Journal for Healthcare Quality最新文献

A Qualitative Analysis of Choice-Driving Factors for Emergency Department Utilization Among Medicare Advantage Patients in Idaho. 爱达荷州医保优势患者急诊科使用选择驱动因素的定性分析

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-06-13 DOI: 10.1097/JHQ.0000000000000482

Hillary E Swann-Thomsen, Alicia Young, Max Hobbs, Hilary Flint, Dan Anderson

{"title":"A Qualitative Analysis of Choice-Driving Factors for Emergency Department Utilization Among Medicare Advantage Patients in Idaho.","authors":"Hillary E Swann-Thomsen, Alicia Young, Max Hobbs, Hilary Flint, Dan Anderson","doi":"10.1097/JHQ.0000000000000482","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000482","url":null,"abstract":"Background: Emergency department (ED) utilization among Medicare Advantage patients has been a growing concern. Many patients opt for ED visits, which can lead to overcrowding and increased healthcare costs. Understanding the underlying reasons for this preference is crucial for developing strategies to optimize healthcare delivery and reduce unnecessary ED visits.Purpose: The current project aimed to understand the reasons Medicare Advantage patients choose to seek care in the ED setting.Methods: Patients completed interviews to understand drivers behind their choice to seek care in the ED. The responses were analyzed using generative AI to identify themes shaping patient decisions.Results: Results showed that most ED visits occurred during hours when clinics were open, with injury and trauma-related visits being the most common reasons. The decision to visit the ED was often self-initiated, influenced by friends and family, or guided by healthcare professionals. Many patients used healthcare-related technology, but indicated challenges related to navigating technology. Patients preferred to seek care from their primary care provider (PCP) and specified that their PCP was their first point of contact for nonemergency issues. Patients' decisions on where and when to seek healthcare services were influenced by factors such as preference for a specific health system, insurance coverage, location and accessibility, and experiences with certain facilities or services.Conclusions: The project provides insights into the reasons for avoidable ED visits and could be useful in developing strategies to reduce avoidable ED visits and improve patient care.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289699","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}

引用次数: 0

The Impact of Primary Disease on Patient Satisfaction in Outpatient Care: A Nationwide Analysis. 原发病对门诊病人满意度的影响：一项全国性的分析。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-06-13 DOI: 10.1097/JHQ.0000000000000480

Jinhee Park, Jinhyun Kim

{"title":"The Impact of Primary Disease on Patient Satisfaction in Outpatient Care: A Nationwide Analysis.","authors":"Jinhee Park, Jinhyun Kim","doi":"10.1097/JHQ.0000000000000480","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000480","url":null,"abstract":"Background: Patient satisfaction is a key indicator of health care quality, yet the impact of primary diseases on outpatient satisfaction remains underexplored. This study examined whether the primary disease independently influences patient satisfaction.Methods: We retrospectively analyzed 8,259 outpatient experience records from clinics (n = 6,347), hospitals (n = 1,374), and tertiary hospitals (n = 538) using data from the 2023 Medical Service Experience Survey in Korea. The primary diseases for outpatient visit were categorized into 50 specific conditions grouped under 9 disease categories. Multivariate analyses were conducted, adjusting for demographic and health care-related factors.Results: The primary disease was identified as an independent factor affecting satisfaction. Patients with cancer, particularly those with thyroid and breast cancer, reported the highest satisfaction, whereas patients with depression or bipolar disorder had the lowest. In addition, different diseases independently influenced satisfaction to varying degrees. Factors such as medical provider's manner (especially nurses) and facility convenience were also significantly associated with satisfaction.Conclusions: Although the precise mechanisms remain unclear, the primary disease should be considered an important determinant of patient satisfaction. Future research should take into account the impact of specific diseases on patient satisfaction when designing studies or interpreting results.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289701","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}

引用次数: 0

Navigating an Intravenous Fluid Shortage Crisis: A Health System's Response to a Hurricane-Induced Supply Disruption. 导航静脉输液短缺危机：卫生系统对飓风引起的供应中断的反应。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-06-13 DOI: 10.1097/JHQ.0000000000000484

Thomas A Nahass, Payal D Parikh, Christopher Gilligan, Stephen O'Mahony, Michael L Loftus, Nancy E Holecek, Ruric Andy Anderson, Kenneth M Granet

