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Mathieu Goyette, Jorge Flores-Aranda, Karine Bertrand, Frédérick Pronovost, Valérie Aubut, Roberto Ortiz, Marianne Saint-Jacques
Background: Men who have sex with men (MSM) have distinctive substance use (SU), which is more often linked to a sexual context than it is for their heterosexual peers. Screening of MSM's SU, its sexual contexts and the associated risks, is of clinical and public health concern. This paper aims to describe the preliminary development of a screening tool for health-risk sexual behaviours related to SU and to make recommendations for its potential use. Methods: Community-based participatory research and transdisciplinary approaches guided the development process...
March 16, 2018: Sexual Health
Nestoras Nicolas Mathioudakis, Estelle Everett, Shuvodra Routh, Peter J Pronovost, Hsin-Chieh Yeh, Sherita Hill Golden, Suchi Saria
Objective: To develop and validate a multivariable prediction model for insulin-associated hypoglycemia in non-critically ill hospitalized adults. Research design and methods: We collected pharmacologic, demographic, laboratory, and diagnostic data from 128 657 inpatient days in which at least 1 unit of subcutaneous insulin was administered in the absence of intravenous insulin, total parenteral nutrition, or insulin pump use (index days). These data were used to develop multivariable prediction models for biochemical and clinically significant hypoglycemia (blood glucose (BG) of ≤70 mg/dL and <54 mg/dL, respectively) occurring within 24 hours of the index day...
2018: BMJ Open Diabetes Research & Care
Peter J Pronovost, C Michael Armstrong, Renee Demski, Ronald R Peterson, Paul B Rothman
Purpose The purpose of this paper is to offer six principles that health system leaders can apply to establish a governance and management system for the quality of care and patient safety. Design/methodology/approach Leaders of a large academic health system set a goal of high reliability and formed a quality board committee in 2011 to oversee quality and patient safety everywhere care was delivered. Leaders of the health system and every entity, including inpatient hospitals, home care companies, and ambulatory services staff the committee...
March 19, 2018: Journal of Health Organization and Management
Graham P Martin, Emma-Louise Aveling, Anne Campbell, Carolyn Tarrant, Peter J Pronovost, Imogen Mitchell, Christian Dankers, David Bates, Mary Dixon-Woods
BACKGROUND: Healthcare organisations often fail to harvest and make use of the 'soft intelligence' about safety and quality concerns held by their own personnel. We aimed to examine the role of formal channels in encouraging or inhibiting employee voice about concerns. METHODS: Qualitative study involving personnel from three academic hospitals in two countries. Interviews were conducted with 165 participants from a wide range of occupational and professional backgrounds, including senior leaders and those from the sharp end of care...
February 19, 2018: BMJ Quality & Safety
Jody E Hooper, Hazel Richardson, Amelia W Maters, Karen C Carroll, Peter J Pronovost
A vertically and horizontally well-integrated quality improvement team is essential for effective quality data collection and implementation of improvement measures. We outline the quality structure of a large academic pathology department and describe successful projects across multiple divisions made possible by this tightly integrated structure. The physician vice chair for quality organizes departmental quality efforts and provides representation at the hospital level. The department has an independent continuous quality improvement unit and each laboratory of the department has a staff quality improvement representative...
January 2018: Academic Pathology
Steven J Kravet, Jennifer Bailey, Peter Pronovost
No abstract text is available yet for this article.
January 2018: Quality Management in Health Care
O Joseph Bienvenu, Lisa Aronson Friedman, Elizabeth Colantuoni, Victor D Dinglas, Kristin A Sepulveda, Pedro Mendez-Tellez, Carl Shanholz, Peter J Pronovost, Dale M Needham
PURPOSE: We aimed to characterize anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms over 5-year follow-up after acute respiratory distress syndrome (ARDS) and determine risk factors for prolonged psychiatric morbidity. METHODS: This prospective cohort study enrolled patients from 13 medical and surgical intensive care units in four hospitals, with follow-up at 3, 6, 12, 24, 36, 48, and 60 months post-ARDS. Trained research staff administered the Hospital Anxiety and Depression Scale (HADS) (scores ≥ 8 on anxiety and depression subscales indicating substantial symptoms) and the Impact of Event Scale-Revised (IES-R, scores ≥ 1...
January 2018: Intensive Care Medicine
Andrew S Jarrell, Rachel M Kruer, Loredana Diana Berescu, Peter J Pronovost, Julie B Trivedi
No abstract text is available yet for this article.
December 8, 2017: Journal of Critical Care
Andrew S Jarrell, Rachel M Kruer, Loredana Diana Berescu, Peter J Pronovost, Julie B Trivedi
PURPOSE: Multidrug-resistant (MDR) Gram-negative infection increases risk of mortality, other complications, and costs. The objective of this study was to determine the prevalence of and identify factors associated with in-hospital mortality among critically ill surgical patients. MATERIALS AND METHODS: This case-control study included critically ill surgical patients from 2011 to 2014 who had a carbapenem-resistant Enterobacteriaceae (CRE), MDR P. aeruginosa, or MDR Acinetobacter spp...
