Journal for Healthcare Quality最新文献_第10页

Efficacy of the Crisis Risk Triage Scale in Inpatient Units Within the United States. 危机风险分诊量表在美国住院单位的有效性。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-01-01 DOI: 10.1097/JHQ.0000000000000349

Kathie S Zimbro, Ralitsa S Maduro, Patricia Ver Schneider, Donna S Hahn, James F Paulson, Merri K Morgan

{"title":"Efficacy of the Crisis Risk Triage Scale in Inpatient Units Within the United States.","authors":"Kathie S Zimbro, Ralitsa S Maduro, Patricia Ver Schneider, Donna S Hahn, James F Paulson, Merri K Morgan","doi":"10.1097/JHQ.0000000000000349","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000349","url":null,"abstract":"Abstract: Patient violence toward others, including doctors and nurses, is a serious concern worldwide. A wealth of literature supports the assertion that violent behavior can be prevented with proper screening and management policies. This project aimed to evaluate the Crisis Triage Rating Scale (CTRS) within a 12-hospital integrated healthcare delivery system located in the southeastern United States. An initial sample of 112,708 unique patient visits between January 2019 and December 2020 was included in this retrospective review of electronic health records. We found that the CTRS harm triage question and risk levels were significant predictors of harm to others. Consistent with previous literature, positive predictive values ranged between 0.025 and 0.070 and negative predictive values ranged between 0.991 and 0.995. Our results support the assertion that clinicians should make balanced judgments about using a positive risk score to allocate safety measures. Variations in practice were evident across our healthcare systems. Improving appropriate assessment procedures may improve the diagnostic tools and risk stratification. When documented correctly, the CTRS performed as expected in an environment where harm to others occurred infrequently.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 1","pages":"51-58"},"PeriodicalIF":1.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10645689","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

A Structured Rounding Proforma in the Hyper Acute Stroke Unit (HASU): A Quality Improvement Project. 超急性中风单元(HASU)的结构化四舍五入形式:一个质量改进项目。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-01-01 DOI: 10.1097/JHQ.0000000000000364

Alistair Ludley, Anna Bahk, Ahmed Al-Shihabi

{"title":"A Structured Rounding Proforma in the Hyper Acute Stroke Unit (HASU): A Quality Improvement Project.","authors":"Alistair Ludley, Anna Bahk, Ahmed Al-Shihabi","doi":"10.1097/JHQ.0000000000000364","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000364","url":null,"abstract":"Abstract: Strokes affect 100,000 patients annually in the United Kingdom. These patients are often complex and require multidisciplinary team input, hence why they are often treated within dedicated and highly specialized \"hyper acute stroke units\". However, such specialist care can prove challenging to recently qualified or more junior doctors, who may miss pertinent aspects of the history or examination within the daily patient rounding documentation. Building on evidence-based practice using structured rounds and checklists, this quality improvement aimed to improve adherence of documentation for 20 predetermined key components of a stroke round by introducing a structured daily stroke rounding proforma. Adherence to documentation for the 20 components improved with the introduction of the stroke rounding proforma, with seven components demonstrating statistically significant positive changes in documentation rates, p < .05. Qualitative feedback was collected to aid in the development and acceptability of the proforma. Our study concluded a structured daily stroke rounding proforma can improve adherence to documentation in stroke care. Chiefly, the proforma was of greatest benefit to junior members of the medical team, particularly as an aid memoire.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 1","pages":"10-18"},"PeriodicalIF":1.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10645688","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

Group Medical Visits Versus Usual Care for Illness Perception and Hypertension: A Randomized Pilot Study. 群体医疗访问与常规护理对疾病感知和高血压的影响:一项随机试点研究。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-01-01 DOI: 10.1097/JHQ.0000000000000359

