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Quality improvement in primary care

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https://www.readbyqxmd.com/read/28437620/american-association-of-clinical-endocrinologists-and-american-college-of-endocrinology-guidelines-for-management-of-dyslipidemia-and-prevention-of-cardiovascular-disease
#1
Paul S Jellinger, Yehuda Handelsman, Paul D Rosenblit, Zachary T Bloomgarden, Vivian A Fonseca, Alan J Garber, George Grunberger, Chris K Guerin, David S H Bell, Jeffrey I Mechanick, Rachel Pessah-Pollack, Kathleen Wyne, Donald Smith, Eliot A Brinton, Sergio Fazio, Michael Davidson
OBJECTIVE: The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). METHODS: Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols...
April 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28435497/improved-accuracy-and-quality-of-information-during-emergency-department-care-transitions
#2
Nnaemeka Okafor, Justin Mazzillo, Sara Miller, Kimberly A Chambers, Samar Yusuf, Vanessa Garza-Miranda, Yashwant Chathampally
INTRODUCTION: Suboptimal communication during emergency department (ED) care transitions has been shown to contribute to medical errors, sometimes resulting in patient injury and litigation. The study objective was to determine whether a standardized checkout process would decrease the number of relevant missed clinical items (MCI). METHODS: In this prospective pre- and post-intervention study conducted in an urban academic ED, we collected data on omitted or inaccurately conveyed medical information before and after the initiation of a standardized checkout process...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435492/applying-systems-engineering-reduces-radiology-transport-cycle-times-in-the-emergency-department
#3
Benjamin A White, Brian J Yun, Michael H Lev, Ali S Raja
INTRODUCTION: Emergency department (ED) crowding is widespread, and can result in care delays, medical errors, increased costs, and decreased patient satisfaction. Simultaneously, while capacity constraints on EDs are worsening, contributing factors such as patient volume and inpatient bed capacity are often outside the influence of ED administrators. Therefore, systems engineering approaches that improve throughput and reduce waste may hold the most readily available gains. Decreasing radiology turnaround times improves ED patient throughput and decreases patient waiting time...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435422/development-and-validation-of-an-instrument-for-assessing-patient-experience-of-chronic-illness-care
#4
José Joaquín Mira, Roberto Nuño-Solinís, Mercedes Guilabert-Mora, Olga Solas-Gaspar, Paloma Fernández-Cano, Maria Asunción González-Mestre, Joan Carlos Contel, Marío Del Río-Cámara
INTRODUCTION: The experience of chronic patients with the care they receive, fuelled by the focus on patient-centeredness and the increasing evidence on its positive relation with other dimensions of quality, is being acknowledged as a key element in improving the quality of care. There are a dearth of accepted tools and metrics to assess patient experience from the patient's perspective that have been adapted to the new chronic care context: continued, systemic, with multidisciplinary teams and new technologies...
August 31, 2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28435420/qualitative-evaluation-of-the-implementation-of-an-integrated-care-delivery-model-for-chronic-patients-with-multi-morbidity-in-the-basque-country
#5
María Luz Jauregui, Carmen Silvestre, Pedro Valdes, Idoia Gaminde
INTRODUCTION: The objective of this study was to assess a model for improving healthcare integration for patients with multiple chronic diseases in an integrated healthcare organisation in the Basque Country and to propose areas for improvement. METHODS: We organised four nominal groups composed of representatives from different categories of clinicians involved in the development of an integrated healthcare organisation and in the integrated care of patients with multiple diseases, namely, internists, general practitioners, and primary care and hospital nurses...
August 19, 2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28435234/strengthening-care-teams-to-improve-adherence-in-cystic-fibrosis-a-qualitative-practice-assessment-and-quality-improvement-initiative
#6
Allison J Gardner, Alice L Gray, Staci Self, Jeffrey S Wagener
BACKGROUND: Treatment regimens for patients with cystic fibrosis (CF) are complex, time consuming, and burdensome, and adherence to CF treatment is suboptimal. CF care teams play a critical role in supporting patients' chronic self-management skills, but there is no uniform method for assessing patients' adherence to treatment or standard interventions to help patients improve when necessary. METHODS: Between May 2015 and March 2016, care team members from 10 CF centers in the USA participated in a practice assessment and quality improvement (QI) initiative...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28434754/-patient-safety-culture-in-family-practice-residents-of-galicia
#7
Manuel Portela Romero, Rosendo Bugarín González, María Sol Rodríguez Calvo
OBJECTIVE: To determine the views held by Family practice (FP) residents on the different dimensions of patient safety, in order to identify potential areas for improvement. DESIGN: A cross-sectional study. LOCATION: Seven FP of Galicia teaching units. PARTICIPANTS: 182 FP residents who completed the Medical Office Survey on Patient Safety Culture questionnaire. MEASUREMENTS: The Medical Office Survey on Patient Safety Culture questionnaire was chosen because it is translated, validated, and adapted to the Spanish model of Primary Care...
