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Quality of physician care

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https://www.readbyqxmd.com/read/29165616/work-system-assessment-to-facilitate-the-dissemination-of-a-quality-improvement-program-for-optimizing-blood-culture-use-a-case-study-using-a-human-factors-engineering-approach
#1
Anping Xie, Charlotte Z Woods-Hill, Anne F King, Heather Enos-Graves, Judy Ascenzi, Ayse P Gurses, Sybil A Klaus, James C Fackler, Aaron M Milstone
Background: Work system assessments can facilitate successful implementation of quality improvement programs. Using a human factors engineering approach, we conducted a work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use in pediatric intensive care units at 2 hospitals. Methods: Semistructured face-to-face interviews were conducted with clinicians from Johns Hopkins All Children's Hospital and University of Virginia Medical Center...
November 20, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/29162609/health-of-health-care-workers-in-canadian-nursing-homes-and-pediatric-hospitals-a-cross-sectional-study
#2
Matthias Hoben, Jennifer A Knopp-Sihota, Maryam Nesari, Stephanie A Chamberlain, Janet E Squires, Peter G Norton, Greta G Cummings, Bonnie J Stevens, Carole A Estabrooks
BACKGROUND: Poor health of health care workers affects quality of care, but research and health data for health care workers are scarce. Our aim was to compare physical/mental health among health care worker groups 1) within nursing homes and pediatric hospitals, 2) between the 2 settings and 3) with the physical/mental health of the Canadian population. METHODS: Using cross-sectional data collected as part of the Translating Research in Elder Care program and the Translating Research on Pain in Children program, we examined the health of health care workers...
November 21, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29162047/treatment-recommendations-within-the-leeway-of-clinical-guidelines-a-qualitative-interview-study-on-oncologists-clinical-deliberation
#3
I Otte, S Salloch, A Reinacher-Schick, J Vollmann
BACKGROUND: Recommending the optimal treatment for an individual patient requires a well-balanced consideration of various medical, social and ethical factors. The interplay of these factors, interpretation of the patient's situation and understanding of the existing clinical guidelines can lead to divergent therapy recommendations, depending on the attending physician. Gaining a better understanding of the individual process of medical decision-making and the differences occurring will support the delivery of optimal individualized care within the clinical setting...
November 21, 2017: BMC Cancer
https://www.readbyqxmd.com/read/29160381/quality-of-communication-questionnaire-for-copd-patients-receiving-palliative-care-translation-and-cross-cultural-adaptation-for-use-in-brazil
#4
Flávia Del Castanhel, Suely Grosseman
OBJECTIVE: To translate the Quality of Communication Questionnaire (QOC) to Portuguese and adapt it for use in Brazil in COPD patients receiving palliative care. METHODS: After approval from the first author of the original QOC and the local research ethics committee, the original, 13-item version of the questionnaire was independently translated to Brazilian Portuguese by two Brazilian translators fluent in English. The two translations were analyzed by a bilingual physician and the two Brazilian translators, who reached a consensus and produced another Portuguese version of the QOC...
September 2017: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
https://www.readbyqxmd.com/read/29159555/use-of-a-hands-free-instantaneous-closed-loop-communication-device-improves-perception-of-communication-and-workflow-integration-in-an-academic-teaching-hospital-a-pilot-study
#5
Daniel Z Fang, Teja Patil, Ilana Belitskaya-Levy, Marianne Yeung, Keith Posley, Nazima Allaudeen
Efficient and effective communication between providers is critical to quality patient care within a hospital system. Hands free communication devices (HFCD) allow instantaneous, closed-loop communication between physicians and other members of a multidisciplinary team, providing a communication advantage over traditional pager systems. HFCD have been shown to decrease emergency room interruptions, improve nursing communication, improve speed of information flow, and eliminate health care waste. We evaluated the integration of an HFCD with an existing alphanumeric paging system on an acute inpatient medicine service...
November 17, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/29159371/care-planning-for-inpatients-referred-for-palliative-care-consultation
#6
Kara Bischoff, David L O'Riordan, Angela K Marks, Rebecca Sudore, Steven Z Pantilat
Importance: Care planning is a critical function of palliative care teams, but the impact of advance care planning and goals of care discussions by palliative care teams has not been well characterized. Objective: To describe the population of patients referred to inpatient palliative care consultation teams for care planning, the needs identified by palliative care clinicians, the care planning activities that occur, and the results of these activities. Design, Setting, and Participants: This was a prospective cohort study conducted between January 1, 2013, and December 31, 2016...
November 20, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29157223/tube-feeding-decreases-pneumonia-rate-in-patients-with-severe-dementia-comparison-between-pre-and-post-intervention
#7
Shintaro Takenoshita, Keiko Kondo, Keiichi Okazaki, Akihiko Hirao, Keiko Takayama, Keisuke Hirayama, Hiroyuki Asaba, Kenji Nakata, Hideki Ishizu, Hiromi Takahashi, Hanae Nakashima-Yasuda, Yasue Sakurada, Kengo Fujikawa, Osamu Yokota, Norihito Yamada, Seishi Terada
BACKGROUND: It is widely supposed that there is no benefit, including extended survival and decreased rate of pneumonia, in patients with severe dementia receiving enteral tube feeding (TF). However, there have been few studies comparing the frequency of pneumonia before and after TF in severe dementia. METHODS: Nine psychiatric hospitals in Okayama Prefecture participated in this retrospective survey. All inpatients fulfilling the entry criteria were evaluated...
