Journal for Healthcare Quality最新文献

{"title":"Improving Sleep Quality in Emergency Department Patients: A Multimodal Nonpharmacological Quality Improvement Initiative.","authors":"Vivian C Wu, Akash Manes, Ivjot Samra, Mariana Cardenas Sepulveda, Rea Kular, Amir Behboudi","doi":"10.1097/JHQ.0000000000000538","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000538","url":null,"abstract":"<p><strong>Background: </strong>Sleep disruption is common in emergency department (ED) patients, and those boarding in hallway beds face compounded barriers including persistent overhead lighting, ambient noise, staff activity, and thermal discomfort.</p><p><strong>Purpose: </strong>To improve patient-reported sleep quality among hallway patients at a community ED through a multimodal, nonpharmacological quality improvement (QI) intervention.</p><p><strong>Methods: </strong>This QI study was conducted in phases. Phase 1 (September-December 2025) established baseline sleep quality through a questionnaire in 44 ED patients: 32 hallway and 12 room-bed patients. A sleep bundle including a Bluetooth sleep mask, heating pad, and a multilingual patient education display was developed through iterative Plan-Do-Study-Act cycles. Phase 2 (January-April 2026) assessed outcomes in 22 hallway patients who received the bundle.</p><p><strong>Results: </strong>Postintervention hallway patients reported improvements across all measured domains. Cold discomfort decreased from 66% to 41%, light disturbance from 91% to 50%, and noise disturbance from 69% to 46%. Poor or very poor sleep decreased from 59% to 18%. Exploratory analyses showed significant improvement in sleep quality using a significance threshold of p < .05.</p><p><strong>Conclusions: </strong>A multimodal, nonpharmacological sleep bundle was feasible to implement in an ED hallway setting and was associated with improvements in patient-reported sleep quality. Sleep disturbance in this environment is modifiable through targeted environmental intervention.</p><p><strong>Implications: </strong>Simple comfort measures improve patient experience in overcrowded acute care settings. This project focused on hallway patients, but the same interventions may be adaptable for patients in ED beds. These findings support broader adoption of nonpharmacological sleep bundles in ED environments.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992146","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":"Nurse and Patient Outcomes Across Pathway to Excellence Designated and Prospective Hospitals.","authors":"Hyunmin Yu, Kathryn A Connell, Matthew D McHugh","doi":"10.1097/JHQ.0000000000000537","DOIUrl":"10.1097/JHQ.0000000000000537","url":null,"abstract":"<p><strong>Background: </strong>The Pathway to Excellence (Pathway) program recognizes healthcare organizations that support positive nurse work environments, yet the impact of Pathway designation and engagement in the Pathway journey before designation on outcomes remain understudied.</p><p><strong>Purpose: </strong>To examine nurse job outcomes, nurses' assessments of the work environment, and patient satisfaction in Pathway-designated hospitals and hospitals pursuing Pathway designation.</p><p><strong>Methods: </strong>This cross-sectional study integrated data from the 2021 RN4CAST Study, the American Hospital Association Annual Survey, and Hospital Consumer Assessment of Healthcare Providers and Systems. The sample included 5,497 nurses across 360 hospitals in New York and Illinois, including Pathway, prospective Pathway, and non-Pathway hospitals. Outcomes included nurse job outcomes, work environment assessments, and patient satisfaction. Multilevel modeling was used to compare nurse outcomes, and multiple linear regression models were used to compare patient satisfaction across two contrasts: (1) Pathway versus non-Pathway hospitals and (2) prospective Pathway versus non-Pathway hospitals.</p><p><strong>Results: </strong>Compared with nurses in non-Pathway hospitals, nurses in Pathway hospitals reported lower burnout, lower job dissatisfaction, more favorable work environment assessments, and higher patient recommendation scores. Nurses in prospective Pathway hospitals reported lower job dissatisfaction and more favorable work environments.</p><p><strong>Conclusion: </strong>Engagement in the Pathway journey was associated with more favorable nurse outcomes. Pathway designation was further associated with higher patient satisfaction.