November 24, 2017: Journal of Critical Care
Peter J Pronovost, Daniel J Brotman, Erik H Hoyer, Amy Deutschendorf
Current hospital readmission measures are part of the Centers for Medicare & Medicaid Services Five-Star Quality Rating System but are inadequate for reporting hospital quality. We review potential biases in the readmission measures and offer policy recommendations to address these biases. Hospital readmission rates are influenced by multiple sources of variation (eg, mix of patients served, bias in the performance measure); true differences in quality of care are often a much smaller source of this variation...
December 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Hanan H Edrees, Mohd Nasir Mohd Ismail, Bernadette Kelly, Christine A Goeschel, Sean M Berenholtz, Peter J Pronovost, Ali Abdul Kareem Al Obaidli, Sallie J Weaver
Objective: Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses. Design, setting, participants, intervention: A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort. Main outcome measures: Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority...
November 1, 2017: International Journal for Quality in Health Care
Simon C Mathews, Peter J Pronovost, E Lee Daugherty Biddison, Brent G Petty, Mark E Anderson, Terry S Nelson, Katie Outten, Ronald Langlotz, Denice Duda, Carrie A Herzke, Kimberly S Peairs, Sherita H Golden, Matthew B Lautzenheiser, Hailey J James, Sanjay V Desai, Sara C Keller, Leonard S Feldman, Amit K Pahwa, Stephen A Berry
Payers, providers, and patients increasingly recognize the importance of quality and safety in health care. Academic Departments of Medicine can advance quality and safety given the large populations they serve and the broad spectrum of diseases they treat. However, there are only few detailed examples of how quality and safety can be organized. This article describes a practical model at The Johns Hopkins Hospital Department of Medicine and details its structure and operation within a large academic health system...
November 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Hazel Crews, Peter J Pronovost, Paul R Helft, J Matthew Austin
No abstract text is available yet for this article.
December 2017: Joint Commission Journal on Quality and Patient Safety
J Matthew Austin, Bernard Black, Peter J Pronovost
No abstract text is available yet for this article.
November 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Adjhaporn Khunlertkit, Leonard Dorissaint, Allen Chen, Lori Paine, Peter J Pronovost
OBJECTIVES: Duplicate medical record creation is a common and consequential health care systems error often caused by poor search system usability and inappropriate user training. METHODS: We conducted two phases of scenario-based usability testing with patient registrars working in areas at risk of generating duplicate medical records. Phase 1 evaluated the existing search system, which led to system redesigns. Phase 2 tested the redesigned system to mitigate potential errors before health system-wide implementation...
October 25, 2017: Journal of Patient Safety
Samantha I Pitts, Nisa M Maruthur, Ngoc-Phuong Luu, Kimberly Curreri, Renee Grimes, Candace Nigrin, Heather F Sateia, Melinda D Sawyer, Peter J Pronovost, Jeanne M Clark, Kimberly S Peairs
BACKGROUND: While there is growing awareness of the risk of harm in ambulatory health care, most patient safety efforts have focused on the inpatient setting. The Comprehensive Unit-based Safety Program (CUSP) has been an integral part of highly successful safety efforts in inpatient settings. In 2014 CUSP was implemented in an academic primary care practice. METHODS: As part of CUSP implementation, staff and clinicians underwent training on the science of safety and completed a two-question safety assessment survey to identify safety concerns in the practice...
November 2017: Joint Commission Journal on Quality and Patient Safety
Geoffrey N Pronovost, Elaine Y Hsiao
There is increasing evidence that the microbiome regulates host metabolism, but specific mechanisms underlying these interactions remain poorly understood. In a recent paper in Science, Wang et al. (2017) reveal that the gut microbiota regulates the expression of circadian-clock genes to impact host lipid metabolism and body composition.
October 17, 2017: Immunity
Carrie L Nieman, C Matthew Stewart, David W Eisele, Peter J Pronovost, Christine G Gourin
OBJECTIVES/HYPOTHESIS: We previously reported that high-volume hospital head and neck cancer (HNCA) surgical care is associated with decreased mortality, largely explained by reduced rates of failure to rescue. Frailty is an independent predictor of mortality, but is significantly less likely in patients receiving high-volume care. We investigate whether differences in frailty rates explain the relationship between volume and outcomes in HNCA patients and whether frailty confounds the relationship between failure to rescue and mortality...
October 17, 2017: Laryngoscope
Brandyn D Lau, Michael B Streiff, Peggy S Kraus, Deborah B Hobson, Dauryne L Shaffer, Jonathan K Aboagye, Peter J Pronovost, Elliott R Haut
No abstract text is available yet for this article.
October 17, 2017: Journal of General Internal Medicine
William V Padula, Robert Brett McQueen, Peter J Pronovost
The Second Panel on Cost-Effectiveness in Health and Medicine recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses has a number of questions unanswered with respect to the implementation of transparent, open source code interface for economic models. The possibility of making economic model source code could be positive and progressive for the field; however, several unintended consequences of this system should be first considered before complete implementation of this model...
November 2017: Medical Care
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