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

{"title":"Malpractice Payments and State Medical Board Discipline: National Evidence From the National Practitioner Data Bank.","authors":"Snehal Patel, Quynh Tran, Tucker Bettis, Logan Glosser, Felipe Maegawa","doi":"10.1097/JMQ.0000000000000361","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000361","url":null,"abstract":"<p><strong>Background: </strong>Malpractice payments and state medical board discipline are often assumed to identify the same physicians, yet that assumption has never been tested nationally.</p><p><strong>Methods: </strong>National retrospective cohort study using the National Practitioner Data Bank Public Use Data File (March 31, 2026 release). A total of 76 353 allopathic and osteopathic physicians without prior state licensure actions were followed from their first observed paid malpractice report (2004-2018) through March 2026. The primary outcome was any substantive new state licensure action; secondary outcomes classified actions as quality-of-care-related, nonclinical, or severe. All outcomes describe the first subsequent action in a time-to-first-event design.</p><p><strong>Results: </strong>Overall, 71 372 physicians (93.5%) had no subsequent state licensure action during observed follow-up; a severe first action occurred in 2.1% within 15 years, including license revocation in 0.2%. Among the 4981 physicians (6.5%) with a subsequent action, the first action occurred a median of 5 years after the index report, and 43.7% involved exclusively nonclinical conduct. The 15-year cumulative incidence was 2.54% for quality-of-care actions and 2.94% for nonclinical actions. Severe injury or death in the index report was not associated with subsequent quality-of-care discipline (adjusted hazard ratio, 1.01; 95% CI, 0.90-1.12).</p><p><strong>Conclusions: </strong>Board discipline following a paid malpractice report was uncommon, delayed, and frequently unrelated to clinical care. These accountability systems appear to serve complementary rather than interchangeable roles in assessing physician quality.</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":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229727","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":"Optimizing Clinic Efficiency and Patient Flow in an Outpatient General Surgery Clinic.","authors":"Madeline J Anderson, Clayton Bobo, Jennifer Johnson, Andrew M Harris, Melissa R Newcomb","doi":"10.1097/JMQ.0000000000000360","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000360","url":null,"abstract":"<p><strong>Background: </strong>Clinic workflow efficiency influences patient and employee satisfaction, impacting effective delivery of care. Utilizing lean methodology, we aim to increase the percentage of patients seen within 15 minutes of scheduled appointment to 75% and reduce nonvalue-added time (NVT) per visit by half within 6 months.</p><p><strong>Methods: </strong>Frontline stakeholders observed workflow inefficiencies in an outpatient general surgery clinic, leading to long wait times and generalized dissatisfaction. From August to September 2023, patient and staff flow was captured and appointment component time intervals observed. Only 35.8% of patients were seen within 15 minutes of appointment, with median appointment-to-seen time (AST) 19.00 minutes and NVT 74%. Interventions were implemented through progressive plan-do-study-act (PDSA) cycles, including changes to workflow, rooming, and scheduling template. Appointment time interval data were collected and analyzed using run charts.</p><p><strong>Results: </strong>PDSA 1 yielded median AST of 15.68 minutes, with 51.7% of patients seen within 15 minutes of appointment. PDSA 2 resulted in a median AST of 8.00 minutes, with 66.4% of patients seen within 15 minutes of appointment and reduced median NVT from 74% to 55.9%. Late in PDSA 2 in December, when the clinic was short-staffed, both median AST and NVT increased. PDSA 3 resulted in reduced median AST of 5.00 minutes, with 82.9% of patients seen within 15 minutes of appointment and reduced median NVT to 51.5%, with improved performance stability particularly with respect to AST.</p><p><strong>Conclusions: </strong>Utilization of lean methodology with multiple targeted workflow and scheduling interventions resulted in improved efficiency in an outpatient general surgery clinic.</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":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229691","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":"AI-Assisted Thematic Analysis in a Quality Improvement Evaluation: Replicable Findings and Subtle Misrepresentations.","authors":"Christopher Olivia","doi":"10.1097/JMQ.0000000000000351","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000351","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":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129799","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":"Electronic Health Record-Embedded Structural Interventions to Improve Sepsis Bundle Quality Measure Performance: A Quality Improvement Initiative at a Veterans Affairs Medical Center.","authors":"Justin C Zhang, Kavon Javaherian, Josue Zapata, Ryan Duffy, Chuanyi M Lu, Erika Price, Helena Snowden, Anil Agarwal, Kip Mihara","doi":"10.1097/JMQ.0000000000000357","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000357","url":null,"abstract":"<p><strong>Background: </strong>Though emphasized as a quality metric, sepsis quality measure (SEP-1) compliance remains low nationwide. Electronic health record (EHR)-based interventions show promise, but few have examined EHR laboratory reference value misconfiguration as a distinct driver of noncompliance.</p><p><strong>Local problem: </strong>The San Francisco Veterans Affairs, a 110-bed tertiary care center, recorded 3 consecutive quarters of SEP-1 composite performance in the lowest national quintile, nadiring at 31.5%.