</p><p><strong>Implications: </strong>Investments in supportive nurse work environments represent a transformative organizational process with potential benefits for both nurse well-being and patient experience.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992094","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 Hospitalist Prescription Drug Monitoring Program Review for Safer Opioid Prescribing: A Quality Improvement Initiative.","authors":"Peyton R Lester, Hailey L Miller, Senka Runjaic, Alejandro A Fabrega Gerbaud, Libardo Rueda Prada","doi":"10.1097/JHQ.0000000000000536","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000536","url":null,"abstract":"<p><strong>Background: </strong>Safe opioid prescribing remains a national priority amid rising overdose-related morbidity and mortality. Prescription drug monitoring programs (PDMPs) aim to improve prescribing safety by identifying high-risk medication patterns; however, clinician engagement remains inconsistent despite legal requirements. Internal audits at our institution demonstrated PDMP review in only 67.6% of opioid-prescribing discharges within the Hospital Internal Medicine Department, identifying a clear quality improvement (QI) opportunity.</p><p><strong>Purpose: </strong>This QI project aimed to increase PDMP review during opioid-prescribing discharges at our Hospital Internal Medicine Department by 20% over a 3-month period.</p><p><strong>Methods: </strong>Using the DMAIC framework, interventions targeted hospitalist physicians, advanced practice providers, and pharmacists. Strategies included stakeholder education, standardized documentation templates, pharmacist secure-chat reminders at discharge, workflow algorithms, and weekly dashboard monitoring with targeted feedback. The primary outcome was the proportion of opioid-prescribing encounters with documented PDMP review. The balancing measure was the percentage of patients discharged before noon to ensure operational efficiency was preserved. Chi-square and two-sample t tests were performed.</p><p><strong>Results: </strong>Among 336 eligible discharges, PDMP review increased from 67.6% at baseline to 84.8% by March 2025, with a peak of 100% observed during the final measurement week (p < .001). Review rates increased steadily, with the largest gains after dissemination of workflow algorithms and targeted feedback. Discharge-before-noon rates remained stable (11.67% vs. 13.47%; p = .27), with no effect on operational efficiency.</p><p><strong>Conclusions: </strong>This QI initiative significantly improved PDMP review adherence without affecting discharge efficiency.</p><p><strong>Implications: </strong>This scalable, multidisciplinary model supports regulatory compliance and strengthens system-level opioid stewardship across health care settings.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714183","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":"Enhancing Reliability in Non-ICU Central Line Maintenance Through System Redesign: A Quality Improvement Initiative.","authors":"Areeba Nayyer, Daniel Salcido, Fathia Mohammed, Donjeta Sulaj, Aileen Tlamsa, Stephanie Rosales","doi":"10.1097/JHQ.0000000000000532","DOIUrl":"10.1097/JHQ.0000000000000532","url":null,"abstract":"<p><strong>Introduction: </strong>Central line-associated bloodstream infections (CLABSIs) remain a major source of preventable harm and cost. Although daily chlorhexidine gluconate (CHG) bathing is recommended for patients with central venous catheters (CVCs), adherence is often inconsistent in non-intensive care unit (ICU) settings where device visibility and maintenance workflows may be less standardized.</p><p><strong>Purpose: </strong>To improve the consistency of CHG bath ordering and documentation among non-ICU adult inpatients with CVCs in a community hospital.</p><p><strong>Methods: </strong>We conducted a single-center quality improvement project using system redesign principles. Interventions included enhanced electronic medical record visibility of CVCs, standardized CHG bath orders within CVC maintenance workflows, and multidisciplinary education and feedback. Process measures included CHG bath order placement compliance and CHG bath completion compliance. Run charts evaluated trends over time.</p><p><strong>Results: </strong>At baseline, CHG bathing orders were lower among patients who developed CLABSI compared with those who did not (42% vs. 60%). The baseline rate of documented CHG baths was 0.42 baths per central line day among patients without CLABSI compared with 0.22 baths per central line day among patients with CLABSI. After implementation, CHG bath order compliance improved to 66-80% and bath completion compliance improved to 69-78%. After stabilization, documented CHG bathing increased to 0.84 baths per central line day.