Quality Management in Health Care最新文献

{"title":"Predicting Risk of Malignant CNS Tumors From Medical History Events.","authors":"Aaron J Hill","doi":"10.1097/QMH.0000000000000497","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000497","url":null,"abstract":"<p><strong>Background and objectives: </strong>Malignant brain and other central nervous system tumors (MBT) are the second leading cause of cancer death among males aged 39 years and younger, and the leading cause of cancer death among males and females younger than 20. There are few widely accepted predictors and a lack of United States Preventive Services Taskforce recommendations for MBT. This study examined how medical history could be used to assess the risk of MBT.</p><p><strong>Methods: </strong>Using over 400,000 patients' medical histories, including nearly 1,800 with MBT, Logistic Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to predict MBT. More than 25,000 diagnoses were grouped into 16 body systems, plus pairwise and triple combinations, as well as indicators for missing values. Data were split into 80/20 training and validation sets with fit and accuracy assessed using McFadden's R2 and the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Diagnoses of the endocrine, nervous, and lymphatic systems consistently showed greater than three times more association with MBT. The best performing model at an AUC of 0.83 consisted of 14 body system diagnosis groups and pairwise interactions among groups, in addition to demographic, social determinant of health, death, and six missing diagnosis grouping indicators.</p><p><strong>Conclusions: </strong>This study demonstrated how large data models can predict MBT in patients using EHR data. With the lack of preventive screening guidelines and known risk factors associated with MBT, predictive models provide a universal, non-invasive, and inexpensive method of identifying at-risk patients.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658299","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 Coming Home Intervention to Enhance Safe Hospital-to-Home Health Transitions: Pilot Evaluation.","authors":"Alicia I Arbaje, Yea-Jen Hsu, Sylvan Greyson, Kathryn H Bowles, Margaret V McDonald, Sasha Vergez, Katie Harbison, Nicole Williams, Dawn Hohl, Kimberly Carl, Ayse P Gurses, Jill A Marsteller, Bruce Leff","doi":"10.1097/QMH.0000000000000519","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000519","url":null,"abstract":"<p><strong>Background: </strong>Care transitions from hospital to skilled home health care (HH) often pose safety risks, especially for older adults. The Coming Home Intervention (CHI) was developed to enhance these transitions based on the Hospital-to-Home Health Transition Quality (H3TQ) index, a previously validated survey instrument assessing quality issues during hospital-to-HH transitions.</p><p><strong>Objectives: </strong>This study aimed to pilot CHI and evaluate its impact at 2 large HH agencies in Baltimore, MD, and New York, NY.</p><p><strong>Methods: </strong>The 2 participating HH agencies implement CHI by providing HH clinicians and patients tools for expectation setting, clarification of healthcare-related roles of family and HH personnel, clinical care guides to support information management, and the H3TQ for identification of quality/safety issues. Using a quasi-experimental, before-and-after difference-in-difference design, changes before and after CHI implementation were compared between intervention and comparison groups. Quality of hospital-to-HH transitions was rated by older adults/caregivers and HH clinicians using the H3TQ before and after CHI implementation. In total, 394 responses were from older adults/caregivers and 604 responses were from HH clinicians. Outcomes including identification of medication issues and 30-day emergency department use or rehospitalization were evaluated using the Outcome and Assessment Information Set with a difference-in-difference approach (n = 3,471 in the Baltimore site; n = 758 in the New York City site). Results were analyzed and reported separately for each HH agency.</p><p><strong>Results: </strong>CHI implementation in Baltimore was associated with a statistically non-significant, decreasing trend in 30-day emergency department use or rehospitalization (odds ratio = 0.68, 95% confidence interval = 0.45-1.03). After implementation, older adults/caregivers rated quality issues measured by H3TQ less favorably. In New York City, older adults/caregivers reported fewer quality issues (incidence rate ratio = 0.50, 95% confidence interval = 0.27-0.89) after implementation. Assessment of other measures did not show significant changes.</p><p><strong>Conclusion: </strong>The pilot implementation of CHI demonstrated potential to improve hospital-to-HH transition quality. Study findings can guide future CHI implementation in larger studies in a broader population of older adults receiving HH services after hospital discharge.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658300","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":"Cost-Related Barriers to Medication Adherence in Uveitis Patients Enrolled in NIH's All of Us Program.","authors":"Bhoomi Dave, Maria Carolina Ibanez Bruron, Wenqing Zhang, Paulina Liberman, Meghan K Berkenstock","doi":"10.1097/QMH.0000000000000510","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000510","url":null,"abstract":"<p><strong>Background and objective: </strong>To investigate cost-related barriers to medication adherence in patients with uveitis.</p><p><strong>Methods: </strong>Non-interventional, retrospective study. The study examined the responses to cost-related medication adherence questions of 879 patients with uveitis who were enrolled in the National Institutes of Health All of Us Research Program database. To be eligible for inclusion, patients were required to have successfully completed at least one self-reported survey. Logistic regression analysis was employed to assess the relationship between race/ethnicity and medication adherence, controlling for relevant covariates.