{"title":"Navigating an Intravenous Fluid Shortage Crisis: A Health System's Response to a Hurricane-Induced Supply Disruption.","authors":"Thomas A Nahass, Payal D Parikh, Christopher Gilligan, Stephen O'Mahony, Michael L Loftus, Nancy E Holecek, Ruric Andy Anderson, Kenneth M Granet","doi":"10.1097/JHQ.0000000000000484","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000484","url":null,"abstract":"Introduction: Hurricane Helene's disruption of Baxter's North Carolina manufacturing facility in September 2024 created significant supply disruptions and an urgent need to reduce intravenous fluid (IVF) usage across our 12 acute care hospital health system.Methods: Our approach combined an integrated informatics and operational response that included real-time electronic health record monitoring, clinical decision support tools, and hospital-level operational interventions.Results: We achieved and sustained a peak 44% reduction in IVF usage while maintaining quality metrics.Conclusions: Analysis of 68,430 patient encounters demonstrated no significant changes in acute kidney injury or mortality rate, although demonstrating a reduction in length of stay. This study describes the rationale and impact of our approach and provides a framework for healthcare systems facing similar supply chain disruptions.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289700","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}

引用次数: 0

Variability in Venous Thromboembolism Prophylaxis in Patients With Orthopedic Trauma at a Level 2 Trauma Center. 二级创伤中心骨科创伤患者静脉血栓栓塞预防的可变性。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-06-13 DOI: 10.1097/JHQ.0000000000000485

Vidushi Tripathi, Riley Sevensky, Kevin Lu, Paris Dattilo, Joseph Bove, Christen Russo

{"title":"Variability in Venous Thromboembolism Prophylaxis in Patients With Orthopedic Trauma at a Level 2 Trauma Center.","authors":"Vidushi Tripathi, Riley Sevensky, Kevin Lu, Paris Dattilo, Joseph Bove, Christen Russo","doi":"10.1097/JHQ.0000000000000485","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000485","url":null,"abstract":"Abstract: Patients with lower extremity orthopedic trauma are at increased risk of venous thromboembolism (VTE). American College of Surgeons data revealed that a New York Level 2 Trauma Center administered unfractionated heparin (UFH) four times more often, and low molecular weight heparin (LMWH) two-and-a-half times less often, than national averages, despite institutional and national guidelines supporting use of LMWH over UFH. We retrospectively reviewed VTE prophylaxis practices in adult patients with lower extremity orthopedic trauma at the institution to identify trends and/or aberrant administration. Pearson chi-square tests of independence were utilized to determine significance. Approximately 57.3% received no preoperative VTE prophylaxis, whereas 32.8% received UFH and 9.1% received LMWH. Unfractionated heparin was administered at greater or equal frequency than LMWH within each age, sex, and diagnosis group. Patients admitted to general surgical units received UFH more frequently than those admitted to orthopedics. A multimodal intervention can be used to change current practices and improve care quality.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289702","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}

引用次数: 0

Enhancing Drug Hypersensitivity Reaction Documentation Through a Clinical Surveillance Tool. 通过临床监测工具加强药物超敏反应记录。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-05-23 DOI: 10.1097/JHQ.0000000000000481

Jennifer Meyer Reid, Karla L Miller, Brant Oliver, Melissa Swee, Jaime R Wilson

{"title":"Enhancing Drug Hypersensitivity Reaction Documentation Through a Clinical Surveillance Tool.","authors":"Jennifer Meyer Reid, Karla L Miller, Brant Oliver, Melissa Swee, Jaime R Wilson","doi":"10.1097/JHQ.0000000000000481","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000481","url":null,"abstract":"Abstract: Drug hypersensitivity reactions (DHRs) are potentially life-threatening, immune-mediated responses resulting from use of a medicinal product often requiring emergency department (ED) triage. For patient safety, DHR documentation in the electronic health record (EHR) is imperative-ensuring the health care team is alerted to patient risks with the offending drug. A Veterans Affairs Health Care System medication safety team uncovered that only 25.6% of patients treated for a DHR in their local ED had appropriate documentation of the DHR. To address this critical issue, a Quality Improvement (QI) project was designed with the aim of using a clinical surveillance tool to increase the DHR documentation rate in a single VA ED from 25.6% to ≥ 50% over 6 months. The DHR documentation rate was measured monthly and calculated by dividing the number of patients with appropriate DHR documentation after an ED visit for treatment of the DHR by the total number of patients visiting the ED for DHR treatment. Six months of postintervention data revealed an increase in appropriate DHR to 65.4%, through Exponentially Weighted Moving Averages Statistical Process Control analyses. This pharmacist-led QI project uses software already available at many institutions and illustrates one low-cost solution to address underreported DHRs.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163157","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}

