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

{"title":"Evaluation of the Rothman Index in Predicting Readmission after Colorectal Resection.","authors":"Kent J Peterson, Carly M O'Donnell, Daniel C Eastwood, Aniko Szabo, Katherine Y Hu, Timothy J Ridolfi, Kirk A Ludwig, Carrie Y Peterson","doi":"10.1097/JMQ.0000000000000149","DOIUrl":"10.1097/JMQ.0000000000000149","url":null,"abstract":"<p><p>The Rothman Index (RI) is a real-time health indicator score that has been used to quantify readmission risk in several fields but has never been studied in gastrointestinal surgery. In this retrospective single-institution study, the association between RI scores and readmissions after unplanned colectomy or proctectomy was evaluated in 427 inpatients. Patient demographics and perioperative measures, including last RI, lowest RI, and increasing/decreasing RI score, were collected. In the selected cohort, 12.4% of patients were readmitted within 30 days of their initial discharge. Last RI, lowest RI, decreasing RI, and increasing RI scores remained significant after controlling for covariates in separate multivariate regression analyses. The last RI score at the time of discharge was found to be the most strongly associated with 30-day readmission risk following colorectal resection. These findings support the RI as a potential tool in the inpatient management of postoperative patients to identify those at high risk of readmission.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"287-293"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430798","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":"Utilization of In-Hospital Orthopaedic Spine Consultations: Evaluating the Impact of Health Care Policy.","authors":"Parker L Brush, Alexa Tomlak, Nick Pohl, Yunsoo Lee, Rajkishen Narayanan, Matthew H Meade, Mark J Lambrechts, Charles L Lawall, Jackson Weber, Amit Syal, Patrick O'Connor, Jose A Canseco, I David Kaye, Mark F Kurd, Alexander R Vaccaro, Chris K Kepler, Alan S Hilibrand, Gregory D Schroeder","doi":"10.1097/JMQ.0000000000000155","DOIUrl":"10.1097/JMQ.0000000000000155","url":null,"abstract":"<p><p>Access to specialty and private practice providers has been a divisive policy issue over the last decade, complicated by the conflict between a reduction in government-funded health care reimbursement and the need for health care providers to sustain a financially sound practice. This study evaluates the orthopedic spine consult service at an academic tertiary care center at 2 separate time points over a 5-year period to better understand the impact of decreasing orthopedic reimbursement rates and the increasing prevalence of federally supported medical insurance on the access to specialty care. In total 500 patients in 2017 and 480 patients in 2021 were included for the final analysis. A higher percentage of consults in 2021 came from the emergency department (74.0% versus 60.4%, P < 0.001); however, the emergency department saw fewer spinal cord injuries (11.9% versus 21.4%, P < 0.001), and the spinal cord injuries were less severe (3.1% versus 6.2% Association Impairment Scale A or B, P = 0.034). A smaller percentage of patients in 2021 went on to receive orthopedic spine surgery following consultation (35.2% versus 43.8%, P = 0.007), and those receiving surgery had an operation performed farther out from the initial consultation (4.73 versus 4.09 days, P < 0.001). Additionally, fewer patients with Medicare insurance (23.5% versus 30.8%) and more patients with Medicaid insurance (20.2% versus 12.4%) were seen in 2021 compared with 2017 (P = 0.003). Overall, this study found an increased proportion of Medicaid patients seen by the spine consult service but a decrease in the acuity of consults. Measures to improve access to health insurance under the Affordable Care Act have revealed the complexity of this issue in health care. This study's findings have demonstrated that while more patients did have insurance coverage following the Affordable Care Act, they still face a barrier to accessing outpatient orthopedic spine providers.