</p><p><strong>Methods: </strong>A multidisciplinary team applied LEAN-A3 methodology to identify root causes of low SEP-1 performance and design targeted countermeasures. The primary outcome was the percentage of suspected sepsis patients with a serum lactate >2.0 mmol/L who received a repeat lactate within 6 hours. Balancing measures included unnecessary repeat lactates and sepsis mortality.</p><p><strong>Interventions: </strong>Three EHR-based interventions were implemented between August and November 2025: (1) an Emergency Department Sepsis order-set embedding dual time-spaced lactate orders; (2) a structured Sepsis Evaluation Note template; and (3) a clinical decision support alert for patients with serum lactate >2.0 mmol/L, implemented to address a laboratory reference range misconfiguration.</p><p><strong>Results: </strong>Postintervention lactate reassessment compliance rose 14 percentage points (54%-68%), meeting Institute for Healthcare Improvement criteria for special cause variation. Facility 12-month rolling performance rose from 31.5% (lowest quintile) to 64.7% (middle quintile), reaching a quarterly high of 74.3%. No increase in unnecessary repeat lactates or sepsis mortality was detected.</p><p><strong>Conclusions: </strong>EHR-embedded structural interventions produced sustained SEP-1 improvement without impacting laboratory utilization or mortality, offering a reproducible model for improvement through systems redesign rather than education alone.</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":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121731","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":"Optimization of Pregnancy Testing in the Emergency Department: A Quality Improvement Initiative.","authors":"Margaret Holstege, Noel Mukubwa, Moira Smith, Timothy Layng, Sarah Wendel","doi":"10.1097/JMQ.0000000000000359","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000359","url":null,"abstract":"<p><strong>Background: </strong>At our institution, a review of emergency department pregnancy testing identified excess use of serum quantitative (quant) human chorionic gonadotropin (hCG) when only a binary result was clinically indicated. Additionally, we observed delays in point-of-care (POCT) urine hCG turnaround time. In response, provider education and electronic health record default modifications were implemented to promote serum qualitative (qual) hCG.</p><p><strong>Methods: </strong>Following a pre/post intervention design, we reviewed emergency department pregnancy tests over 2 periods: July 1, 2024-June 30, 2025, and September 1, 2025-February 28, 2026. Outcomes included utilization patterns, order-to-result time, per-test cost, appropriateness of serum quant hCG, and test completion.</p><p><strong>Results: </strong>Inappropriate serum quant hCG orders decreased from 42.2% to 36.2%. Serum qual hCG use increased from 8.4% to 55.4%, while POCT and serum quant hCG use decreased from 71.8% to 33.0% and 19.8% to 11.6%, respectively. POCT order-to-result time decreased from 92.2 to 77.6 minutes, with no significant change in serum turnaround time. Mean cost per test decreased from $211.08 to $147.79, a $63.29 (30%) reduction. Pregnancy test completion increased from 78.8% to 89.8%.</p><p><strong>Conclusions: </strong>Pairing electronic health record default order modification with targeted provider education reduced low-yield quant hCG ordering and increased use of serum qual hCG testing, reducing costs without compromising diagnostic accuracy. Additionally, POCT urine hCG turnaround times decreased and overall pregnancy test completion rates increased, suggesting improved workflow efficiency with greater use of serum-based testing.</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":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121732","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":"Procalcitonin Reduces Overuse of Antibiotics in Nursing Facility Residents: A Quality Improvement Initiative.","authors":"Salwa M Gerges, Emuran Saidy, Giorgio R Sansone","doi":"10.1097/JMQ.0000000000000350","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000350","url":null,"abstract":"<p><p>Procalcitonin (PCT), a biomarker for bacterial infections, has been studied in different clinical settings, including primary care, emergency departments, and intensive care units. Much less in nursing facilities (NFs), where antibiotic use is usually excessive. The aim of this quality assurance performance improvement initiative was to determine the effectiveness and sustainability of PCT in reducing unnecessary antibiotics in a 304-bed skilled NF. The initiative consisted of: (1) a 9-month baseline as a reference point; (2) a 9-month intervention where eligible residents were tested for PCT to help guide and monitor their antibiotic treatments. During the intervention, the plan-do-study-act cycle was applied to gauge the initiative, and control charts were used to determine the intervention success; and (3) a 9-month follow-up to validate the PCT effectiveness. The control chart rule of ≥8 consecutive months below the chart centerline indicated that the PCT intervention was successful. Monthly number of residents on antibiotics decreased from 34 at baseline down to 24 at follow-up, an overall 29% reduction. Days of therapy and antibiotic starts decreased from 33.0 and 5.4 at baseline down to 21.6 and 4.2 at follow-up, an overall reduction of 35% and 22%, respectively. Thus, utilization of PCT as a tool of antibiotic stewardship was associated with a reduction in antibiotic overuse among residents in this skilled NF.</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":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121911","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":"Implementing a Remote Blood Pressure Monitoring Program at Rural Resident Primary Care Clinic.","authors":"Sameer Acharya, Seungho Jun, Samjhauta Bhattarai, Kushal Regmi, Taha Mohammad, Eric Elzinga, Mariam Arif, Jasmit Heera, Michael Berlin, Yashashwi Pokharel","doi":"10.1097/JMQ.0000000000000355","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000355","url":null,"abstract":"<p><strong>Introduction: </strong>We evaluated feasibility of implementing remote blood pressure (BP) monitoring (RBPM) program in rural resident primary care clinic.