引用次数: 0

Feasibility of a Multidisciplinary Procedural Team Dedicated to Complex In-Patient Bedside Procedures. 多学科程序团队致力于复杂的住院病人床边程序的可行性。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-05-09 DOI: 10.1097/JHQ.0000000000000479

Daniel Ricaurte, Michael Russo, Patrick Deegan, Pallavi Nadendla, Steve Lee, Matthew Lissauer, William Sardella, Adam Steinberg

{"title":"Feasibility of a Multidisciplinary Procedural Team Dedicated to Complex In-Patient Bedside Procedures.","authors":"Daniel Ricaurte, Michael Russo, Patrick Deegan, Pallavi Nadendla, Steve Lee, Matthew Lissauer, William Sardella, Adam Steinberg","doi":"10.1097/JHQ.0000000000000479","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000479","url":null,"abstract":"Introduction: Hospitals have found difficulties performing routine procedures in a cost-effective and timely manner. We created a multidisciplinary \"In-patient Procedural Team\" (IPT) with the intent to meet the demand of nonvascular, nonenteral access procedures.Methods: A team was assembled comprising advanced practice providers and sonographers with oversight by a surgeon. The IPT scope of practice includes thoracentesis, paracentesis, and lumbar punctures, performed at the bedside under ultrasound guidance.Results: During 11 months, 2,453 procedures were performed. Of those, 1,196 were paracentesis, 1,099 thoracentesis (with 70 pigtail chest tubes placed), and 88 lumbar punctures. An 80.9% decrease in average consult completion time (9.75 hours vs. 1.86 hours, p < .01) and an 80.9% decrease in case creation-to-procedure start time (13.92 hours vs. 2.66 hours, p < .01) were found. When compared with pre-IPT data, procedures were now completed a mean of 19.2 hours earlier than historic controls. An estimate of 710 off-floor nursing hours were saved. In total, 3,500 patient transports around the hospital were eliminated.Conclusions: The creation of an IPT intended to tackle complex in-patient procedures is a safe way to reduce time-to-procedure and off-floor nursing time while maintaining high-quality standards.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163159","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}

引用次数: 0

Evaluating a Nurse-Driven Protocol for Indwelling Bladder Catheter Removal in Patients With Traumatic Brain Injury. 评估创伤性脑损伤患者留置膀胱导管拔除的护士驱动方案。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-04-25 DOI: 10.1097/JHQ.0000000000000477

Christian Makar, Aeryus Holloway, Olutola Akande, Akhil Chandekar, Olive Anagu, Mallory Jebbia, Victor C Joe

{"title":"Evaluating a Nurse-Driven Protocol for Indwelling Bladder Catheter Removal in Patients With Traumatic Brain Injury.","authors":"Christian Makar, Aeryus Holloway, Olutola Akande, Akhil Chandekar, Olive Anagu, Mallory Jebbia, Victor C Joe","doi":"10.1097/JHQ.0000000000000477","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000477","url":null,"abstract":"Introduction: Catheter-associated urinary tract infections (CAUTIs) are common complications in patients with traumatic brain injury (TBI) who require indwelling bladder catheters (IBCs). This study examined the impact of an Acute Urinary Retention Algorithm (AURA) nursing protocol that incorporates intermittent catheterization (IC) on CAUTI incidence.Methods: A retrospective analysis was conducted on TBI patients with IBCs placed between 2018 and 2022 at a Level I trauma center in Southern California. Catheter-associated urinary tract infection incidence and catheter-associated complications were compared between patients treated with and without the AURA protocol.Results: Among 73,005 patients with IBC, 255 had TBI and were admitted to the intensive care unit. Only 27 (10.6%) patients had catheters removed through the AURA protocol and had longer dwell times than the nonprotocol patients (2.59 vs. 2.44 days, p < .001). Catheter-associated urinary tract infection incidence was statistically similar between the protocol (7.4%) and nonprotocol groups (3.5%) (p = .327). However, patients who developed CAUTI were more likely to have undergone more than one IC.Conclusions: Timely removal of IBCs is crucial to minimizing the risk of CAUTI. This study highlights the underutilization of nurse-driven protocols such as AURA and suggests a careful application of IC in such protocols because of its potential association with increased CAUTI risk.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027367","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}

