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Quality Improvement

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411 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/29511090/pathology-of-poverty-the-need-for-quality-improvement-efforts-to-address-social-determinants-of-health
#1
Andrew S Boozary, Kaveh G Shojania
No abstract text is available yet for this article.
March 6, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29511005/effectiveness-of-implementation-interventions-in-improving-physician-adherence-to-guideline-recommendations-in-heart-failure-a-systematic-review
#2
Deepti Shanbhag, Ian D Graham, Karen Harlos, R Brian Haynes, Itzhak Gabizon, Stuart J Connolly, Harriette Gillian Christine Van Spall
BACKGROUND: The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success. METHODS: We searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction...
March 6, 2018: BMJ Open
https://www.readbyqxmd.com/read/29507124/next-generation-audit-and-feedback-for-inpatient-quality-improvement-using-electronic-health-record-data-a-cluster-randomised-controlled-trial
#3
Sajan Patel, Alvin Rajkomar, James D Harrison, Priya A Prasad, Victoria Valencia, Sumant R Ranji, Michelle Mourad
BACKGROUND: Audit and feedback improves clinical care by highlighting the gap between current and ideal practice. We combined best practices of audit and feedback with continuously generated electronic health record data to improve performance on quality metrics in an inpatient setting. METHODS: We conducted a cluster randomised control trial comparing intensive audit and feedback with usual audit and feedback from February 2016 to June 2016. The study subjects were internal medicine teams on the teaching service at an urban tertiary care hospital...
March 5, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29467276/neonatal-jaundice-improved-quality-and-cost-savings-after-implementation-of-a-standard-pathway
#4
Holly M Romero, Coral Ringer, Michael G Leu, Elaine Beardsley, Karen Kelly, Megan D Fesinmeyer, Wren L Haaland, James B Johnson, Darren Migita
OBJECTIVES: Seattle Children's Hospital sought to optimize the value equation for neonatal jaundice patients by creating a standard care pathway. METHODS: An evidence-based pathway for management of neonatal jaundice was created. This included multidisciplinary team assembly, comprehensive literature review, creation of a treatment algorithm and computer order sets, formulation of goals and metrics, roll-out of an education program for end users, and ongoing pathway improvement...
February 21, 2018: Pediatrics
https://www.readbyqxmd.com/read/29474657/a-comprehensive-framework-identifying-readmission-risk-factors-using-the-chaid-algorithm-a-prospective-cohort-study
#5
SiDiKA Kaya, Gulay Sain Guven, Seda Aydan, Onur Toka
Objective: To identify frequency of readmission after discharge from internal-medicine wards, readmission risk factors, and reasons and costs of readmission. Design: Prospective cohort study. Setting: A tertiary-care hospital in Turkey. Participants: 2622 adult patients discharged from internal-medicine wards of the hospital between 1 February 2015 and 31 January 2016. Main outcome measures: Thirty day all-cause readmission rates, reasons and costs of readmission...
February 21, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29280903/framework-for-research-on-implementation-of-process-redesigns
#6
Mahima Ashok, Dorothy Hung, Lucia Rojas-Smith, Michael T Halpern, Michael Harrison
BACKGROUND: Complex system interventions benefit from close attention to factors affecting implementation and resultant outcomes. This article describes a framework for examining these factors in process redesign (PR) and for assessing PR outcomes. METHODS: Using literature scans and expert comment on draft frameworks based on the Consolidated Framework for Implementation Research, a team of researchers developed the PR framework for the Agency for Healthcare Research and Quality...
January 2018: Quality Management in Health Care
https://www.readbyqxmd.com/read/29344622/barriers-to-and-facilitators-of-implementing-enhanced-recovery-pathways-using-an-implementation-framework-a-systematic-review
#7
(no author information available yet)
No abstract text is available yet for this article.
March 1, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29385959/reducing-frequent-utilization-of-psychiatric-emergency-services-among-veterans-while-maintaining-quality-of-care
#8
Daniel M Blonigen, Luisa Manfredi, Adrienne Heinz, Xiaoyu Bi, Paola Suarez, Andrea L Nevedal, Anita A Vashi, Christine Timko, Todd Wagner
OBJECTIVE: Use of psychiatric emergency services in emergency departments (EDs) and inpatient psychiatry units contributes substantially to the cost of mental health care. Among patients who utilize psychiatric emergency services, a small percentage ("high utilizers") contributes a disproportionate share of the total cost, yet little is known about the context of care for these patients. This study employed qualitative methods to identify barriers to and facilitators of reducing use of psychiatric emergency services among high utilizers...
April 1, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/29393960/md-anderson-39-s-population-health-approaches-to-cancer-prevention
#9
Lewis Foxhall, Mark Moreno, Ernest Hawk
Texas's size and unique population demographics present challenges to addressing the state's cancer burden. The University of Texas MD Anderson Cancer Center is one of 69 National Cancer Institute-designated cancer centers across the United States. While these centers traditionally have focused on research, education and training, and providing research-driven patient care, they are in a unique position to collaboratively advance population health through cancer control. Unlike the traditional academic model of a three-legged stool representing research, education, and patient care, MD Anderson's mission includes a fourth leg that incorporates population health approaches...
February 1, 2018: Texas Medicine
https://www.readbyqxmd.com/read/29429430/review-of-implementation-strategies-to-change-healthcare-provider-behaviour-in-the-emergency-department
#10
Kerstin de Wit, Janet Curran, Brent Thoma, Shawn Dowling, Eddy Lang, Nebojsa Kuljic, Jeffrey J Perry, Laurie Morrison
OBJECTIVES: Advances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments. METHODS: A systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience...
