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

{"title":"Algorithmic Convergence Across Machine Learning Models Identifies Robust Strategic Priorities for Improving Patient Experience.","authors":"Richard H Savel, Payam Benson, Carmen Collins, Jill Fennimore, Dwight McBee, Kwaku Gyekye, Ije Akunyili, Marc Milano, Ruric Andy Anderson","doi":"10.1097/JMQ.0000000000000348","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000348","url":null,"abstract":"<p><strong>Background: </strong>Improved patient experience is associated with enhanced clinical outcomes. The Hospital Consumer Assessment of Healthcare Providers and Systems Overall Rating of the Hospital (ORH) can be considered a quality metric for health systems. We hypothesized that machine learning models could identify actionable predictors of a less-than-top-box ORH score across a multihospital system and sought to determine whether these predictors were consistent across model architectures and hospital size.</p><p><strong>Methods: </strong>We analyzed 86 351 Hospital Consumer Assessment of Healthcare Providers and Systems surveys from 12 hospitals within a New Jersey health system (January 2023 to May 2026). Four machine learning models (logistic regression, decision tree, random forest, and XGBoost) were developed to predict a less-than-top-box ORH score. Feature importance was compared across the 3 highest-performing models, and SHapley Additive exPlanations (SHAP) analysis was performed on the XGBoost model. All analyses were repeated separately across hospitals stratified by size (large, medium, and small).</p><p><strong>Results: </strong>XGBoost, logistic regression, and random forest demonstrated excellent, comparable discrimination (area under the curve 0.871-0.883); the decision tree model underperformed and was excluded. Feature importance and SHAP analysis converged on the same 3 predictor domains: nursing communication, physician communication, and hospital environment, which jointly accounted for 67% of total SHAP importance. This 3-domain pattern remained stable across hospital-size strata, with only modest shifts in relative ranking.</p><p><strong>Conclusions: </strong>Across multiple machine learning architectures, analytic methods, and hospital sizes, nursing communication, physician communication, and hospital environment consistently emerged as the primary, modifiable drivers of overall hospital rating. These convergent, generalizable findings identify clear strategic priorities for health systems seeking to improve patient experience.</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":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893171","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":"From Compliance to Collaboration to Culture: A Prospective Evaluation of the HIPESAC Timeout and Patient Safety Advocate Platform.","authors":"James F Schlund, Ashley Davis, Linda Esparza, Sadie M Voigtlander","doi":"10.1097/JMQ.0000000000000342","DOIUrl":"10.1097/JMQ.0000000000000342","url":null,"abstract":"<p><strong>Background: </strong>The Universal Protocol has standardized pre-procedural verification since 2004, yet procedural sentinel events persist; 127 wrong-surgery events were reported nationally in 2024. Compliance-based checklists may be insufficient for the human-factors environment of complex procedural care.</p><p><strong>Methods: </strong>In a prospective 3-phase quality improvement evaluation at a rural health system, we tested an enhanced timeout (HIPESAC) in which the proceduralist presents and justifies each verification element to the full team, any member empowered to question, correct, or halt the procedure. For high-risk cases, an expanded Patient Safety Advocate (PSA) protocol adds voicing of concerns from least to most senior, with a designated patient advocate issuing consent to proceed. Phase 1 piloted 4 PSA-activated procedures; Phase 2 audited 20 with surveys; and Phase 3 evaluated the standard timeout across 22 procedures.</p><p><strong>Results: </strong>The platform identified latent threats before initiation: material readiness events in 8 of 20 high-risk procedures (40%; one critical absent item, 7 proactive adjustments) and 9 process deficiencies across 22 standard procedures. The timeout added a median of 54 seconds. Surveys indicated high acceptance among respondents, with unanimous endorsement of speaking-up empowerment. In 2 cases-one per tier-a non-proceduralist surfaced information that altered the procedure.</p><p><strong>Conclusions: </strong>The platform was feasible, well accepted, and surfaced latent procedural threats in this single-center evaluation. By requiring the proceduralist to present to the team and, at higher risk, inverting the order of voice, it may operationalize authority-gradient inversion as an intrinsic feature. Multi-site controlled evaluation is warranted.</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":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868778","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":"Imaging Actionable Incidental Findings: Communication and Follow Up to Eliminate Preventable Harm.","authors":"Mallory A Koshiol, Richard Dery, Lori Reiland, Samuel P Osei, Nathan Fix, David P Ingham, Ganesh Asaithambi","doi":"10.1097/JMQ.0000000000000325","DOIUrl":"10.1097/JMQ.0000000000000325","url":null,"abstract":"<p><p>In this retrospective study of 1217 incidental imaging findings within a large integrated health system, 97% were classified as actionable and required follow-up, and an electronic medical record-based communication workflow contributed to follow-up in 29% of cases.