Quality Management in Health Care最新文献

{"title":"Clinical Care Service Coordinators: An Evergreen Method for Personal Patient Experience.","authors":"Steve F Meth, Shannon L Cole, Albert W Wu","doi":"10.1097/QMH.0000000000000479","DOIUrl":"10.1097/QMH.0000000000000479","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"33 3","pages":"216-218"},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470493","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":"Development and Validation of the Hospital-to-Home-Health Transition Quality (H3TQ) Index: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality.","authors":"Alicia I Arbaje, Yea-Jen Hsu, Maningbe Keita, Sylvan Greyson, Jiangxia Wang, Nicole E Werner, Kimberly Carl, Dawn Hohl, Kate Jones, Kathryn H Bowles, Kitty S Chan, Jill A Marsteller, Ayse P Gurses, Bruce Leff","doi":"10.1097/QMH.0000000000000419","DOIUrl":"10.1097/QMH.0000000000000419","url":null,"abstract":"<p><strong>Background: </strong>Patients requiring skilled home health care (HH) after hospitalization are at high risk of adverse events. Human factors engineering (HFE) approaches can be useful for measure development to optimize hospital-to-home transitions.</p><p><strong>Objective: </strong>To describe the development, initial psychometric validation, and feasibility of the Hospital-to-Home-Health-Transition Quality (H3TQ) Index to identify patient safety risks.</p><p><strong>Methods: </strong>Development : A multisite, mixed-methods study at 5 HH agencies in rural and urban sites across the United States. Testing : Prospective H3TQ implementation on older adults' hospital-to-HH transitions. Populations Studied : Older adults and caregivers receiving HH services after hospital discharge, and their HH providers (nurses and rehabilitation therapists).</p><p><strong>Results: </strong>The H3TQ is a 12-item count of hospital-to-HH transitions best practices for safety that we developed through more than 180 hours of observations and more than 80 hours of interviews. The H3TQ demonstrated feasibility of use, stability, construct validity, and concurrent validity when tested on 75 transitions. The vast majority (70%) of hospital-to-HH transitions had at least one safety issue, and HH providers identified more patient safety threats than did patients/caregivers. The most frequently identified issues were unsafe home environments (32%), medication issues (29%), incomplete information (27%), and patients' lack of general understanding of care plans (27%).</p><p><strong>Conclusions: </strong>The H3TQ is a novel measure to assess the quality of hospital-to-HH transitions and proactively identify transitions issues. Patients, caregivers, and HH providers offered valuable perspectives and should be included in safety reporting. Study findings can guide the design of interventions to optimize quality during the high-risk hospital-to-HH transition.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"140-148"},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10730761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9675983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Experience Measurement and Innovation: Pachyderms, Precision, and Progress.","authors":"Geoffrey A Silvera, Amy Y Landry, Jane Banaszak-Holl","doi":"10.1097/QMH.0000000000000482","DOIUrl":"10.1097/QMH.0000000000000482","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"33 3","pages":"129-131"},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470496","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":"Hospital Patient Experience: Exploring Hospitals as Shifters and Sustainers Over Time.","authors":"Hanadi Hamadi, Geoffrey A Silvera, Sinyoung Park, Jing Xu, Zhigang Xie","doi":"10.1097/QMH.0000000000000470","DOIUrl":"10.1097/QMH.0000000000000470","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patient experience is a key factor in measuring hospital performance, and the Hospital Consumer Assessment of Healthcare Providers and Systems survey tool is used to assess patient perceptions. Hospitals with positive patient experience tend to have a better quality of clinical care, lower readmission and mortality rates, and an overall shorter inpatient length of stay. Studies have identified several organizational determinants of high- and low-rated patient experiences, including hospital size, type, staffing levels, and patient demographics.This study aims to explore the determinants of consistently high- and low-rated patient experience, as well as factors associated with positive and negative changes in patient experience over time.</p><p><strong>Method: </strong>The 2014 to 2019 American Hospital Association annual survey and the Centers for Medicare and Medicaid Services Hospital Value-Based Purchasing database were used. A total of 2801 acute-care hospitals were included in this study. A series of multivariate logistic regressions were used to model the probability of \"1\" (being a superior hospital or an inferior hospital). In addition, a generalized linear mixed model for binary responses was used to analyze the change (probability of positive and negative change).</p><p><strong>Results: </strong>The results showed that most hospitals did not sustain superior or inferior performance, and competition decreased the likelihood of a hospital consistently performing well in terms of patient experience. Superior performance was associated with hospital ownership (P < .001), size (P = .026), location (P = .002), teaching status (P = .009), average Herfindahl-Hirschman Index value (P = .005), and Medicaid and Medicare patient population. On the other hand, inferior performance was associated with hospital ownership (P = .003), size (P < .001), teaching status (P = .003), safety net status (P = .020), and Medicaid and Medicare patient population.