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Quality improvement in primary care

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https://www.readbyqxmd.com/read/29453557/a-framework-for-regional-primary-health-care-to-organise-actions-to-address-health-inequities
#1
Toby Freeman, Sara Javanparast, Fran Baum, Anna Ziersch, Tamara Mackean
OBJECTIVES: Regional primary health-care organisations plan, co-ordinate, and fund some primary health-care services in a designated region. This article presents a framework for examining the equity performance of regional primary health-care organisations, and applies it to Australian Medicare Locals (funded from 2011 to 2015). METHODS: The framework was developed based on theory, literature, and researcher deliberation. Data were drawn from Medicare Local documents, an online survey of 210 senior Medicare Local staff, and interviews with 50 survey respondents...
February 16, 2018: International Journal of Public Health
https://www.readbyqxmd.com/read/29453197/paediatric-hospital-admission-processes-and-outcomes-a-qualitative-study-of-parents-experiences-and-priorities
#2
JoAnna K Leyenaar, Paul A Rizzo, Emily R O'Brien, Peter K Lindenauer
BACKGROUND: Hospital admission, like hospital discharge, represents a transition of care associated with changes in setting, healthcare providers and clinical management. While considerable efforts have focused on improving the quality and safety of hospital-to-home transitions, there has been little focus on transitions into hospital. OBJECTIVES: Among children hospitalised with ambulatory care sensitive conditions, we aimed to characterise families' experiences as they transitioned from outpatient to inpatient care, identify hospital admission processes and outcomes most important to families and determine how parental perspectives differed between children admitted directly and through emergency departments (ED)...
February 16, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29453189/evaluating-the-care4carer-blended-care-intervention-for-partners-of-patients-with-acquired-brain-injury-protocol-for-a-randomized-controlled-trial
#3
Vincent Cm Cox, Vera Pm Schepers, Marjolijn Ketelaar, Caroline M van Heugten, Johanna Ma Visser-Meily
BACKGROUND: Support programs for partners of patients with acquired brain injury are necessary since these partners experience several unfavorable consequences of caregiving, such as a high burden, emotional distress, and poor quality of life. Evidence-based support strategies that can be included in these support programs are psychoeducation, skill building, problem solving, and improving feelings of mastery. A promising approach would seem to be to combine web-based support with face-to-face consultations, creating a blended care intervention...
February 16, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29452549/characterizing-potentially-preventable-cancer-and-chronic-disease-related-emergency-department-use-in-the-year-after-treatment-initiation-a-regional-study
#4
Laura Panattoni, Catherine Fedorenko, Mikael Anne Greenwood-Hickman, Karma Kreizenbeck, Julia R Walker, Renato Martins, Keith D Eaton, John W Rieke, Ted Conklin, Bruce Smith, Gary Lyman, Scott D Ramsey
PURPOSE: As new quality metrics and interventions for potentially preventable emergency department (ED) visits are implemented, we sought to compare methods for evaluating the prevalence and costs of potentially preventable ED visits that were related to cancer and chronic disease among a commercially insured oncology population in the year after treatment initiation. METHODS: We linked SEER records in western Washington from 2011 to 2016 with claims from two commercial insurers...
February 8, 2018: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29451944/total-hip-arthroplasty-in-patients-with-avascular-necrosis-after-hematopoietic-stem-cell-transplantation
#5
Anita Vijapura, Harlan B Levine, Michele Donato, Mark A Hartzband, Melissa Baker, Gregg R Klein
The immunosuppressive regimens required for hematopoietic stem cell transplantation predispose recipients to complications, including avascular necrosis. Cancer-related comorbidities, immunosuppression, and poor bone quality theoretically increase the risk for perioperative medical complications, infection, and implant-related complications in total joint arthroplasty. This study reviewed 20 primary total hip arthroplasties for avascular necrosis in 14 patients. Outcomes were assessed at routine clinical visits and Harris hip scores were calculated...