</p><p><strong>Results: </strong>Patients with an annual income of less than $75 000 were significantly more likely than those with an income above $150 000 to report difficulty affording medication, delaying filling prescriptions, skipping doses, taking less medication, and exploring alternative therapies to save money. Patients aged 60 years and above were more likely to report difficulty affording medication, as were those without health insurance.</p><p><strong>Conclusion: </strong>This study revealed that income and age are barriers to medication adherence. These findings have important implications for health care providers and policymakers, who should consider strategies to address these cost-related barriers to medication adherence.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650044","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 Potential of Patient Stories to Advance Birth Equity.","authors":"Anjali Walia, Fiona Miller, Linda Jones, Julie Harris-Taylor, Breezy Powell, Sarah B Garrett","doi":"10.1097/QMH.0000000000000504","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000504","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059407","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":"Peer Audit and Feedback: A Documentation-Focused Quality Improvement Project.","authors":"Michal I Glass, Kelly Powers, Laura M Magennis, Carmen L Shaw","doi":"10.1097/QMH.0000000000000496","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000496","url":null,"abstract":"<p><strong>Background and objectives: </strong>Nurses' documentation of communication, including notification of critical laboratory results (CLR), is important to ensure safe, high-quality care. Evidence supports peer audit with feedback as a quality improvement (QI) intervention to improve documentation. Nursing compliance with CLR documentation requirements was below goal for several years in an intensive care unit. To address this problem, a peer audit and feedback intervention was implemented and evaluated.</p><p><strong>Methods: </strong>Compliance with CLR documentation requirements was evaluated pre- and postintervention, for a total of 12 months. The evaluation also included data from the peer audits and a survey to assess nurses' perceptions. The 5-month intervention was a timely peer audit and feedback of CLR events.</p><p><strong>Results: </strong>CLR documentation compliance improved from 6.4% to 9.6% (50% improvement), which was clinically meaningful but not statistically significant. Nurses had overall positive perceptions of the peer audit and feedback as a QI tool, perceiving it as nonpunitive and helpful for improving practice.</p><p><strong>Conclusion: </strong>Results support continued examination of peer audit and feedback to improve nursing documentation. Future projects should address the limited time for nurses to engage in QI projects.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047633","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":"Surgical Scheduling Errors During Manual Data Transfer.","authors":"Timothy Davis, Tony Ong, Terry Nguyen, Adrienne Dang, Anil Chaganti, Stephanie Jones, Jungjae Lim, Akash Bajaj, Ramana Naidu, Richard Paicius, Sanjay Khurana","doi":"10.1097/QMH.0000000000000501","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000501","url":null,"abstract":"<p><strong>Background and objectives: </strong>Retrospective studies examining errors within a surgical scheduling setting do not fully represent the effects of human error involved in transcribing critical patient health information (PHI). These errors can negatively impact patient care and reduce workplace efficiency due to insurance claim denials and potential sentinel events. Previous reports underscore the burden physicians face with prior authorizations which may lead to serious adverse events or the abandonment of treatment due to these delays. This study simulates the process of PHI transfer during surgical scheduling to examine the error rate of experienced schedulers when manually transferring PHI from surgical forms into electronic health records (EHR).</p><p><strong>Methods: </strong>Participants (n = 50) manually input PHI from four surgical scheduling forms into a simulated EHR form. Eight critical data points were identified and defined as data that delay claim approvals and payments. Subjects were randomly assigned to either a control (18 minutes) or experimental (10 minutes) group. Transcription errors were flagged to measure the percentage of incorrectly inputted data fields. Two-tailed t-tests were used to determine statistical significance (P < .05).</p><p><strong>Results: </strong>100% of subjects in both cohorts had at least one or more errors in every form. The 10-minute cohort had a higher average \"critical errors\" rate than the 18-minute cohort (P = .03). Of the 200 forms completed, 171 forms contained 1 or more \"critical errors,\" resulting in a potential 85.5% delay or denial in authorization or payments. The highest incidence of critical errors across all fields occurred with ICD-10 codes, CPT codes, authorization number, procedure, and insurance ID number. As critical errors fields of authorization number and insurance ID often lead to automatic denials, not only are they more susceptible to transcription error due to alphanumeric values but more indicative of delays in treatment.