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"300-305"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430803","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":"IDEAL PICU Rounds: Improving Daily Efficiency by Applying Lean Principles.","authors":"William Edward Cagle, Kacy Bennett Bagwell, Margaret Oates Poisson, Amy Marien Petro, Kaitlin Verdone","doi":"10.1097/JMQ.0000000000000156","DOIUrl":"10.1097/JMQ.0000000000000156","url":null,"abstract":"<p><p>The objective of this project was to improve communication, patient throughput, and rounding efficiency. Primary outcome studied was transfer/discharge order entry time and secondary outcomes included medication order entry time, staff perception, and time spent per patient. The location was a level one pediatric intensive care unit in an academic children's hospital. Utilizing Lean Six methodologies the major contributor to increased variability was different attending physician rounding patterns. These patterns were evaluated by a multidisciplinary committee, and the most efficient was adopted by all attending physicians during the study period. Data was collected by secret observers and a pre-post staff perception survey. Transfer/discharge order entry improved by 45 minutes/patient. Medication order entry improved by 89 minutes/order. Staff survey showed increased satisfaction in 9 of 12 aspects. Time spent per patient increased by 20%. In conclusion, standardization of rounds improved patient throughput, medication order entry, and staff satisfaction while increasing value-added time during rounds.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"279-286"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430799","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 Impact of Multimodal Analgesia on Length of Stay and Patient Satisfaction After COVID-19: A Retrospective Study Examining Lean Methodology in Pain Management for Patients Undergoing Partial Nephrectomies.","authors":"Aimee Pehrson, Gulsah Onar, Matthew Vance, Wesley White, Jason Buehler","doi":"10.1097/JMQ.0000000000000143","DOIUrl":"10.1097/JMQ.0000000000000143","url":null,"abstract":"Introduction: Opioids are considered the standard of care for managing post-operative pain for nephrectomies, often with side effects that impact key hospital indicators. Research has shown that discharging patients earlier assists in operational efficiency from decreasing excessive holds in the emergency room to reducing the number of postoperative readmissions. At the University of Tennessee Medical Center, the COVID-19 pandemic strained healthcare delivery, prompting changes in pain management strategies to increase hospital resources. The purpose of this cross-sectional, retrospective study was to determine if applying lean methodology to the use of quadratus lumborum (QL) nerve blocks, as part of a multimodal pain management strategy, impacted hospital resources while maintaining patient satisfaction in patients undergoing partial nephrectomies. Methods: All patients (n=217) who underwent non-emergent partial nephrectomies from 01/01/2019-12/31/2021 were included in this study. Continuous variables were measured by central tendency, and non-parametric Mann-Whitney U test was used to examine significance (p < .05). Statistical process control was applied at the level 3-sigma. Results: Among participants who received multimodal analgesia, the length of stay significantly decreased (p=.013) compared to","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"320-321"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430800","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 New Metric to the Efficiency of the Ventilator Liberation Process.","authors":"Lindsey Morris, Ryan Commins, Richard Loynd, Brian Chwiecko, Robert Hilton, Erika Yoo, David Aaron Oxman","doi":"10.1097/JMQ.0000000000000135","DOIUrl":"10.1097/JMQ.0000000000000135","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"322"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430795","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":"Utility of Respiratory Pathogen Panels in the Outpatient Oncology Setting.","authors":"Emily W Gripp, Bryan D Hess, Adam F Binder","doi":"10.1097/JMQ.0000000000000154","DOIUrl":"10.1097/JMQ.0000000000000154","url":null,"abstract":"<p><p>Oncology patients presenting for outpatient evaluation of a respiratory tract infection (RTI) are often tested for a variety of viruses with a respiratory pathogen panel (RPP) in addition to influenza and SARS-CoV-2. This triad of testing is expensive and uncomfortable because it requires 2 nasal swabs. Little evidence supports the use of an RPP in outpatient settings, but it is routinely ordered. This retrospective chart review analyzed 183 RPPs performed at Jefferson between April 2020 and November 2021 in outpatient oncology patients presenting with RTI. Data collected included patient demographics, symptoms, and exam findings at time of RPP, additional testing completed, results of RPP, antibiotic and antiviral use before and after RPP results, and patient outcomes 30 days after RPP. Descriptive statistics were calculated. Of the 183 RPPs analyzed, 16.9% (31) were positive for at least 1 respiratory virus. Fifty-two patients (28.4%) started antibiotics before results of the RPP. Of those, 2 patients (3.8%) had a change in antibiotic plan after RPP results returned. Zero patients were started on antiviral medication before results of the RPP. One patient started antiviral treatment after RPP results returned. In total, only 3 patients (1.6%) had an RPP-driven change in medication management. This study suggests limited utility in use of RPPs for oncology patients presenting to the office with RTI symptoms. Targeted testing with a single nasal swab for influenza, RSV, and SARS-CoV-2 may be more clinically relevant. The authors hope to use these data to implement a quality improvement initiative to reduce RPP utilization in this population.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"294-299"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430802","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":"Urgent Need to Reduce Regulatory Burdens on Clinicians.","authors":"Peter J Pronovost, Jennifer Gonzalez, Khaliah Fisher-Grace","doi":"10.1097/JMQ.0000000000000151","DOIUrl":"10.1097/JMQ.0000000000000151","url":null,"abstract":"","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"314-316"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430801","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":"Effect of a Performance Feedback Dashboard on Hospitalist Laboratory Test Utilization.","authors":"Caroline McCormick, Sarvpreet Ahluwalia, Ankur Segon","doi":"10.1097/JMQ.0000000000000150","DOIUrl":"10.1097/JMQ.0000000000000150","url":null,"abstract":"<p><strong>Background: </strong>Healthcare spending continues to be an area of improvement across all forms of medicine. Overtreatment or low-value care, including overutilization of laboratory testing, has an estimated annual cost of waste of $75.7-$101.2 billion annually. Providing performance feedback to hospitalists has been shown to be an effective way to encourage the practice of quality-improvement-focused medicine. There remains limited data regarding the implementation of performance feedback and direct results on hospital laboratory testing spending in the short term.</p><p><strong>Objective: </strong>The objective of this project was to identify whether performance-based feedback on laboratory utilization between both hospitalists and resident teams results in more conservative utilization of laboratory testing.</p><p><strong>Design, setting, participants: </strong>This quality improvement project was conducted at a tertiary academic medical center, including both direct-care and house-staff teams.</p><p><strong>Intervention or exposure: </strong>A weekly performance feedback report was generated and distributed to providers detailing laboratory test utilization by all hospitalists in a ranked system, normalized by the census of patients, for 3 months.</p><p><strong>Main outcomes and measures: </strong>The outcome measure was cumulative laboratory utilization during the intervention period compared to baseline utilization during the corresponding 3 months in the year prior and the weekly trend in laboratory utilization over 52 weeks. The aggregate laboratory utilization rate during intervention and control time periods was defined as the total number of laboratory tests ordered divided by the total number of patient encounters. Additionally, the cost difference was averaged per quarter and reported. The week-by-week trend in laboratory utilization was evaluated using a statistical process control (SPC) chart.</p><p><strong>Results: </strong>We found that following intervention during January-March 2020, the cumulative complete blood count utilization rate decreased from 5.54 to 4.83 per patient encounter and the basic metabolic panels/CMP utilization rate decreased from 6.65 to 6.11 per patient encounter compared with January-March 2019. This equated to cost savings of ~$42,700 in total for the quarter. Nonrandom variation was seen on SPC charts in weekly laboratory utilization rates for common laboratory tests during the intervention period.</p><p><strong>Conclusions: </strong>We found that our intervention did result in a decrease in laboratory test utilization rates across direct-care and house-staff teams. This study lays promising groundwork for one tool that can be used to eliminate a source of hospital waste and improve the quality and efficiency of patient care.</p>","PeriodicalId":101338,"journal":{"name":"American journal of medical quality : the official journal of the American College of Medical Quality","volume":"38 6","pages":"273-278"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430797","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}