引用次数: 0

Decreasing the Use of As-Needed Antihypertensive Therapy in Hospitalized Patients With Asymptomatic Hypertension. 减少无症状高血压住院患者按需降压治疗的应用

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-04-16 DOI: 10.1097/JHQ.0000000000000473

Kirsten M Lipps, Allison M Samuel, Deval Patel, Deborah Lemaster, Jordan Kenik

{"title":"Decreasing the Use of As-Needed Antihypertensive Therapy in Hospitalized Patients With Asymptomatic Hypertension.","authors":"Kirsten M Lipps, Allison M Samuel, Deval Patel, Deborah Lemaster, Jordan Kenik","doi":"10.1097/JHQ.0000000000000473","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000473","url":null,"abstract":"Background: Hypertension (HTN) is common in the inpatient setting, with many patients receiving as-needed (PRN) antihypertensive medications (anti-HTN) despite lack of benefit and risk of adverse events. We aimed to decrease PRN anti-HTN use in medical patients without hypertensive emergency without increasing adverse events associated with untreated HTN.Methods: Our multimodal quality improvement (QI) intervention, which included multidisciplinary education and changes to the admission order set in the electronic medical record, was implemented from October 2021 through December 2021. We included adult medical patients with elevated blood pressure (BP) (systolic ≥130 mm Hg or diastolic ≥80 mm Hg) for evaluation of PRN anti-HTN use in pre- and postintervention periods. We excluded patients with admission diagnoses of hypertensive emergency and those requiring conservative BP management.Results: Postintervention, the proportion of admissions with PRN anti-HTN use decreased by 53% for orders and 29% for administrations. Adverse events due to PRN anti-HTN use were more common than those due to untreated HTN (4% vs. 0.3%), and complications related to untreated HTN did not increase postintervention.Conclusions: Our multimodal, multidisciplinary QI initiative was associated with decreased use of PRN anti-HTN in hospitalized medical patients and did not increase adverse events attributable to untreated HTN.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052809","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}

引用次数: 0

Optimizing Workplace Violence Reporting in a Multisite Hospital Setting: A Quality Improvement Initiative. 在多地点医院环境中优化工作场所暴力报告：质量改进倡议。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-04-01 Epub Date: 2025-01-28 DOI: 10.1097/JHQ.0000000000000468

Johanna Skippon, Caroline Pullan, Emilie Ballarino, Maaha Farrukh, Jane Topolovec-Vranic

{"title":"Optimizing Workplace Violence Reporting in a Multisite Hospital Setting: A Quality Improvement Initiative.","authors":"Johanna Skippon, Caroline Pullan, Emilie Ballarino, Maaha Farrukh, Jane Topolovec-Vranic","doi":"10.1097/JHQ.0000000000000468","DOIUrl":"10.1097/JHQ.0000000000000468","url":null,"abstract":"Introduction: Workplace violence (WPV) is a significant concern in healthcare settings and indicates the need for accurate reporting to plan and implement effective interventions. This article presents the results of a quality improvement (QI) initiative implemented at a large academic health sciences center to improve the reporting of WPV events.Methods: The Plan-Do-Study-Act (PDSA) model was adopted to optimize the electronic reporting process, reduce inaccuracies of WPV reporting, and ensure appropriate follow-up from leadership and the Workplace Health, Safety, and Wellness (WHSW) team. Over two PDSA cycles, modifications of an electronic incident reporting form were made.Results: The proportion of inaccurate reporting was significantly lower (χ 2 (1, N = 1,219) = 111.86, p = .001), after the QI initiative. In addition, the revisions increased staff follow-up and support from WHSW.Conclusions: Our QI initiative demonstrated that simple adjustments to our WPV reporting, with the revision of an electronic reporting form, had a significant improvement on incident data accuracy and staff follow-up. These findings will contribute to our organization's staff and patient safety.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060766","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}

引用次数: 0

Process-Focused Approach to Reduce Central Line Bloodstream Infections in the Pediatric Population. 以流程为重点的方法减少儿科人群中的中心管血流感染。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-04-01 Epub Date: 2025-02-14 DOI: 10.1097/JHQ.0000000000000470

Lacey Kovar, Tiffany Patterson, Amber Cline, Brittany Hilton, Kelsey Seigman, Sarah McMenamy, Kimberly Malinowski

引用次数: 0