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Natalie Purcell, Kara Zamora, Jenny Tighe, Yongmei Li, Mathew Douraghi, Karen Seal
OBJECTIVE:  To evaluate the impact of the Integrated Pain Team (IPT)-an interdisciplinary chronic pain care intervention embedded in primary care at a large Veterans Affairs health care system. Outcomes evaluated included IPT's impact on the perceived effectiveness of chronic pain care; provider self-confidence; and primary care team satisfaction, stress, and burnout. METHOD:  This mixed-methods quality-improvement study employed: 1) qualitative semistructured interviews of 61 primary care providers, other primary care team members, and organizational stakeholders; and 2) a supplementary quantitative survey of 65 providers, comparing those who had referred patients to IPT with those who had not...
October 12, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Amanda C Schondelmeyer, Laura H Brower, Angela M Statile, Christine M White, Patrick W Brady
Achieving rapid and meaningful improvement in healthcare requires the dissemination of quality improvement project results via publication. Doing this well requires detailed descriptions of the complex interventions and of the context in which the improvement took place. This report builds on the first 2 articles in the series to cover important considerations in writing quality improvement manuscripts with a focus on how it differs from writing traditional clinical research reports. The recommendations we outline here also apply to reviewing quality improvement manuscripts...
October 5, 2017: Journal of the Pediatric Infectious Diseases Society
Patrick W Brady, Michael J Tchou, Lilliam Ambroggio, Amanda C Schondelmeyer, Erin E Shaughnessy
In this second article in the quality improvement (QI) methods series, we discuss how data are best displayed and analyzed in QI projects while focusing on some similarities with and differences from traditional clinical research. We demonstrate why displaying data over time on a run or control chart is superior to using pre-post analysis for QI studies. We introduce several types of statistical process control charts for data commonly collected during QI programs and provide guidance on how to use the proper chart...
October 5, 2017: Journal of the Pediatric Infectious Diseases Society
Di Liang, Vickie M Mays, Wei-Chin Hwang
Eager to build an integrated community-based mental health system, in 2004 China started the '686 Programme', whose purpose was to integrate hospital and community services for patients with serious mental illness. In 2015, the National Mental Health Working Plan (2015-2020) proposed an ambitious strategy for implementing this project. The goal of this review is to assess potential opportunities for and barriers to successful implementation of a community-based mental health system that integrates hospital and community mental health services into the general healthcare system...
October 13, 2017: Health Policy and Planning
Jordan T Blough, Sumanas W Jordan, Gildasio S De Oliveira, Michael M Vu, John Y S Kim
Background: The "July Effect" refers to a theoretical increase in complications that may occur with the influx of inexperienced interns and residents at the beginning of each academic year in July. Objectives: We endeavored to determine if a July Effect occurs in plastic surgery. Methods: Plastic surgery procedures were isolated from the National Surgical Quality Improvement Program registry. Cases involving residents were grouped as either having occurred within the first academic quarter (AQ1) or remaining year (AQ2-4)...
September 15, 2017: Aesthetic Surgery Journal
Sameer Prakash, Tyler Hamby, Van Leung-Pineda, Don P Wilson
Objective: Statistical methods can be utilized to optimize the order for reflex diagnostic testing to attenuate patient and hospital costs without affecting quality of care. Our objective is to demonstrate the method of developing an order for testing and to apply this method to an illustrative example. Methods: An algorithm was developed for minimizing costs for any given number of diagnostic tests, and it was retrospectively applied to a sample. Results: The actual scenario of using both tests on all patients was compared to 2 other hypothetical reflex testing approaches: all patients are given 1 test, and those patients who tested negative were then given the second test...
September 23, 2017: Laboratory Medicine
Hanan Khalil, Monica Shahid, Libby Roughead
BACKGROUND: Medication safety plays an essential role in all healthcare organizations; improving this area is paramount to quality and safety of any wider healthcare program. While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated, no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliation or computerized physician order entry...
