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Quality Improvement

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394 papers 100 to 500 followers
By Jamie Jarmul Md / PhD student at UNC - Chapel Hill, PhD in Health Policy and Management
https://www.readbyqxmd.com/read/28060053/safety-net-hospitals-face-more-barriers-yet-use-fewer-strategies-to-reduce-readmissions
#1
Jose F Figueroa, Karen E Joynt, Xiner Zhou, Endel J Orav, Ashish K Jha
OBJECTIVE: US hospitals that care for vulnerable populations, "safety-net hospitals" (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program, which penalizes hospitals with higher-than-expected readmissions. Understanding whether SNHs face unique barriers to reducing readmissions or whether they underuse readmission-prevention strategies is important. DESIGN: We surveyed leadership at 1600 US acute care hospitals, of whom 980 participated, between June 2013 and January 2014...
March 2017: Medical Care
https://www.readbyqxmd.com/read/27973617/quantifying-geographic-variation-in-health-care-outcomes-in-the-united-states-before-and-after-risk-adjustment
#2
Barry L Rosenberg, Joshua A Kellar, Anna Labno, David H M Matheson, Michael Ringel, Paige VonAchen, Richard I Lesser, Yue Li, Justin B Dimick, Atul A Gawande, Stefan H Larsson, Hamilton Moses
BACKGROUND: Despite numerous studies of geographic variation in healthcare cost and utilization at the local, regional, and state levels across the U.S., a comprehensive characterization of geographic variation in outcomes has not been published. Our objective was to quantify variation in US health outcomes in an all-payer population before and after risk-adjustment. METHODS AND FINDINGS: We used information from 16 independent data sources, including 22 million all-payer inpatient admissions from the Healthcare Cost and Utilization Project (which covers regions where 50% of the U...
2016: PloS One
https://www.readbyqxmd.com/read/27922462/fostering-evidence-based-quality-improvement-for-patient-centered-medical-homes-initiating-local-quality-councils-to-transform-primary-care
#3
Susan E Stockdale, Jessica Zuchowski, Lisa V Rubenstein, Negar Sapir, Elizabeth M Yano, Lisa Altman, Jacqueline J Fickel, Skye McDougall, Timothy Dresselhaus, Alison B Hamilton
BACKGROUND: Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation...
December 3, 2016: Health Care Management Review
https://www.readbyqxmd.com/read/27926614/clinical-coordination-in-accountable-care-organizations-a-qualitative-study
#4
Valerie A Lewis, Karen Schoenherr, Taressa Fraze, Aleen Cunningham
BACKGROUND: Accountable care organizations (ACOs) are becoming a common payment and delivery model. Despite widespread interest, little empirical research has examined what efforts or strategies ACOs are using to change care and reduce costs. Knowledge of ACOs' clinical efforts can provide important context for understanding ACO performance, particularly to distinguish arenas where ACOs have and have not attempted care transformation. PURPOSE: The aim of the study was to understand ACOs' efforts to change clinical care during the first 18 months of ACO contracts...
December 6, 2016: Health Care Management Review
https://www.readbyqxmd.com/read/27926663/the-impact-of-value-based-healthcare-for-inflammatory-bowel-diseases-on-healthcare-utilization-a-pilot-study
#5
Welmoed K van Deen, Arlen Spiro, A Burak Ozbay, Martha Skup, Adriana Centeno, Natalie E Duran, Precious N Lacey, Darius Jatulis, Eric Esrailian, Martijn G H van Oijen, Daniel W Hommes
BACKGROUND AND OBJECTIVES: Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring...
March 2017: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27893129/us-emergency-department-visits-for-outpatient-adverse-drug-events-2013-2014
#6
Nadine Shehab, Maribeth C Lovegrove, Andrew I Geller, Kathleen O Rose, Nina J Weidle, Daniel S Budnitz
Importance: The Patient Protection and Affordable Care Act of 2010 brought attention to adverse drug events in national patient safety efforts. Updated, detailed, nationally representative data describing adverse drug events can help focus these efforts. Objective: To describe the characteristics of emergency department (ED) visits for adverse drug events in the United States in 2013-2014 and describe changes in ED visits for adverse drug events since 2005-2006...
November 22, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27872113/does-integrated-care-reduce-hospital-activity-for-patients-with-chronic-diseases-an-umbrella-review-of-systematic-reviews
#7
Sarah Damery, Sarah Flanagan, Gill Combes
OBJECTIVE: To summarise the evidence regarding the effectiveness of integrated care interventions in reducing hospital activity. DESIGN: Umbrella review of systematic reviews and meta-analyses. SETTING: Interventions must have delivered care crossing the boundary between at least two health and/or social care settings. PARTICIPANTS: Adult patients with one or more chronic diseases. DATA SOURCES: MEDLINE, Embase, ASSIA, PsycINFO, HMIC, CINAHL, Cochrane Library (HTA database, DARE, Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP, HEED, manual screening of references...