Orhan Acehan, Nafiz Bozdemir, Sevgi Özcan, Olgun Duran, Hatice Kurdak

{"title":"Group Medical Visits Versus Usual Care for Illness Perception and Hypertension: A Randomized Pilot Study.","authors":"Orhan Acehan, Nafiz Bozdemir, Sevgi Özcan, Olgun Duran, Hatice Kurdak","doi":"10.1097/JHQ.0000000000000359","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000359","url":null,"abstract":"Abstract: Despite separate evidence regarding illness perception (IP) and group medical visits (GMVs) for hypertension, research on both is limited. Here, we have assessed and compared the effectiveness of GMVs and usual care (UC) on IP and blood pressure (BP) in patients with hypertension. This was a two-group parallel randomized controlled study with 1:1 allocation. Patients with essential hypertension on antihypertensive medication and no cognitive impairments were screened for BP control status and eligibility. A web-based program randomly assigned them to the GMV and UC groups. Group medical visits were held once a month for 3 months. Primary and secondary outcome measures included improvements in IP and BP control. Among 152 participants, 40 and 43 were assigned to the GMV and UC groups, respectively. The control group had a 9.3% dropout rate. The chronic timeline and illness coherence improved significantly in the intervention group ( p < .01). Systolic BP in the intervention group decreased significantly compared with that of the control group (Δ: -18.8 ± 18.4 mm Hg vs. Δ: -10.6 ± 12.5 mm Hg, p = .025). The participation in GMVs had a significant association with the odds of an increase in BP regulation (OR 3.8, 95% confidence interval 1.4-10.3, p = .007). Therefore, GMVs may be feasible for BP control in hypertensive patients with similar characteristics.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 1","pages":"27-37"},"PeriodicalIF":1.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10612254","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

Pay-for-Performance in the Massachusetts Medicaid Delivery System Transformation Initiative. 马萨诸塞州医疗补助交付系统转型倡议中的绩效付费。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2023-01-01 DOI: 10.1097/JHQ.0000000000000357

Laura Sefton, Laxmi Tierney

{"title":"Pay-for-Performance in the Massachusetts Medicaid Delivery System Transformation Initiative.","authors":"Laura Sefton, Laxmi Tierney","doi":"10.1097/JHQ.0000000000000357","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000357","url":null,"abstract":"Abstract: Pay-for-performance (P4P) is among the alternative payment models (APMs) that are designed to incentivize enhancements to healthcare efficiency and quality. Massachusetts' Office of Medicaid implemented a delivery system transformation initiative (DSTI) through an 1115(a) Demonstration Waiver to support and incentivize seven safety net hospitals to implement clinical care changes and transition to risk-based APMs. Comparative case study design was used to describe achievement of hospital-specific clinical and operational measures. Qualifying hospitals implemented 47 projects across three categories: (1) development of a fully integrated delivery system, (2) health outcomes and quality, and (3) ability to respond to statewide transformation to value-based purchasing and to accept alternatives to fee-for-service payments that promote system sustainability. Projects commonly focused on care transitions improvements, physical and behavioral healthcare integration, and chronic disease care management interventions. Collectively, the hospitals met all or most of 60 population-focused improvement measures and 10 common measures' targets, indicative of the progress. Some hospitals achieved substantial positive gains; however, missed targets suggest substantial organizational and workflow changes over a longer timeframe as well as consistent patient engagement may be necessary. Overall, the P4P structure of DSTI was effective in encouraging organizational change and supporting the transition of these hospitals towards APMs.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"45 1","pages":"38-50"},"PeriodicalIF":1.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9175537","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

Thank You to Reviewers. 感谢审稿人。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2022-11-01 DOI: 10.1097/JHQ.0000000000000365

引用次数: 0

Internal Operational Metrics and Center for Medicare and Medicaid Services Hospital Compare Quality Ratings. 内部操作指标和医疗保险和医疗补助服务中心医院比较质量评级。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2022-11-01 DOI: 10.1097/JHQ.0000000000000347

