Quality Management in Health Care最新文献

{"title":"When Auditing Is Not Enough: Analysis of a Central Line Bundle Audit Program.","authors":"Christopher A Linke, Paul Hodges, Megan E Edgerton, Johannah D Bjorgaard","doi":"10.1097/QMH.0000000000000489","DOIUrl":"10.1097/QMH.0000000000000489","url":null,"abstract":"<p><strong>Background and objectives: </strong>Bundled interventions and auditing have been recommended to reduce central line-associated bloodstream infection (CLABSI) events at acute care hospitals. We review the outcomes of a bundle audit program at an adult and pediatric academic medical center from April 1, 2021, to May 31, 2022. To analyze the impact on CLABSI rates following the introduction of a central line maintenance bundle audit process.</p><p><strong>Methods: </strong>All audit survey data, CLABSI event rates, and line days were collected. Statistical relationships were evaluated for CLABSI bundle performance with CLABSI rates and audit volume with CLABSI rates. Analyses were conducted at the hospital and unit level.</p><p><strong>Results: </strong>No correlation is found between CLABSI rates and audit performance at the hospital level (adult units, P = .619, r-sq = 2.13%; peds/NICU, P = .825, r-sq = 0.43%) or at the unit level (n = 7; P = .8-.896, r-sq = 0.15%-18.2%). There was no correlation in CLABSI rates when reviewing performance by audit volume at the hospital level (adult, P = .65, r-sq = 1.7%; peds/NICU, P = .677, r-sq = 1.5%) or at the unit level (n = 7; P = .25-.8, r-sq = 1.2%-8.5%). By contrast, a single unit that did not participate in the audit program during the sample period reported a lower CLABSI rate than comparable participating units ( P = .008).</p><p><strong>Conclusion: </strong>During the sample period, there was no relationship found between this CLABSI bundle audit program and improvement in CLABSI performance.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"256-261"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865167","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":"Specialty-Based Ambulatory Quality Improvement Program: A Specialty-Specific Ambulatory Metric Project.","authors":"Arielle R Nagler, Paul A Testa, Ilseung Cho, Gbenga Ogedegbe, Gary Kalkut, Dana R Gossett","doi":"10.1097/QMH.0000000000000481","DOIUrl":"10.1097/QMH.0000000000000481","url":null,"abstract":"<p><strong>Background and objectives: </strong>Healthcare is increasingly being delivered in the outpatient setting, but robust quality improvement programs and performance metrics are lacking in ambulatory care, particularly specialty-based ambulatory care.</p><p><strong>Methods: </strong>To promote quality improvement in ambulatory care, we developed an infrastructure to create specialty-specific quality measures and dashboards that could be used to display providers' performance across relevant measures to individual providers and institutional leaders.</p><p><strong>Results: </strong>The products of this program include a governance and infrastructure for specialty-specific ambulatory quality metrics as well as two distinct dashboards for data display. One dashboard is provider-facing, displaying provider's performance on specialty-specific measures as compared to institutional standards. The second dashboard is a leadership dashboard that provides overall and provider-level information on performance across measures.</p><p><strong>Conclusions: </strong>The Specialty-based Ambulatory Quality program reflects a systematic, institutionally-supported quality improvement framework that can be applied across diverse ambulatory specialties. As next steps, we plan to evaluate the program's impact on provider performance across measures and expand this program to other specialties practicing in the outpatient setting.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"243-248"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522844","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":"Effectiveness of a Hands-on Group Activity in Quality Improvement Education.","authors":"","doi":"10.1097/QMH.0000000000000485","DOIUrl":"10.1097/QMH.0000000000000485","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"262-263"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381516","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":"Advancing Behavioral Health Through Measurement-Based Care and the Intermountain Psychotherapy Institute.","authors":"R Lynae Roberts, Nichole Cunha, Tammer Attallah, Mason Turner, Kimberly Myers, Timothy R Fowles, Rajendu Srivastava","doi":"10.1097/QMH.0000000000000541","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000541","url":null,"abstract":"","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":"34 3","pages":"264-265"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609258","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 Quality Improvement Project to Improve Nurse-Patient Communication and Patient Satisfaction in Outpatient Center.","authors":"Ying Shen, Xiaoqiu Zhu, Fang Lei, Lifei Feng","doi":"10.1097/QMH.0000000000000522","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000522","url":null,"abstract":"<p><strong>Background and objectives: </strong>Poor communication brings troubles to patients' understanding of their diagnosis and nursing care, which can jeopardize patients' treatment and prognosis. Streamlined nurse-patient communication interventions are proved to improve patient satisfaction and nursing care quality. Guided by the Plan-do-Study-Act Quality Improvement Model, we used the Contact, Introduce, Communicate, Ask, Respond, and Exit (CICARE) communication mode aimed at improving nurse-patient communication and patient satisfaction in our outpatient center.</p><p><strong>Methods: </strong>Nurses in the center were trained on CICARE communication mode in the 1-month training sessions. They incorporated the CICARE communication mode into their routine nursing practices for all outpatients. Data were collected before implementation of the project and at 1-month post-implementation, between October 2023 and March 2024. The CICARE communication mode utilization rate, nurses' communication knowledge, practice skills, and ability, and the patient satisfaction rate were measured.