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"Quality improvement" driver

Mathieu Floury, Philippe Usseglio-Polatera, Cecile Delattre, Yves Souchon
Although species traits have the potential to disentangle long-term effects of multiple, potentially confounded, drivers in ecosystems, this issue has received very little attention in the literature. We aimed at filling this gap by assessing the relative effects of hydroclimatic and water quality factors on the trait composition of invertebrate assemblages over 30 years in the Middle Loire River (France). Using a priori predictions on the long-term variation of trait-based adaptations over the three decades, we evaluated the ability of invertebrate traits to indicate the effects of warming, discharge reduction and water quality improvement...
November 22, 2016: Global Change Biology
Allison Redpath Mahon, Alicia M Neu
Peritonitis is a leading cause of hospitalizations, morbidity, and modality change in pediatric chronic peritoneal dialysis (CPD) patients. Despite guidelines published by the International Society for Peritoneal Dialysis aimed at reducing the risk of peritonitis, registry data have revealed significant variability in peritonitis rates among centers caring for children on CPD, which suggests variability in practice. Improvement science methods have been used to reduce a variety of healthcare-associated infections and are also being applied successfully to decrease rates of peritonitis in children...
October 18, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Kyla D Joubert, Charles D Mabry, Kyle J Kalkwarf, Richard D Betzold, Horace J Spencer, Kara M Spinks, Austin Porter, Saleema Karim, Ronald D Robertson, Michael J Sutherland, Robert T Maxson
Major trunk trauma is common and costly, but comparisons of costs between trauma centers (TCs) are rare. Understanding cost is essential to improve quality, manage trauma service lines, and to facilitate institutional commitment for trauma. We have used results of a statewide trauma financial survey of Levels I to IV TC to develop a useful grouping method for costs and clinical characteristics of major trunk trauma. The trauma financial survey collected billing and clinical data on 75 per cent of the state trauma registry patients for fiscal year 2012...
September 2016: American Surgeon
Christopher P Price, Andrew St John, Robert Christenson, Volker Scharnhorst, Michael Oellerich, Patricia Jones, Howard A Morris
Improving quality and patient safety, containing costs and delivering value-for-money are the key drivers of change in the delivery of healthcare and have stimulated a shift from an activity-based service to a service based on patient-outcomes. The delivery of an outcomes-based healthcare agenda requires that the real value of laboratory medicine to all stakeholders be understood, effectively defined and communicated. The value proposition of any product or service is the link between the provider and the needs of the customer describing the utility of the product or service in terms of benefit to the customer...
November 1, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
Katherine E Rebello, Jeffrey Gosian, Marci Salow, Pamela Sweeney, James L Rudolph, Jane A Driver
PURPOSE: To evaluate the efficacy of the Rural Pharmacological Intervention in Late Life (PILL) program, a quality improvement initiative in which a Boston-based pharmacist provided postdischarge telepharmacy care to veterans from rural Maine. METHODS: Using an automated screening tool, we identified 100 veterans aged 65 and older who had an acute care admission to VA medical centers in Boston or Maine and were at risk of problems with medication management. The PILL pharmacist called patients the week after hospital discharge to reconcile medications, assess adherence, and identify potentially inappropriate drugs...
September 8, 2016: Journal of Rural Health
Raquel M Bemfeito, Jéssica F Rodrigues, Jonas G E Silva, Luiz R Abreu
The Serra da Canastra region, located in southwestern Minas Gerais, Brazil, is recognized worldwide for its tradition of producing artisanal cheeses. However, as production is done by hand, great variability exists in the characteristics of artisanal Minas cheese. Thus, it is important to characterize the sensory profile of these products and verify the quality attributes that lead to their acceptance. Therefore, this study aimed to characterize the dynamic sensorial profile of artisanal Minas cheese produced in the Serra da Canastra region through temporal dominance of sensations and sensory acceptance tests and verify the attributes that lead to product quality...