</p><p><strong>Methods: </strong>This is Internal Medicine resident physicians-led single arm RBPM study among Medicare populations with hypertension in rural United States. Resident physicians provided a comprehensive self-management support (SS) and home BP guided pharmacotherapy over 6 months in collaboration with a third-party vendor. Our primary outcomes were changes between the first and the last 2 weeks of BP and its control (<130/80). Secondary outcomes were trend in home BP monitoring (HBPM), medication changes, progression towards patients' set SS goals and emergency room (ER) visits/hospitalization.</p><p><strong>Results: </strong>Seventy-two patients provided 6 months of HBPM; 75% were White patients, 61.1% female and 81.9% from rural areas. They provided a mean (SD) of 7.3 (0.5) HBPM readings/week/patient that was stable over the study period. Mean (SD) BP difference and BP control were 11.4 (11.7)/3.4 (6.5) mmHg and 37.5% (all P < 0.01), respectively. One hundred and fifty-nine SS goals were set (66% either achieved or had progress made), 63.9% had medications changes. Twenty-four patients had ER visits; 16 were hospitalized, among them 4 ER visits were likely related to hypertension or anti-hypertensive medications which improved with medication changes. There were significant reductions in body mass index, cholesterol levels and glycated hemoglobin at the end of the study.</p><p><strong>Conclusions: </strong>Resident-led RBPM program is feasible and associated with significant BP reduction. Future studies should consider program evaluation to inform context-driven implementation.</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":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121812","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":"\"I Would Prefer to Take Fewer Medicines\": Identifying Patient-Centered Approaches to Geriatric Assessment and Deprescribing Among Older Emergency Department Patients.","authors":"Sarah Bernard, Lauren Burke, Danny Soo, Andrea Slusarczyk, Edward Yang, Hilai Ahmadzai","doi":"10.1097/JMQ.0000000000000356","DOIUrl":"10.1097/JMQ.0000000000000356","url":null,"abstract":"<p><p>Comprehensive geriatric assessments are recommended to address polypharmacy and inappropriate prescribing during unplanned hospitalizations of older adults; however, there is limited study of these practices in emergency departments. This study described changes in prescribing following comprehensive geriatric assessment and patient experiences in a tertiary emergency department in Western Australia.</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":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121734","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":"A Blue Rose From His Daughter.","authors":"Farzana Hoque","doi":"10.1097/JMQ.0000000000000352","DOIUrl":"10.1097/JMQ.0000000000000352","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":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043252","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":"Physician Composition of Hospitals' Workforce and Mortality Across US Hospitals: A Cross-Sectional Study.","authors":"Cameron J Gettel, Katerina Zhuohui Lin, Craig Rothenberg, Zhenqiu Lin, Tara Lagu, Kate Goodrich, Joseph S Ross, Arjun K Venkatesh","doi":"10.1097/JMQ.0000000000000354","DOIUrl":"10.1097/JMQ.0000000000000354","url":null,"abstract":"<p><strong>Background: </strong>The inpatient clinical workforce in US hospitals is evolving, with advanced practice practitioners-nurse practitioners and physician assistants-playing increasingly prominent roles. The relationship between hospital clinician mix and patient mortality remains unclear. Our objective was to examine the association between hospital-level physician proportion and 30-day risk-standardized mortality rates (RSMRs) for common inpatient conditions.</p><p><strong>Methods: </strong>We conducted a cross-sectional national study of US hospitals treating Medicare fee-for-service beneficiaries in 2022. Medicare and American Hospital Association datasets were linked at the hospital level. The hospital-level exposure was the physician proportion, defined as affiliated physicians divided by total affiliated physicians and advanced practice practitioners. Outcomes were hospital-level RSMRs for acute myocardial infarction, coronary artery bypass graft surgery, chronic obstructive pulmonary disease, heart failure, pneumonia, and stroke.</p><p><strong>Results: </strong>Among 3487 hospitals, the mean physician proportion was 79.7% (standard deviation, 9.4%), ranging from 67.8% in the lowest quartile to 91.6% in the highest. Hospitals in the highest physician proportion quartile (Q4) had lower RSMRs than hospitals in the lowest quartile (Q1) for all conditions-acute myocardial infarction (12.54 versus 12.86; P < 0.001), coronary artery bypass graft (2.92 versus 3.05; P = 0.106), chronic obstructive pulmonary disease (9.11 versus 9.83; P < 0.001), heart failure (11.24 versus 12.73; P < 0.001), pneumonia (17.51 versus 18.64; P < 0.001), and stroke (13.41 versus 14.31; P < 0.001). Weighted multivariable models identified significant inverse associations between physician proportion and RSMRs.</p><p><strong>Conclusions: </strong>Greater physician representation was associated with lower hospital-level mortality across common and high-burden medical conditions, indicating workforce composition may be an important determinant of hospital quality.</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":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077188","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}