Michele Thornton, Sarah Bonzo, Raihan Khan, Leah Souza

{"title":"Internal Operational Metrics and Center for Medicare and Medicaid Services Hospital Compare Quality Ratings.","authors":"Michele Thornton, Sarah Bonzo, Raihan Khan, Leah Souza","doi":"10.1097/JHQ.0000000000000347","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000347","url":null,"abstract":"Abstract: The Center for Medicare and Medicaid Services (CMS) has made several refinements to their model for calculating hospital quality star ratings (Hospital Compare) amidst criticism and evidence of bias against some institutions. We argue that the CMS model does align with important internal quality metrics and encourage a measured approach to redesign, potentially using categorizations or tiers, rather than a complete abandonment of the ratings system. We find that institutional characteristics (available resources, average severity of illness, and academic affiliation) are associated with internal quality metrics related to patient flow. Furthermore, regression results from the original and revised CMS star rating methodologies suggest that patient flow metrics (discharges before noon [p < .01] and weekend discharges [p < .001]) have a positive relationship with the Hospital Compare rating. Hospitals with better patient flow, as measured by higher levels of discharges before noon and weekend discharges, are associated with higher CMS quality ratings. These findings suggest that CMS star ratings do reflect key aspects of operational performance, specifically efforts to improve patient flow, but the ranking system should consider hospital characteristics that influence internal operations as we move toward a system capable of quality and price transparency for consumers.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"44 6","pages":"331-340"},"PeriodicalIF":1.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10019260","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

Piloting a Mobility Tech Role at an Academic Medical Center. 在学术医疗中心试行移动技术角色。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2022-11-01 DOI: 10.1097/JHQ.0000000000000345

David James, Shari Harrell, Valerie Labbe, Midge Ray

{"title":"Piloting a Mobility Tech Role at an Academic Medical Center.","authors":"David James, Shari Harrell, Valerie Labbe, Midge Ray","doi":"10.1097/JHQ.0000000000000345","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000345","url":null,"abstract":"Introduction: There is often a breakdown in communication between physical therapy and nursing regarding the responsibility of patient mobility. This communication problem contributes to mobility being the most frequently missed clinical intervention. To address this gap, a Mobility Tech (MT) role was implemented at a large academic medical center. The purpose of this article is to describe the implementation of this role.Methods: Using the Institute for health care improvement (IHI) model for improvement, iterative small tests of change were developed to integrate the MT role on four acute care units. Using process flow mapping, the team developed a MT workflow that was adapted to create MT protocols.Results: Program outcomes included fall rates and the highest level of mobility documented by staff. During the MT pilot from February 2020 through June 2020, MTs provided an average of over 500 interventions each month. There was a clinically and statistically significant increase in mobility noted in two of the four pilot units.Conclusion: We have demonstrated that MTs can be safely incorporated into acute care nursing workflow, and comments from staff and patients validate the role is \"value added.\"","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"44 6","pages":"363-372"},"PeriodicalIF":1.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10019257","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: 1

Impact of a Transition of Care Pharmacist in a Community Hospital Discharge Model. 社区医院出院模式中护理药师转变的影响

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2022-11-01 DOI: 10.1097/JHQ.0000000000000348

Nicole Rudawsky, Hinal U Patel

{"title":"Impact of a Transition of Care Pharmacist in a Community Hospital Discharge Model.","authors":"Nicole Rudawsky, Hinal U Patel","doi":"10.1097/JHQ.0000000000000348","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000348","url":null,"abstract":"Introduction: Pharmacists can provide a variety of discharge services that aid in transitions of care. The purpose of this study is to evaluate the impact of a pilot program implementing a unit-based clinical pharmacist at a community teaching hospital.Methods: This prospective study evaluated pharmacist-led discharge services on an adult medicine unit over a 5-week period. The control cohort received usual care, and the intervention cohort received additional pharmacy services (e.g., counseling, medication reconciliation, ensuring medication access, and overcoming discharge barriers). The primary outcome was 30-day all-cause hospital readmissions. Secondary outcomes included emergency department (ED) utilization, Hospital Consumer Assessment of Healthcare Providers and Systems scores, and patient satisfaction survey scores.Results: Overall, 197 patients were included in the control group and 210 in the intervention group. Characteristics including previous hospital utilization, comorbidity count, and medication count at discharge were similar between groups. A reduction in 30-day all-cause hospital readmissions was observed in the cohort receiving pharmacist intervention, 13.3% versus 20.8% (p = 0.044). This study also demonstrated a significant decrease in ED utilization rates and improved patient satisfaction.Conclusions: This study adds to the growing body of literature supporting transition of care pharmacists in the hospital discharge model to improve patient care.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"44 6","pages":"347-353"},"PeriodicalIF":1.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10019258","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 Unilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Quality Improvement Study. 优化单侧腹下深穿支皮瓣乳房重建:质量改善研究。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2022-11-01 DOI: 10.1097/JHQ.0000000000000358