November 21, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/29153591/informing-physician-strategies-to-overcome-language-barriers-in-encounters-with-pediatric-patients
#8
Natalie Guerrero, Alissa L Small, Rebecca J Schwei, Elizabeth A Jacobs
OBJECTIVES: To describe physician perceptions of differences in limited English proficient (LEP) pediatric encounters and the behavioral adaptations they make to provide quality care to LEP pediatric patients. METHODS: We conducted 30min, semi-structured interviews with 6 family physicians and 5 pediatricians in one health system. Audiotapes from each interview were transcribed verbatim then coded using content analysis. RESULTS: Multiple aspects of the LEP pediatric encounter were perceived by physicians as different from other encounters: trust and relationship between physician and LEP child/child's family, continuity of care, encounter's structure and flow, patient assessment, and communication barriers...
November 15, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/29153353/-something-humane-has-been-lost-re-evaluation-of-the-attitudes-of-senior-physicians-towards-the-g-drg-system-a-qualitative-normative-analysis
#9
Marco Knoll, Ina Otte, Sabine Salloch, Caroline Ruiner, Esta Kruppa, Jochen Vollmann
Only a few years after the implementation of the G-DRG (German Diagnosis Related Group) system physicians already began to complain of its negative effects on the quality of inpatient healthcare. The present study examines the recent experiences senior physicians have made with regard to the impact of the G-DRG system on the quality of healthcare and medical professionalism. Nine qualitative guided expert interviews were conducted focusing on the experiences of physicians in leading positions dealing with the G-DRG system in their everyday work...
November 15, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/29150885/recognizing-the-haystack-is-the-task-of-the-primary-care-physician
#10
N A Kukutsch, G Argenziano, W Bergman
In a reply to our letter Ferrandiz and colleagues wondered why dermoscopy experts did not already fully embrace teledermoscopy (TD) for suspicious pigmented skin lesions.(1) Our study showed that the structure of the health systems that were investigated differed, with countries where primary care physicians (PCP) hold a gate keeper function and others with direct access to a dermatologist. Significant differences in waiting time and travel distance were observed.(2) Since we believe that there is enough evidence that the addition of high quality dermoscopic pictures to a teleconsultation leads to higher accuracy of the diagnosis we did not investigate this question in our survey...
November 17, 2017: Journal of the European Academy of Dermatology and Venereology: JEADV
https://www.readbyqxmd.com/read/29150180/family-centre-bereavement-practices-in-danish-intensive-care-units-a-cross-sectional-national-survey
#11
Ingrid Egerod, Gudrun Kaldan, Maureen Coombs, Marion Mitchell
BACKGROUND: Mortality in Danish intensive care units (ICUs) continues at 27%, resulting in a large number of bereaved family members being cared for in the ICU. OBJECTIVES: To investigate the provision of bereavement care and follow-up services for bereaved families in Danish ICUs. METHODOLOGY: Self-administered computerized cross-sectional nation-wide survey of Danish ICUs. RESULTS: Nurses at 46 of 48 (96%) ICUs in Denmark responded...
November 14, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29149150/the-hopeless-case-palliative-cryoablation-and-cementoplasty-procedures-for-palliation-of-large-pelvic-bone-metastases
#12
Tyler M Coupal, Kevin Pennycooke, Paul I Mallinson, Hugue A Ouellette, Paul W Clarkson, Pippa Hawley, Peter L Munk
BACKGROUND: Metastases to the bone are common in cancer patients, and it has been estimated that up to 50% of patients with pelvic bone metastases will not achieve adequate pain control with medications alone. This has led to a paradigm shift over recent years towards the use and development of minimally invasive image-guided treatment options for palliation of bony metastases. Despite these developments, large metastatic lesions are still often considered to be "hopeless cases" that would garner little to no benefit from image-guided intervention...
November 2017: Pain Physician
https://www.readbyqxmd.com/read/29148968/collecting-practice-level-data-in-a-changing-physician-office-based-ambulatory-care-environment-a-pilot-study-examining-the-physician-induction-interview-component-of-the-national-ambulatory-medical-care-survey
#13
Meghan C Halley, Katharine A Rendle, Brian Gugerty, Denys T Lau, Harold S Luft
Objective This report examines ways to improve National Ambulatory Medical Care Survey (NAMCS) data on practice and physician characteristics in multispecialty group practices. Methods From February to April 2013, the National Center for Health Statistics (NCHS) conducted a pilot study to observe the collection of the NAMCS physician interview information component in a large multispecialty group practice. Nine physicians were randomly sampled using standard NAMCS recruitment procedures; eight were eligible and agreed to participate...
