American journal of medical quality : the official journal of the American College of Medical Quality最新文献

{"title":"Development and Early Validation of A Survey Instrument for Measuring Patient Engagement in Pain Management.","authors":"Yea-Jen Hsu, Traci J Speed, Ariana Prinzbach, Olivia Sutton, Eileen M McDonald, Amro Khasawneh, Samuel Kim, Ima Samba, Ronen Shechter, Marie N Hanna, Jill A Marsteller, Anping Xie","doi":"10.1097/JMQ.0000000000000236","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000236","url":null,"abstract":"<p><p>Efforts to improve patient engagement in pain management are often hindered by inconsistent definitions and measurements. To address this gap, we developed and pilot-tested the 15-item Patient Engagement in Pain Management survey. A systematic review of 77 survey instruments identified 6 key constructs of patient engagement, and semi-structured interviews with 36 patients and 3 providers from the Johns Hopkins Personalized Pain Program informed its development. The initial 33-item survey was refined to 15 items, and usability and test-retest reliability were evaluated with 60 Personalized Pain Program patients. The median completion time was 3.5 minutes, with minimal missing data (<0.5%). Most respondents (96-100%) found the questions relevant, with higher average scores for patient-provider communication (3.6-4.5 on a 5-point scale) and lower scores for adherence challenges. Although the Patient Engagement in Pain Management survey demonstrated good usability and applicability, further studies are needed to enhance its test-retest reliability and psychometric validation.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Independent Risk Factors for Less Than \"Top Box\" Doctor Communication Patient Experience Survey Scores in an Urban Teaching Hospital.","authors":"Richard H Savel, Payam Benson, Carmen Collins, Srinivas Gongireddy, Christina Oquendo, Kwaku Gyekye, Eva Villar-Trinidad, Jill Fennimore, Ije Akunyili","doi":"10.1097/JMQ.0000000000000238","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000238","url":null,"abstract":"<p><p>This study explored the independent risk factors for patients giving a less than \"top box\" score on their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys in the \"doctor communication\" domain (DCD). After adjusting for age, gender, length of stay, receiving a postdischarge phone call (PC), new medication during hospitalization, highest education level, language spoken at home, and zip code, results from 803 HCAHPS surveys (from January 1 to December 31, 2023) revealed that not receiving a PC was associated with a more than doubling of the odds that a patient would give less than a \"top box\" score for the DCD (overall adjusted odds ratio of 2.22; 95% confidence interval: 1.77-2.78) and a nearly doubling the actual probability of doing so (34.3% less than \"top box\" score if no PC, 17.9% less than \"top box\" score if PC). These findings support the potential value of a post-discharge patient PC.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value-Based Care in Medical Specialties: Improving Hierarchical Condition Category Capture.","authors":"Joseph A Randy Englert, Christopher J White","doi":"10.1097/JMQ.0000000000000233","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000233","url":null,"abstract":"<p><p>Risk adjustment plays a key role in payment, especially in value-based payment models, which use a practice's performance with cost and quality metrics to determine reimbursement. Inaccurate representation of a patient's medical complexity can cause a practice to fall below cost and/or quality performance targets, potentially leading to a substantial loss of shared savings dollars. This quality improvement study evaluated the effectiveness of a clinical documentation excellence program, focused on addressing hierarchical condition category diagnoses, involving the medical specialties. The program included tools in the electronic health record, metrics to monitor and provide feedback on clinician performance, and regular interactions with the nurse and physician leads for each specialty. For clinicians of medical specialties, the education program resulted in an increase in the percentage of hierarchical condition category diagnoses addressed at outpatient encounters from 25% to 62% over a 2-year period.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Management of Chest Pain with a High Sensitivity Troponin-Based Protocol.","authors":"Kristin Lohr, Colleen O'Connor, Timothy Shapiro, Steven Gamburg, Pradeep Bhagat, Francis Colangelo, Mary Reich Cooper","doi":"10.1097/JMQ.0000000000000235","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000235","url":null,"abstract":"<p><p>Chest pain is one of the most common presenting complaints to emergency departments in the United States, and management centers on identifying myocardial infarction or other forms of rare but problematic cardiac diagnoses. The high-sensitivity troponin assay can detect abnormal troponin elevations at 10- to 100-fold lower levels compared with traditional troponin assays and thus can allow faster time to disposition and diagnosis, yet adoption has not been universal. Implementing a high-sensitivity troponin protocol with a risk prediction algorithm can decrease the numbers of patients admitted, reduce unnecessary testing, and shorten patient stays in the emergency department. This quality improvement project was undertaken in a community-academic health system lacking a system-wide protocol to workup patients presenting