Quality Management in Health Care最新文献

{"title":"Enhancing Patient Safety Awareness Among Medical Students: A Pilot Study.","authors":"Ana C Corona-Pantoja, María F Rodelo-Uraga, Diana M Barreto-Navarro, Ilse S Dávalos-Higareda, Edgar O Zamora-González, Ángel R Castro-Navarro, Benjamín Gómez-Díaz, Marcela M Rodríguez-Baeza, Norma A Vázquez-Cárdenas, Luz B López-Hernández","doi":"10.1097/QMH.0000000000000507","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000507","url":null,"abstract":"<p><strong>Background and objectives: </strong>The practice of medicine involves the risk of causing harm, even under the best circumstances and despite having optimal training. Therefore, patient safety is not only an essential part of healthcare but is also crucial for the training of resilient future doctors. The awareness of medical students regarding patient safety issues is of utmost importance for their professional formation. The objective of the present study was to gain insights into the awareness of medical students at the Autonomous University of Guadalajara about patient safety problems and the expectations of how patient safety is being managed in the health system.</p><p><strong>Methods: </strong>A descriptive and longitudinal study was carried out in which eighth-semester medical students were invited to participate. The questionnaire was adapted from the World Health Organization Medical School Curricular Guide for Patient Safety questionnaire and applied before and after the course \"Seminar on Quality and Safety in Medical Care.\" In total, 419 students answered the questionnaire.</p><p><strong>Results: </strong>The data showed a significant increase in the scores on the questionnaire after the course (P < .05).</p><p><strong>Conclusion: </strong>Students showed satisfactory awareness and positive expectations with regard to reporting and learning from errors and helping others when medical errors occur, which has implications for health care quality. Application of the WHO questionnaire in other settings and countries may contribute to a better comprehension of awareness and expectations of future health professionals in the world.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Quality in Chronic Diseases in the Outpatient Setting Using a CNS-Led Care Management Program.","authors":"Molly L McClelland, Douglas A MacDonald, Kacie Garver, Nancy Pattyn","doi":"10.1097/QMH.0000000000000531","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000531","url":null,"abstract":"<p><strong>Background and objectives: </strong>The magnitude of chronic disease management is a daunting health care problem at the same time when there is a reduction in primary care physicians, making achieving high-quality standards and goals extremely challenging for health care professionals. The research objective for this project was to provide evidence to support the use of clinical nurse specialist (CNS)-led multidisciplinary teams in the outpatient setting to improve quality measures in chronic conditions.</p><p><strong>Methods: </strong>Patient data were collected from 2019 to 2023 for patients engaging in a multidisciplinary care management program in an outpatient internal medicine office. Pre-post data were collected for weight, body mass index, blood pressure, glucose levels, A1C levels, cholesterol levels, and medical diagnosis. Data were recorded for the first care management patient visit and compared to the most recent care management visit. Four hundred five patient records were included in the study.</p><p><strong>Results: </strong>Ten of the 11 t-tests evaluated were statistically significant in improving health measures. The only variable that did not emerge significant was HDL.</p><p><strong>Conclusions: </strong>Because of their education and training, CNSs are the best-suited health professionals to lead a team-based collaborative approach to chronic disease care management and improve quality health outcomes in primary care environments. Patients choosing to participate in care management programs demonstrated significant improvement in their health, therefore reducing risk for health, complications.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Communication: Crafting Guidelines for Epic Secure Chat in an Academic Medical Center.","authors":"Escher L Howard-Williams, Elizabeth Dreesen, John Downs, Lauren Schiff, Cristie Dangerfield, Clare Mock","doi":"10.1097/QMH.0000000000000547","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000547","url":null,"abstract":"<p><strong>Background: </strong>Effective communication among health care providers constitutes a critical cornerstone for delivering optimal patient care. However, the achievement of efficient communication within patient care remains a challenge in modern medicine. While traditional paging systems have served as the primary means of communication in health care, they are limited to unidirectional communication. To address these shortcomings, bidirectional models emerged, seeking to enhance communication among health care partners. To foster improved communication, our institution implemented a 2-way secure messaging system, Epic Secure Chat. This introduction, however, occurred without tailored guidance on appropriate use, leading to confusion among health care staff regarding optimal, safe utilization of the new platform.