</p><p><strong>Conclusion: </strong>This study aimed to examine the trends in hospital patient experience performance and the influence of hospital organizational characteristics on those trends. Our findings allow us to question the widely held belief that patient experience is a metric of differentiation and industry competition, suggesting that performance in this domain has not been utilized by most hospitals as a source of sustainable competitive advantage. The findings from this study highlight the importance of considering changes in performance over time and the need for significant organizational efforts to improve hospital performance in terms of patient experience.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"33 3","pages":"132-139"},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470494","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":"Simplifying Outpatient Procedure Access: Rethinking the GI Access Challenge Using Human Centered Design and an A3 Framework.","authors":"Nathan Merriman, Katie Liljestrand, Timothy R Fowles, Josh Lewis, Adam Balls, Rajendu Srivastava","doi":"10.1097/QMH.0000000000000475","DOIUrl":"10.1097/QMH.0000000000000475","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"33 3","pages":"213-215"},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470506","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":"Examining Soft and Hard Attributes of Health Care Service Quality and Their Impacts on Patient Satisfaction and Loyalty.","authors":"Li-Hsin Chen, Chun-Hung Chen, Jennifer Pasion Loverio, Mei-Jung Sebrina Wang, Ling-Hui Lee, Ya-Pin Hou","doi":"10.1097/QMH.0000000000000420","DOIUrl":"10.1097/QMH.0000000000000420","url":null,"abstract":"<p><strong>Background and objectives: </strong>Many studies have confirmed the influences of various service quality dimensions on patient satisfaction and loyalty, but no existing theoretical model accounts for variation in how different types of patients evaluate service quality's soft and hard attributes. This research gap may cause problems for administrators needing to decide how to distribute resources appropriately across multiple departments. Therefore, this study establishes a theoretical model of the differences between inpatients' and outpatients' evaluations of hard and soft qualities and compares such evaluations' influences on patient satisfaction and loyalty. Also, to supplement statistical analysis and respond to scholars' calls for more mixed-methods studies of health care quality, this research incorporates analysis of online reviews to provide a holistic, close to real-time picture of patients' service experience perceptions.</p><p><strong>Methods: </strong>This study's survey sample comprised 292 inpatients and 137 outpatients from a Taiwanese hospital. We used partial least squares structural equation modeling to test the hypothetical model and importance-performance map analysis to identify factors that were significant to the service process but performed poorly. Finally, we used a text-mining technique to scrape 536 reviews posted on Google Maps, and Leximancer Portal to perform automated content and sentiment analyses on those data, as a means of mapping the critical concepts and themes that influenced patient experiences.</p><p><strong>Results: </strong>This study's analyses support the ideas that both hard and soft qualities are critical dimensions of service quality, and that each has different influences on inpatients' and outpatients' satisfaction and loyalty. Specifically, the sampled inpatients strongly valued the hard qualities of the hospital but were not satisfied with it. On the other hand, soft qualities attracted outpatients' attention and influenced their satisfaction and loyalty. In addition, content analysis revealed that soft qualities were the main reason patients left comments, whether positive or negative. Waiting time emerged as another critical element in triggering patients' unfavorable reviews.</p><p><strong>Conclusions: </strong>Patient population type, whether inpatient or outpatient, has been found to impact perceptions of service quality within health care institutions. As such, health care administrators should be cognizant of this phenomenon and make informed and tailored decisions when addressing quality within their respective services. Emphasis on the development of both interpersonal and professional skills among health care personnel may prove beneficial in enhancing the patient experience and ultimately fostering positive online reviews.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"176-191"},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9857978","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":"Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center.","authors":"Sherita House, Hebatallah A. Naim Ali, Christopher Stucky","doi":"10.1097/QMH.0000000000000444","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000444","url":null,"abstract":"BACKGROUND AND OBJECTIVES\u0000High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center.\u0000\u0000\u0000METHODS\u0000We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other.\u0000\u0000\u0000RESULTS\u0000Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00).\u0000\u0000\u0000CONCLUSIONS\u0000We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"39 24","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140661371","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":"Associations Between Lean IT Management and Financial Performance in US Hospitals.","authors":"Justin Lee, Dorothy Y Hung, Elina Reponen, Thomas G Rundall, Aaron A Tierney, Pierre-Luc Fournier, Stephen M Shortell","doi":"10.1097/QMH.0000000000000440","DOIUrl":"10.1097/QMH.0000000000000440","url":null,"abstract":"<p><strong>Background and objectives: </strong>To understand the relationship between Lean implementation in information technology (IT) departments and hospital performance, particularly with respect to operational and financial outcomes.