</p><p><strong>Results: </strong>A total of 28 outpatient nurses attended the education training sessions. The utilization rate of the CICARE communication mode was 86%. Compared to before training, nurses' communication knowledge, practice skills, and ability, and the patient satisfaction scores improved significantly after training ( P < .05).</p><p><strong>Conclusion: </strong>Application of the CICARE communication mode in outpatient nursing work is beneficial for enhancing nurses' proficiency in nurse-patient communication and improving patient satisfaction, which can help to increase the quality of nursing care.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980863","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":"Lean Management Helps to Reduce Errors in Histopathology: A Real-life Experience From a Tertiary Care Public Sector Hospital.","authors":"Arpita Joshi, Garima Singh, Aarzoo Jahan, Namrata Sarin, Sompal Singh, Ruchika Gupta","doi":"10.1097/QMH.0000000000000516","DOIUrl":"10.1097/QMH.0000000000000516","url":null,"abstract":"<p><strong>Background and objectives: </strong>Histopathology has been increasingly playing a vital role in patient diagnosis. Histopathology laboratories have been riddled with multiple problems such as inefficiency, errors, and rising costs. Lean management, a concept derived from the Toyota production systems, helps in improving the operational efficiency by removing waste or errors. The lean concept has been demonstrated to reduce waiting times, improve patient safety and satisfaction, and reduce costs in health care. We aimed to assess the impact of lean management on the frequency of errors in the histopathology laboratory of a tertiary level hospital.</p><p><strong>Methods: </strong>This was a before-and-after study where the lean process was implemented in a phased manner beginning with an assessment of its need by the senior specialists, data collection, training of staff, post-training data collection and analysis. The various errors that were possible in the workflow of the laboratory were identified. The frequency of errors in 2018 (pre-intervention) and 2021 (post-intervention) was noted and compared.</p><p><strong>Results: </strong>Data collection from the pre-intervention period revealed that delay in microtomy, incorrect patient identification details on the requisition form, and sample received without appropriate fixative had the highest frequency of events leading to errors in histopathology. After the implementation of lean principles in the laboratory, the error frequency reduced by 30.79%. The highest decline was noted in the delay caused by grossing being performed in the morning hours (64.5% reduction), while the smallest reduction (16.67%) was noted for samples arriving from the clinical departments at erratic times.</p><p><strong>Conclusion: </strong>The present study emphasizes that the implementation of simple measures of lean management in a histopathology laboratory can be effective in reducing errors and improving efficiency without adding to the cost to the laboratory.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094730","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":"Safety, Efficiency, and Cost Conflicts in Emergency Department Point of Care Troponin Testing.","authors":"Zoe Grabinski, Jordan L Swartz, Yelan Wang, Aya Itani, Maria Aguero-Rosenfeld, Neldis Sanchez, Rajneesh Gulati, Ian G Wittman, Silas W Smith","doi":"10.1097/QMH.0000000000000502","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000502","url":null,"abstract":"<p><strong>Background and objectives: </strong>Assessment of acute coronary syndrome (ACS) has pressured rapid diagnostic evaluation through point of care troponins (POCT-Tns). However, POCT-Tns have demonstrated inconsistent accuracy compared to laboratory (LABT)-Tn. A POCT-Tn used inappropriately to \"rule-out\" ACS can lead to premature diagnostic closure. We aimed to minimize indiscriminate POCT-Tn testing, while balancing test turnaround time (TAT), institutional cost, and impact on patient time to disposition (TTD).</p><p><strong>Methods: </strong>A quality improvement (QI) initiative from 2018 to 2022 included educational interventions and electronic health record (EHR) adaptations. We evaluated test characteristics, trended test frequency, TATs, cost, and TTD. We used statistical process control charts to evaluate changes in test frequency over time. We used the Mann-Whitney U and Wilcoxon Signed-Rank Sum test to analyze changes in TAT, TTD, and cost.</p><p><strong>Results: </strong>POCT-Tn had high discordance with LAB-Tn (9.7%) and low sensitivity (52.5%). SPCs showed a significant decrease in POCT-Tn tests performed over time. LABT-Tn TATs were longer than POCT-Tn (54 vs 21 min; P < .001). Total Tn testing costs decreased by $668 827.83 annually. Compared to pre-initiative, arrival to disposition was 20 min longer for patients receiving a LABT-Tn (P < .001) and 37 min shorter for patients receiving a POCT with reflex to LABT-Tn (P < .001).</p><p><strong>Conclusion: </strong>POCT-Tn test characteristics may place patients at risk for missed ACS. A combined approach using education and EHR adaptations decreased use of indiscriminate POCT-Tn tests, decreased health care costs, and resulted in clinically appropriate changes in disposition times for this large cohort of ED patients.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080037","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":"Tutorial on Multiple Mediation Analysis Using Causal Networks: Application to Diagnosing COVID-19 From Its Early and Late Symptoms.","authors":"Farrokh Alemi, Vasantha Sandhya Venu, Sai Chandra Nikhil Madduru, Kyung Hee Lee","doi":"10.1097/QMH.0000000000000471","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000471","url":null,"abstract":"<p><strong>Background and objectives: </strong>There are two methods of studying multiple mediation: network-based and analysis of coefficients in regression equations.