</p><p><strong>Methods: </strong>Employing a system-wide survey to gather data from various in- and outpatient departments, we sought to comprehend the present state of affairs concerning the usage of this platform. The survey was distributed using a hierarchical email approach, beginning with Tier III Safety Huddle participants and cascading through departmental leadership at our institution. Department leaders further disseminated the survey to a wide range of clinical and administrative staff, including providers, nurses, pharmacists, technicians, and ancillary personnel, to ensure diverse role representation. Open-ended responses were analyzed using thematic analysis. The research team systematically coded and categorized responses to identify key themes, areas of consensus, and divergent viewpoints, enabling the extraction of meaningful insights into the use and perception of Epic Secure Chat.</p><p><strong>Results: </strong>The majority of survey respondents were physicians or advanced practice providers (56.54%) and nurses (31.78%), reflecting a predominantly clinical user base. Epic Secure Chat was widely used for interdisciplinary care coordination (34.07%) and 2-way communication (23.33%), though over 10% reported minimal use. While many valued its efficiency and ease of use, significant concerns emerged. Safety issues, including inappropriate use for urgent communication and lack of closed-loop messaging, accounted for 46.21% of feedback. Workflow challenges (34.70%) and compliance concerns (6.57%) were also noted. Despite these issues, 12.12% of responses highlighted positive impacts on team communication and workflow efficiency.</p><p><strong>Conclusion: </strong>These findings may serve as a model for other health care organizations seeking to implement or refine secure messaging systems. As communication technologies continue to evolve, it is essential to balance efficiency with safety, ensuring that tools like Secure Chat enhance rather than hinder clinical care. Continued evaluation and adaptation will be critical to achieving this balance and supporting both provider well-being and patient outcomes.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned From Provider Minder: A Provider Tracking Application for Improving Stroke Risk Screening in Sickle Cell Anemia.","authors":"Alyssa M Schlenz, Shannon M Phillips, Judson Stevens, Logan P Williams, Margaret T Lee, Robert Nickel, Beng Fuh, Lily Dolatshahi, Julie Kanter","doi":"10.1097/QMH.0000000000000515","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000515","url":null,"abstract":"<p><strong>Background and objectives: </strong>We developed a novel web-based application, Provider Minder, for providers to track and monitor stroke risk screening in children with sickle cell anemia. Here, we describe the development of the application, the process evaluation during implementation, and our lessons learned.</p><p><strong>Methods: </strong>An iterative development process was used to develop the Provider Minder application and its functionalities. For our process evaluation, our team conducted surveys and interviews with study teams across 13 sites that used Provider Minder as part of a multi-intervention trial for the Dissemination and Implementation of Stroke Prevention Looking at the Care Environment study. Surveys and interviews were conducted with providers and coordinators at midpoint (1 year) and end point (2 years). Results were integrated and organized according to themes.</p><p><strong>Results: </strong>The process evaluation indicated factors critical for implementation success, such as coordination across stakeholders. Successes of the intervention included high adaptability for unique site needs, ease of use, low costs of implementation, and perceived effectiveness at capturing missed screenings. Key challenges were the time burden for use, redundancy of data capture, and lack of integration, as Provider Minder was distinct from the electronic medical record.</p><p><strong>Conclusions: </strong>While providers and coordinators described multiple barriers to implementing Provider Minder, results indicated that perceived successes outweighed barriers. Future efforts to reduce the burden associated with health care complexity and improvement in interoperability of electronic medical records will be important for improving the success of similar tracking applications for complex conditions.