</p><p><strong>Conclusions: </strong>System-level workflow redesign improved reliability of CHG bath ordering and documentation for patients with CVCs in non-ICU settings.</p><p><strong>Implications: </strong>System-level approaches that prioritize leadership engagement and standardization may help improve central line maintenance practices in non-ICU settings.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563389","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":"Reduction of Unnecessary in-Person Visits During an in Vitro Fertilization Cycle While Maintaining High Quality Patient Care.","authors":"Salina Kanji, Victoria O'Driscoll, Heather Shapiro, Crystal Chan, Qixuan Li, Ella Huszti, Claire Ann Jones","doi":"10.1097/JHQ.0000000000000530","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000530","url":null,"abstract":"<p><strong>Introduction: </strong>In vitro fertilization (IVF) cycles typically require multiple in-person visits for blood tests and ultrasonography to monitor the response to gonadotropins and predict treatment outcomes.The aim of the quality improvement project was to reduce the number of in-person visits for patients undergoing IVF while maintaining high-quality patient care.</p><p><strong>Methods: </strong>A multimodal quality improvement (QI) initiative was implemented for patients undergoing IVF through changes to the default settings in the electronic medical record and staff education. Data were collected prospectively for all patients undergoing IVF from June to August 2020 and retrospectively from June to August 2019.</p><p><strong>Results: </strong>A total of 178 and 202 IVF cycles were included in the preintervention and postintervention periods, respectively. The median number of visits per IVF cycle was reduced by 50% in the postintervention period compared with baseline (4.00 [3.00, 5.00] vs. 8.00 [7.00, 8.00], p < .001). There were no statistically significant differences in the odds of having more than 20 oocytes retrieved (OR 1.568; 95% CI 0.91-2.703), moderate or severe ovarian hyperstimulation syndrome (OHSS) symptoms (OR 1.08, 95% CI 0.17-6.73), or pregnancy rate per embryo transfer (OR 0.82, 95% CI 0.45-1.50). A high level of patient satisfaction was observed.</p><p><strong>Conclusions: </strong>In-person visits during an IVF cycle were rapidly reduced, with good patient satisfaction and no statistically significant differences in outcomes.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537393","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":"Quality Improvement Educator Training in Healthcare: A Systematic Review of Programs, Methods, and Outcomes.","authors":"Ashlyne P Elliott, David Wittkower, Dani Mathisen, Natalie Polacek, Kyler M Godwin","doi":"10.1097/JHQ.0000000000000533","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000533","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review identifies and describes programs preparing clinician educators to teach quality improvement (QI) in health care.</p><p><strong>Method: </strong>A systematic search of sources published from 2000 through 2025 was conducted. Duplicates were removed, and titles and abstracts were initially screened. A full-text review of remaining articles was then conducted. Data were extracted and analyzed to identify common themes and characteristics.</p><p><strong>Results: </strong>The initial search yielded 7,897 articles. After deduplication, 6,431 remained; when titles and abstracts were screened, 5,209 did not meet criteria. Full-text review of the remaining 43 articles identified 23 meeting the inclusion criteria. Quality improvement educator programs were primarily affiliated with university institutions or health care systems and predominantly within medical schools. Overall, many programs targeted clinician educators who balanced teaching and clinical responsibilities. Substantial variation in duration, content, and instructional methods was noted across programs. However, most programs incorporated both didactic and experiential or project-based learning. Participants frequently reported high satisfaction and significant improvements in QI knowledge and skills on program completion. However, most studies relied on short-term, self-reported measures to assess these outcomes.