November 2017: Vital and Health Statistics. Series 2, Data Evaluation and Methods Research
https://www.readbyqxmd.com/read/29148344/moderating-effects-of-patient-characteristics-on-the-impact-of-financial-incentives
#14
Meredith B Rosenthal, Andrea B Troxel, Kevin G Volpp, Walter F Stewart, Thomas D Sequist, James B Jones, AnneMarie G Hirsch, Karen Hoffer, Jingsan Zhu, Wenli Wang, Amanda Hodlofski, Darra Finnerty, Jack J Huang, David A Asch
While financial incentives to providers or patients are increasingly common as a quality improvement strategy, their impact on patient subgroups and health care disparities is unclear. To examine these patterns, we analyzed data from a randomized clinical trial of financial incentives to lower low-density lipoprotein (LDL) cholesterol levels in patients at risk for cardiovascular disease. Patients with higher baseline LDL experienced greater cholesterol reductions in the shared incentive arm (0.23 mg/dL per unit change in baseline LDL, 95% CI [-0...
May 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148329/the-implementation-of-performance-management-systems-in-u-s-physician-organizations
#15
Alexander F Pimperl, Hector P Rodriguez, Julie A Schmittdiel, Stephen M Shortell
Performance management systems (PMSYS) aid in improving the quality and efficiency of care, but little is known about factors that influence more robust PMSYS among physician organizations. Using a nationally representative survey of U.S. medical practices, we examined the extent to which organizational capabilities and external factors were associated with more developed PMSYS. Linear regression estimated the relative impact of these factors on PMSYS. On average, practices implemented a minority (32 points out of 100) of the PMSYS processes assessed...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29147847/r-hyper-cvad-versus-r-chop-cytarabine-with-high-dose-therapy-and-autologous-haematopoietic-stem-cell-support-in-fit-patients-with-mantle-cell-lymphoma-20%C3%A2-years-of-single-center-experience
#16
Fabienne Widmer, Stefan Balabanov, Davide Soldini, Panagiotis Samaras, Bernhard Gerber, Markus G Manz, Jeroen S Goede
Standard of care for untreated mantle cell lymphoma (MCL) is still debated. At the University Hospital Zurich, advanced MCL in physically fit patients is treated either with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone induction followed by consolidating high-dose chemotherapy and autologous stem cell support (R-CHOP/HD-ASCT), or with rituximab plus fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with high-dose methotrexate-cytarabine (R-hyper-CVAD/MTX-AraC) without consolidating HD-ASCT upon physicians' and patients' choice...
November 16, 2017: Annals of Hematology
https://www.readbyqxmd.com/read/29146562/multi-method-laboratory-user-evaluation-of-an-actionable-clinical-performance-information-system-implications-for-usability-and-patient-safety
#17
Benjamin Brown, Panos Balatsoukas, Richard Williams, Matthew Sperrin, Iain Buchan
INTRODUCTION: Electronic audit and feedback (e-A&F) systems are used worldwide for care quality improvement. They measure health professionals' performance against clinical guidelines, and some systems suggest improvement actions. However, little is known about optimal interface designs for e-A&F, in particular how to present suggested actions for improvement. We developed a novel theory-informed system for primary care (the Performance Improvement plaN GeneratoR; PINGR) that covers the four principal interface components: clinical performance summaries; patient lists; detailed patient-level information; and suggested actions...
November 13, 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29144862/are-physician-orders-for-life-sustaining-treatments-the-answer-to-the-end-of-life-care-quality-conundrums-in-cancer-care
#18
Keith M Swetz
No abstract text is available yet for this article.
November 16, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29144250/case-not-closed-prescription-errors-12-years-after-computerized-physician-order-entry-implementation
#19
Gili Kadmon, Michal Pinchover, Avichai Weissbach, Shirley Kogan Hazan, Elhanan Nahum
OBJECTIVE: To assess the prolonged impact of computerized physician order entry (CPOE) on medication prescription errors in pediatric intensive care patients. STUDY DESIGN: This observational study was conducted at a pediatric intensive care unit in which a CPOE (Metavision, iMDsoft, Israel) with a limited clinical decision support system was implemented between 2004 and 2007. Since then, no changes were made to the systems. We analyzed 2500 electronic prescriptions (1250 prescriptions from 2015 and 1250 prescriptions from 2016)...
November 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29144156/upmc-prescription-for-wellness-a-quality-improvement-case-study-for-supporting-patient-engagement-and-health-behavior-change
#20
Rebecca J Maners, Eric Bakow, Michael D Parkinson, Gary S Fischer, Geoffrey R Camp
Addressing patient health and care behaviors that underlie much of chronic disease continues to challenge providers, medical practices, health systems, and insurers. Improving health and care as described by the Quadruple Aim requires innovation at the front lines of clinical care: the doctor-patient interaction and office practice. This article describes the use of Lean Six Sigma in a quality improvement (QI) effort to design an effective and scalable method for physicians to prescribe health coaching for healthy behaviors in a primary care medical home within a large integrated delivery and financing system...
November 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
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