Journal for Healthcare Quality最新文献

{"title":"Are Safety Net Hospitals Reimbursed Fairly Under Hospital Value-Based Purchasing-Prioritizing Satisfaction Over Outcomes?","authors":"Irving Jorge, Miriam Weismann, Justin Brady, Chi Zhang, Kayla Li Haydon, David Etzioni, Yu-Hui Chang, Zhi Ven Fong, Nabil Wasif","doi":"10.1097/JHQ.0000000000000490","DOIUrl":"10.1097/JHQ.0000000000000490","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Medicare and Medicaid Services (CMS) reimburse hospitals through the Hospital Value-Based Purchasing Program (HVBP) based on clinical outcomes, safety, efficiency, and patient satisfaction, currently weighted equally. The aim is to explore whether adjusting these weights could address reimbursement inequities for safety net hospitals (SNH).</p><p><strong>Methods: </strong>We assessed 2,731 non-federal hospitals using CMS payment files. They were divided into SNH and non-SNH based on their DSH (Disproportionate Share Hospital) status in 2020. We compared both groups' 2020 HVBP scores to ensure data accuracy and account for COVID-19 impacts.</p><p><strong>Results: </strong>SNHs had lower person and community engagement domain scores (6.9) compared to non-SNHs (8.87, p<0.001), resulting in lower HVBP total performance scores (TPS) (p<0.001) and lower 2020 HVBP adjustment factors (p<0.001). Changing the TPS weights to 35% for clinical outcomes and safety, 25% for efficiency, and 5% for patient and community engagement improved TPS for SNH.</p><p><strong>Conclusions: </strong>Prioritizing clinical outcomes and safety measures can ease financial pressure on SNH.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975284","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":"Maintaining Neck Biopsy Diagnostic Yield and Time-to-Biopsy Through Volume Increase: A Quality Improvement Initiative.","authors":"Fardad Behzadi, Jisoo Kim, Amir A Satani, Michelle Mai, Erik K Loken, Thomas F Flood, Raymond Y Huang, Rose L Wach, Jeffrey P Guenette","doi":"10.1097/JHQ.0000000000000499","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000499","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous ultrasound-guided core needle biopsies (CNB) and fine needle aspirations (FNA) provide high yield and minimal risk for neck pathology diagnosis. Organizational shifts led to the planned closing of a long-standing pathology FNA clinic and a potential doubling in biopsy volume for our neuroradiology neck biopsy service.</p><p><strong>Purpose: </strong>We formulated a quality improvement (QI) initiative with three goals for our service: (1) maintain or decrease mean days to biopsy, (2) maintain or decrease variation in days to biopsy, and (3) maintain diagnostic yield.</p><p><strong>Methods: </strong>We added physician assistants to the biopsy team and opened a community hospital biopsy clinic. Weekly neuroradiology neck CNB and FNA were tracked from September 4, 2023, to June 23, 2024.</p><p><strong>Results: </strong>As anticipated, biopsy volume nearly doubled (6.1 ± 2.4 to 12.1 ± 1.2 per week between the first and last 8 weeks, p = .006). Statistical process control methods showed special cause shorter mean times-to-biopsy (8.6 days from 9.6 days) and special cause reduced week-to-week variation (0.8 days from 2.0 days) attributable to our process changes without special cause change in diagnostic rate (90.1% across the project period).</p><p><strong>Conclusions: </strong>These results highlight the successful application of QI methodology to modify and monitor volume-driven adaptations in a medical procedure clinic.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070742","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":"Rule-Based Artificial Intelligence and Workflow to Prompt Early Sepsis Management: A Quality Improvement Project.","authors":"Emily Grooms, Karen Biesack, Bart Abban, Joan Kramer","doi":"10.1097/JHQ.0000000000000493","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000493","url":null,"abstract":"<p><strong>Introduction: </strong>Early identification and management of sepsis improves patient outcomes, yet hospitals struggle to consistently screen patients on arrival and during hospitalization. The Centers for Disease Control published Hospital Sepsis Program Core Elements to guide hospital sepsis management and outcomes improvement efforts and will measure the sepsis core elements with the National Healthcare Safety Network Annual Hospital Survey.</p><p><strong>Methods: </strong>To further sepsis care management, our community-owned, nonprofit hospital implemented an emergency department quality improvement project, introducing rule-based artificial intelligence (AI) for sepsis identification with a workflow. Objectives were to measure rule-based AI sensitivity, sepsis management compliance, length of stay (LOS), and mortality rate.