February 16, 2018: Orthopedics
https://www.readbyqxmd.com/read/29451814/variability-in-asthma-quality-and-costs-in-children-with-different-medicaid-insurance-plans-in-maricopa-county
#6
Matthew Rank, Natalie Landman, Gevork Harootunian, Michelle Winscott, Neil Jain, Keith Frey, Gena Wilson, Rupali Drewek, Lilia Parra-Roide, Charlton Wilson, Robert Smoldt, Denis Cortese
OBJECTIVE: To describe the variation in asthma quality and costs among children with different Medicaid insurance plans. METHODS: We used 2013 data from the Center for Health Information and Research, which houses a database that includes individuals who have Medicaid insurance in Arizona. We analyzed children ages 2-17 years-old who lived in Maricopa County, Arizona. Asthma medication ratio (AMR, a measure of appropriate asthma medication use), outpatient follow-up within 2 weeks after asthma-related hospitalization (a measure of continuity of care), asthma-related hospitalizations, and all emergency department (ED) visits were the primary quality metrics...
February 16, 2018: Journal of Asthma: Official Journal of the Association for the Care of Asthma
https://www.readbyqxmd.com/read/29450524/effect-of-a-quality-improvement-intervention-on-clinical-outcomes-in-patients-in-india-with-acute-myocardial-infarction-the-acs-quik-randomized-clinical-trial
#7
Mark D Huffman, Padinhare P Mohanan, Raji Devarajan, Abigail S Baldridge, Dimple Kondal, Lihui Zhao, Mumtaj Ali, Mangalath N Krishnan, Syam Natesan, Rajesh Gopinath, Sunitha Viswanathan, Joseph Stigi, Johny Joseph, Somanathan Chozhakkat, Donald M Lloyd-Jones, Dorairaj Prabhakaran
Importance: Wide heterogeneity exists in acute myocardial infarction treatment and outcomes in India. Objective: To evaluate the effect of a locally adapted quality improvement tool kit on clinical outcomes and process measures in Kerala, a southern Indian state. Design, Setting, and Participants: Cluster randomized, stepped-wedge clinical trial conducted between November 10, 2014, and November 9, 2016, in 63 hospitals in Kerala, India, with a last date of follow-up of December 31, 2016...
February 13, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29449200/mhealth-technology-and-nurse-health-coaching-to-improve-health-in-diabetes-protocol-for-a-randomized-controlled-trial
#8
Sheridan Miyamoto, Madan Dharmar, Sarina Fazio, Yajarayma Tang-Feldman, Heather M Young
BACKGROUND: Chronic diseases, including diabetes mellitus, are the leading cause of mortality and disability in the United States. Current solutions focus primarily on diagnosis and pharmacological treatment, yet there is increasing evidence that patient-centered models of care are more successful in improving and addressing chronic disease outcomes. OBJECTIVE: The objective of this clinical trial is to evaluate the impact of a mobile health (mHealth) enabled nurse health coaching intervention on self-efficacy among adults with type-2 diabetes mellitus...
February 15, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29449140/effectiveness-of-a-multicomponent-self-management-intervention-for-adults-with-epilepsy-zmile-study-a-randomized-controlled-trial
#9
Loes A M Leenen, Ben F M Wijnen, Alfons G H Kessels, HoiYau Chan, Reina J A de Kinderen, Silvia M A A Evers, Caroline M van Heugten, Marian H J M Majoie
BACKGROUND: The objective of the ZMILE study was to compare the effectiveness of a multicomponent self-management intervention (MCI) with care as usual (CAU) in adult patients with epilepsy (PWE) over a six-month period. METHODS: Participants (PWE & relative) were randomized into intervention or CAU groups. Self-report questionnaires were used to measure disease-specific self-efficacy as the primary outcome measure and general self-efficacy, adherence, seizure severity, emotional functioning, quality of life, proactive coping, and side-effects of antiepileptic drugs (AED) as secondary outcome measures...
February 12, 2018: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/29447364/salzburg-global-seminar-session-565-better-health-care-how-do-we-learn-about-improvement
#10
M Rashad Massoud, Leighann E Kimble, Don Goldmann, John Ovretveit, Nancy Dixon
A fundamental question for the field of healthcare improvement is the extent to which the results achieved can be attributed to the changes that were implemented and whether or not these changes are generalizable. Answering these questions is particularly challenging because the healthcare context is complex, and the interventions themselves tend to be complex and multi-dimensional. The Salzburg Global Seminar Session 565-'Better Health Care: How do we learn about improvement?' was convened to address questions of attribution, generalizability and rigor, and to think through how to approach these concerns in the field of quality improvement...