October 2017: JBI Database of Systematic Reviews and Implementation Reports
Brian Isetts
(1) Background: As the U.S. healthcare system evolves from fee-for-service financing to global population-based payments designed to be accountable for both quality and total cost of care, the effective and safe use of medications is gaining increased importance. The purpose of this project was to determine the feasibility of integrating medication therapy management (MTM) services provided by community pharmacists into the clinical care teams and the health information technology (HIT) infrastructure for Minnesota Medicaid recipients of a 12-county community-based accountable care organization (ACO)...
October 16, 2017: Pharmacy (Basel, Switzerland)
Piotr Slomka, Guang-Uei Hung, Guido Germano, Daniel S Berman
Recent novel approaches in myocardial perfusion single photon emission CT (SPECT) have been facilitated by new dedicated high-efficiency hardware with solid-state detectors and optimized collimators. New protocols include very low-dose (1 mSv) stress-only, two-position imaging to mitigate attenuation artifacts, and simultaneous dual-isotope imaging. Attenuation correction can be performed by specialized low-dose systems or by previously obtained CT coronary calcium scans. Hybrid protocols using CT angiography have been proposed...
December 1, 2016: Cardiovasc Innov Appl
Shay Golan, Melanie A Adamsky, Scott C Johnson, Nimrod S Barashi, Zachary L Smith, Maria V Rodriguez, Chuanhong Liao, Norm D Smith, Gary D Steinberg, Arieh L Shalhav
PURPOSE: To evaluate the accuracy of the American College of Surgeons National Surgical Quality Improvement Programs (ACS-NSQIP) surgical risk calculator in patients undergoing radical cystectomy (RC) with urinary diversion. MATERIALS AND METHODS: Preoperative characteristics of patients who underwent RC with ileal conduit or orthotropic neobladder (ONB) between 2007 and 2016 were entered into the proprietary online ACS-NSQIP calculator to generate 30-day predicted risk profiles...
October 12, 2017: Urologic Oncology
Venkat Boddapati, Michael C Fu, David J Mayman, Edwin P Su, Peter K Sculco, Alexander S McLawhorn
BACKGROUND: Periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) is a devastating complication. The short-term morbidity profile of revision TKA performed for PJI relative to non-PJI revisions is poorly characterized. The purpose of this study is to determine 30-day postoperative outcomes after revision TKA for PJI, relative to primary TKA and aseptic revision TKA. METHODS: The American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015 was queried for primary and revision TKA cases...
September 23, 2017: Journal of Arthroplasty
K A Foley, P A Groome, D Feldman-Stewart, M D Brundage, J H Foley, S McArdle, W J Mackillop
AIMS: To describe the quality of the non-technical component of the care (personal care) of patients receiving radical radiotherapy for prostate cancer and to identify elements of personal care that should be priorities for quality improvement. MATERIALS AND METHODS: One hundred and eight patients undergoing radiotherapy for localised prostate cancer completed a self-administered questionnaire that asked them to rate the importance of 143 non-technical elements of care and to rate the quality of their own care with respect to each element...
October 9, 2017: Clinical Oncology: a Journal of the Royal College of Radiologists
T Pindyck, K Gupta, J Strymish, K M Itani, M E Carter, Y Suo, M T Bessesen, J Topkoff, A S Steele, A E Barón, A V Gundlapalli, W Branch-Elliman
BACKGROUND: Surveillance is an effective strategy for reducing surgical site infections (SSIs); however, current identification methods are resource-intensive. Therefore, we sought to validate an electronic SSI triaging tool for detection of probable infections and identify operational barriers and challenges. METHODS: A retrospective cohort study was conducted among all Veterans Affairs Surgical Quality Improvement Program (VASQIP)-reviewed surgeries at 2 Veterans Affairs medical centers from October 1, 2011-September 30, 2014...
October 11, 2017: American Journal of Infection Control
Carola J M Groenen, Noortje T L van Duijnhoven, Jan A M Kremer, Marisja Scheerhagen, Frank P H A Vandenbussche, Marjan J Faber
OBJECTIVES: Professionals in maternity care have started working in a network approach. To further enhance the efficacy of this multidisciplinary maternity network, the identification of priorities for improvement is warranted. The aim of this study was to create key recommendations for the improvement agenda, in co-production with patients and professionals. STUDY DESIGN: We conducted a Delphi study to inventory (round 1), prioritize (round 2) and eventually approve (round 3) the improvement agenda for the maternity network...
