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

{"title":"AI-Assisted Thematic Analysis in a Quality Improvement Evaluation: Replicable Findings and Subtle Misrepresentations.","authors":"Elena T Broaddus-Shea, Steven Lockhart, Neva M Howard, Sandra P Spencer","doi":"10.1097/JMQ.0000000000000341","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000341","url":null,"abstract":"<p><p>Using artificial intelligence to identify themes in interview data from a quality improvement program evaluation produced 4 replicable themes grounded in the data. However, 2 consistently identified themes resulted from subtle misrepresentations and could have easily misled results without thorough data knowledge and output audit by the human research team.</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":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804377","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 Journey and Benefits of Obtaining ISO 9001 Certification.","authors":"Douglas Hewitt, Elizabeth Musick, Kristy Tansey, Peter J Pronovost","doi":"10.1097/JMQ.0000000000000346","DOIUrl":"10.1097/JMQ.0000000000000346","url":null,"abstract":"<p><strong>Introduction: </strong>University Hospitals transformed its quality strategy by transitioning to Det Norske Veritas accreditation and seeking International Organization for Standardization (ISO) 9001 certification to support its zero-harm framework and establish a sustainable quality management system.</p><p><strong>Intervention: </strong>Through standardized governance, leadership engagement, risk-based thinking, internal auditing, and an ISO 9001 implementation toolkit, hospitals embedded continuous readiness, accountability, and improvement into daily operations while aligning board-level oversight with frontline practice.</p><p><strong>Closing gaps: </strong>Det Norske Veritas accreditation and ISO 9001 certification are not well-known models in the United States. This journey describes implementation of a scalable model, moving beyond episodic compliance to continuous learning and improvement.</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":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764022","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 Screening for Adolescent Substance Use and Mental Health in Primary Care.","authors":"Ulfat Shaikh, Anna B Correa, Jennifer Monti, Maria H Rahmandar, Cheryl Courtlandt","doi":"10.1097/JMQ.0000000000000337","DOIUrl":"10.1097/JMQ.0000000000000337","url":null,"abstract":"<p><strong>Background: </strong>Mental health and substance use can coexist and worsen outcomes for youth. The goals of the Transformative and Evidence-based Approaches to Mental Health and Substance Use Screening (TEAMSS) quality improvement virtual learning collaborative were to enhance the implementation of screening and follow-up practices for adolescent substance use and mental health issues in primary care.</p><p><strong>Methods: </strong>TEAMSS engaged 160 clinicians at 27 pediatric primary care clinics in 18 states. Interventions focused on enhancing clinical processes related to screening, brief intervention, and follow-up for substance use, depression, anxiety, and suicide risk. The learning collaborative model was adapted for a virtual environment with learning sessions and action periods of shorter duration interspersed with individualized coaching.</p><p><strong>Results: </strong>Clinics standardized processes for screening and intervention, incorporated use of validated screening tools, increased the use of electronic health records and mobile devices in screening, engaged interprofessional team members, identified community resources, and increased clinician and staff knowledge of evidence-based guidelines and quality improvement methods. Substance use screening significantly increased from 35% to 75%. Follow-up of adolescents with positive substance use screening increased from 69% to 86%. Depression screening increased from 82% to 90%, anxiety screening increased from 32% to 69%, and suicide risk screening increased from 18% to 41%.</p><p><strong>Conclusions: </strong>TEAMSS significantly improved care for substance use, depression, anxiety, and suicide risk for adolescents at participating primary care clinics. Adapting a learning collaborative approach to a virtual setting requires close attention to maintaining engagement with clinical care teams, especially those in busy primary care clinics.</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":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148709077","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":"Integrating Health System Sciences Into a Medical School Curriculum: Challenges and Opportunities.","authors":"Chikeluba V Okafor, Jenna Garris, Dmitry Tumin, Luan Lawson, Suzanne Lazorick, Jill Sutton, Elizabeth G Baxley, Timothy Reeder","doi":"10.1097/JMQ.0000000000000340","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000340","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":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674774","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":"Identifying Discharge Delays: A Multidisciplinary Quality Improvement Initiative.","authors":"Kavya Bana, Kristin Myers, Katherine Woo, Jan Schriefer, Jack Bramley, Meghan K Train","doi":"10.1097/JMQ.0000000000000338","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000338","url":null,"abstract":"<p><p>In July 2021, our institution launched a program to begin documenting the medically ready for discharge date (MRDD) and the discharge delays (DDs) in the electronic medical