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"287-292"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371567","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":"Achieving SEP-1 Compliance: Common Pitfalls and Pearls from the Emergency Department.","authors":"Leon Z Jia, Eric C Hyder, Michael N Cocchi, Amanda M Scudder, Bryan A Stenson, David T Chiu, Daniel L Shaw","doi":"10.1097/JMQ.0000000000000334","DOIUrl":"10.1097/JMQ.0000000000000334","url":null,"abstract":"<p><p>The Centers for Medicare & Medicaid Services has recently tied the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) compliance to financial incentives, increasing pressure on hospital performance. We aim to review the mechanics of SEP-1 and provide a focused guide for best practices to improve compliance from the perspective of a US-based community emergency department. SEP-1 quality improvement initiatives may benefit from focusing on common failure points. Key strategies include multidisciplinary engagement, staff education, workflow changes, and electronic health record optimization. Implementing such programs may improve performance on this increasingly important metric.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"279-286"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582000","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 Hepatitis A Vaccination Rates in Cirrhotic and HIV+ Patients: A Quality Improvement Initiative at an Academic Center.","authors":"Michael Bebawy, Rohan Karkra, Kirsys Guerrero, Mirona Dobri, Salil Chowdhury, Ahmed Al-Khazraji, Jared Walsh","doi":"10.1097/JMQ.0000000000000333","DOIUrl":"10.1097/JMQ.0000000000000333","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis A virus (HAV) infection remains a preventable cause of acute viral hepatitis with disproportionate morbidity among adults with chronic liver disease and people living with HIV. Despite longstanding Advisory Committee on Immunization Practices recommendations, HAV vaccination coverage in high-risk adults remains suboptimal. We conducted a quality improvement initiative to improve HAV vaccination practices in an academic ambulatory clinic.</p><p><strong>Methods: </strong>This QI project was implemented at an academic ambulatory care center using Plan-Do-Study-Act (PDSA) cycles from October 2024 to April 2025. Interventions included electronic health record smart-phrase modification, resident and nursing education, workflow integration, and patient education. Adults with cirrhosis or HIV seen during preintervention (October 2023-October 2024) and postintervention (December 2024-April 2025) periods were included in the analysis. Primary outcomes were HAV vaccination initiation and completion rates; secondary outcomes included documentation of HAV discussions and patterns of serologic testing. Proportions were compared using 2-proportion z-tests.</p><p><strong>Results: </strong>Among patients with HIV (n = 91), overall HAV serologic testing declined significantly postintervention (64% vs 38%, P < 0.05). The completion rate of the HAV vaccine series increased from 18% to 30%, although this did not reach statistical significance. Documentation of planned vaccination improved modestly within the internal medicine clinic. Among patients with cirrhosis (n = 100), HAV immunity and vaccination rates were high at baseline and remained stable postintervention, with a nonsignificant increase in HAV addressal (78% vs 84%). Across both cohorts, documentation of vaccination plans improved slightly but remained limited.</p><p><strong>Conclusions: </strong>A multifaceted, electronic health record-integrated QI intervention was associated with reduced HAV serologic testing and modestly improved vaccination practices, particularly in patients with HIV. Persistent gaps in vaccine completion highlight the need for sustained workflow and follow-up strategies to improve HAV immunization among high-risk adults.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"270-278"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582021","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 Day-Surgery Clinical Pathway for CT-Guided Lung Biopsy: A Propensity-Matched Analysis of Safety, Efficacy, and Resource Efficiency.","authors":"Dongmei Peng, Li Hou, Yuanyuan Gao, Xingqin Liu, Zhichao Li","doi":"10.1097/JMQ.0000000000000318","DOIUrl":"10.1097/JMQ.0000000000000318","url":null,"abstract":"<p><p>Computed tomography-guided percutaneous lung biopsy (CT-PLB) is a cornerstone diagnostic procedure for pulmonary lesions. While traditionally managed via inpatient admission, this model imposes considerable clinical and operational burdens. Day-surgery management offers a streamlined alternative, yet comparative evidence on its safety and efficiency remains scarce. The authors conducted a retrospective cohort study of patients undergoing CT-PLB in 2024, comparing a day-surgery pathway (Day-Surgery Center) with the conventional inpatient pathway (oncology ward). Propensity score matching ensured group comparability. Outcomes focused on clinical management metrics: safety (complication/readmission rates), diagnostic performance, and health care efficiency (length of stay, cost). Among 154 patients, overall outcomes were favorable. After matching, the day-surgery cohort demonstrated comparable safety (complication rate 2.22% vs 6.67%, risk difference -4.45% [95% confidence interval, -12.0% to 3.4%]; P = 0.62) and comparable diagnostic accuracy (82.22% vs 79.17%, P = 0.84) relative to inpatients. Crucially, the day-surgery model significantly optimized efficiency, drastically reducing hospitalization duration and costs ( P < 0.001), with 100% patient satisfaction in both groups. Day-surgery CT‑PLB appears comparable to inpatient procedure in safety and diagnostic yield, with significantly lower costs and shorter hospital stay. Given the retrospective design and small sample size, these findings are hypothesis‑generating. Prospective, adequately powered validation is needed.