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Quality Improvement

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355 papers 25 to 100 followers
By Jamie Jarmul Md / PhD student at UNC - Chapel Hill, PhD in Health Policy and Management
Aleksey Tentler, Mirela Feurdean, Steven Keller, Neil Kothari
BACKGROUND: Quality improvement (QI) is essential in clinical practice, requiring effective teaching in residency. Barriers include lack of structure, mentorship, and time. OBJECTIVE: To develop a longitudinal QI curriculum for an internal medicine residency program with limited faculty resources and evaluate its effectiveness. METHODS: All medicine residents were provided with dedicated research time every 8 weeks during their ambulatory blocks...
July 2016: Journal of Graduate Medical Education
Rashmi N Aurora, Stuart F Quan
Obstructive sleep apnea (OSA) is a highly prevalent condition which remains under-diagnosed and under-treated. Untreated OSA is associated with several chronic medical conditions, a reduction in quality of life and increases in health care costs. Therefore, early identification of undiagnosed cases is important. Implementation of a screening measure in a primary care environment for populations at high-risk for OSA could improve patient outcomes and reduce the health care burden of untreated OSA.
2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Joshua R Lakin, Susan D Block, J Andrew Billings, Luca A Koritsanszky, Rebecca Cunningham, Lisa Wichmann, Doreen Harvey, Jan Lamey, Rachelle E Bernacki
IMPORTANCE: The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satisfaction, and lower health care costs; however, the role of primary care clinicians in driving conversations about goals and priorities in serious illness is not well defined...
September 1, 2016: JAMA Internal Medicine
Mohammed K Ali, Kavita Singh, Dimple Kondal, Raji Devarajan, Shivani A Patel, Roopa Shivashankar, Vamadevan S Ajay, A G Unnikrishnan, V Usha Menon, Premlata K Varthakavi, Vijay Viswanathan, Mala Dharmalingam, Ganapati Bantwal, Rakesh Kumar Sahay, Muhammad Qamar Masood, Rajesh Khadgawat, Ankush Desai, Bipin Sethi, Dorairaj Prabhakaran, K M Venkat Narayan, Nikhil Tandon
BACKGROUND: Achievement of diabetes care goals is suboptimal globally. Diabetes-focused quality improvement (QI) is effective but remains untested in South Asia. OBJECTIVE: To compare the effect of a multicomponent QI strategy versus usual care on cardiometabolic profiles in patients with poorly controlled diabetes. DESIGN: Parallel, open-label, pragmatic randomized, controlled trial. ( NCT01212328). SETTING: Diabetes clinics in India and Pakistan...
September 20, 2016: Annals of Internal Medicine
Michael J Kavanaugh, Joanne D So, Peter J Park, Konrad L Davis
INTRODUCTION: Risk stratification with the Modified Early Warning System (MEWS) or electronic cardiac arrest trigger (eCART) has been utilized with ward patients to preemptively identify high-risk patients who might benefit from enhanced monitoring, including early intensive care unit (ICU) transfer. In-hospital mortality from cardiac arrest is ∼80%, making preventative interventions an important focus area. ICUs have lower patient to nurse ratios than wards, resulting in less emphasis on the development of ICU early warning systems...
July 8, 2016: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Tinisha M Lambeth, Mario A Rojas, Amy P Holmes, Robin B Dail
BACKGROUND: Very low birth-weight (<1500 g) infants are vulnerable to their environment during the first hour after birth. We designed an evidence-based golden hour protocol (GHP) with a goal to stabilize and perform admission procedures within 1 hour of birth at a level IIIB neonatal intensive care unit (NICU). PURPOSE: The aim of this quality improvement project was to ascertain whether an evidence-based GHP would improve care efficiency and short-term outcomes...
August 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Nicholas M Selby, Anna Casula, Laura Lamming, Mohammed Mohammed, Fergus Caskey
Acute kidney injury (AKI) is common and associated with extremely poor outcomes. While strategies to tackle deficiencies in basic care delivery are advocated, robust testing of their effectiveness is also needed. The Tackling AKI study was designed to test whether a complex intervention (consisting of an e-alert, care bundle and education programme) can be successfully implemented across a range of UK hospitals, and whether this will deliver improved patient outcomes. This multicentre, pragmatic clinical trial will employ a cluster randomised stepped wedge design to study this in all adult patients who sustain AKI in the 5 participating hospitals over a 2-year period...