February 13, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29445533/insomnia-and-cognitive-behavioural-therapy-how-to-assess-your-patient-and-why-it-should-be-a-standard-part-of-care
#11
REVIEW
Kirstie N Anderson
Hippocrates recognized the importance of asking about sleep as long ago as 400 BC when he wrote " sleep and watchfulness, both of them when immoderate, constitute disease ". Disrupted sleep for any reason has immediate and long term consequences on physical and mental health. Insomnia disorder ("immoderate watchfulness") remains the commonest sleep disorder in primary and secondary care with an estimated 5-10% of the adult population affected. While it is commonly comorbid with other physical and mental health problems, the new diagnostic classification has been helpfully simplified such that it is considered a disorder in itself...
January 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29445285/the-effect-of-exercise-on-cancer-related-fatigue-in-cancer-survivors-a-systematic-review-and-meta-analysis
#12
REVIEW
Ellen Kessels, Olga Husson, Christina M van der Feltz-Cornelis
Objective: The objective of the study was to conduct systematic review and meta-analysis to establish the effect of exercise interventions on cancer-related fatigue (CRF) in cancer survivors, compared to non-exercise intervention controls. Methods: Trials published between January 1st 2000 and August 17th 2016 were included through PubMed database search and search of references. Eligible trials compared the effect of an exercise intervention on CRF compared to non-exercise intervention controls, with CRF as primary outcome and measured by validated self-report questionnaire, in cancer survivors not receiving palliative care...
2018: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/29444853/interprofessional-teamwork-innovation-model-itim-to-promote-communication-and-patient-centred-coordinated-care
#13
Jing Li, Preetham Talari, Andrew Kelly, Barbara Latham, Sherri Dotson, Kim Manning, Lisa Thornsberry, Colleen Swartz, Mark V Williams
BACKGROUND: Despite recommendations and the need to accelerate redesign of delivery models to be team-based and patient-centred, professional silos and cultural and structural barriers that inhibit working together and communicating effectively still predominate in the hospital setting. Aiming to improve team-based rounding, we developed, implemented and evaluated the Interprofessional Teamwork Innovation Model (ITIM). METHODS: This quality improvement (QI) study was conducted at an academic medical centre...
February 14, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29444787/randomised-controlled-pragmatic-clinical-trial-evaluating-the-effectiveness-of-a-discharge-follow-up-phone-call-on-30-day-hospital-readmissions-balancing-pragmatic-and-explanatory-design-considerations
#14
Maame Yaa A B Yiadom, Henry Domenico, Daniel Byrne, Michele Marie Hasselblad, Cheryl L Gatto, Sunil Kripalani, Neesha Choma, Sarah Tucker, Li Wang, Monisha C Bhatia, Johnston Morrison, Frank E Harrell, Tina Hartert, Gordon Bernard
INTRODUCTION: Hospital readmissions within 30 days are a healthcare quality problem associated with increased costs and poor health outcomes. Identifying interventions to improve patients' successful transition from inpatient to outpatient care is a continued challenge. METHODS AND ANALYSIS: This is a single-centre pragmatic randomised and controlled clinical trial examining the effectiveness of a discharge follow-up phone call to reduce 30-day inpatient readmissions...
February 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29443839/how-common-and-how-serious-is-clostridium-difficile-colitis-after-geriatric-hip-fracture-findings-from-the-nsqip-dataset
#15
Patawut Bovonratwet, Daniel D Bohl, Glenn S Russo, Nathaniel T Ondeck, Denis Nam, Craig J Della Valle, Jonathan N Grauer
BACKGROUND: Patients with geriatric hip fractures may be at increased risk for postoperative Clostridium difficile colitis, which can cause severe morbidity and can influence hospital quality metrics. However, to our knowledge, no large database study has calculated the incidence of, factors associated with, and effect of C. difficile colitis on geriatric patients undergoing hip fracture surgery. QUESTIONS/PURPOSES: To use a large national database with in-hospital and postdischarge data (National Surgical Quality Improvement Program [NSQIP®]) to (1) determine the incidence and timing of C...
