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"Quality improvement" driver

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https://www.readbyqxmd.com/read/29045256/a-quality-improvement-initiative-to-increase-scoring-consistency-and-accuracy-of-the-finnegan-tool-challenges-in-obtaining-reliable-assessments-of-drug-withdrawal-in-neonatal-abstinence-syndrome
#1
Wendy Timpson, Cheryl Killoran, Louise Maranda, Alan Picarillo, Elisabeth Bloch-Salisbury
BACKGROUND: Current practice for diagnosing neonatal abstinence syndrome and guiding pharmacological management of neonatal drug withdrawal is dependent on nursing assessments and repeated evaluation of clinical signs. PURPOSE: This single-center quality improvement initiative was designed to improve accuracy and consistency of Finnegan scores among neonatal nurses. METHODS: One-hundred seventy neonatal nurses participated in a single-session withdrawal-assessment program that incorporated education, scoring guidelines, and a restructured Finnegan scale...
October 17, 2017: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/29043947/outpatient-continuing-care-after-residential-substance-use-disorder-treatment-in-the-u-s-veterans-health-administration-facilitators-and-challenges
#2
Anna D Rubinsky, Laura S Ellerbe, Shalini Gupta, Tyler E Phelps, Thomas Bowe, Jennifer L Burden, Alex H S Harris
BACKGROUND: In the U.S. Veterans Health Administration (VHA), residential treatment programs are an important part of the continuum of care for patients with substance use disorders (SUDs). Outpatient continuing care after residential treatment helps maintain early recovery and treatment gains. Knowing more about the drivers of variation in continuing care practices and performance across residential programs might inform quality improvement efforts. METHODS: We operationalized measures of continuing care and calculated these metrics for each of VHA's 63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs) and 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track in fiscal year 2012...
October 18, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28974584/regular-and-frequent-feedback-of-specific-clinical-criteria-delivers-a-sustained-improvement-in-the-management-of-diabetic-ketoacidosis%C3%A2
#3
Punith Kempegowda, Ben Coombs, Peter Nightingale, Joht Singh Chandan, Jaffar Al-Sheikhli, Bhavana Shyamanur, Kasun Theivendran, Anitha Vijayan Melapatte, Umesh Salanke, Mohammed Akber, Sandip Ghosh, Parth Narendran
Efficient management of diabetic ketoacidosis (DKA) improves outcomes and reduces length of stay. While clinical audit improves the management of DKA, significant and sustained improvement is often difficult to achieve. We aimed to improve the management of DKA in our trust through the implementation of quality improvement methodology. Five specific targets (primary drivers: fluid prescription, fixed rate intravenous insulin infusion, glucose measurement, ketone measurement and specialist referral) were selected following a baseline audit...
October 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28967954/deviation-management-key-management-subsystem-driver-of-knowledge-based-continuous-improvement-in-the-henry-ford-production-system
#4
Richard J Zarbo, Jacqueline R Copeland, Ruan C Varney
Objectives: To develop a business subsystem fulfilling International Organization for Standardization 15189 nonconformance management regulatory standard, facilitating employee engagement in problem identification and resolution to effect quality improvement and risk mitigation. Methods: From 2012 to 2016, the integrated laboratories of the Henry Ford Health System used a quality technical team to develop and improve a management subsystem designed to identify, track, trend, and summarize nonconformances based on frequency, risk, and root cause for elimination at the level of the work...
October 1, 2017: American Journal of Clinical Pathology
https://www.readbyqxmd.com/read/28912950/quality-improvement-regarding-handoff
#5
Scott Studeny, Lauren Burley, Kelsey Cowen, Melanie Akers, Kelly O'Neill, Susan L Flesher
BACKGROUND AND OBJECTIVES: Previous studies have emphasized the importance of effectual communication during patient handoffs. The objectives of this study were to (1) implement a resident-driven quality improvement project to improve handoffs by including key elements that are necessary for a safe and effective handoff. We chose to use the IPASS (illness severity, patient summary, action items, situation awareness and contingency planning, synthesis by receiver) mnemonic as our standardized handoff model; (2) Consider balancing measures in an effort to be aware of any negative effects of our interventions on resident satisfaction with the system...