</p><p><strong>Conclusions: </strong>These findings reveal a clear \"pain point\" in the routine scheduling process that leads to authorization and payment denials. With various touch points of manual data transfer in surgical scheduling, data degradation due to human error may compound at each step. Health care institutions should consider adopting digital solutions and investing in training programs to optimize clinical practice efficiency and reduce the possibility of inaccurate manual PHI transfer. Future case studies on denied payments will help further elucidate the economic impact on practices, as well as inform strategic decisions by those who directly handle health care management.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034100","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":"Call for Papers.","authors":"","doi":"10.1097/QMH.0000000000000002","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000002","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"34 1","pages":"87"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711093","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":"Call for Papers.","authors":"","doi":"10.1097/QMH.0000000000000002","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000002","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"34 1","pages":"87"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142954087","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":"Internal Audit to Monitor the Injected Activity in PET/CT Using Control Charts.","authors":"Sara Russo, Pedro Almeida, Teresa Lúcio, Luís Oliveira, Isabel Conde, Ana Aleixo, Ana Sofia Matos","doi":"10.1097/QMH.0000000000000449","DOIUrl":"10.1097/QMH.0000000000000449","url":null,"abstract":"<p><strong>Background and objective: </strong>In an effort to limit the risks associated with medical radiation exposure, the last century witnessed the development of dose control mechanisms, recommended by the International Commission on Radiological Protection. This organization recommends the optimization of radiation protection to provide the highest level of safety that may reasonably be achievable. Adhering to the \"as low as reasonably achievable\" principle, the purpose of this study was to monitor the 18 F-FDG injected activity in PET and optimize the radiation protection through an internal audit process. This monitoring allows the identification of opportunities for improvement in patient care and safety, as well as to establish a periodic review of the medical unit reference levels.</p><p><strong>Methods: </strong>The methodology is based on short run Quesenberry (Q) statistics and normalized nonconstant sample size (Z-chart) control charts. Anonymized data from 512 patients were selected from a set of 18 F-FDG PET/CT (Siemens, Biograph 6) examinations performed during 10 months. The analyzed variable was the ratio between the 18 F-FDG injected activity (MBq) and patient weight (kg).</p><p><strong>Results: </strong>Mean injected 18 F-FDG activity was 347.811 ± 64.967 MBq corresponding to a mean effective dose of 6.608 ± 1.234 mSv. The ratio between the 18 F-FDG injected activity and the body mass of patients was reduced from 5.243 ± 0.716 to 5.171 ± 0.672 MBq/kg during the statistical data analysis. The study demonstrates that control charts can be a useful tool to signal situations where patients receive an activity significantly different from the standard practice in a medical unit.</p><p><strong>Conclusion: </strong>The use of joint control charts is a suitable tool for detecting nonoptimized radiopharmaceutical administration. This analysis provides opportunities to evaluate and improve the quality of practice in nuclear medicine. This methodology constitutes an internal audit that may help health care professionals to make appropriate decisions to ensure all patients receive the safest and most appropriate care.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"55-62"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748998","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 Integration of Quality Improvement and Health Care Simulation: A Scoping Review.","authors":"Ashleigh Allgood, Susan Wiltrakis, Marjorie Lee White, Leslie W Hayes, Scott Buchalter, Allyson G Hall, Michelle R Brown","doi":"10.1097/QMH.0000000000000464","DOIUrl":"10.1097/QMH.0000000000000464","url":null,"abstract":"<p><strong>Background and objectives: </strong>Quality improvement (QI) and simulation employ complementary approaches to improve the care provided to patients. There is a significant opportunity to leverage these disciplines, yet little is known about how they are utilized in concert. The purpose of this study is to explore how QI and simulation have been used together in health care.</p><p><strong>Methods: </strong>This scoping review includes studies published between 2015 and 2021 in 4 databases: CINAHL, Embase, PubMed, and Scopus.</p><p><strong>Results: </strong>The search yielded 921 unique articles.18 articles met the inclusion criteria and specifically described QI and simulation collaborative projects. Of the 18 articles, 28% focused on improvements in patient care, 17% on educational interventions, 17% on the identification of latent safety threats (LSTs) that could have an impact on clinical care, 11% on the creation of new processes, 11% on checklist creation, and 6% on both LST identification and educational intervention. The review revealed that 61% of the included studies demonstrated a concurrent integration of simulation and QI activities, while 33% used a sequential approach.</p><p><strong>Conclusions: </strong>There is a paucity of studies detailing the robust and synergistic use of QI and simulation. The findings of this review suggest a positive impact on patient safety when QI and simulation are used in tandem. The systematic integration of these disciplines and the use of established reporting guidelines can promote patient safety in practice and in the literature.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"1-12"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748975","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}