</p><p><strong>Methods: </strong>Primary data were sourced from 1222 hospitals that responded to the National Survey of Lean (NSL)/Transformational Performance Improvement, which was fielded to 4500 general medical-surgical hospitals across the United States. Secondary sources included hospital performance data from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS). We performed 2 sets of multivariable regressions using data gathered from US hospitals, linked to AHRQ and CMS performance outcomes. We examined 10 different outcomes measuring financial performance, quality of care, and patient experience, and their associations with Lean adoption within hospital IT departments. We then focused only on those hospitals that adopted Lean in IT to identify specific practices associated with performance.</p><p><strong>Results: </strong>Controlling for other factors, adoption of Lean IT management was associated with lower length of stay ( b = -0.098, P = .018) and inpatient expense per discharge ( b = -0.112, P = .090). Specifically, use of visual management tools (eg, A3 storyboards, status sheets) was associated with lower adjusted inpatient expense per discharge ( b = -0.176, P = .034) and higher earnings before interest, taxes, depreciation, and amortization margin ( b = 0.124, P = .042). Such tools were also associated with hospital participation in bundled payment programs (odds ratio = 2.326; P = .046; 95% confidence interval, 0.979-5.527) and percentage of net revenue paid on a shared risk basis ( b = 0.188, P = .031).</p><p><strong>Conclusions: </strong>Lean IT management was associated with positive financial performance, particularly with hospital participation in value-based payment. More detailed study is needed to understand other influential factors and types of work processes, activities, or mechanisms by which high-functioning IT can contribute to financial outcomes.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"67-76"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41210937","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":"Creating a Framework for Physician & APP Leader Development and Peer Collaboration.","authors":"Mary Claire C Jenkins, Samuel C Thomas, Emily Stirling, Timothy Fowles, Rajendu Srivastava, Anne Pendo","doi":"10.1097/QMH.0000000000000461","DOIUrl":"10.1097/QMH.0000000000000461","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"33 2","pages":"123-126"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319114","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":"A Stepped-Wedge Cluster-Randomized Controlled Trial of a Multi-interventional Approach for Fall Prevention.","authors":"Zhila Najafpour, Mohammad Arab, Arash Rashidian, Kamran Shayanfard, Mehdi Yaseri, Somayeh Biparva-Haghighi","doi":"10.1097/QMH.0000000000000435","DOIUrl":"10.1097/QMH.0000000000000435","url":null,"abstract":"<p><strong>Background and objectives: </strong>Falls are one of the most common adverse events at hospitals that may result in injury and even death. They are also associated with raised length of stay (LOS) and hospitalization costs. This experiment aimed to examine the effectiveness of multiple interventions in reducing inpatient fall rates and the consequent injuries.</p><p><strong>Methods: </strong>The present study was a stepped-wedge cluster-randomized controlled trial. It was done in 18 units in a public university hospital over 36 weeks. Patients included in this research were at risk of falls. Overall, 33 856 patients were admitted, of whom 4766 were considered high-risk patients. During the intervention phases, a series of preventive and control measures were considered, namely staff training; patient education; placement of nursing call bells; adequate lighting; supervision of high-risk patients during transmission and handovers; mobility device allocation; placement of call bell and safe guard in bathrooms; placing \"fall alert\" signs above patients' beds; nurses informing physicians timely about complications such as delirium and hypoxia; encouraging appropriate use of eyeglasses, hearing aids and footwear; keeping side rails up; and reassessing patients after each fall. The primary outcome was participant falls per 1000 patient-days. Secondary outcomes were fall-related injuries and LOS.</p><p><strong>Results: </strong>The results revealed a decrease in fall rate (n = 4 per 1000 patient-days vs 1.34 per 1000 patient-days, incidence rate ratio (IRR) = 0.19 [95% confidence interval (CI), 0.14-0.26]; P = .001) and injuries (n = 2.4 per 1000 patient-days vs 0.79 per 1000 patient-days, IRR = 0.22 [95% CI, 0.15-0.32]; P = .001) in exposed compared with unexposed phases. There was not a significant difference in LOS (exposed mean 10.63 days [95% CI, 10.26-10.97], unexposed mean 10.84 days [95% CI, 10.59-11.09], mean difference = -0.13 [95% CI, -0.53 to 0.27], P = .52).</p><p><strong>Conclusions: </strong>This multi-interventional trial showed a reduction in falls and fall rates with injury but without an overall effect on LOS. Further research is needed to understand the sustainability of multiple fall prevention strategies in hospitals and their long-term impacts.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"77-85"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138462339","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}