with chest pain to the emergency department. Key stakeholders evaluated multiple barriers and identified measures, planned implementation of the new assay and its associated algorithm, led postimplementation data monitoring and analysis, and delivered progress reports to organizational leaders. Chest pain admissions were managed by hospitalists in the absence of a cardiology inpatient service. The most important barriers were found to be individual provider strategy, electronic medical record design, and the lack of capacity for cardiology evaluations in both inpatient and outpatient settings. Stakeholder buy-in, monthly data reports, team meetings, and widespread education were used to support the changes in ordering patterns and evaluation. Postimplementation, 3293 patients were assessed over a 12-month period. Baseline mean length of stay for chest pain in the emergency department decreased from 297 minutes (SD, 53) to 274 minutes (SD, 33; P = 0.03). Hospital chest pain observation admissions decreased from 23% to 14% of patients presenting with chest pain (P <0.001). Stress tests ordered for observation patients decreased from 12 per month to 3 (P <0.001). Similarly, in observation patients, echocardiograms decreased from 61 to 46 per month (P <0.001), cardiology consultation decreased from 125 per month to 81 (P <0.001), and cardiac catheterization decreased from 41 per month to 32 following the intervention (P = 0.003). Developing a standardized management protocol and selecting physician leaders to maintain and revise protocols were high-impact, low to moderate-effort interventions resulting in significant changes in practice. This study demonstrated that a high-sensitivity troponin assay, combined with a chest pain clinical management protocol based on the Heart, EKG, Age, Risk factor, Troponin score, was able to achieve a reduction in emergency department length of stay, a decrease in hospital observation admissions, and reduced cardiac testing in this patient population.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fragmented Ambulatory Care and Medication Count among Older Adults.","authors":"Indrani Guzman Das, Joanna Bryan Ringel, Mangala Rajan, Lisandro D Colantonio, Monika M Safford, Lisa M Kern","doi":"10.1097/JMQ.0000000000000227","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000227","url":null,"abstract":"<p><p>This nationwide cross-sectional study explored the relationship between ambulatory care fragmentation and medication use in older US adults, examining variations by chronic conditions and race. Utilizing data from the 2003-2016 REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study linked with fee-for-service Medicare claims, the authors analyzed care fragmentation (measured by the reversed Bice-Boxerman Index) and medication counts through a 2-week in-person prescription inventory. They employed negative binomial regression, adjusting for potential confounders, and conducted subgroup analyses based on chronic conditions and race. Of the 4524 participants, 40.7% experienced high care fragmentation and 59.8% used 5 or more medications. High fragmentation was associated with a 4% overall increase in medication count (P = 0.03), a 7% increase for those with 4+ chronic conditions (P = 0.01), and a 9% increase for Black participants (P = 0.01). In conclusion, fragmented care is independently associated with greater polypharmacy, particularly among Black older adults and those with multiple chronic conditions.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Physician Inbox Management in Electronic Health Record by a Multifaceted Bundled Intervention.","authors":"Abdul Waheed, Mudasir Umer, Anousheh Paracha, Asfandyar Latif, Nabiha Malik, Hira Fatima, Syed M Atif, Erum Azhar","doi":"10.1097/JMQ.0000000000000230","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000230","url":null,"abstract":"<p><p>Timely closure of patient encounters and addressing tasks in the Electronic Health Record (EHR) inbox are essential for quality care and efficiency. Delinquent items in the EHR inbox impact patient care, cost of care, and overall patient and provider experience. This project aimed to improve the management of these items using a quality improvement initiative with a bundled intervention. This study was conducted using a quasi-experimental method with interrupted time series. Stakeholders were engaged to define policies and expectations based on root cause analysis. Interventions included creating policy and procedures with clear expectations, creating resources, addressing inbox management delinquency using Just Culture with consoling, coaching, and disciplining. Simple rubrics using the situation-behavior-impact framework and motivational interviewing questions were used for coaching. Data were analyzed using JMP Pro 16 with statistical process control charts for phase analysis. Poisson regression was used to explore statistically significant trends after the implementation of the intervention bundle. The average number of open encounters decreased from 71 per week preintervention to 33.8 per week in the rollout period, and 12.2 per week postintervention. The phase analysis on individual moving range control chart showed a significant shift in the process after the implementation of the intervention. Poisson regression showed a 78% decrease in the number of delinquent items (P < 0.001) after the implementation of the bundled intervention. A multifaceted intervention significantly improved EHR inbox management with potentially positive impact on the quadruple aim.