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pandemic or Hurricanes? Service Quality Influence on Satisfaction in a Primary Health Care Public Clinic in Mexico.","authors":"Francisco Javier Urcádiz Cázares, Judith Guadalupe Martínez Tirado, Víctor Hugo Cruz Escalona, Arturo Bell Enríquez García, Mauro Alejandro Monroy Ceseña, Jesús Manuel Bautista Ortega, Mario Cortés Larrinaga, Carmen Julia Angulo Chinchillas","doi":"10.1097/QMH.0000000000000537","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000537","url":null,"abstract":"<p><strong>Background and objectives: </strong>The pandemic has severely impacted health services worldwide, making it crucial to document its effects on service quality. This longitudinal study is the first to assess how the COVID-19 pandemic affected the perceived service quality at a public clinic in Mexico and how it affected satisfaction among ambulatory patients.</p><p><strong>Methods: </strong>The study used the service performance (SERVPERF) survey during the pandemic (period 1, n = 143, 2022) and post-pandemic (period 2, n = 100, 2023-2024) and structural equation modeling to examine the influence of various service quality dimensions on satisfaction during both periods.</p><p><strong>Results: </strong>Contrary to expectations of a decrease in quality and satisfaction due to the increased demand for services during the pandemic, the findings indicated that overall service quality and patient satisfaction was high in both survey periods. The only exception was in the dimension of \"tangible aspects,\" which experienced a decline in quality attributed to the effects of unexpected hurricanes. Interestingly, there was a relative improvement in service quality during the pandemic. Furthermore, factors related to empathy significantly impacted patient satisfaction during this time.</p><p><strong>Conclusion: </strong>This study contributes valuable insights into perceived service quality at a public clinic in Mexico during and after the pandemic. It also advocates for an evaluation mechanism based on user perceptions, suggesting that political and economic efforts should focus on enhancing public service.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a Post-Discharge Telephone-Based Intervention Led by Social Workers to Reduce Heart Failure Readmissions.","authors":"Crystal Lihong Yan, Austin Erben, Kristel Sarmiento, Estin Kelly, Luanda Grazette, Marie Anne Sosa","doi":"10.1097/QMH.0000000000000535","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000535","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) readmission rates at our institution were often higher than the expected levels for our institution type. Social work post-discharge telephone calls were identified as an opportunity to address reasons for HF therapy noncompliance, a major reason for readmissions identified among HF patients at our institution.</p><p><strong>Methods: </strong>Our study aimed to improve existing post-discharge telephone outreach performed by social workers to reduce 30-day all-cause readmission rates in traditional Medicare patients with HF at a single academic tertiary care hospital. A multidisciplinary team of social workers, nurses, and physicians created 2 HF-specific forms based on an online resource (Target: HF telephone form) provided by the American Heart Association. The first form focused on HF transition of care-related issues, while the second form focused on HF patient education. These HF-specific forms replaced a generic checklist used by social workers during their post-discharge outreach.</p><p><strong>Results: </strong>Fifty-one patients were included in the intervention. The mean age was 76.82 years old. Most patients were male (56.9%), White (82.4%), Hispanic (58.8%), and spoke English as their preferred language (54.9%). Pre-intervention, the 30-day all-cause readmission rate ranged from 7.1% to 30.8%. Post-intervention, the 30-day all-cause readmission rate ranged from 8.3% to 25.0%. The pre-intervention mean 30-day all-cause readmission rate was 15.5% with a standard deviation of 8.1%, whereas the post-intervention mean was 16.8% and a standard deviation of 5.3% (P = .721).</p><p><strong>Conclusions: </strong>HF-specific structured telephone support by social workers post-discharge did not reduce 30-day all-cause readmission rates in an elderly, traditional Medicare population with HF.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Screening and Treatment of Hepatitis C in a Rural Primary Care Clinic.","authors":"Neil Langer, Pam LaBorde","doi":"10.1097/QMH.0000000000000532","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000532","url":null,"abstract":"<p><strong>Background and objectives: </strong>With the potential to lead to liver failure, cirrhosis, and death and the availability of hepatitis C Virus (HCV) treatment with direct-acting antiviral medications, primary care clinicians need to take action to improve screening and treatment of HCV. Current literature demonstrates gaps in knowledge contribute to low HCV screening and treatment rates. The project's purpose is to use a multidisciplinary approach to patient and clinician education to improve HCV care in a rural primary care clinic.