</p><p><strong>Results: </strong>A total of 895 cases were included in the final dataset, 370 preimplementation and 525 postimplementation. Postimplementation rule-based AI alerts identified 93.9% (493 of 525) cases for sepsis management interventions. After rule and workflow implementation, combined 3-hour compliance for antibiotic given, blood culture drawn, and lactate measured was 89.5%. Average LOS decreased by 2.3 days (p < .001), and mortality per 100 cases decreased by 22.3% (p = .0998).</p><p><strong>Conclusions: </strong>Implementing rule-based AI software to identify severe sepsis in conjunction with a sepsis workflow decreased LOS for patients diagnosed with either severe sepsis or septic shock.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070774","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":"Eliminating Routine Maternal Blood Work After Cesarean Birth: A Quality Improvement Project.","authors":"Yannay Khaikin, Harsukh Benipal, Jackie Thomas, Jodi L Shapiro, Andrea Page, Claire A Jones","doi":"10.1097/JHQ.0000000000000491","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000491","url":null,"abstract":"<p><strong>Objective: </strong>Low-value laboratories lead to healthcare inefficiencies, unnecessary interventions, and environmental waste. Maternal complete blood count (CBC) testing is routine after cesarean birth, but does not change clinical management in most cases. We aimed to decrease routine postpartum CBC testing at a tertiary-care hospital and replace it with targeted ordering for patients at increased risk of severe anemia.</p><p><strong>Methods: </strong>After reviewing baseline practices, we implemented a quality improvement intervention with two plan-do-study-act (PDSA) cycles. The intervention involved modification of the CBC order in the electronic postpartum order set and creation of ordering criteria: hemoglobin ≤110g/L, above average blood loss, or operating time. The primary outcome was the postpartum CBC draw proportion. Short- and long-term data were collected and evaluated using a run chart.</p><p><strong>Results: </strong>During PDSA2, we observed a reduction in CBC draws from 99% to 34% (n = 202). Nine patients met criteria for CBC but did not have a draw; none had signs or symptoms of anemia. Decrease in draws was stable at 1 year. Detection of severe anemia (≤70 g/L) was unchanged before and after intervention (2.4 vs. 2.3%, p = .88).</p><p><strong>Conclusions: </strong>Our intervention resulted in a significant and sustained change in postpartum CBC ordering. Similar initiatives should consider modifying ordering criteria to suit local trends.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034505","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 Initiative Designed to Increase Veteran Choice and Consult Retention.","authors":"Marina E Robson Chase, Madeline J Anderson, Wesley A Stephens, Andrew M Harris, Melissa R Newcomb","doi":"10.1097/JHQ.0000000000000494","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000494","url":null,"abstract":"<p><strong>Introduction: </strong>To improve access to care, the Veterans Administration (VA) offers eligible veterans the choice to receive Community Care (CC). Local changes to CC scheduling coincided with a decrease in expected surgical volumes. This project aimed to increase the retention of CC eligible veterans from 66% to 76% by September 2024, while prioritizing veteran autonomy.</p><p><strong>Methods: </strong>The quality improvement team learned CC eligible veterans were not offered a choice between community and VA care during scheduling. A decentralized and individualized scheduling process was developed to ensure veteran choice was respected and to increase consult retention. Consult retention rates were measured as the intervention was progressively scaled across surgical disciplines.</p><p><strong>Results: </strong>With the new scheduling process, retention rate increased from 66.1% to 69.3% and veteran choice was respected for over 5,500 veterans.</p><p><strong>Conclusions: </strong>As both private and VA networks explore strategies to retain patients within their health systems, a decentralized scheduling approach may not significantly affect retention rates. However, this project highlights how easily complex health care processes can lose sight of patient-centered care, which must remain the ultimate goal.