2017: SAGE Open Medicine
https://www.readbyqxmd.com/read/28904910/complications-acknowledging-managing-and-coping-with-human-error
#6
REVIEW
Sevann Helo, Carol-Anne E Moulton
Errors are inherent in medicine due to the imperfectness of human nature. Health care providers may have a difficult time accepting their fallibility, acknowledging mistakes, and disclosing errors. Fear of litigation, shame, blame, and concern about reputation are just some of the barriers preventing physicians from being more candid with their patients, despite the supporting body of evidence that patients cite poor communication and lack of transparency as primary drivers to file a lawsuit in the wake of a medical complication...
August 2017: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28872426/enhancing-quality-practice-for-prevention-and-diagnosis-of-urinary-tract-infection-during-inpatient-spinal-cord-rehabilitation
#7
Seyed Mohammad Alavinia, Maryam Omidvar, Farnoosh Farahani, Mark Bayley, Joana Zee, Beverley Catharine Craven
Objectives To reduce the incidence of Urinary Tract Infection (UTI) in subacute SCI individuals admitted for tertiary inpatient rehabilitation. Design A quality improvement team was assembled to improve UTI prevention/diagnosis. To plan data collection, UTI-related factors were mapped in an Ishikawa (fishbone) driver diagram. Data including patient demographics, presence and frequency of signs and/or symptoms of UTI and antibiotic initiation from August to December 2015 were recorded. Sensitivity, Specificity, Positive and Negative Predictive Values (PPV, NPV), and Likelihood Ratios (LR) were calculated for each sign and symptom...
September 5, 2017: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/28851769/what-role-does-performance-information-play-in-securing-improvement-in-healthcare-a-conceptual-framework-for-levers-of-change
#8
Jean-Frederic Levesque, Kim Sutherland
OBJECTIVE: Across healthcare systems, there is consensus on the need for independent and impartial assessment of performance. There is less agreement about how measurement and reporting performance improves healthcare. This paper draws on academic theories to develop a conceptual framework-one that classifies in an integrated manner the ways in which change can be leveraged by healthcare performance information. METHODS: A synthesis of published frameworks. RESULTS: The framework identifies eight levers for change enabled by performance information, spanning internal and external drivers, and emergent and planned processes: (1) cognitive levers provide awareness and understanding; (2) mimetic levers inform about the performance of others to encourage emulation; (3) supportive levers provide facilitation, implementation tools or models of care to actively support change; (4) formative levers develop capabilities and skills through teaching, mentoring and feedback; (5) normative levers set performance against guidelines, standards, certification and accreditation processes; (6) coercive levers use policies, regulations incentives and disincentives to force change; (7) structural levers modify the physical environment or professional cultures and routines; (8) competitive levers attract patients or funders...
August 28, 2017: BMJ Open
https://www.readbyqxmd.com/read/28840966/the-diy-digital-medical-centre
#9
James Kenneth Timmis, Kenneth Timmis
Healthcare systems worldwide are confronted with major economic, organizational and logistical challenges. Historic evolution of health care has led to significant healthcare sector fragmentation, resulting in systemic inefficiencies and suboptimal resource exploitation. To attain a sustainable healthcare model, fundamental, system-wide improvements that effectively network, and ensure fulfilment of potential synergies between sectors, and include and facilitate coherent strategic planning and organisation of healthcare infrastructure are needed...
September 2017: Microbial Biotechnology
https://www.readbyqxmd.com/read/28832865/drivers-of-payment-variation-in-90-day-coronary-artery-bypass-grafting-episodes
#10
Vinay Guduguntla, John D Syrjamaki, Chad Ellimoottil, David C Miller, Richard L Prager, Edward C Norton, Patricia Theurer, Donald S Likosky, James M Dupree
Importance: Coronary artery bypass grafting (CABG) is scheduled to become a mandatory Medicare bundled payment program in January 2018. A contemporary understanding of 90-day CABG episode payments and their drivers is necessary to inform health policy, hospital strategy, and clinical quality improvement activities. Furthermore, insight into current CABG payments and their variation is important for understanding the potential effects of bundled payment models in cardiac care. Objective: To examine CABG payment variation and its drivers...