</p><p><strong>Conclusions: </strong>These findings highlight the need for more standardized QI educator training programs which integrate theoretical QI content with practical application. Future research should prioritize longitudinal evaluation of educator development to better define best practices for competency-based QI educator training.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425522","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":"Increasing Naloxone Coprescription for High-Risk Opioid Prescribing: A Hospitalist-Focused Quality Improvement Initiative.","authors":"Libardo Rueda Prada, Peyton R Lester, Senka Runjaic, Marta Berguido de la Guardia, Hailey L Miller","doi":"10.1097/JHQ.0000000000000534","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000534","url":null,"abstract":"<p><strong>Background: </strong>High opioid doses markedly increase fatal overdose risk, for which the 2022 Centers for Disease Control and Prevention opioid guidelines reinforce naloxone coprescription among patients receiving them. Purpose: To reduce the percentage of patients discharged with a prescription of ≥90 morphine equivalents daily dose (MEDD) without naloxone in their medication list by 30%, from 54.20% to 37.94%, without negatively affecting provider satisfaction.</p><p><strong>Methods: </strong>This project was conducted in the Hospital Internal Medicine inpatient group at our institution from August 20, 2024, to June 30, 2025. Baseline and improvement metrics were obtained from the Epic opioid stewardship dashboard. The improvement measure was the percentage of patients discharged with ≥90 MEDD without naloxone. Provider satisfaction with the naloxone coprescribing process served as the balancing measure, assessed through surveys at baseline and postinterventions. The first intervention (January 2025) included staff education on MEDD calculation, naloxone indications, and prescription, supported by pharmacist reminders to providers. The second (March 2025) introduced algorithms for providers and pharmacists to standardize decision making. Proportions were compared using one-sided and two-sided proportion z-tests.</p><p><strong>Results: </strong>The percentage of patients with ≥90 MEDD discharged without naloxone decreased from 54.2% at baseline (n = 352/651) to 39.4% after the first intervention and to an average of 25.0% (n = 26/104) across 3 months after the second intervention (z = 5.53, p < .0001). Provider satisfaction increased from 44% to 73% postinterventions (p = .016).</p><p><strong>Conclusions: </strong>Targeted education, specialized algorithms, and reminders substantially improved naloxone coprescription rates among patients receiving ≥90 MEDD at discharge. Implications: Other institutions could reproduce this project in efforts to decrease fatal overdoses.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413391","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 Devil Is in the Details: Sustaining First-Case On-Time Starts at a Quaternary Care Center.","authors":"Gregory Glauser, Shaarada Srivatsa, Scott Steele, Jorge A Guzman, Keith Sulzer, Toms Augustin","doi":"10.1097/JHQ.0000000000000518","DOIUrl":"10.1097/JHQ.0000000000000518","url":null,"abstract":"<p><strong>Background: </strong>First case on time start is an increasingly important surgical operations metric. First case on time start delay is multifactorial, and institutional improvement requires an iterative, efficiency-centered approach.</p><p><strong>Methods: </strong>An institution-specific Lean Six Sigma Approach was taken to identify causes for case start delay and modify processes to improve \"ready for induction\" (RFI) times. A perioperative checklist was developed to track active steps to on-time start. Emphasis was placed on a visual management board, daily perioperative huddles, shared responsibility across all stakeholder departments, and the sharing of granular surgeon data with department leadership.</p><p><strong>Results: </strong>This study took place at a nonprofit multispecialty quaternary care academic medical center. From April 2024 to July 2025, RFI on-time improved from 52% to 77%. \"In OR\" time reduced by 6 minutes, RFI time by 7 minutes, and incision time by 7 minutes. After intervention, median skin incision time was 20 minutes earlier for comparable on-time starts, and these cases ended 47 minutes earlier. Delays were most often related to surgical team (19.6%).</p><p><strong>Conclusions: </strong>This sustained quality improvement initiative demonstrated successful application of a perioperative checklist and focused behavior modification.