March 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29443647/system-level-health-care-integration-and-the-costs-of-cancer-care-across-the-disease-continuum
#16
Deborah R Kaye, Hye Sung Min, Edward C Norton, Zaojun Ye, Jonathan Li, James M Dupree, Chad Ellimoottil, David C Miller, Lindsey A Herrel
PURPOSE: Policy reforms in the Affordable Care Act encourage health care integration to improve quality and lower costs. We examined the association between system-level integration and longitudinal costs of cancer care. METHODS: We used linked SEER-Medicare data to identify patients age 66 to 99 years diagnosed with prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian cancer from 2007 to 2012. We attributed each patient to one or more phases of care (ie, initial, continuing, and end of life) according to time from diagnosis until death or end of study interval...
February 13, 2018: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29442143/randomized-controlled-study-comparing-disposable-negative-pressure-wound-therapy-with-standard-care-in-bilateral-breast-reduction-mammoplasty-evaluating-surgical-site-complications-and-scar-quality
#17
V Tanaydin, J Beugels, A Andriessen, J H Sawor, R R W J van der Hulst
BACKGROUND: Negative pressure wound therapy (NPWT) for postsurgical incision treatment has demonstrated benefits. A prospective randomized study was developed including 32 patients who underwent bilateral breast reduction mammoplasty. Patients served as their own control and received NPWT to one breast and fixation strips to the other breast. METHODS: The primary outcome was the number of wound healing complications within 21 days when comparing NPWT treatment with fixation strips...
February 13, 2018: Aesthetic Plastic Surgery
https://www.readbyqxmd.com/read/29441105/quality-improvement-in-pediatric-care
#18
REVIEW
Moon Sung Park
We often overlook the importance of several safety issues such as identification of patients, timeout procedure, hand hygiene, handoff communication, and many others. This ignorance, along with many other issues, leads to medical error being ranked as a third leading cause of death in the U.S. Consequently, quality improvement (QI) has become one of the major subjects in healthcare despite a relatively short history. Improving quality is about making healthcare safe, effective, patient-centered, timely, efficient, and equitable...
January 2018: Korean Journal of Pediatrics
https://www.readbyqxmd.com/read/29440217/using-big-data-to-improve-cardiovascular-care-and-outcomes-in-china-a-protocol-for-the-chinese-electronic-health-records-research-in-yinzhou-cherry-study
#19
Hongbo Lin, Xun Tang, Peng Shen, Dudan Zhang, Jinguo Wu, Jingyi Zhang, Ping Lu, Yaqin Si, Pei Gao
INTRODUCTION: Data based on electronic health records (EHRs) are rich with individual-level longitudinal measurement information and are becoming an increasingly common data source for clinical risk prediction worldwide. However, few EHR-based cohort studies are available in China. Harnessing EHRs for research requires a full understanding of data linkages, management, and data quality in large data sets, which presents unique analytical opportunities and challenges. The purpose of this study is to provide a framework to establish a uniquely integrated EHR database in China for scientific research...
February 12, 2018: BMJ Open
https://www.readbyqxmd.com/read/29440160/interventions-to-increase-access-to-or-uptake-of-physical-health-screening-in-people-with-severe-mental-illness-a-realist-review
#20
Frédérique Lamontagne-Godwin, Caroline Burgess, Sarah Clement, Melanie Gasston-Hales, Carolynn Greene, Anne Manyande, Deborah Taylor, Paul Walters, Elizabeth Barley
OBJECTIVES: To identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work. DESIGN: Realist review. SETTING: Primary, secondary and tertiary care. RESULTS: A systematic search identified 1448 studies, of which 22 met the inclusion criteria. Studies were from Australia (n=3), Canada (n=1), Hong Kong (n=1), UK (n=11) and USA (n=6)...
February 10, 2018: BMJ Open
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