October 2016: Journal of Dairy Science
Frederick B Peng, James F Burrows, Eric D Shirley, Paul Rosen
BACKGROUND: Despite efforts to enhance the patient experience, many health care providers continue to struggle to improve patient satisfaction as the identification of tangible quality improvement areas remains difficult. This dilemma is particularly relevant in pediatric settings, where patient satisfaction measures have not been as thoroughly studied in subspecialties such as orthopaedics. We investigate this issue to identify the major drivers of patient satisfaction in pediatric orthopaedics, which has significant financial and professional implications for both hospital administrators and health care providers...
July 20, 2016: Journal of Pediatric Orthopedics
Evan S Fieldston, Jennifer A Jonas, Virginia A Lederman, Ashley J Zahm, Rui Xiao, Christina M DiMichele, Ellen Tracy, Katherine Kurbjun, Rebecca Tenney-Soeiro, Debra L Geiger, Annique Hogan, Michael Apkon
BACKGROUND: To develop the capacity for rapid-cycle improvement at the unit level, a large freestanding children's hospital designated 2 inpatient units with normal patient loads and workforce as pilot "Innovation Units" where frontline staff was trained to lead rigorous improvement portfolios. METHODS: Frontline staff received improvement training, and interdisciplinary teams brainstormed ideas for tests of change. Ideas were prioritized using an impact-effort evaluation and an assessment of how they aligned with high-level goals...
August 2016: Hospital Pediatrics
Angela M Statile, Amanda C Schondelmeyer, Joanna E Thomson, Laura H Brower, Blair Davis, Jacob Redel, Julie Hausfeld, Karen Tucker, Denise L White, Christine M White
BACKGROUND AND OBJECTIVE: Children with medical complexity have unique needs when facilitating transitions from hospital to home. Defining readiness for discharge is challenging, and preparation requires coordination of family, education, equipment, and medications. Our multidisciplinary team aimed to increase the percentage of medically complex hospital medicine patients discharged within 2 hours of meeting medical discharge goals from 50% to 80%. METHODS: We used quality improvement methods to identify key drivers and inform interventions...
August 2016: Pediatrics
Shawn L Ralston, Emily Carson Atwood, Matthew D Garber, Alison Volpe Holmes
OBJECTIVES: Unnecessary care is well-established as a quality problem affecting acute viral bronchiolitis, one of the most common pediatric illnesses. While there is an extensive quality improvement literature on the disease, published work primarily reflects the experience of freestanding children's hospitals. We sought to better understand the specific barriers and drivers for successful quality improvement in community and non-freestanding children's facilities. METHODS: We undertook a mixed methods study to identify correlates of success in a bronchiolitis quality improvement collaborative of community hospitals and children's hospitals within adult hospitals...
July 8, 2016: Academic Pediatrics
Maria Lucia Specchia, Antonio Giulio de Belvis, Paolo Parente, Maria Avolio, Walter Ricciardi, Gianfranco Damiani
BACKGROUND: Clinical governance (CG) is an approach to quality improvement in healthcare aimed at achieving a patient-centered health care system. The main objective of this study was to highlight human centered healthcare latent factors underlying the results of a CG assessment performed in the teaching hospital "A. Gemelli" of Rome, Italy. MATERIALS AND METHODS: CG implementation levels were assessed through OPTIGOV© (OPTimizing healthcare GOVernance), a CG scorecard methodology...
April 2016: Annali Dell'Istituto Superiore di Sanità
N Gow, C McGuinness, A J Morris, A McLellan, J T Morris, S A Roberts
AIM: To determine the excess costs attributable to surgical site infections (SSI) following primary hip and knee joint arthroplasty at Auckland City Hospital. METHODS: A retrospective case-control study. Cases were patients who developed a SSI following primary hip (THA) and knee arthroplasty (TKA) surgery within 90 days of the procedure. Cases were matched 1:2 with controls; patients whose primary hip and knee arthroplasty procedures were not complicated by infection...
2016: New Zealand Medical Journal
Daan Westra, Federica Angeli, Evelina Jatautaitė, Martin Carree, Dirk Ruwaard
INTRODUCTION: Medical specialists seem to increasingly work in- and be affiliated to- multiple organizations. We define this phenomenon as specialist sharing. This form of inter-organizational cooperation has received scant scholarly attention. We investigate the extent of- and motives behind- specialist sharing, in the price-competitive hospital market of the Netherlands. METHODS: A mixed-method was adopted. Social network analysis was used to quantitatively examine the extent of the phenomenon...