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975297","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":"What Matters to You, Matters to Us: A Case Study on Leveraging the Electronic Health Record for Patient-Centered Care.","authors":"Carly Critchfield, Vignesh Prasad, Maulik Joshi","doi":"10.1097/JHQ.0000000000000489","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000489","url":null,"abstract":"<p><strong>Introduction: </strong>Patient-centered care is paramount for optimal outcomes. To address this, at Meritus Health, we asked a simple, yet profound question: \"What matters most to you? (WMM)\" This question, integrated into the patients' electronic health records (EHRs), facilitates meaningful conversations and helps tailor care to align with patient goals. This initiative, grounded in the principles of Age-Friendly Healthcare from the John A. Hartford Foundation, underscores the power of information by enabling clinicians to gain a comprehensive understanding of their patients. Our implementation required significant teamwork and provider engagement. Over 3 years, we have recorded more than 65,000 responses, creating a strategic priority for the health system to personalize care, guide clinical decision making, and drive continuous improvement. This strategic priority is health system wide. Patient-facing units and departments all across the health system track and report monthly metrics on the number of WMM responses captured. In addition, many departments across the system lead quality-improvement projects to improve and refine the process of asking this question.</p><p><strong>Methods: </strong>We assessed the patient responses to the WMM question to identify the frequency of common answers and also sought to review the implementation of the question process for learning.</p><p><strong>Results: </strong>In our analysis of more than 65,000 patient responses, we categorized the answers into the top distinct groups with the top five categories identified being family and relationships (noted 38% of the time), well-being (22%), health concerns (15%), lifestyle (6%), and religion and faith (3%).</p><p><strong>Conclusions: </strong>Asking and knowing WMM to patients offers more than just insight; it builds a meaningful conversation and relationship between the provider and patient in knowing the whole person. The top responses from patients are intuitively not surprising. The key to our questioning of the patients and the integration in the EHR are not the responses themselves, but the process of asking, knowing, and acting on WMM to patients. Ultimately, asking WMM can be a powerful tool in advancing patient-centric care and building population health.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975312","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":"Community of Practice Implementation: Leveraging Veterans Affairs/Department of Defense Diabetes Clinical Practice Guidelines and Data Insights.","authors":"Sarah Davis-Arnold, Jennifer Ballard-Hernandez, James Sall, Lisa Wayman","doi":"10.1097/JHQ.0000000000000475","DOIUrl":"10.1097/JHQ.0000000000000475","url":null,"abstract":"<p><strong>Abstract: </strong>Effective management of patient care delivery within the Veterans Affairs (VA) and Department of Defense (DOD) healthcare systems requires innovative strategies to implement clinical practice guidelines (CPGs). The authors explore the expansion of these strategies by leveraging the Strategic Analytics for Improvement and Learning data, the Electronic Quality Measures dashboard, and Patient Aligned Care Teams across the Veterans Health Administration enterprise. A multidisciplinary, national, virtual Community of Practice (CoP) using subject matter expert presentations that utilize the VA/DOD CPGs and strategic methods for implementation to enhance patient outcomes was developed and implemented. This work aims to detail the development and implementation of a virtual CoP that integrates multidisciplinary expertise and data analytics to enhance CPG adoption and implementation. The implications of CPG CoP discussed reflect the ongoing success and growth of the program's CPG CoP.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"47 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859822","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":"Reducing Daily Laboratory Tests in a Rural-Serving Health System: Insights and Challenges.","authors":"Greeshma Sheri, Pranaya Pakala, Dmitry Tumin, James R Manning, Yaolin Zhou","doi":"10.1097/JHQ.0000000000000487","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000487","url":null,"abstract":"<p><strong>Introduction: </strong>Laboratory test utilization initiatives are well-studied in academic centers but less so in rural and community hospitals. We applied the EPIDEM model (exploration, promotion, implementation, documentation, evaluation, modification) across a nine-hospital, predominantly rural health system to reduce unnecessary daily laboratory tests.</p><p><strong>Methods: </strong>At the medical center, we began engaging key partners in October 2020 through targeted in-person meetings. Electronic health record (EHR) interventions (removing daily ×3 ordering, Choosing Wisely reminders, interval-based ordering restrictions) started system-wide in April 2021. Regional hospitals received EHR interventions and educational materials only.