August 23, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28820652/decreasing-stroke-code-to-ct-time-in-patients-presenting-with-stroke-symptoms
#11
Aleksandrs Kalnins, L Jake Mickelsen, Daisha Marsh, Christoph Zorich, Stephanie Casal, Waimei Amy Tai, Nirali Vora, Gennette Olalia, Max Wintermark, David B Larson
Guided quality improvement (QI) programs present an effective means to streamline stroke code to computed tomography (CT) times in a comprehensive stroke center. Applying QI methods and a multidisciplinary team approach may decrease the stroke code to CT time in non-prenotified emergency department (ED) patients presenting with symptoms of stroke. The aim of this project was to decrease this time for non-prenotified stroke code patients from a baseline mean of 20 minutes to one less than 15 minutes during an 18-week period by applying QI methods in the context of a structured QI program...
September 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/28801468/minnesota-integrated-health-partnership-demonstration-implementation-of-a-medicaid-aco-model
#12
Lynn A Blewett, Donna Spencer, Peter Huckfeldt
In recent years, accountable care organizations (ACOs) have become more prevalent in the United States, as a means to provide coordinated care by local providers. This study describes the origins, implementation, and early results of Minnesota's Medicaid ACO payment model, the Integrated Health Partnership (IHP) demonstration project. We describe the structure of the program and present preliminary evaluation results to document the state's important work and to provide lessons for other states interested in implementing Medicaid ACOs...
August 11, 2017: Journal of Health Politics, Policy and Law
https://www.readbyqxmd.com/read/28765794/diabetes-as-an-independent-predictor-for-extended-length-of-hospital-stay-and-increased-adverse-post-operative-events-in-patients-treated-surgically-for-cervical-spondylotic-myelopathy
#13
Nancy Worley, John Buza, Cyrus M Jalai, Gregory W Poorman, Louis M Day, Shaleen Vira, Shearwood McClelland Iii, Virginie Lafage, Peter G Passias
BACKGROUND: Diabetes as an independent driver of peri-operative outcomes, and whether its severity impacts indications is conflicted in the research. The purpose of this study is to evaluate diabetes as a predictor for postoperative outcomes in cervical spondylotic myelopathy (CSM) patients. METHODS: A retrospective review was performed of patients treated surgically for CSM (ICD-9 721.1) from 2010-2012 in the prospectively-collected American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database...
2017: International Journal of Spine Surgery
https://www.readbyqxmd.com/read/28725841/findings-and-predictors-of-patient-reported-experience-of-primary-health-care-in-nigeria
#14
Daprim S Ogaji, Sally Giles, Gavin Daker-White, Peter Bower
OBJECTIVE: The study reports findings and patients' characteristics that predict their experiences of primary health care (PHC) in Nigeria. METHODS: A cross-sectional survey of 1680 patients attending 24 primary health centers in 6 states from the 6 geopolitical subdivisions in Nigeria. The patient evaluation scale was used for exit survey of patients' experiences with PHC. Categorical findings and mean ratings on experiences of PHC were analyzed using both descriptive and inferential statistics...
September 2016: Journal of patient experience
https://www.readbyqxmd.com/read/28705223/improving-preventive-health-care-in-aboriginal-and-torres-strait-islander-primary-care-settings
#15
Jodie Bailie, Veronica Matthews, Alison Laycock, Rosalie Schultz, Christopher P Burgess, David Peiris, Sarah Larkins, Ross Bailie
BACKGROUND: Like other colonised populations, Indigenous Australians experience poorer health outcomes than non-Indigenous Australians. Preventable chronic disease is the largest contributor to the health differential between Indigenous and non-Indigenous Australians, but recommended best-practice preventive care is not consistently provided to Indigenous Australians. Significant improvement in health care delivery could be achieved through identifying and minimising evidence-practice gaps...