April 20, 2017: Atencion Primaria
https://www.readbyqxmd.com/read/28434422/patient-web-portals-and-patient-provider-relationships-a-summary-perspective
#8
Hannah D Caldwell, Neil B Minkoff, Kalyani Murthy
OBJECTIVES: Patient Web portals (PWPs) have been gaining traction as a means to collect patient-reported outcomes and maintain quality patient care between office visits. PWPs have the potential to impact patient-provider relationships by rendering additional channels for communication outside of clinic visits and could help in the management of common chronic medical conditions. Studies documenting their effect in primary care settings are limited. This perspective aims to summarize the benefits and drawbacks of using PWPs in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma, focusing on communication, disease management, compliance, potential barriers, and the impact on patient-provider dynamic...
April 24, 2017: International Journal of Technology Assessment in Health Care
https://www.readbyqxmd.com/read/28430830/assessment-of-global-kidney-health-care-status
#9
Aminu K Bello, Adeera Levin, Marcello Tonelli, Ikechi G Okpechi, John Feehally, David Harris, Kailash Jindal, Babatunde L Salako, Ahmed Rateb, Mohamed A Osman, Bilal Qarni, Syed Saad, Meaghan Lunney, Natasha Wiebe, Feng Ye, David W Johnson
Importance: Kidney disease is a substantial worldwide clinical and public health problem, but information about available care is limited. Objective: To collect information on the current state of readiness, capacity, and competence for the delivery of kidney care across countries and regions of the world. Design, Setting, and Participants: Questionnaire survey administered from May to September 2016 by the International Society of Nephrology (ISN) to 130 ISN-affiliated countries with sampling of key stakeholders (national nephrology society leadership, policy makers, and patient organization representatives) identified by the country and regional nephrology leadership through the ISN...
April 21, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28430573/roles-of-physicians-and-health-care-systems-in-difficult-clinical-encounters
#10
Elizabeth S Goldsmith, Erin E Krebs
Physicians are, by definition, contributing partners in "difficult" patient-physician encounters. Although research on relevant physician qualities is limited, common themes mirror the more extensive literature on physician burnout. Focusing on primary care, we discuss physician-level factors in difficult encounters related to psychosocial attitudes and self-awareness, communication skills, and practice environments. Potential approaches to mitigating these factors include changes to medical training, such as structured peer case discussion groups and communication skills development, and changes to workplace environments, such as integrated mental health...
April 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28429977/are-some-areas-more-equal-than-others-socioeconomic-inequality-in-potentially-avoidable-emergency-hospital-admissions-within-english-local-authority-areas
#11
Jessica Sheringham, Miqdad Asaria, Helen Barratt, Rosalind Raine, Richard Cookson
Objectives Reducing health inequalities is an explicit goal of England's health system. Our aim was to compare the performance of English local administrative areas in reducing socioeconomic inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions. Methods We used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12. We linked inpatient hospital activity, deprivation, primary care, and population data to small area neighbourhoods (typical population 1500) within administrative areas (typical population 250,000)...
April 2017: Journal of Health Services Research & Policy
https://www.readbyqxmd.com/read/28429527/balancing-health-care-education-and-patient-care-in-the-uk-workplace-a-realist-synthesis
#12
Sarah Sholl, Rola Ajjawi, Helen Allbutt, Jane Butler, Divya Jindal-Snape, Jill Morrison, Charlotte Rees
CONTEXT: Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic...
April 20, 2017: Medical Education
https://www.readbyqxmd.com/read/28429473/surgery-for-limited-stage-small-cell-lung-cancer
#13
REVIEW
Hayley Barnes, Katharine See, Stephen Barnett, Renée Manser
BACKGROUND: Current treatment guidelines for limited-stage small-cell lung cancer (SCLC) recommend concomitant platinum-based chemo-radiotherapy plus prophylactic cranial irradiation, based on the premise that SCLC disseminates early, and is chemosensitive. However, although there is usually a favourable initial response, relapse is common and the cure rate for limited-stage SCLC remains relatively poor. Some recent clinical practice guidelines have recommended surgery for stage 1 (limited) SCLC followed by adjuvant chemotherapy, but this recommendation is largely based on the findings of observational studies...