July 5, 2016: Nephron
Karin E Johnson, Tracy M Mroz, Marie Abraham, Marlaine Figueroa Gray, Mary Minniti, Wendy Nickel, Robert Reid, Jennifer Sweeney, Dominick L Frosch, Debra L Ness, Clarissa Hsu
INTRODUCTION: Ambulatory practices that actively partner with patients and families in quality improvement (QI) report benefits such as better patient/family interactions with physicians and staff, and patient empowerment. However, creating effective patient/family partnerships for ambulatory care improvement is not yet routine. The objective of this paper is to provide practices with concrete evidence about meaningfully involving patients and families in QI activities. METHODS: Review of literature published from 2000-2015 and a focus group conducted in 2014 with practice advisors...
August 2016: Advances in Therapy
Peter S Vosler, Jason I Kass, Eric W Wang, Carl H Snyderman
OBJECTIVE: We compare the management of patients with severe epistaxis before and after the implementation a clinical care pathway (CCP) to standardize care, minimize hospital stay, and decrease cost. STUDY DESIGN: Single prospective analysis with historical control. SETTING: Tertiary academic hospital. SUBJECTS AND METHODS: Patients treated for epistaxis between October 2012 to December 2013 were compared with a prospective analysis of patients treated for severe epistaxis after implementation of a CCP from June 2014 to February 2015...
June 28, 2016: Otolaryngology—Head and Neck Surgery
Deborah J Cohen, Bijal A Balasubramanian, Leah Gordon, Miguel Marino, Sarah Ono, Leif I Solberg, Benjamin F Crabtree, Kurt C Stange, Melinda Davis, William L Miller, Laura J Damschroder, K John McConnell, John Creswell
BACKGROUND: The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic)...
2016: Implementation Science: IS
Leslie A Rhodes, Kevin M Wall, Staci L Abernathy, Ashley B Moellinger, Santiago Borasino, Jeffrey A Alten
OBJECTIVES: IV potassium supplementation is commonly used in the pediatric cardiovascular ICU. However, concentrated IV potassium chloride doses can lead to life-threatening complications. We report results of a quality improvement project aimed at decreasing concentrated IV potassium chloride exposure. DESIGN: Retrospective evaluation of a quality improvement project aimed at reducing IV potassium chloride exposure. SETTING: Pediatric cardiac ICU...
August 2016: Pediatric Critical Care Medicine
David A Stewart, Justin Junn, Megan A Adams, Joanna L Spencer-Segal, Emily Perdoncin, Kerri Lopez, Christopher S Kim
OBJECTIVES: Patient safety event (PSE) reporting is a critical element for healthcare organizations that are striving for continuous quality improvement. Although resident physicians routinely provide the majority of direct patient care, the level of their participation in PSE reporting historically has been low. In addition, as part of the Accreditation Council for Graduate Medical Education's Next Accreditation System, the Clinical Learning Environment Review site visit assesses residents' engagement in PSE reporting at each accredited academic institution...
July 2016: Southern Medical Journal
Paul A Heidenreich, Anju Sahay, Nancy Oliva, Parisa Gholami, Shoutzu Lin, Brian S Mittman, John S Rumsfeld
BACKGROUND: Hospital to Home (H2H) is a national quality improvement initiative sponsored by the Institute for Healthcare Improvement and the American College of Cardiology, with the goal of reducing readmission for patients hospitalized with heart disease. We sought to determine the impact of H2H within the Veterans Affairs (VA) health care system. METHODS: Using a controlled interrupted time series, we determined the association of VA hospital enrollment in H2H with the primary outcome of 30-day all-cause readmission following a heart failure hospitalization...