November 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/27886435/a-multicomponent-quality-improvement-intervention-to-improve-blood-pressure-and-reduce-racial-disparities-in-rural-primary-care-practices
#8
Crystal W Cené, Jacqueline R Halladay, Ziya Gizlice, Katrina E Donahue, Doyle M Cummings, Alan Hinderliter, Cassandra Miller, Larry F Johnson, Beverly Garcia, Jim Tillman, Edwin P Little, Marjorie R Rachide, Thomas C Keyserling, Alice Ammerman, Haibo Zhou, Jia-Rong Wu, Darren DeWalt
The Southeastern United States has the highest prevalence of hypertension and African Americans have disproportionately worse blood pressure control. The authors sought to evaluate the effect of a multicomponent practice-based quality improvement intervention on lowering mean systolic blood pressure (SBP) at 12 and 24 months compared with baseline among 525 patients, and to assess for a differential effect of the intervention by race (African Americans vs white). At 12 months, both African Americans (-5.0 mm Hg) and whites (-7...
April 2017: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/27397857/a-conceptual-model-for-episodes-of-acute-unscheduled-care
#9
Jesse M Pines, Gaetano R Lotrecchiano, Mark S Zocchi, Danielle Lazar, Jacob B Leedekerken, Gregg S Margolis, Brendan G Carr
We engaged in a 1-year process to develop a conceptual model representing an episode of acute, unscheduled care. Acute, unscheduled care includes acute illnesses (eg, nausea and vomiting), injuries, or exacerbations of chronic conditions (eg, worsening dyspnea in congestive heart failure) and is delivered in emergency departments, urgent care centers, and physicians' offices, as well as through telemedicine. We began with a literature search to define an acute episode of care and to identify existing conceptual models used in health care...
October 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27512721/factors-associated-with-emergency-department-visits-a-multistate-analysis-of-adult-fee-for-service-medicaid-beneficiaries
#10
Parul Agarwal, Thomas K Bias, Suresh Madhavan, Nethra Sambamoorthi, Stephanie Frisbee, Usha Sambamoorthi
OBJECTIVE: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. METHODS: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file...
April 27, 2016: Health Services Research and Managerial Epidemiology
https://www.readbyqxmd.com/read/27552616/association-of-integrated-team-based-care-with-health-care-quality-utilization-and-cost
#11
COMPARATIVE STUDY
Brenda Reiss-Brennan, Kimberly D Brunisholz, Carter Dredge, Pascal Briot, Kyle Grazier, Adam Wilcox, Lucy Savitz, Brent James
IMPORTANCE: The value of integrated team delivery models is not firmly established. OBJECTIVE: To evaluate the association of receiving primary care in integrated team-based care (TBC) practices vs traditional practice management (TPM) practices (usual care) with patient outcomes, health care utilization, and costs. DESIGN: A retrospective, longitudinal, cohort study to assess the association of integrating physical and mental health over time in TBC practices with patient outcomes and costs...
August 23, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27724889/roles-of-disease-severity-and-post-discharge-outpatient-visits-as-predictors-of-hospital-readmissions
#12
Hao Wang, Carol Johnson, Richard D Robinson, Vicki A Nejtek, Chet D Schrader, JoAnna Leuck, Johnbosco Umejiego, Allison Trop, Kathleen A Delaney, Nestor R Zenarosa
BACKGROUND: Risks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission...
October 10, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27858564/preparing-for-value-based-payment-a-stepwise-approach-for-cancer-centers
#13
Kerin B Adelson, Salimah Velji, Kavita Patel, Basit Chaudhry, Catherine Lyons, Rogerio Lilenbaum
Most cancer centers are ill-equipped to pursue value-based payment (VBP) because of limited information on their population's cost of care. Herein, we outline the stepwise approach used by Smilow Cancer Hospital at Yale-New Haven in our pursuit of better value care. First, we addressed institutional barriers. A move toward value required demonstration to Yale-New Haven Health System leadership that OCM would improve patient care, fund new infrastructure, and provide the opportunity to gain experience with VBP without a major threat to the financial stability of the health system...