</p><p><p>This tutorial shows how multiple mediation analysis can be conducted through first constructing causal networks; and then evaluating the direct and mediated impact within the network. The proposed method is demonstrated in the context of diagnosing COVID-19 from its symptoms.</p><p><strong>Methods: </strong>822 individuals who had completed a COVID-19 test were recruited through listservs and via employees and patients of Virginia Commonwealth University Health Center. Participants reported their symptoms and which symptom(s) occurred first. A Causal Network model was established through a repeated chain of regressions in four steps: First, we identified the order of occurrence of symptoms. Second, COVID-19 test results were LASSO regressed on symptoms and demographic variables, establishing direct effects. Third, the direct effects were LASSO regressed on prior symptoms and demographic variables, establishing indirect effects. Fourth, the joint distribution of the variables in the network was simulated by evaluating regression equations at factorial combinations of their direct effects. Fifth, the mediated effect was calculated through twin modeling, where the model derived from the real data was compared to the counterfactual model that represented 'what if' there was no mediation.</p><p><strong>Results: </strong>The 10-fold cross-validated area under the receiver curve for the network model was 0.82, which is a moderate to high level of accuracy. The network model identified later symptoms (e.g., chills) mediated the effect of earlier symptoms (e.g. fever).</p><p><strong>Conclusions: </strong>A network-based multiple mediation analysis led to new insights by integrating findings of 19 separate regressions into a single network model. The procedure showed how artificial intelligence can help in triage of COVID-19 patients from their symptoms, before any home or laboratory tests.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008787","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":"Initiating the Conversation: Prioritizing Women's Reproductive Health in Primary Care.","authors":"Katherine H Endres, Grace Thapa, Cheryl Oetjen","doi":"10.1097/QMH.0000000000000509","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000509","url":null,"abstract":"<p><strong>Background: </strong>The United States continues to have the highest rates of maternal mortality and morbidity of all high-income countries. Added to this is the high rate of unintended pregnancy, making it clear that reproductive health services in this country are still deficient. National health care organizations recommend prioritizing reproductive health in primary care.</p><p><strong>Methods: </strong>Using the knowledge-to-action framework, this quality improvement project applied evidence-based practice regarding preconception and contraceptive services to primary care. King's Goal Attainment Theory was used to disrupt the usual routine and create a culture promoting reproductive health conversations with patients. Staff received education on reproductive health in the primary care setting, leading to the development of a new process to screen for pregnancy intent. Providers were guided on the use of shared decision-making tools to discuss reproductive services and to provide preconception care and the full range of contraceptive methods.</p><p><strong>Results: </strong>Over 40% of female patients seen received unexpected yet desired reproductive health services. Providers and staff reported that the implementation of the process was feasible and sustainable. A new culture emerged in which reproductive health inquiry became usual care.</p><p><strong>Conclusions: </strong>Including reproductive health inquiry as part of the primary care visit was an easy intervention to implement that led to success in bridging the gap to reproductive health in primary care without placing undue burden on providers or staff.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032082","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":"Evaluation of Soft and Hard Total Quality Management at Shahroud University of Medical Sciences.","authors":"Mohammad Amiri, Zahra Mehmannavaz Mikal, Hasan Bagheri, Elham Sadeghi, Ahmad Khosravi","doi":"10.1097/QMH.0000000000000499","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000499","url":null,"abstract":"<p><strong>Background and objectives: </strong>This research aims to examine the current level of soft and hard Total Quality Management (TQM) at Shahroud University of Medical Sciences and explore the factors contributing to its success.</p><p><strong>Methods: </strong>The present cross-sectional study included 462 university managers and employees selected by stratified random sampling method in 2022. The participants were asked to answer TQM, soft TQM, and hard TQM questionnaires. The data were analyzed using ANOVA and chi-square tests, Pearson's correlation coefficient, and structural equation modeling.</p><p><strong>Results: </strong>Managers made up 73 of the participants (15.8%). The average score for TQM was 143.02 ± 11.56, soft TQM 52.47 ± 9.35, and hard TQM 36.49 ± 9.54. There was no statistically significant variation in the mean score of hard TQM, soft TQM, and TQM based on gender or course completion. There was a strong and positive link between the scores of soft TQM, hard TQM, and TQM. Leadership commitment, employee suggestion systems, problem-solving groups, information quality, and preventive maintenance were strongly associated with quality management in the structural equation model.</p><p><strong>Conclusion: </strong>Given the university's average level of TQM implementation, it appears that steps should be taken to improve the evaluation process and provide feedback to employees. Steps should also be taken toward improving the commitment of senior management to implementing and enhancing the system of employee suggestions, establishing problem-solving groups, and training job duties. TQM can assist employees and increase the quality of the information to improve the university's rank in quality management.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009950","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}