Carrie S Stern, Ethan L Plotsker, Jonas A Nelson, Evan Matros, Eleni Kalandranis, Dana Fatterusso, Colette Mooney, Yigu Chen, Jeena Velzen, Babak J Mehrara

{"title":"Optimizing Unilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Quality Improvement Study.","authors":"Carrie S Stern, Ethan L Plotsker, Jonas A Nelson, Evan Matros, Eleni Kalandranis, Dana Fatterusso, Colette Mooney, Yigu Chen, Jeena Velzen, Babak J Mehrara","doi":"10.1097/JHQ.0000000000000358","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000358","url":null,"abstract":"Abstract: Deep inferior epigastric perforator (DIEP) flap surgery commonly involves multiday hospitalization, although data suggest 95% of complications after unilateral DIEP flap breast reconstruction occur within the first 24 hours. The aim of this study was to decrease hospitalization time and optimize care of patients undergoing unilateral DIEP flap breast reconstruction. Our study followed Six Sigma's DMAIC (define, measure, analyze, improve, control) framework. First, we delineated the stakeholders involved in the process and defined workgroups based on temporal relation to the operation. We measured performance according to project SMART (specific, measurable, achievable, relevant, time bound) goals and subsequently conducted an analysis of inefficiencies. We then created new interventions for quality improvement. Control will entail ongoing monitoring to ensure progress is sustained after study completion. Our interventions lasted 6 months and included 70 patients. By actively striving to advance patients through postoperative milestones during their inpatient stay and creating an outpatient nursing roadmap including aspects of inpatient care, we decreased the median length of stay from 67.8 to 44.8 hours ( p < .001). After receiving nursing instruction, 77% of patients agreed that they felt ready to be discharged. Our study suggests that the DMAIC framework can decrease hospitalization time after DIEP surgery and spare resources for additional patients.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"44 6","pages":"354"},"PeriodicalIF":1.3,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633393/pdf/nihms-1825830.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10094640","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}

引用次数: 2

Lessons on Increasing Racial and Health Equity From Accountable Health Communities. 从负责任的卫生社区增加种族和卫生公平的经验教训。

IF 1.3 4区医学

Journal for Healthcare Quality Pub Date : 2022-09-01 DOI: 10.1097/JHQ.0000000000000356

Brandon G Wilson, Emily Jones

{"title":"Lessons on Increasing Racial and Health Equity From Accountable Health Communities.","authors":"Brandon G Wilson, Emily Jones","doi":"10.1097/JHQ.0000000000000356","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000356","url":null,"abstract":"Background: The Accountable Health Communities model (AHC) was developed to test whether systematically screening for health-related social needs and referrals to community-based organizations to resolve unmet needs would affect healthcare use and costs for CMS beneficiaries. Purpose: The AHC model required applicants to develop Disparities Impact Statements (DIS), to increase the model's potential impact on health equity.Methods: Authors conducted a thematic analysis of awardees' DISs to identify minority and underserved populations of focus, and the strategies awardees used to increase equitable participation in the model by minority and underserved populations.Results: Most awardees focused on multiple minority and underserved populations and used multipronged innovative strategies to pursue equity goals.Conclusions: Considering recent health equity advancements as Executive Order 13985 and the release of CMS Innovation Center's Strategy Refresh, with highlights of health equity best practices from the AHC model, assessing use of DISs in the AHC model provides valuable lessons. Implications: Given HHS' broadscale promotion of DISs adoption as a viable quality improvement approach to achieving health equity, disseminating how the tool was used by a myriad of organizational types in the AHC model is critically important to improving future efforts to increase equity.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"44 5","pages":"276-285"},"PeriodicalIF":1.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10018775","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: 3