October 2016: Journal of Oncology Practice
https://www.readbyqxmd.com/read/27881093/continuous-quality-improvement-in-nephrology-a-systematic-review
#14
Julie Wright Nunes, F Jacob Seagull, Panduranga Rao, Jonathan H Segal, Nandita S Mani, Michael Heung
BACKGROUND: Continuous quality improvement (CQI) has been successfully applied in business and engineering for over 60 years. While using CQI techniques within nephrology has received increased attention, little is known about where, and with what measure of success, CQI can be attributed to improving outcomes within nephrology care. This is particularly important as payors' focus on value-based healthcare and reimbursement is tied to achieving quality improvement thresholds. We conducted a systematic review of CQI applications in nephrology...
November 24, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27877025/medication-knowledge-of-patients-hospitalized-for-heart-failure-at-admission-and-after-discharge
#15
Florian Custodis, Franziska Rohlehr, Angelika Wachter, Michael Böhm, Martin Schulz, Ulrich Laufs
BACKGROUND: A substantial aspect of health literacy is the knowledge of prescribed medication. In chronic heart failure, incomplete intake of prescribed drugs (medication non-adherence) is inversely associated with clinical prognosis. Therefore, we assessed medication knowledge in a cohort of patients with decompensated heart failure at hospital admission and after discharge in a prospective, cross-sectional study. METHODS: One hundred and eleven patients presenting at the emergency department with acute decompensated heart failure were included (mean age 78...
2016: Patient Preference and Adherence
https://www.readbyqxmd.com/read/27202993/assessing-the-effectiveness-and-cost-effectiveness-of-audit-and-feedback-on-physician-s-prescribing-indicators
#16
F Soleymani, A Rashidian, R Dinarvand, A Kebriaeezade, M Hosseini, M Abdollahi
No abstract text is available yet for this article.
November 2014: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/27288054/theory-based-and-evidence-based-design-of-audit-and-feedback-programmes-examples-from-two-clinical-intervention-studies
#17
Sylvia J Hysong, Harrison J Kell, Laura A Petersen, Bryan A Campbell, Barbara W Trautner
BACKGROUND: Audit and feedback (A&F) is a common intervention used to change healthcare provider behaviour and, thus, improve healthcare quality. Although A&F can be effective its effectiveness varies, often due to the details of how A&F interventions are implemented. Some have suggested that a suitable conceptual framework is needed to organise the elements of A&F and also explain any observed differences in effectiveness. Through two examples from applied research studies, this article demonstrates how a suitable explanatory theory (in this case Kluger & DeNisi's Feedback Intervention Theory (FIT)) can be systematically applied to design better feedback interventions in healthcare settings...
April 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/27412170/model-depicting-aspects-of-audit-and-feedback-that-impact-physicians-acceptance-of-clinical-performance-feedback
#18
Velma L Payne, Sylvia J Hysong
BACKGROUND: Audit and feedback (A&F) is a strategy that has been used in various disciplines for performance and quality improvement. There is limited research regarding medical professionals' acceptance of clinical-performance feedback and whether feedback impacts clinical practice. The objectives of our research were to (1) investigate aspects of A&F that impact physicians' acceptance of performance feedback; (2) determine actions physicians take when receiving feedback; and (3) determine if feedback impacts physicians' patient-management behavior...
July 13, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27613786/a-practice-facilitation-and-academic-detailing-intervention-can-improve-cancer-screening-rates-in-primary-care-safety-net-clinics
#19
Emily M Mader, Chester H Fox, John W Epling, Gary J Noronha, Carlos M Swanger, Angela M Wisniewski, Karen Vitale, Amanda L Norton, Christopher P Morley
BACKGROUND: Despite the current evidence of preventive screening effectiveness, rates of breast, cervical, and colorectal cancer in the United States fall below national targets. We evaluated the efficacy and feasibility of combining practice facilitation and academic detailing quality improvement (QI) strategies to help primary care practices increase breast, cervical, and colorectal cancer screening among patients. METHODS: Practices received a 1-hour academic detailing session addressing current cancer screening guidelines and best practices, followed by 6 months of practice facilitation to implement evidence-based interventions aimed at increasing patient screening...
September 2016: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/27722149/how-to-make-feedback-more-effective-qualitative-findings-from-pilot-testing-of-an-audit-and-feedback-report-for-endoscopists
#20
Fiona Webster, Jigisha Patel, Kathleen Rice, Nancy Baxter, Lawrence Paszat, Linda Rabeneck, Jill Tinmouth
Background. Audit and feedback (A/F) reports are one of the few knowledge translation activities that can effect change in physician behavior. In this study, we pilot-tested an endoscopist A/F report to elicit opinions about the proposed report's usability, acceptability and usefulness, and implications for knowledge translation. Methods. Semi-structured qualitative interviews were conducted with eleven endoscopists in Ontario, Canada. We tested an A/F report template comprising 9 validated, accepted colonoscopy quality indicators populated with simulated data...
2016: Canadian Journal of Gastroenterology & Hepatology
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