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"253-261"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681535","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":"Patient Experience and Physician Communication: Aligning Clinical Excellence and Quality Improvement.","authors":"Farzana Hoque","doi":"10.1097/JMQ.0000000000000312","DOIUrl":"10.1097/JMQ.0000000000000312","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"304-305"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936831","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":"Increasing Cardiometabolic Health Awareness in the Outpatient Psychiatric Setting.","authors":"D Nyasha Chagwedera, Ololade Adebiyi, John Chamberlain, Shavalee Rios-Savanapridi, Tammy Duong","doi":"10.1097/JMQ.0000000000000323","DOIUrl":"10.1097/JMQ.0000000000000323","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"41 5","pages":"308-309"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868791","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":"Access to Care and Patient Safety Measures: Placement in Healthcare Quality Frameworks, Degree to Which They Meet Criteria Used to Select and/or Prioritize Quality Measures, and Mapping to the National Quality Strategy Levers.","authors":"Diana Zhang, Todd Schneberk, Lisa Rubenstein, Kimberly A Miller, Mariana C Stern, Jennifer B Unger, Sachi Yagyu, Aneesa Motala, Susanne Hempel","doi":"10.1097/JMQ.0000000000000332","DOIUrl":"10.1097/JMQ.0000000000000332","url":null,"abstract":"<p><strong>Background: </strong>Access to care and patient safety are central components of healthcare quality, yet lack clear conceptual and operational integration within measurement systems. This study examined how access and patient safety measures align with prominent healthcare quality frameworks and criteria commonly used to prioritize quality measures.</p><p><strong>Methods: </strong>We systematically identified access and patient safety measures from the literature and applied them to 3 US healthcare quality frameworks. We assessed measures against 7 prioritization criteria using predefined tests and mapped them to 9 National Quality Strategy (NQS) levers.</p><p><strong>Results: </strong>Three access measures and 10 patient safety measures met criteria for inclusion. Most showed partial conceptual alignment with the frameworks. Importance was consistently met, whereas feasibility, reliability, scientific soundness, and improvability were infrequently met due to data and reporting limitations. Mapping to the NQS levers identified various potential pathways to improve health care.</p><p><strong>Conclusions: </strong>Empirical application revealed gaps in conceptual clarity and operational feasibility. Improved data infrastructure, clearer framework definitions, and stronger guidance may enhance the usefulness of access and patient safety measurement.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"227-236"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400369","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 Interrater Reliability of Cardiac Arrest Video Review: A Pilot Study.","authors":"Moshe Ryan Ostreicher, Joseph Landers, Molly McCann Pineo, Ghania Haddad, Tabetha Garver-Mosher, Timmy Li, Lance Becker, Daniel M Rolston, Daniel Jafari","doi":"10.1097/JMQ.0000000000000326","DOIUrl":"10.1097/JMQ.0000000000000326","url":null,"abstract":"<p><p>Audio and video recording of cardiac arrest (CA) is a valuable quality improvement, education, and research tool, but the interrater reliability (IRR) of data collection is not well studied. We aimed to evaluate the IRR of data abstracted from our review of video recordings of Emergency Department (ED) CAs. In this retrospective study, 2 blinded, expert physicians reviewed 21 randomly selected CA videos from a single academic ED. Predefined categorical (eg, initial rhythm) and noncategorical (eg, time to defibrillation, duration of compression interruptions) variables were abstracted. IRR was evaluated using Cohen's kappa for categorical variables and interclass correlation coefficient (ICC) with a 2-way mixed-effects model for noncategorical variables, including nested analysis for repeated events. IRR was excellent for noncategorical and time-to-event variables, such as time to defibrillator pad attachment (ICC = 0.99), first rhythm analysis (ICC = 0.94), first shock (ICC = 1.00), number of interruptions (ICC = 0.93), and time of death (ICC = 1.00). In contrast, categorical variables demonstrated moderate reliability for emergency medical services reported rhythm (κ = 0.61), initial ED rhythm (κ = 0.69), and endotracheal tube presence on arrival (κ = 0.70); though agreement was perfect for variables like mechanical compression or vascular access presence on arrival. The mixed linear model showed good IRR for durations of chest compression interruptions (ICC = 0.85), return of spontaneous circulation (ICC = 0.79), and number of intubation attempts (ICC = 0.96). CA video review demonstrates excellent IRR for collecting noncategorical, time-based data, but only moderate IRR for categorical variables.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"262-269"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371649","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}