record (EMR) to better allocate resources to streamline patient flow. The MRDD is the date at which a patient is deemed clinically stable for discharge by their medical team. DDs describe the reasons why a patient remains in the hospital beyond the MRDD. Our aim was to increase entry of DDs from 1.7% to ≥10% in hospitalized patients on a 26-bed Medicine unit between November 2023 and October 2025. The DD information would enable us to identify trends among vulnerable patient populations. We implemented Plan-Do-Study-Act cycles utilizing in-person and email communication by interdisciplinary teams as well as incorporating specific columns into the residents' EMR. We additionally stratified DD types based on the patient social vulnerability index. Since November 2023, the percentage of documented DDs for patients discharged beyond the MRDD was sustained above the target of 10% and peaked at 24% in October 2025. The most common themes of DDs were Placement, Disposition, Consult, and Home Coordination. We also found patients with higher social vulnerability index were disproportionately affected by DDs, including Consult, Home Coordination, and Transportation.</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":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674761","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 Quality Improvement Initiative: Reducing Unnecessary Phlebotomy, Enhancing Patient Experience, and Minimizing Environmental Impact in the Inpatient Setting.","authors":"Ashwin Varkey, Simran Parmar, Nai Chen Yeat, Vladimir Ornstein","doi":"10.1097/JMQ.0000000000000336","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000336","url":null,"abstract":"<p><strong>Background: </strong>The steady increase in laboratory testing volume burdens the health care system with substantial costs, contributes to patient dissatisfaction, and generates adverse environmental effects. Beyond financial expenditure, unnecessary testing poses medical risks and affects patient well-being. Our quality improvement (QI) project aimed to employ a multimodal intervention to enhance appropriate laboratory utilization amongst residents and hospitalists.</p><p><strong>Methods: </strong>This QI initiative used a multimodal intervention to enhance appropriate lab utilization among residents and hospitalists. It involved evaluating baseline knowledge gaps, implementing targeted education, and integrating daily structured discussions on lab necessity. In addition, an electronic dashboard was utilized with real-time data on lab ordering volume and labs ordered per attending.</p><p><strong>Results: </strong>The intervention led to a net decrease of 4657 lab orders over the 3-month period. Specifically, there were significant reductions in comprehensive metabolic panel (CMP) (19.5%), serum Mg (11.8%), serum Phos (14.1%), and complete blood count (CBC) (11.2%) orders, alongside a 20% increase in basic metabolic panel (BMP) orders. Patient satisfaction improved, with affirmative \"rest and recover\" responses rising from 51.8% to 63.2%. This reduction generated an estimated $10,645 in cost savings and a 1304.61 kg reduction in CO2 emissions.</p><p><strong>Conclusion: </strong>This multifaceted QI approach, integrating systemic interventions and education, effectively reduced unnecessary lab testing. It simultaneously improved patient experience, yielded cost savings, and mitigated environmental impact, offering a transferable framework.</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":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674787","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 Perceptions and Clinical Outcomes of a Novel Standardized Outside Hospital Admission Process.","authors":"Kennedy E Gallagher, Jeffrey M Riggio, Alan A Kubey","doi":"10.1097/JMQ.0000000000000339","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000339","url":null,"abstract":"<p><p>Transfers are high-risk events, and outside hospital admissions lack standardized processes to ensure timely delivery of essential clinical information. We piloted a novel, standardized process for outside admissions to a single academic medical center's resident- and hospital medicine-attending-based medicine services. Following literature review, Epic UserWeb review, and frontline physician input, a workflow and templated electronic health record accept note were developed to centralize outside admission documentation. Completed by physicians during real-time communication with outside physicians, the template captures key clinical data and incorporates a communication checklist. Physician education was delivered electronically and in person. Subjective attending and resident perceptions were assessed via electronic prepost surveys administered 1 week before and 90 days after implementation. Secondarily, exploratory patient clinical outcomes were assessed through 90-day prepost manual retrospective chart review. Survey responses were obtained from 60/38 residents and 12/7 attendings (pre/post). Documentation sufficiency on patient arrival was directionally promising among residents (21.7% vs 39.5%, P = 0.062). Satisfaction with the admission process and perceived patient safety improved significantly among residents and attendings (P ≤ 0.036). Most respondents rated the note as useful or very useful (84% residents; 86% attendings), and attendings reported reduced time managing outside admissions. The intervention was associated with exploratory, nonsignificant reductions in rapid response team activation, intensive care unit transfer, 30-day readmission, mortality, and length of stay compared with preintervention patients. A standardized documentation and communication process improved physician satisfaction and perceived patient safety, with promising exploratory patient outcomes. Further study is warranted to assess impact at scale.