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436820","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":"Population Health Approach to Blood Pressure Control Using Advanced Practice Provider-Managed Remote Patient Monitoring.","authors":"Karly Pikel, Kristin Burger, Shreyas Menon, Alexis Sassower, Micah J Eimer, Karin Ulstrup, Stephen D Persell, James Paparello, Emily Tuchman","doi":"10.1097/JHQ.0000000000000519","DOIUrl":"10.1097/JHQ.0000000000000519","url":null,"abstract":"<p><strong>Background: </strong>Guidelines suggest that home blood pressure (BP) readings are more reliable than in-clinic measurements; however, quality metrics for patients with hypertension (HTN) primarily rely on in-clinic readings. To improve BP documentation and management, we implemented an advanced practice provider (APP)-managed remote patient monitoring (RPM) program.</p><p><strong>Methods: </strong>The electronic health records (EHR) of internal medicine patients with HTN and uncontrolled BP (≥140/90 mm Hg, per our institution's quality metric) were reviewed for more recent controlled (<140/90 mm Hg) home readings. If found, these values were imported into the chart's patient-reported vitals section. If not, patients were offered RPM. Participants (n = 472) received a BP monitor that automatically transmitted home readings to the EHR and had APP-led follow-up to guide lifestyle and medication adjustments until target BP was achieved. Lower targets (<130/80 mm Hg) were pursued for higher risk patients.</p><p><strong>Results: </strong>For 12 months, average systolic and diastolic BP of patients with initially uncontrolled HTN improved from 149.8 to 131.3 mm Hg and from 84.0 to 79.3 mm Hg, respectively ( p < .001). The percentage of patients with HTN and last documented BP < 140/90 mm Hg increased 7.94% compared with 1.75% at a comparison clinic providing standard care ( p = .022).</p><p><strong>Conclusions: </strong>This APP-managed RPM program significantly improved BP outcomes and institutional quality metrics.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436791","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":"Artificial Intelligence in Health Care: Clinical Opportunities, Validation Trends, and Implementation Challenges (2020-2025).","authors":"Itrat Zehra, Shakir Ali, Seung Won Lee","doi":"10.1097/JHQ.0000000000000524","DOIUrl":"10.1097/JHQ.0000000000000524","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial intelligence (AI) continues to reshape health care, supported by advances in computing power, affordable data storage, and widespread electronic health record adoption.</p><p><strong>Methods: </strong>This systematic review followed PRISMA 2020 guidelines, searching PubMed, IEEE Xplore Digital Library, and Web of Science for studies published between January 2020 and September 2025. Eligible articles included original research addressing AI applications in clinical contexts with prospective or external validation.</p><p><strong>Results: </strong>Fifteen studies met inclusion criteria. Publication volume peaked in 2024 (n = 5, 33.3%). Deep learning was the most widely adopted method (60.0%), with convolutional neural networks frequently used in medical imaging. Radiology comprised 33.3% of applications, followed by oncology (20.0%) and cardiology (13.3%). The median diagnostic performance of imaging-based models was an area under the curve (AUC) of 0.91 AUC. Primary implementation challenges included regulatory compliance (53.3%), lack of algorithmic transparency (40.0%), data quality problems (33.3%), and clinical integration challenges (26.7%). Compared with earlier reviews (2015-2019), recent studies demonstrated increased external validation rates (rising from 23% to 46.7%) and greater focus on algorithmic fairness.</p><p><strong>Conclusions: </strong>Artificial intelligence demonstrates substantial potential to advance health care quality across multiple domains improving diagnostic accuracy and patient safety, enhancing care efficiency and timeliness, and supporting equitable care delivery when appropriately validated across diverse populations. However, realizing these quality improvements requires addressing persistent implementation barriers including regulatory uncertainty, algorithmic transparency, data quality concerns, and clinical workflow integration challenges.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730378","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}