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

{"title":"Book Review: The Journey's End.","authors":"Donald E Casey","doi":"10.1097/JMQ.0000000000000166","DOIUrl":"10.1097/JMQ.0000000000000166","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"39 2","pages":"91"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998746","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 Evolving Landscape of Emergency Department Patient Transfers: Challenges and Opportunities.","authors":"Daniel L Shaw, David T Chiu, Leon D Sanchez","doi":"10.1097/JMQ.0000000000000173","DOIUrl":"10.1097/JMQ.0000000000000173","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"86-88"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975265","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":"Incorporating Acute Conditions into Risk-Adjustment for Provider Profiling: The Case of the US News and World Report Best Hospitals Rankings Methodology.","authors":"Bradley G Hammill, Molly N Hoffman, Amy G Clark, Jonathan G Bae, Richard P Shannon, Lesley H Curtis","doi":"10.1097/JMQ.0000000000000171","DOIUrl":"10.1097/JMQ.0000000000000171","url":null,"abstract":"<p><p>Several years ago, the US News and World Report changed their risk-adjustment methodology, now relying almost exclusively on chronic conditions for risk adjustment. The impacts of adding selected acute conditions like pneumonia, sepsis, and electrolyte disorders (\"augmented\") to their current risk models (\"base\") for 4 specialties-cardiology, neurology, oncology, and pulmonology-on estimates of hospital performance are reported here. In the augmented models, many acute conditions were associated with substantial risks of mortality. Compared to the base models, the discrimination and calibration of the augmented models for all specialties were improved. While estimated hospital performance was highly correlated between the 2 models, the inclusion of acute conditions in risk-adjustment models meaningfully improved the predictive ability of those models and had noticeable effects on hospital performance estimates. Measures or conditions that address disease severity should always be included when risk-adjusting hospitalization outcomes, especially if the goal is provider profiling.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"69-77"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10903999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139935003","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}

{"title":"The Impact of Text Messaging to Promote Patient Reported Outcome Measures (PROMs) Completion in Orthopedic Practice: Findings From a Randomized Controlled Study.","authors":"Jeanette Y Ziegenfuss, Stephen E Asche, Steven P Dehmer, Megan Reams, Elizabeth S Grossman, Leif I Solberg","doi":"10.1097/JMQ.0000000000000174","DOIUrl":"10.1097/JMQ.0000000000000174","url":null,"abstract":"<p><p>It is difficult to achieve high response rates to Patient Reported Outcome Measures (PROMs) surveys collected as part of clinical care. However, they are operationally and clinically important. To understand the impact of text message reminders on response rates to PROMs collected via email as part of routine care for hip or knee replacement surgery, initial nonresponders were randomized to receive a text reminder or not at 7 and 12 days, if needed. At day 7, the overall survey response rate was 63%. Model-derived estimates for survey return after this point were 51.1% (95% confidence interval [CI], 48.0%-54.2%) in the text arm compared to 34.5% (95% CI, 31.6%-37.6%) in the no text arm. The effect of text messages on response rates did not vary by subpopulations considered nor were there differences in rates of key outcomes between the 2 groups, suggesting that it did not impact any underlying response bias. Given the relative low cost of text messages, they can be an efficient means to increase response rates.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"78-85"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11366300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975266","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}

