routine provision of nicotine dependence treatment to smokers in inpatient psychiatric facilities, the prevalence of such treatment provision is low. The aim of this study was to examine the effectiveness of a clinical practice change intervention in increasing clinician recorded provision of nicotine dependence treatment to patients in inpatient psychiatric facilities. METHODS: We undertook an interrupted time series analysis of nicotine dependence treatment provision before, during and after a clinical practice change intervention to increase clinician recorded provision of nicotine dependence treatment for all hospital discharges (aged >18 years, N = 4175) over a 19 month period in two inpatient adult psychiatric facilities in New South Wales, Australia...
February 7, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28152791/improving-venous-thromboembolism-vte-prophylaxis-for-hospitalized-malignant-hematology-bone-marrow-transplant-heme-bmt-patients
#14
John Dzundza, Archana Ajmera, Ashley Gustafson, Mimi Lo, Richard Fong, Larissa Graff, Bao Dao, Rebecca Young, Lloyd Earl Damon, Thomas G Martin, Rebecca Leah Olin
79 Background: Hospitalized patients on the heme/BMT service at our academic cancer center have historically not received pharmacologic VTE prophylaxis (VTEP) due to concerns regarding thrombocytopenia and bleeding risk. However, a retrospective review of heme/BMT admissions from 2009 to 2013 revealed that 59% of hospital-acquired VTE cases occurred at a platelet count > 50 x 10E9/L, suggesting missed opportunities for VTE prevention. METHODS: To implement VTEP on the heme/BMT service, a multidisciplinary quality improvement team developed a pilot intervention with 5 strategies: 1) identification of heme/BMT-specific contraindications to VTEP, 2) standardized use of VTEP for all heme/BMT patients unless contraindications are present, 3) hold parameter for platelet count < 50 x 10E9/L within the VTEP order, 4) note template to document VTEP plan, and 5) provider, nurse, pharmacist, and patient education...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28132746/acc-aha-special-report-clinical%C3%A2-practice-guideline-implementation-strategies-a%C3%A2-summary-of-systematic-reviews-by-the-nhlbi-implementation-science-work-group-a-report-of-the-american-college-of-cardiology-american-heart-association-task-force-on-clinical-practice
#15
Wiley V Chan, Thomas A Pearson, Glen C Bennett, William C Cushman, Thomas A Gaziano, Paul N Gorman, Joel Handler, Harlan M Krumholz, Robert F Kushner, Thomas D MacKenzie, Ralph L Sacco, Sidney C Smith, Victor J Stevens, Barbara L Wells
BACKGROUND: In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity. OBJECTIVES: Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines...
February 28, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28126839/acc-aha-special-report-clinical-practice-guideline-implementation-strategies-a-summary-of-systematic-reviews-by-the-nhlbi-implementation-science-work-group-a-report-of-the-american-college-of-cardiology-american-heart-association-task-force-on-clinical-practice
#16
Wiley V Chan, Thomas A Pearson, Glen C Bennett, William C Cushman, Thomas A Gaziano, Paul N Gorman, Joel Handler, Harlan M Krumholz, Robert F Kushner, Thomas D MacKenzie, Ralph L Sacco, Sidney C Smith, Victor J Stevens, Barbara L Wells, Graciela Castillo, Susan K R Heil, Jennifer Stephens, Julie C Jacobson Vann
BACKGROUND: In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity. OBJECTIVES: Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines...
January 26, 2017: Circulation
https://www.readbyqxmd.com/read/28095911/mistreatment-of-women-during-childbirth-in-abuja-nigeria-a-qualitative-study-on-perceptions-and-experiences-of-women-and-healthcare-providers
#17
Meghan A Bohren, Joshua P Vogel, Özge Tunçalp, Bukola Fawole, Musibau A Titiloye, Akinpelu Olanrewaju Olutayo, Modupe Ogunlade, Agnes A Oyeniran, Olubunmi R Osunsan, Loveth Metiboba, Hadiza A Idris, Francis E Alu, Olufemi T Oladapo, A Metin Gülmezoglu, Michelle J Hindin
BACKGROUND: Global efforts have increased facility-based childbirth, but substantial barriers remain in some settings. In Nigeria, women report that poor provider attitudes influence their use of maternal health services. Evidence also suggests that women in Nigeria may experience mistreatment during childbirth; however, there is limited understanding of how and why mistreatment this occurs. This study uses qualitative methods to explore women and providers' experiences and perceptions of mistreatment during childbirth in two health facilities and catchment areas in Abuja, Nigeria...
January 17, 2017: Reproductive Health
https://www.readbyqxmd.com/read/28069045/improving-nursing-home-care-through-feedback-on-performance-data-inform-protocol-for-a-cluster-randomized-trial
#18
Matthias Hoben, Peter G Norton, Liane R Ginsburg, Ruth A Anderson, Greta G Cummings, Holly J Lanham, Janet E Squires, Deanne Taylor, Adrian S Wagg, Carole A Estabrooks
BACKGROUND: Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers...
January 10, 2017: Trials
https://www.readbyqxmd.com/read/28057024/behavior-change-interventions-and-policies-influencing-primary-healthcare-professionals-practice-an-overview-of-reviews
#19
REVIEW
Bhupendrasinh F Chauhan, Maya Jeyaraman, Amrinder Singh Mann, Justin Lys, Becky Skidmore, Kathryn M Sibley, Ahmed Abou-Setta, Ryan Zarychanksi
BACKGROUND: There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. METHODS: Study design: overview of reviews. DATA SOURCE: MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015)...
January 5, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/27999061/from-guidelines-to-practice-a-pharmacist-driven-prospective-audit-and-feedback-improvement-model-for-peri-operative-antibiotic-prophylaxis-in-34-south-african-hospitals
#20
Adrian J Brink, Angeliki P Messina, Charles Feldman, Guy A Richards, Dena van den Bergh
BACKGROUND: Few data exist on the implementation of process measures to facilitate adherence to peri-operative antibiotic prophylaxis (PAP) guidelines in Africa. OBJECTIVES: To implement an improvement model for PAP utilizing existing resources, in order to achieve a reduction in surgical site infections (SSIs) across a heterogeneous group of 34 urban and rural South African hospitals. METHODS: A pharmacist-driven, prospective audit and feedback strategy involving change management and improvement principles was utilized...
December 20, 2016: Journal of Antimicrobial Chemotherapy
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