October 7, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Maxwell Teets, Dmitry Tumin, Hina Walia, Jenna Stevens, Sharon Wrona, David Martin, Tarun Bhalla, Joseph D Tobias
INTRODUCTION: Untreated pain or overly aggressive pain management may lead to adverse physiologic consequences and activation of the hospital's Rapid Response Team. This study is a quality improvement initiative that attempts to identify patient demographics and patterns associated with Rapid Response Team consultations for patients on the acute pain service. METHODS: A retrospective review of all patients on the acute pain service from February 2011 until June 2015 was cross-referenced with inpatients requiring consultation from the Rapid Response Team...
November 2017: Paediatric Anaesthesia
Dong Cao, Hongxia Wang, Bo Zhang, Baolong Liu, Dengcai Liu, Wenjie Chen, Huaigang Zhang
Avenin-like storage proteins influence the rheological properties and processing quality in common wheat, and the discovery of new alleles will benefit wheat quality improvement. In this study, 13 avenin-like b alleles (TaALPb7D-A-M) were discovered in 108 Aegilops tauschii Coss. accessions. Ten alleles were reported for the first time, while the remaining three alleles were the same as alleles in other species. A total of 15 nucleotide changes were detected in the 13 alleles, resulting in only 11 amino acid changes because of synonymous mutations...
October 13, 2017: Genetica
Ann Kellams, Margaret G Parker, Nicole L Geller, Rachel Y Moon, Eve R Colson, Emily Drake, Michael J Corwin, Mary McClain, W Christopher Golden, Fern R Hauck
BACKGROUND AND OBJECTIVES: Nursing education and role modeling can increase adherence to safe sleep practices. Eight US hospital maternity units with variable baseline approaches to education participated in a national multicenter nursing quality improvement (QI) intervention to promote safe sleep practices. The goals at participating maternity units were to (1) increase the rate of mothers who reported receiving safe sleep information from nurses to ≥90% and (2) increase the rates of infants observed sleeping supine in a safe environment to ≥90%...
October 13, 2017: Pediatrics
Alexander J Jonokuchi, Jared Knopman, Ryan E Radwanski, Moises A Martinez, Blake Eaton Samuel Taylor, Michael Rothbaum, Sean Sullivan, Trae R Robison, Brandon R Christophe, Dimitri Sigounas, Brett Youngerman, Emilia Bagiella, Peter D Angevine, Franklin D Lowy, E Sander Connolly
Surgical-site infections (SSIs) account for 20% of all healthcare-associated infections, are the most common nosocomial infection among surgical patients, and are a focus of quality improvement initiatives. Despite implementation of many quality care measures (e.g. prophylactic antibiotics), SSIs remain a significant cause of morbidity, mortality, and economic burden, particularly in the field of neurosurgery. Topical vancomycin is increasingly utilized in instrumented spinal and cardiothoracic procedures, where it has been shown to reduce the risk of SSIs...
October 10, 2017: Contemporary Clinical Trials
David A Etzioni, Cynthia Lessow, Liliana G Bordeianou, Hiroko Kunitake, Sarah E Deery, Evie Carchman, Christina M Papageorge, George Fuhrman, Rachel V Seiler, James Ogilvie, Elizabeth B Habermann, H Chang Yu-Hui, Samuel R Money
BACKGROUND: Previous studies have documented significant differences between administrative data and registry data in the determination of post-operative MI. The goal of this study is to characterize discordance between administrative and registry data in the determination of post-operative myocardial infarction (MI). STUDY DESIGN: This study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) merged with administrative data from 8 different hospitals between 2013 and 2015...
October 10, 2017: Journal of the American College of Surgeons
Kara Bischoff, David L O'Riordan, Kristyn Fazzalaro, Anne Kindermann, Steven Z Pantilat
CONTEXT: Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams. OBJECTIVE: Identify characteristics associated with pain and pain improvement among inpatients referred to PC. METHODS: Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement...
October 10, 2017: Journal of Pain and Symptom Management
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