April 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28429077/-implementation-of-the-german-s3-guidelines-on-dementia-in-clinical-practice-wish-or-reality
#14
H Lohmann, F Kulessa, H Holling, A Johnen, S Reul, G Lueg, T Duning
BACKGROUND: Published in 2009, the German S3 guidelines on dementia define a milestone in quality improvement of the diagnostics and treatment of dementia. In clinical practice patients suffering from dementia are primarily treated by physicians in private practice; therefore, this study examined how the guidelines are implemented in outpatient clinical settings. Furthermore, it aimed at the identification of behavioral determinants that govern the actual diagnostic and therapeutic approach in clinical practice...
April 20, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28428245/thematic-analysis-of-us-stakeholder-views-on-the-influence-of-labour-nurses-care-on-birth-outcomes
#15
Audrey Lyndon, Kathleen Rice Simpson, Joanne Spetz
BACKGROUND: Childbirth is a leading reason for hospital admission in the USA, and most labour care is provided by registered nurses under physician or midwife supervision in a nurse-managed care model. Yet, there are no validated nurse-sensitive quality measures for maternity care. We aimed to engage primary stakeholders of maternity care in identifying the aspects of nursing care during labour and birth they believe influence birth outcomes, and how these aspects of care might be measured...
April 20, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28427372/protocol-for-evaluation-of-the-continuum-of-primary-care-in-the-case-of-a-miscarriage-in-the-emergency-room-a-mixed-method-study
#16
Francine de Montigny, Chantal Verdon, Diane Dubeau, Annie Devault, Martin St-André, Éric Tchouaket Nguemeleu, Carl Lacharité
BACKGROUND: In Quebec (Canada), nearly 20,000 pregnancies end in miscarriage, and the majority of the miscarriages are dealt with in an emergency unit. Although there are studies documenting the effects of this type of grief on mental health, men's experiences are much less discussed than those of women. Similarly, no study has evaluated best practices in terms of service continuity, from emergency care to community resources. The aim of this study is to better understand the relationships that exist between the organization of emergency room and primary care health services for women presenting with miscarriage, on the one hand, and the positions and experiences of women and men within these services, on the other...
April 20, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28427336/protocol-for-the-home-hazards-removal-program-harp-study-a-pragmatic-randomized-clinical-trial-and-implementation-study
#17
Susan Stark, Emily Somerville, Marian Keglovits, Jane Conte, Melody Li, Yi-Ling Hu, Yan Yan
BACKGROUND: Falls remain the leading cause of injury, long-term disability, premature institutionalization, and injury-related mortality in the older adult population. Home modifications, when delivered by occupational therapists, can reduce falls among high-risk community-dwelling older adults by 39%. However, home-modification implementation is not standard practice in the United States. The goal of the Home Hazard Removal Program (HARP) study is to implement an evidence-based home modification intervention for older adults designed to reduce the incidence of falls through an aging services network...
April 20, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28425230/attitudes-wishes-and-needs-of-diabetes-patients-and-their-relatives-turkish-data-from-the-dawn2-study
#18
İlhan Tarkun, Suzan Dumanli Özgöksu
BACKGROUND/AIM: The DAWN2 (Diabetes Attitudes, Wishes, and Needs) study was conducted in order to ascertain the wishes, needs, and attitudes of diabetes patients, their relatives, and healthcare professionals. The study was conducted across 17 countries, including Turkey, and its objective was to introduce policies that could successfully meet these requirements. In this article, the needs, wishes, and attitudes of diabetes patients and their relatives in Turkey are compared with those from other countries...
April 18, 2017: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/28425023/challenges-and-opportunities-in-global-mental-health-a-research-to-practice-perspective
#19
REVIEW
Milton L Wainberg, Pamela Scorza, James M Shultz, Liat Helpman, Jennifer J Mootz, Karen A Johnson, Yuval Neria, Jean-Marie E Bradford, Maria A Oquendo, Melissa R Arbuckle
PURPOSE OF REVIEW: Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research...
May 2017: Current Psychiatry Reports
https://www.readbyqxmd.com/read/28424052/using-implementation-facilitation-to-foster-clinical-practice-quality-and-adherence-to-evidence-in-challenged-settings-a-qualitative-study
#20
Mona J Ritchie, Louise E Parker, Carrie N Edlund, JoAnn E Kirchner
BACKGROUND: We evaluated a facilitation strategy to help clinical sites likely to experience challenges implement evidence-based Primary Care-Mental Health Integration (PC-MHI) care models within the context of a Department of Veterans Affairs (VA) initiative. This article describes our assessment of whether implementation facilitation (IF) can foster development of high quality PC-MHI programs that adhere to evidence, are sustainable and likely to improve clinical practices and outcomes...
April 20, 2017: BMC Health Services Research
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