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of a Novel Use of Volunteers on Patient Satisfaction.","authors":"John Marshall, Haley Manella","doi":"10.1097/JMQ.0000000000000232","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000232","url":null,"abstract":"<p><p>A novel volunteer program was implemented in the adult emergency department waiting room to combat declining patient satisfaction, a crucial quality metric impacting everything from hospital reimbursement to clinical outcomes. Net Promotor Scores (NPS) were tracked in a retrospective cohort design, with patients interacting with volunteers serving as the intervention cohort and those who did not serving as control. Analysis using monthly NPS means was conducted from 2022 to 2023. The absolute difference in NPS between the 2 groups was 17.43. Using monthly means, an unpaired t-test was conducted. NPS in the intervention group was 51.86 with a standard deviation of 7.01. NPS in the control was 34.43 with a standard deviation of 5.32. Data is significant, with P = 0.0002. This emergency department waiting room volunteer program led to increases in patient satisfaction. Study authors think similar effects are achievable at other institutions, and future trials would be beneficial in confirming this suspected causal relationship.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Hospitalists in Training Are Improving Quality of Patient Care in Dutch Hospitals.","authors":"Renske Labordus-van Helvoirt, Julia Mangione","doi":"10.1097/JMQ.0000000000000229","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000229","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Team-Based Painting and Learning Approach to Recognizing Topical Ophthalmic Drops.","authors":"Zuhair Al-Bahrani, Meryl Ponce, Elizabeth Teixeira, Shayan Ghiaee, Dimitri Papanagnou, Maureen Lloyd, Xiao Chi Zhang","doi":"10.1097/JMQ.0000000000000221","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000221","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"40 2","pages":"71-72"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of Standardized Coding Limits Accuracy of Electronic Clinical Quality Measure for Pulmonary Embolism Diagnosis.","authors":"Lisa Baumann Kreuziger, Megan Keenan, Hayley Dykhoff, Marie Hall, Kyle Campbell, Emily Cahill, Ryan Hanson, Dustin McEvoy, Wei He, Sayon Dutta, Rachel P Rosovsky, Damon E Houghton","doi":"10.1097/JMQ.0000000000000223","DOIUrl":"10.1097/JMQ.0000000000000223","url":null,"abstract":"<p><p>Guidelines for diagnosing pulmonary embolism (PE) start with a risk assessment using a pretest probability (PTP) tool, followed by D-dimer testing or computed tomography pulmonary angiography (CTPA) depending on risk. The project aimed to develop an electronic clinical quality measure (eCQM) to encourage broader use of a validated PTP scoring tool in emergency departments (EDs) to more accurately diagnose PE and to reduce unnecessary CTPAs. To identify a value set to accurately identify CTPA and abnormal D-dimer tests using standard classification systems and clinical vocabularies (ie, Current Procedural Terminology [CPT], Logical Observation Identifiers Names and Codes [LOINC], systematized nomenclature of medicine clinical terms [SNOMED CT]) across 3 academic United States health care systems. A comprehensive value set to identify CTPAs was selected, which contained 31 codes. Additionally, each health care system had unique, site-specific codes to more granularly identify CTPAs. Three health care systems representing 38 EDs from across the country submitted data from all ED encounters between September 12, 2022, and January 11, 2023. Imaging types were reviewed from each of the CPT codes and LOINC. The project evaluated whether a D-dimer was obtained using CPT and LOINC and whether the D-dimer result was elevated using SNOMED CT. The number of ED encounters, PTP use, and diagnosis of PE using different codes were determined. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value for selected codes were calculated. Over a 4-month study period, 270,214 encounters were included from 38 EDs. 11,794 ED encounters with CTPAs during the study period, using the site-specific codes were identified. The comprehensive value set had a PPV of 63.4%. Restricting the CTPA value set to CPT code 71275 or LOINC 88322-3 improved the PPV to 82% with 100% sensitivity and 99% specificity. The restricted value set captured the highest proportion of relevant site-specific codes. D-dimer values were identified using LOINC codes 48065-7 and 91556-1 at Site 1 and 48067-3 at Site 2. SNOMED CT codes were not used at any site to identify elevated D-dimer results. Different D-dimer tests with different normal ranges were used at each site, and only one site provided an abnormal flag for D-dimer results. Heterogeneity in the use of nationally standardized codes for labs and imaging tests limits the ability to measure and compare quality across health care organizations for CTPA and D-dimer results. Restricting the identification of CTPA to CPT Code 71275 or LOINC 88322-3 resulted in high sensitivity and specificity, but false positives remain. Additionally, coding for an abnormal D-dimer test result is not standardized across institutions. Therefore, the currently available value sets cannot be used to develop eCQMs whose aim is to evaluate whether CTPA is ordered appropriately based on the PTP risk level and laboratory testing.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"38-43"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}