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

{"title":"Aligning Thrombophilia Testing With Evidence-Based Guidelines: The Impact of Clinical Decision Support Redesign in an Academic Medical Center.","authors":"Lyncean Ung, Marcus H Lee, Suguna Raju, Luke Z Li, Lisa Senzel, Michael Guido, Theodore G Gabig, Rosa Maria Bobek, Mathew Tharakan, Veena Lingam, Rachel Wong","doi":"10.1097/JMQ.0000000000000321","DOIUrl":"10.1097/JMQ.0000000000000321","url":null,"abstract":"<p><strong>Background: </strong>Thrombophilia testing is frequently overused despite limited clinical utility in most acute thrombotic settings and clear guideline recommendations, contributing to unnecessary health care utilization and costs.</p><p><strong>Objective: </strong>To improve the appropriateness of thrombophilia testing through EHR-based clinical decision support.</p><p><strong>Methods: </strong>Five thrombophilia PowerPlans containing outdated or inappropriate testing were revised into 4 evidence-based PowerPlans using current guidelines and local expert consensus. Orders were analyzed over 30 weeks before and after intervention for PowerPlan usage, inappropriate testing, ordering by provider type, and estimated laboratory charges.</p><p><strong>Results: </strong>Appropriate testing remained stable, whereas nonevidence-based testing decreased from 19.0% to 12.6% ( P = 0.00001), with ordering reduction across all provider groups. Postintervention, inappropriate PowerPlans orders decreased from 41.4% to 3.1%, with laboratory charges decreasing by $117 436 for nonevidence-based testing over 30 weeks.</p><p><strong>Conclusions: </strong>Updating PowerPlans reduced inappropriate thrombophilia testing and estimated laboratory charges without reducing appropriate testing, demonstrating the value of EHR-based interventions in promoting high-value care.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"293-299"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371597","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":"Screening for Equity: Improving Colorectal Cancer Screening in Non-English Language Preferring Patients.","authors":"Jordan Anders-Rumsey, Steven King, Avilasha Sinha, Isabella Gau, Muna Almasri, Amani Karim, Elizabeth Spranger, Scott Gray, Tami Ellies, Christopher Grondin","doi":"10.1097/JMQ.0000000000000328","DOIUrl":"10.1097/JMQ.0000000000000328","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":"310-311"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868841","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":"Standardizing ICU-to-Ward Transitions: Introducing and Refining ICU-PAUSE in the Process of Medical Intensive Care Unit Downgrade.","authors":"Edwin Perez, Benjamin Tasevac, Timothy Kuchera, Erika J Yoo","doi":"10.1097/JMQ.0000000000000314","DOIUrl":"10.1097/JMQ.0000000000000314","url":null,"abstract":"<p><p>Intensive care unit-to-ward transitions are high-risk processes in which unstandardized communication can contribute to adverse events. Structured handoff tools such as ICU-PAUSE can improve these transitions. Thus, the authors introduced the standardized ICU-PAUSE framework and reassigned authorship from the receiving ward team to the sending ICU team and evaluated the impact of these interventions. A survey-based pre-post, staged quality improvement study of the ICU-to-ward transfer process at a single academic medical center was conducted. Internal Medicine housestaff were surveyed before and after the introduction of the tool to assess their satisfaction with the changes and their understanding of the patient's ICU course. The intervention was supplemented by 2 targeted educational sessions based on housestaff feedback. The first session was followed by a posteducation survey assessing similar domains as prior surveys but also focusing on perceptions of authorship and education. There was no difference in mean provider satisfaction scores pre- vs postintervention (6.0 vs 5.9, P = 0.75). Understanding of the ICU course was similar between pre- and postintervention surveys, although most respondents perceived ICU-PAUSE and targeted education to improve care transitions. After education, 67.9% of attendees reported an improved level of comfort writing ICU-PAUSE notes, and 61.2% believed ICU-PAUSE improved transitions of care. Most respondents (81.6%) believed the sending ICU team was best equipped to write the transfer notes. Standardizing the ICU downgrade note and changing authorship had no impact on provider satisfaction. However, providers felt authorship was best assigned to the ICU team.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"237-244"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936778","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":"Using Deming's System of Profound Knowledge to Form Quality Focused Age-Friendly Teams.","authors":"Kanishk D Sharma, Prachi P Chavan, Sandip A Godambe","doi":"10.1097/JMQ.0000000000000331","DOIUrl":"10.1097/JMQ.0000000000000331","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"300-303"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371585","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 FITness: Increasing Colorectal Cancer Screening in Veterans Aged 45-49.","authors":"Anveet Janwadkar, Duncan Pearce, Ryan Burden, Marla Stewart, Anthony Marsh, Leela Nayak, Tanya Payton, William Kirsch, Caitlin Martin-Klinger, Albert Jang","doi":"10.1097/JMQ.0000000000000324","DOIUrl":"10.1097/JMQ.0000000000000324","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":"306-307"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868765","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":"Using New Quality Indicators in Five Transfusion Centers in a One-Year Period: An Experience.","authors":"Berrin Uzun, Hulya Duran, Tugba Kula Atik, Melda Ozdamar, Fahri Yuce Ayhan","doi":"10.1097/JMQ.0000000000000317","DOIUrl":"10.1097/JMQ.0000000000000317","url":null,"abstract":"<p><strong>Background: </strong>This study aims to select 9 of the quality indicators recommended by International Society for Blood Transfusion in five different transfusion centers and analyze the results.</p><p><strong>Methods: </strong>Nine new indicators were retrospectively examined monthly in 2024 in 5 centers, including 2 educational and research centers, 1 city, 1 university, and 1 private hospital.