February 12, 2018: CJEM
https://www.readbyqxmd.com/read/29457357/improving-outpatient-advance-care-planning-for-adults-with-congenital-or-pediatric-heart-disease-followed-in-a-pediatric-heart-failure-and-transplant-clinic
#11
Lindsay A Edwards, Christine Bui, Antonio G Cabrera, Jill Ann Jarrell
OBJECTIVE: To improve outpatient advanced care planning (ACP) for adults with congenital/pediatric heart disease followed in a pediatric heart failure (HF) and transplant clinic through quality improvement (QI) methodology. DESIGN: A one-year QI project was completed. We conducted quarterly chart reviews and incorporated feedback from the providers to direct subsequent interventions. PATIENTS AND SETTING: Patients ≥18 years of age seen in the HF and Transplant Clinic for follow-up visit were included in analysis...
February 18, 2018: Congenital Heart Disease
https://www.readbyqxmd.com/read/29382327/a-systematic-review-of-care-management-interventions-targeting-multimorbidity-and-high-care-utilization
#12
Jennifer M Baker, Richard W Grant, Anjali Gopalan
BACKGROUND: Evidence supporting the effectiveness of care management programs for complex patients has been inconclusive. However, past reviews have not focused on complexity primarily defined by multimorbidity and healthcare utilization. We conducted a systematic review of care management interventions targeting the following three patient groups: adults with two or more chronic medical conditions, adults with at least one chronic medical condition and concurrent depression, and adults identified based solely on high past or predicted healthcare utilization...
January 30, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29370791/the-use-of-external-change-agents-to-promote-quality-improvement-and-organizational-change-in-healthcare-organizations-a-systematic-review
#13
Esra Alagoz, Ming-Yuan Chih, Mary Hitchcock, Randall Brown, Andrew Quanbeck
BACKGROUND: External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings. METHODS: We searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies...
January 25, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29370813/a-randomized-matched-pairs-study-of-feasibility-acceptability-and-effectiveness-of-systems-consultation-a-novel-implementation-strategy-for-adopting-clinical-guidelines-for-opioid-prescribing-in-primary-care
#14
Andrew Quanbeck, Randall T Brown, Aleksandra E Zgierska, Nora Jacobson, James M Robinson, Roberta A Johnson, Brienna M Deyo, Lynn Madden, Wen-Jan Tuan, Esra Alagoz
BACKGROUND: This paper reports on the feasibility, acceptability, and effectiveness of an innovative implementation strategy named "systems consultation" aimed at improving adherence to clinical guidelines for opioid prescribing in primary care. While clinical guidelines for opioid prescribing have been developed, they have not been widely implemented, even as opioid abuse reaches epidemic levels. METHODS: We tested a blended implementation strategy consisting of several discrete implementation strategies, including audit and feedback, academic detailing, and external facilitation...
January 25, 2018: Implementation Science: IS
https://www.readbyqxmd.com/read/29382686/reducing-unnecessary-imaging-and-pathology-tests-a-systematic-review
#15
REVIEW
Harriet Hiscock, Rachel Jane Neely, Hayley Warren, Jason Soon, Andrew Georgiou
CONTEXT: Unnecessary imaging and pathology procedures represent low-value care and can harm children and the health care system. OBJECTIVE: To perform a systematic review of interventions designed to reduce unnecessary pediatric imaging and pathology testing. DATA SOURCES: We searched Medline, Embase, Cinahl, PubMed, Cochrane Library, and gray literature. STUDY SELECTION: Studies we included were: reports of interventions to reduce unnecessary imaging and pathology testing in pediatric populations; from developed countries; written in the English language; and published between January 1, 1996, and April 29, 2017...
February 2018: Pediatrics
https://www.readbyqxmd.com/read/29350246/data-driven-quality-improvement-project-to-increase-the-value-of-the-congenital-echocardiographic-report
#16
Pei-Ni Jone, Ruthanne Gould, Cindy Barrett, Adel K Younoszai, Brian Fonseca
Echocardiography is the primary diagnostic modality for congenital heart disease patients. The written report is used to communicate with the care team and organization is often divided into the body with detailed findings and the conclusions with important findings summarized. Strategies to increase workflow efficiency include batch writing of reports after performance of multiple echocardiograms and the use of report templates which may contribute to discrepancies within report leading to potential downstream medical errors...
April 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29081997/implementation-of-effective-practices-in-health-facilities-a-systematic-review-of-cluster-randomised-trials
#17
Emma R Allanson, Özge Tunçalp, Joshua P Vogel, Dina N Khan, Olufemi T Oladapo, Qian Long, Ahmet Metin Gülmezoglu
BACKGROUND: The capacity for health systems to support the translation of research in to clinical practice may be limited. The cluster randomised controlled trial (cluster RCT) design is often employed in evaluating the effectiveness of implementation of evidence-based practices. We aimed to systematically review available evidence to identify and evaluate the components in the implementation process at the facility level using cluster RCT designs. METHODS: All cluster RCTs where the healthcare facility was the unit of randomisation, published or written from 1990 to 2014, were assessed...
2017: BMJ Global Health
https://www.readbyqxmd.com/read/28060053/safety-net-hospitals-face-more-barriers-yet-use-fewer-strategies-to-reduce-readmissions
#18
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
#19
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
#20
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...
April 2018: Health Care Management Review
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