</p><p><strong>Methods: </strong>This quality improvement project involved 1225 adult patients aged 18-79 seen at a rural Federally Qualified Health Center (FQHC) in Arkansas, from February 15 to April 1, 2024. The project applied the Chronic Care Model to promote change in decision support and clinical information systems by educating patients and clinicians, reinforcing care accuracy, and monitoring practice. Project interventions included provider, clinical staff, and patient education and improving the visibility of the patient's HCV screening status in the electronic medical record (EMR). The clinic manager and marketing director assisted the project leader with educational training. The laboratory director designated an area for HCV screening history in the EMR, and the quality director evaluated the program's efficacy. A manual retrospective chart review was performed to evaluate the program's effectiveness. The collected data were analyzed using descriptive statistics to demonstrate the efficacy of the quality improvement project.</p><p><strong>Results: </strong>Following the implementation of this project, providers at the clinic demonstrated an improved understanding of current HCV screening and treatment guidelines. Additionally, the HCV screening rates for eligible adults increased from the baseline screening rate of 42% to 44.8% with 549 of 1225 eligible patients screened for HCV during the project implementation period. Additionally, 100% (n = 4) of adult patients diagnosed with HCV from February 15, 2024, to April 1, 2024, initiated HCV treatment ordered by their primary care provider.</p><p><strong>Conclusions: </strong>While the short duration of the project poses a limitation, implications from this project to current practice point to the importance of innovative changes in information technologies as well as patient, staff, and clinician education to improve access to HCV screening and care in rural primary care clinics. Further, to improve the quality of care and the screening and treatment of HCV, rural health clinics and organizations should consider updating policies and procedures to standardize HCV screening for adults aged 18-79.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Promise of Barcode Medication Administration for Enhancing Medication Safety in Low-Resource Settings.","authors":"Ama Akoma Essuman, Angela Green","doi":"10.1097/QMH.0000000000000539","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000539","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Evidence-Based Quality Improvement in Health Care Quality and Patient Safety and Clinical Research Programs.","authors":"Evelyn O'Shea, Anita O'Donovan, Sharon Sheehan, Mary Coffey, Sinead Brennan, Maureen Flynn, Mary Browne, Petar Popivanov, Charles Gillham, Patricia Daly, Sarah Bergin","doi":"10.1097/QMH.0000000000000520","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000520","url":null,"abstract":"<p><strong>Background and objectives: </strong>This paper defines quality improvement (QI), describes the differences and connections among QI, clinical audit/quality assurance, and clinical research, highlights the importance of strong organizational governance for QI, and provides a simplified, evidence-based QI methodology that can be readily used by health care staff.</p><p><strong>Methods: </strong>The authors draw on their diverse QI experiences, encompassing a university maternity hospital, a radiation oncology specialist center, an acute general hospital, senior health care management, and academia. This demonstrates the feasibility of implementing QI in diverse health care settings and by all members of the multidisciplinary team.</p><p><strong>Results: </strong>Embedding QI in clinical audit, incident, and service user feedback management enables learning from Quality and Patient Safety activities, driving evidence-based improvements by frontline staff. Strong governance and accountability are essential to ensure QI efforts are sustained and impactful. QI also supports and enhances clinical research activities, improving patient outcomes and care.</p><p><strong>Conclusion: </strong>QI is most effective when it is kept simple, includes frontline multidisciplinary teams and patients/service users, and is supported by staff with QI expertise. This paper demonstrates the successful application of a QI methodology across varied health care specialties, emphasizing its broad applicability and significant benefits for health care delivery.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerating Clinical Practice Integration: IV Fluid Best Practice Implementation in a Merged Health System.","authors":"Ian J Howells, Timothy R Fowles, R Lynae Roberts, Danielle Groat, George Scott, Joseph Bledsoe, Rajendu Srivastava","doi":"10.1097/QMH.0000000000000553","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000553","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}