</p><p><strong>Results: </strong>The rate of meeting blood requests varies between institutions and is in the wide range of 30.9%-99.0%. Expired erythrocyte suspension rates are similar and roughly <1% both among institutions and in the monthly analysis of the institutions themselves, while expired platelet suspension rates vary and are in the wide range of 0.7%-33.3%. Monthly analysis of institutions' disposal rates is lower and acceptable, but their expired platelet suspension rates are much higher. The rates of returned blood components and damaged blood components were roughly similar across all 5 institutions and were mostly <1%. To evaluate the errors in the preanalytical process of transfusion centers, the rate of improper pre-transfusion test requests was evaluated, it varied between institutions and was found to be <5%. The rate of erythrocyte suspension given without testing in an emergency was found to be <2%. Serious adverse reactions occurred only in Tekirdağ City Hospital during the 1-year period and the rate was found to be 0.08%.</p><p><strong>Conclusion: </strong>It was concluded that the indicators of transfusion centers in our country should be updated, and their number should be increased to cover the entire process.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"245-252"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944601","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":"Restricting Claims Data to 25 ICD-10-CM Codes Leads to Underestimation of Elixhauser Comorbidities.","authors":"Stephanie S Anderson, Bryan P Hull, Sean C Dowdy, Benjamin D Pollock","doi":"10.1097/JMQ.0000000000000347","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000347","url":null,"abstract":"<p><strong>Objective: </strong>The Centers for Medicare and Medicaid Services (CMS) inpatient claims data include up to 25 International Classification of Diseases Clinical Modification (ICD-10-CM) diagnosis codes per encounter, which are relied upon for comparing hospitals' risk-adjusted outcomes. Because hospital billing frequently includes more than 25 codes, we aimed to assess the extent of underestimation of Elixhauser comorbidities in risk-adjusted hospital outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study of all Medicare inpatient encounters across our health system from January 2019 to December 2025. We calculated number of codes per encounter and prevalence of Elixhauser comorbidities. We compared Elixhauser prevalence when limiting to 25 codes versus collecting all codes using chi-squared and Kruskal-Wallis tests and calculated the percent of Elixhausers that go uncaptured by the 25-code restriction. We assessed variation ICD-10 capture across all US hospitals using the 2024 CMS inpatient claims data, using codes in the 25th position as a proxy for percentage of encounters potentially having more than 25 codes.</p><p><strong>Results: </strong>148,929/397,301 (37.5%) inpatient encounters had more than 25 ICD-10-CM codes in our health system. 16/38 (42.1%) Elixhausers were significantly more prevalent when using all codes. There were 25 ICD-10 codes documented in 1,470,064/8,096,044 (18.2%) Medicare inpatient encounters across all US hospitals.</p><p><strong>Conclusion: </strong>More than 1/3 of inpatient encounters at our institution, and as many as 1/6 across the United States, have ICD-10-CM codes which are not included in CMS risk-adjustment models due to the limit of 25 ICD-10-CM codes per claim. CMS should expand claims data to include all ICD-10-CM codes.</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":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835760","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":"Quality Improvement Initiative to Increase Newborn RSV Immunization.","authors":"Shayda W Daneshvari, Sheri L Nemerofsky","doi":"10.1097/JMQ.0000000000000343","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000343","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) is a major cause of respiratory illness in infants. In 2023, the Food and Drug Administration approved 2 methods of RSV prevention: birthing parent bivalent RSVpreF vaccine and infant nirsevimab monoclonal antibody. During the 2023-2024 RSV season, 57.8% of newborns at Montefiore Medical Center Wakefield Division were immunized. This single-center quality improvement initiative aimed to increase RSV immunization rates by 10% in the following season.</p><p><strong>Methods: </strong>Multidisciplinary teams implemented targeted interventions across preconception, prenatal, and postnatal periods. Strategies included posting RSV educational flyers, conducting staff education meetings, and incorporating mandatory RSV-related phrases into newborn discharge summaries. Weekly monitoring enabled real-time tracking and adjustments. Immunization rates were tracked using maternal records and newborn discharge data; engagement with educational materials was measured using quick-response code analytics.</p><p><strong>Results: </strong>The average newborn RSV immunization rate increased to 75.9% during the 2024-2025 season. Maternal RSVpreF uptake significantly increased from 10.9 to 33.5% within the first month. The nirsevimab administration remained stable at 57.1% in the second season. Required documentation in the electronic medical record ensured that all newborns were assessed for immunization before discharge. Quick-response code flyers had moderate engagement, with higher click-through rates for Spanish-language materials.</p><p><strong>Conclusions: </strong>This quality improvement initiative exceeded its target, improving newborn RSV protection through provider education, documentation standardization, and patient outreach. These interventions streamlined workflow and advanced equitable immunization practices. Continued refinements and provider awareness will be essential to sustain high immunization rates amid evolving vaccine guidance and hesitancy.</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":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835660","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":"Project HOPE: Helping Overcome Pressures in Eldercare.","authors":"Amy Abramowitz, Jennifer Muise","doi":"10.1097/JMQ.0000000000000345","DOIUrl":"10.1097/JMQ.0000000000000345","url":null,"abstract":"<p><p>Project HOPE (Helping Overcome Pressures in Eldercare) involved implementing routine caregiver burden screening and a standardized support intervention in an outpatient geriatric medicine 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":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820628","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":"Four Domains to Support Responsible AI Integration.","authors":"Charles E Binkley, Brett Moran, Lucas Zier, Lee Beauchamp, Robert C Lloyd","doi":"10.1097/JMQ.0000000000000344","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000344","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":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804340","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}