{"title":"Improving Compliance with Preoperative Nasal Povidone-Iodine to Prevent Surgical Site Infection in Vascular and Neurosurgery Services in a Community Teaching Hospital.","authors":"Chizoba Ugwummadu, Eric Schmidt, Mark Hoeprich, Alyssa Bonta, Kay Ridgway, Luella Walker, Julia Witkowski, Jeffrey Weinstein, Mary Reich Cooper","doi":"10.1097/JMQ.0000000000000172","DOIUrl":"10.1097/JMQ.0000000000000172","url":null,"abstract":"<p><p>Surgical site infections (SSI) remain a cause of morbidity, prolonged hospitalization, surgical readmission, and death. Nasal colonization with methicillin-resistant Staphylococcal aureus is a frequent cause of device-related SSI and nasal mupirocin has been used for prevention. More recently, povidone-iodine nasal swabs have become an alternative. It is cheaper, ensures compliance and there are no concerns regarding antimicrobial resistance. However, its adoption was suboptimal in a community hospital system in southwestern Ohio, especially in neurosurgery and vascular surgery. Quality improvement techniques, including solicitation of stakeholder input, surgeons and perioperative nurses' education, and the use of reminders to order and administer the povidone-iodine nasal swabs improved physician ordering and nurse administration compliance, leading to fewer infections. The interventions continued after the project was completed, sustaining decreases in neurosurgery and vascular surgery, and fewer SSI through the first years of the pandemic. Despite the complexity of these surgeries, simple interventions were effective in addressing the problem.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"59-68"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975263","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":"Reflections on 3 Years of Innovation: Recognizing the Need for Innovation Beyond the Clinical Care Pathway.","authors":"Shoshana H Bardach, Amanda N Perry, Evan T Cavanaugh, Albert G Mulley","doi":"10.1097/JMQ.0000000000000164","DOIUrl":"10.1097/JMQ.0000000000000164","url":null,"abstract":"<p><p>The Susan and Richard Levy Healthcare Delivery Incubator is designed to bring about rapid, sustainable, scalable, and transformational health care redesign. All 10 projects in the initial 3 cohorts of teams embraced the Incubator process-forming diverse teams and following a design-thinking informed curriculum-and each successfully implemented improvements or innovations by the end of their project. The purpose of this article is to identify the key features of teams' work that may help account for projects' success. For the 10 projects completed, findings from debrief interviews and staff observations were examined to identify processes key to project's success. Analysis highlighted cross-project learnings that indicate nonclinical aspects of care delivery that play a critical role in project innovation success. Innovating health care delivery requires considering social and political determinants of health. The Incubator's process and structures enable teams to identify and respond to a broad range of health determinants.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"55-58"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975264","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 Effective Care in a University Population Based on National Vaccination Recommendations.","authors":"Julie Richards, Kevin Brunacini, Nancy Stoll, Robyn Tepper","doi":"10.1097/JMQ.0000000000000162","DOIUrl":"10.1097/JMQ.0000000000000162","url":null,"abstract":"<p><p>Vaccines are among the most cost-effective and successful medical interventions, saving approximately 2.3 million lives annually. Unfortunately, vaccination coverage for adults remains low, leading to unnecessary and costly health consequences. An initial chart review revealed that 95% (N = 20) of students were not up to date with vaccines. In a patient survey, 100% of students (N = 21) did not recall receiving useful vaccine information, but 66.7% reported it would be helpful (≥4 of 5 on the Likert scale). Strategies supporting effective care, an Institute of Medicine quality domain, were used to address these gaps. The aim was to increase effective care in university adult students for vaccines by 30% over 90 days. The quality improvement method of Plan-Do-Study-Act cycles was used to evaluate iterative tests of change. Examining contextual elements, team and patient feedback, aggregate data, and run charts informed tests of change over 4 cycles. Core interventions included enhanced screening, vaccine shared decision-making, provider checklists, and a team engagement plan. Greater than 83% (N = 152) of students were not up to date with vaccines as per national guidelines. Over 8 weeks, the team effectively referred students for 265 of the 274 vaccines they were eligible for-an accuracy rate of 95.3%. The aim score, a mean composite score reflecting all 3 interventions, increased from 49% to 95%. Effective care for vaccine uptake increased by 83.8%-far exceeding the goal. Campus health centers and other primary care settings could benefit from adopting a similar strategy that provides clear benefits to patients and the broader community while decreasing health care costs.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"42-49"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833893","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":"Prospective Study of the Multisite Spread of a Medication Safety Intervention: Factors Common to Hospitals With Improved Outcomes.","authors":"Heather C Kaplan, Stuart L Goldstein, Claude Rubinson, Nancy Daraiseh, Fang Zhang, Isabelle M Rodgers, Devesh S Dahale, David J Askenazi, Michael J G Somers, Joshua J Zaritsky, Jason Misurac, Vimal Chadha, Karyn E Yonekawa, Scott M Sutherland, Patricia L Weng, Kathleen E Walsh","doi":"10.1097/JMQ.0000000000000161","DOIUrl":"10.1097/JMQ.0000000000000161","url":null,"abstract":"<p><p>Context and implementation approaches can impede the spread of patient safety interventions. The objective of this article is to characterize factors associated with improved outcomes among 9 hospitals implementing a medication safety intervention. Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) is a pharmacist-driven intervention that led to a sustained reduction in nephrotoxic medication-associated acute kidney injury (NTMx-AKI) at 1 hospital. Using qualitative comparative analysis, the team prospectively assessed the association between context and implementation factors and NTMx-AKI reduction during NINJA spread to 9 hospitals. Five hospitals reduced NTMx-AKI. These 5 had either (1) a pharmacist champion and >2 pharmacists working on NINJA (Scon 1.0, Scov 0.8) or (2) a nephrologist-implementing NINJA with minimal competing organizational priorities (Scon 1.0, Scov 0.2). Interviews identified ways NINJA team leaders obtained pharmacist support or successfully implemented without that support. In conclusion, these findings have implications for future spread of NINJA and suggest an approach to study spread of safety interventions more broadly.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"21-32"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833910","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":"Engaging GME Learners in Health System-Aligned Improvement Work in the Clinical Learning Environment.","authors":"Glenn Rosenbluth, Lei W Choi, Christy K Boscardin, Ralph Gonzales, Adrienne Green, Antonio Hernandez, Arpana R Vidyarthi, Katherine A Julian, Robert B Baron","doi":"10.1097/JMQ.0000000000000160","DOIUrl":"10.1097/JMQ.0000000000000160","url":null,"abstract":"<p><p>Alignment between graduate medical education (GME) and health system priorities is foundational to meaningful engagement of residents and fellows in systems improvement work within the clinical learning environment. The Residents and Fellows Leading Interprofessional Continuous Improvement Teams program at the University of California San Francisco was designed over a decade ago to address barriers to trainee participation in health system-based improvement work. The program provides structure and support for health system-aligned trainee-led improvement projects in the clinic learning environment. Project champions (residents/fellows) from GME programs attend workshops where they learn improvement methodologies and develop proposals for health system-based improvement projects for their training programs. Proposals are supported by local faculty mentors and are reviewed and approved by GME and health systems' leaders. During the academic year, teams share their progress using visual management boards and interactive leader rounds. The health system provides a modest financial incentive for successful projects. Since the program's inception, thousands of trainees from 58 residency and fellowship programs have participated either as champions or participants in the program at least once, and in total over 300 projects have been implemented. Approximately three-quarters of the specific improvement goals were met, all projects meaningfully engaged residents and fellows, and many projects continued after the learners graduated. This active partnership between GME and a health system created a symbiotic relationship; trainees received education and support to complete improvement projects, while the health system reaped additional benefits from the alignment and impact of the projects. This partnership continues to grow with steady increases in participating programs, spread to partner health systems, and scholarship for trainees and faculty.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":" ","pages":"33-41"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833891","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 Sepsis Patient Education: A Quality Improvement Process.","authors":"Bethany Koschel, Claudia Leonard, Shelley Schoepflin Sanders","doi":"10.1097/JMQ.0000000000000163","DOIUrl":"10.1097/JMQ.0000000000000163","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"39 1","pages":"52-53"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139050040","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}