August 2016: Social Science & Medicine
Rhoda MacRae, Kevin D Rooney, Alan Taylor, Katrina Ritters, Julita Sansoni, Manuel Lillo Crespo, Brigita Skela-Savič, Barbara O'Donnell
BACKGROUND: Numerous international policy drivers espouse the need to improve healthcare. The application of Improvement Science has the potential to restore the balance of healthcare and transform it to a more person-centred and quality improvement focussed system. However there is currently no accredited Improvement Science education offered routinely to healthcare students. This means that there are a huge number of healthcare professionals who do not have the conceptual or experiential skills to apply Improvement Science in everyday practise...
July 2016: Nurse Education Today
Jodie Bailie, Alison Laycock, Veronica Matthews, Ross Bailie
INTRODUCTION: There is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary health care (PHC) centers in delivery of care. Where aspects of care are not being done well across a range of PHC centers, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders' perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement...
2016: Frontiers in Public Health
Mathilde François, François Osiurak, Alexandra Fort, Philippe Crave, Jordan Navarro
Automotive human-machine interface (HMI) design is facing new challenges due to the technological advances of the last decades. The design process has to be adapted in order to address human factors and road safety challenges. It is now widely accepted that user involvement in the HMI design process is valuable. However, the current form of user involvement in industry remains at the stages of concept assessment and usability tests. Moreover, the literature in other fields (e.g. information systems) promotes a broader user involvement with participatory design (i...
May 10, 2016: Ergonomics
Ko Un Park, Ilan Rubinfeld, Arielle Hodari, Zane Hammoud
BACKGROUND: Although influence of technical complications in association to hospital length of stay has been studied extensively in esophageal resection, nontechnical factors responsible for prolonged length of stay have not been reported. Using the NSQIP dataset, we hypothesized that we would be able to identify factors associated with prolonged length of stay after esophagectomy. STUDY DESIGN: National Surgical Quality Improvement Program data from 2005 to 2012 were reviewed for CPT codes for esophagectomy...
August 2016: Journal of the American College of Surgeons
Akin Nihat, Simon de Lusignan, Nicola Thomas, Mohammad Aumran Tahir, Hugh Gallagher
OBJECTIVES: This study is a process evaluation of the Quality Improvement in Chronic Kidney Disease (QICKD) study, comparing audit-based education (ABE) and sending clinical guidelines and prompts (G&P) with usual practice, in improving systolic blood pressure control in primary care. This evaluation aimed to explore how far clinical staff in participating practices were aware of the intervention, and why change in practice might have taken place. SETTING: 4 primary care practices in England: 2 received ABE, and 2 G&P...
2016: BMJ Open
Jean Anne Connor, Jeanne P Ahern, Barbara Cuccovia, Courtney L Porter, Alana Arnold, Roger E Dionne, Patricia A Hickey
BACKGROUND: The incidence of medication errors remains a continued concern across the spectrum of health care. Approaches to averting medication errors and implementing a culture of safety are key areas of focus for most institutions. We describe our experience of implementing a distraction-free medication safety practice across a large free-standing children's hospital. METHODS: A nurse-led interprofessional group was convened to develop a program-wide quality improvement process for the practice of medication safety...
May 2016: Dimensions of Critical Care Nursing: DCCN
Natalia O Glebova, Michael Bronsert, Karl E Hammermeister, Mark R Nehler, Douglas R Gibula, Mahmoud B Malas, James H Black, William G Henderson
OBJECTIVE: Postoperative readmissions are frequent in vascular surgery patients, but it is not clear which factors are the main drivers of readmissions. Specifically, the relative contributions of patient comorbidities vs those of operative factors and postoperative complications are unknown. We sought to study the multiple potential drivers of readmission and to create a model for predicting the risk of readmission in vascular patients. METHODS: The 2012-2013 American College of Surgeons National Surgical Quality Improvement Program data set was queried for unplanned readmissions in 86,238 vascular patients...
July 2016: Journal of Vascular Surgery
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