</p><p><strong>Results: </strong>After clinical leadership approval in December 2020, our initiative's popularity accelerated, as groups requested inclusion. Across the health system, there was a 6%-20% reduction in tests per inpatient day. At the medical center, ordering decreased in December 2020 and dropped further with each EHR intervention. Unlike the sustained improvement observed at the medical center, ordering initially increased in the regional hospitals, decreased with each EHR intervention, but ultimately returned near baseline levels.</p><p><strong>Conclusions: </strong>Social and behavioral strategies are essential for sustaining daily laboratory test reduction efforts. Lasting cultural change may require local champions at each hospital. The EPIDEM model prioritizes relational and contextual factors, enabling quality improvement even in resource-limited settings.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849373","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":"Using Quality Improvement and Implementation Science to Identify Strategies That Foster Electronic Patient-Reported Outcome Submissions.","authors":"James W Doolin, Samira L Dias, Christine Cronin, Don S Dizon, Hannah W Hazard-Jenkins, Jessica J Bian, Sandra L Wong, Deborah Schrag, Roshan Paudel, Raymond U Osarogiagbon, Michael J Hassett","doi":"10.1097/JHQ.0000000000000478","DOIUrl":"10.1097/JHQ.0000000000000478","url":null,"abstract":"<p><strong>Background: </strong>Six cancer centers conducted a pragmatic type-II hybrid effectiveness-implementation study of eSyM, an electronic patient-reported outcomes (ePRO)-based symptom management program. Centers collected key performance indicators and recorded implementation strategies. To inform efforts to deploy ePROs as part of routine care, we sought to identify strategies associated with periods of special cause variation in weekly ePRO submission rates.</p><p><strong>Methods: </strong>ePRO utilization rates and implementation strategies were collected from August 2019 to April 2022. Statistical process control (SPC) methodology was used to identify periods of non-random variation, known as special cause variation, for all six centers. Investigators identified implementation strategies that were temporally associated with periods of special cause variation across centers.</p><p><strong>Results: </strong>For 714 weeks of ePRO reporting, the mean weekly response rate was 22.3% with wide variability by site. SPC charts detected multiple special cause variations at all sites. Direct patient outreach strategies to educate about and encourage use of ePROs were most associated with positive special cause variation.</p><p><strong>Conclusions: </strong>These findings highlight the positive effect of direct patient outreach on ePRO responsiveness and identify opportunities for improving symptom management. Quality improvement techniques, such as SPC charting, could help facilitate implementation of complex interventions and tailor them to the needs of specific populations and health systems.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709608","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":"Increasing Pneumococcal Vaccination Rates Using Previsit Planning in Patients Age 65 and Older.","authors":"Reema H Dbouk, Katherine Gray, Dominique Munroe, Miranda A Moore","doi":"10.1097/JHQ.0000000000000476","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000476","url":null,"abstract":"<p><strong>Abstract: </strong>Although pneumococcal vaccination decreases the rate of pneumonia-associated hospitalization and mortality, rates of pneumococcal vaccination among adults aged 65 years and older remained relatively unchanged during the period of 2019-2022. To improve the rate of pneumococcal vaccine coverage among patients aged 65 years and older in our academic internal medicine clinic, we conducted a quality improvement project centered on previsit planning as the intervention. Previsit planning was implemented in a phased approach, divided into three intervention periods, each involving an increasing number of medical teams. The previsit planning intervention was performed by medical assistants who reviewed vaccination status of patients scheduled for the following day and pended vaccination orders when indicated. When compared with baseline vaccination rates, rates increased in each of the three interventions (7.5%-33.3% [p < .05], 8.9%-39.6% [p < .05], 27.8%-38.9% [p < .05], respectively). Previsit planning can improve pneumococcal vaccination uptake in the ambulatory setting by distributing responsibilities for addressing care gaps across multiple team members, with potential benefits also including reduced provider burnout, improved clinic flow, and improvement of team members' preparation for patient visits.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660855","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}