July 14, 2017: Globalization and Health
https://www.readbyqxmd.com/read/28699944/improving-the-readability-of-pediatric-hospital-medicine-discharge-instructions
#16
Ndidi Unaka, Angela Statile, Karen Jerardi, Devesh Dahale, Joan Morris, Brianna Liberio, Ashley Jenkins, Blair Simpson, Randi Mullaney, Jodi Kelley, Michelle Durling, Jennifer Shafer, Patrick Brady
BACKGROUND: Readable discharge instructions may help caregivers understand and implement care plans following hospitalization. Many caregivers of hospitalized children, however, have limited literacy. We aimed to increase the percentage of discharge instructions written at 7th grade level or lower for hospital medicine patients from 13% to 80% in 6 months. METHODS: Quality improvement efforts targeted a 42-bed unit at the community satellite of our large, urban academic hospital...
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28678071/reporting-of-perioperative-adverse-events-by-pediatric-anesthesiologists-at-a-tertiary-children-s-hospital-targeted-interventions-to-increase-the-rate-of-reporting
#17
Glyn D Williams, Matthew K Muffly, Julianne M Mendoza, Nina Wixson, Kit Leong, Rebecca E Claure
BACKGROUND: Incident reporting systems (IRSs) are important patient safety tools for identifying risks and opportunities for improvement. A major IRS limitation is underreporting of incidents. Perioperative anesthesia IRSs have been established at multiple pediatric institutions and a national pediatric anesthesia IRS for perioperative serious adverse events (SAEs) is maintained by Wake Up Safe (WUS), a patient safety organization dedicated to pediatric anesthesia quality improvement...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28675597/using-quality-improvement-methods-to-reduce-clear-fluid-fasting-times-in-children-on-a-preoperative-ward
#18
Richard J G Newton, Grant M Stuart, Daniel J Willdridge, Mark Thomas
OBJECTIVES: We applied quality improvement (QI) methodology to identify the different aspects of why children fasted for prolonged periods in our institution. Our aim was for 75% of all children to be fasted for clear fluid for less than 4 hours. BACKGROUND: Prolonged fasting in children can increase thirst and irritability and have adverse effects on haemodynamic stability on induction. By reducing this, children may be less irritable, more comfortable and more physiologically stable, improving the preoperative experience for both children and carers...
August 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28647442/the-impact-of-the-transition-from-volume-to-value-on-heart-failure-care-implications-of-novel-payment-models-and-quality-improvement-initiatives
#19
REVIEW
Dushyanth Srinivasan, Nihar R Desai
In response to wide variation in quality and outcomes as well as escalating health care costs, the U.S. health care system is moving away from a volume-based payment system to a quality- and value-based system. Medicare, the largest insurer and payer of health care, has accelerated the movement toward value-based care with the development and implementation of myriad alternate payment models and pay-for-performance programs as part of the Affordable Care Act. Given that heart failure affects a significant number of Medicare patients and that these patients account for a disproportionate amount of health care utilization and spending, heart failure has become a focal point for these initiatives...
June 21, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28642742/microbial-resources-and-enological-significance-opportunities-and-benefits
#20
REVIEW
Leonardo Petruzzi, Vittorio Capozzi, Carmen Berbegal, Maria R Corbo, Antonio Bevilacqua, Giuseppe Spano, Milena Sinigaglia
Among the innovative trends in the wine sector, the continuous exploration of enological properties associated with wine microbial resources represents a cornerstone driver of quality improvement. Since the advent of starter cultures technology, the attention has been focused on intraspecific biodiversity within the primary species responsible for alcoholic fermentation (Saccharomyces cerevisiae) and, subsequently, for the so-called 'malolactic fermentation' (Oenococcus oeni). However, in the last decade, a relevant number of studies proposed the enological exploitation of an increasing number of species (e...
2017: Frontiers in Microbiology
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