July 2016: Quality Management in Health Care
Walter T Lee, David L Witsell, Kourosh Parham, Jennifer J Shin, Nikita Chapurin, Melissa A Pynnonen, Alan Langman, Anh Nguyen-Huynh, Sheila E Ryan, Andrea Vambutas, Rhonda S Roberts, Kris Schulz
OBJECTIVES: (1) Compare postoperative bleeding in the CHEER network (Creating Healthcare Excellence through Education and Research) among age groups, diagnoses, and practice types. (2) Report the incidence of bleeding by individual CHEER practice site based on practice guidelines. STUDY DESIGN: Retrospective data collection database review of the CHEER network based on ICD-9 and CPT codes related to tonsillectomy patients. SETTING: Multisite practice-based network...
July 2016: Otolaryngology—Head and Neck Surgery
Tracy E Robinson, Anna Janssen, Paul Harnett, Kylie E Museth, Pamela J Provan, Danny J Hills, Tim Shaw
Objective The aim of the present study was to identify key enabling factors for engaging multidisciplinary teams (MDTs) in cancer care across the spectrum of translational research and quality improvement (QI) projects.Methods The study was conducted in two large Sydney metropolitan hospitals. Qualitative methods, including structured observations of MDT meetings and semi-structured interviews with MDT leaders and champions, were used to identify how teams interact with and generate research and implementation initiatives...
July 4, 2016: Australian Health Review: a Publication of the Australian Hospital Association
Kathleen Broderick-Forsgren, Wynn G Hunter, Ryan D Schulteis, Wen-Wei Liu, Joel C Boggan, Poonam Sharma, Steven Thomas, Aimee Zaas, Jonathan Bae
Background Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians...
May 2016: Journal of Graduate Medical Education
Ellen C Rubin, Radhika Pisupati, Steven F Nerenberg
PURPOSE: The purpose of this study is to determine the accuracy of a pharmacy technician-collected medication history pilot program in the emergency department. This was completed by reviewing all elements of the technician activity by direct observation and by verifying the technician-collected medication list through a second phone call by a pharmacist to the outpatient pharmacy. METHODS: This was a retrospective, single-center study conducted from March to April 2015...
May 2016: Hospital Pharmacy
Edward S Lee, Rajesh Vedanthan, Panniyammakal Jeemon, Jemima H Kamano, Preeti Kudesia, Vikram Rajan, Michael Engelgau, Andrew E Moran
BACKGROUND: The majority of global cardiovascular disease (CVD) burden falls on people living in low- and middle-income countries (LMICs). In order to reduce preventable CVD mortality and morbidity, LMIC health systems and health care providers need to improve the delivery and quality of CVD care. OBJECTIVES: As part of the Disease Control Priorities Three (DCP3) Study efforts addressing quality improvement, we reviewed and summarized currently available evidence on interventions to improve quality of clinic-based CVD prevention and management in LMICs...
2016: PloS One
Sohini Stone, Henry C Lee, Paul J Sharek
BACKGROUND: The California Perinatal Quality Care Collaborative led the Breastmilk Nutrition Quality Improvement Collaborative from October 2009 to September 2010 to increase the percentage of very low birth weight infants receiving breast milk at discharge in 11 collaborative neonatal ICUs (NICUs). Observed increases in breast milk feeding and decreases in necrotizing enterocolitis persisted for 6 months after the collaborative ended. Eighteen to 24 months after the end of the collaborative, some sites maintained or further increased their gains, while others trended back toward baseline...
July 2016: Joint Commission Journal on Quality and Patient Safety
Debbie McKetta, T Eugene Day, Virginia Jones, Alexis Perri, Susan C Nicolson
BACKGROUND: Managing service disruptions is a challenge in every health care environment. Discrete event simulation (DES)--a computer modeling tool used to build in silico (that is, in a digital computer) testbeds for potential changes in complex systems--has been deployed in health care for research and quality improvement (QI), specifically in surgical suite management. A strategy for managing a 6-week planned service disruption needed to be enacted 12 weeks after the announcement, in late October 2014, of the closure of the Hybrid Suite (operating room/catheterization laboratory) for renovation, at The Children's Hospital of Philadelphia's Cardiac Center's Cardiac Operative and Imaging Complex (COIC)...
July 2016: Joint Commission Journal on Quality and Patient Safety
2016-06-18 19:18:31
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