</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":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671910","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":"Advancing Patient Experience and Doctor Communication Excellence Through Targeted Multidisciplinary Intervention: A Quality Improvement Study.","authors":"Farzana Hoque, Richard H Savel, Payam Benson","doi":"10.1097/JMQ.0000000000000308","DOIUrl":"10.1097/JMQ.0000000000000308","url":null,"abstract":"<p><strong>Background: </strong>This quality improvement study aimed to enhance patient experience (PX) scores related to doctor communication (DC) on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Recognizing that effective physician-patient communication is central to patient satisfaction, our institution sought to implement a structured, multidisciplinary approach to improving DC performance.</p><p><strong>Methods: </strong>We implemented 7 coordinated interventions: (1) a weekly PX meeting with leadership oversight; (2) a standardized, system-wide approach to didactic PX content; (3) weekly one-on-one provider coaching; (4) quarterly hospital-wide educational sessions; (5) trainee-specific PX didactics; (6) detailed provider feedback based on patient comments; and (7) a formalized postdischarge telephone follow-up process. Data were extracted from 4859 completed HCAHPS surveys collected before and after intervention implementation. Mean percentile rankings and standard deviations for DC questions were calculated, and differences were evaluated for statistical significance.</p><p><strong>Results: </strong>The average DC percentile ranking improved from 26 ± 5 to 49 ± 13 for all DC questions combined ( P < 0.05). Question-specific improvements were observed from 36 ± 8 to 57 ± 15, 30 ± 3 to 50 ± 13, and 17 ± 5 to 35 ± 11 for DC questions 1-3, respectively (all P < 0.05).</p><p><strong>Conclusions: </strong>A structured, multidisciplinary approach incorporating education, coaching, and feedback was associated with significant improvements in physician communication HCAHPS scores. This framework may be generalizable to other hospital settings 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":"191-198"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936817","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":"Reducing Surgical Instrument Contamination Through Multidisciplinary Quality Improvement: A Systems Approach at an Academic Medical Center.","authors":"Kamga Nkouli, Emily Tally, James Lutz, Nina Dao, Robert Rusco, Kaitlin Marshall, Wendy Seiger, Lisa Case, Michael Morrey, Andrew Jea","doi":"10.1097/JMQ.0000000000000320","DOIUrl":"10.1097/JMQ.0000000000000320","url":null,"abstract":"<p><strong>Background: </strong>In early 2025, OU Health identified an increase in contaminated surgical instrument sets reaching the operating room (OR). Contaminants, including bioburden, hair, holes in wrapping, debris, and wet sets, posed risks to patient safety, workflow efficiency, and OR productivity, suggesting systemic deficiencies across the sterile processing department (SPD) and perioperative workflow.</p><p><strong>Methods: </strong>We convened a multidisciplinary quality-improvement team comprising administrators, surgeons, nurses, scrub technicians, SPD technicians, and quality specialists. Using the 8-Step methodology, we conducted root cause analysis, process mapping, and longitudinal data tracking. Interventions included standardized point-of-use cleaning, enhanced SPD personal protective equipment and gowning practices, washer maintenance, adoption of heavier wrapping materials, containerization of high-risk sets, limiting tray weight, removal of static-attracting materials, and targeted staff education.</p><p><strong>Results: </strong>From July 1, 2025, through January 31, 2026, 388 contamination events were recorded across service lines. Neurosurgery accounted for 36% (136 events) of all events. Common contamination types were holes (113 events), debris (98), bioburden (51), and filter defects (28); hair (20), wet sets (15), and improper disassembly (15) were less common but clinically significant. Temporal analysis demonstrated intermittent short-term improvements but persistent recurrence across contamination types. Contaminated sets contributed to 57% of all documented OR delays, totaling 2851 minutes. Estimated direct costs were $176 762; projected annual costs were $589 042.</p><p><strong>Conclusions: </strong>Contaminated surgical instrument sets represented a recurrent systems-level failure. Institution-wide efforts, including multidisciplinary collaboration, structured quality-improvement methodology, and targeted interventions, produced measurable improvements. Continued monitoring, workforce competency reinforcement, and system redesign are needed to mitigate future risk.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"41 4","pages":"206-212"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335483","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":"Intersectionality: Race, Place, and Dead Ends.","authors":"Meghan B Brennan","doi":"10.1097/JMQ.0000000000000306","DOIUrl":"10.1097/JMQ.0000000000000306","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"217-218"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148321600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}