Journal for Healthcare Quality最新文献_第2页

Why Access Matters in Value-Based Healthcare: A Systematic Review. 为什么访问在基于价值的医疗保健中很重要：一项系统综述。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-04-01 DOI: 10.1097/JHQ.0000000000000471

Allen M Chen

{"title":"Why Access Matters in Value-Based Healthcare: A Systematic Review.","authors":"Allen M Chen","doi":"10.1097/JHQ.0000000000000471","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000471","url":null,"abstract":"Inroduction: To outline why access to care should be central to quality improvement efforts across health systems while identifying patient-centric strategies that could be used.Methods: This study was designed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. A literature search of original peer-reviewed publications was undertaken to identify studies pertaining to the benefits of healthcare access in the setting of patient care. Articles published from January 2013 to January 2023 were included. An interpretive synthesis was then presented.Results: A total of 61 peer-reviewed studies were identified and differed significantly in their clinical design, methods, and endpoints. The core themes could be broadly categorized into the following: health outcomes (N = 32), patient satisfaction or experience (N = 15), operational efficiency (N = 7), and cost containment (N = 7). Twelve publications focused at least in part on equity issues, structural racism, and/or implicit bias; and five publications addressed disparities in education and/or technical literacy.Conclusions: Access to healthcare affects quality of care, impacts the patient experience, and influences health outcomes and is a fundamental stalwart of value-based medicine.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"47 2","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103068","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

Electronic Clinical Quality Measures for Prosthetic Joint Infection Diagnosis: Pitfalls and Potential. 人工关节感染诊断的电子临床质量测量：缺陷与潜力。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-02-01 Epub Date: 2025-02-06 DOI: 10.1097/JHQ.0000000000000467

Andy O Miller, Amy S Chin, Alberto V Carli, George Sayegh, Diana Chee, Daniel B Buchalter, Sam Simon, Catherine H Maclean

{"title":"Electronic Clinical Quality Measures for Prosthetic Joint Infection Diagnosis: Pitfalls and Potential.","authors":"Andy O Miller, Amy S Chin, Alberto V Carli, George Sayegh, Diana Chee, Daniel B Buchalter, Sam Simon, Catherine H Maclean","doi":"10.1097/JHQ.0000000000000467","DOIUrl":"10.1097/JHQ.0000000000000467","url":null,"abstract":"Introduction: Prosthetic joint infection (PJI) after total hip and knee arthroplasty (TJA) is a major cause of morbidity in orthopedics. Fully specified quality measures for PJI diagnosis are lacking. We aimed to specify and evaluate electronic clinical quality measures (eCQM) across different healthcare institutions.Methods: Measures were specified using an iterative process through which elements in the measures were identified and evaluated, and their capture optimized in the electronic health record (EHR). Measures were then retrospectively tested at three institutions. Performance on the measures at each institution, and across surgeons at one, was also assessed. Qualitative interviews with each institution identified technical, structural, and clinical reasons for poor performance on the measures.Results: Four of the five eCQMs could be implemented within the EHRs. Wide variations were found in measure performance. Qualitative interviews revealed differences in EHR coding, data not being shared within institutions, and focus on specific tests within the testing set as reasons for poor performance.Conclusions: Significant variability in posthetic joint infection eCQMs exists, driven both by variations in data availability and clinical practice. Electronic clinical quality measures hold significant potential to enhance diagnostic quality measurement, but successful implementation is highly dependent on process standardization, data accuracy, and adaptation of measures across healthcare settings.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366493","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

Reducing Emergency Department Hold Hours: A Hospital-wide Effort. 减少急诊室等候时间：全医院的努力。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-02-01 DOI: 10.1097/JHQ.0000000000000466

Jill McCormick, Faith Kinsinger, Ritika J Patel, Grant Wicklund, Deb Roybal

引用次数: 0

Personalizing Quality Improvement: Addressing Anticoagulation Gaps in Atrial Fibrillation. 个性化的质量改进：解决房颤抗凝差距。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-02-01 Epub Date: 2024-12-12 DOI: 10.1097/JHQ.0000000000000460

Gary D Owen, Christopher J Terry, Erin B Neal, Scott D Nelson, Mohamed Omar, Mariah J Pettapiece-Phillips, Sunil Kripalani

{"title":"Personalizing Quality Improvement: Addressing Anticoagulation Gaps in Atrial Fibrillation.","authors":"Gary D Owen, Christopher J Terry, Erin B Neal, Scott D Nelson, Mohamed Omar, Mariah J Pettapiece-Phillips, Sunil Kripalani","doi":"10.1097/JHQ.0000000000000460","DOIUrl":"10.1097/JHQ.0000000000000460","url":null,"abstract":"Introduction: Risk of stroke is greater in patients with atrial fibrillation. Anticoagulation is effective at decreasing risk, yet 40-50% of eligible patients are not prescribed anticoagulation and seem to have a concerning gap in care quality. This quality improvement initiative implemented a pharmacist-led approach to identify, verify, and close apparent anticoagulation treatment gaps.Methods: We included adult primary care patients with diagnosis of atrial fibrillation; congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke/transient ischemic attack (doubled), vascular disease, age 65-74 years, and sex (female) (CHA 2 DS 2 -VASc) score of at least 2, and no current anticoagulant use. We identified patients using claims and electronic health record data and evaluated explanations through chart review and provider contact. A provider outreach protocol was developed and implemented to address opportunities for anticoagulation.Results: Of 242 patients with an apparent gap, 84% had a verified treatment gap. However, 86% of verified treatment gaps were explained through pharmacist chart review and outreach to providers, and they did not require further action. Explanations included spontaneous resolution of atrial fibrillation, patient declining treatment, completion of a procedure to correct atrial fibrillation or mitigate stroke risk, and high bleeding risk.Conclusions: Relying solely on claims- and electronic health record-based algorithms may substantially overestimate gaps in care quality.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819973","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

Preoperative Optimization of Patients Undergoing Orthopedic Foot and Ankle Surgery: A Single Institution Cohort. 骨科足踝关节手术患者的术前优化：单一机构队列。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-02-01 Epub Date: 2025-01-28 DOI: 10.1097/JHQ.0000000000000464

Julia Kessel, Rebecca J Cleveland, Trapper Lalli, Joshua Tennant, Jennifer Woody

{"title":"Preoperative Optimization of Patients Undergoing Orthopedic Foot and Ankle Surgery: A Single Institution Cohort.","authors":"Julia Kessel, Rebecca J Cleveland, Trapper Lalli, Joshua Tennant, Jennifer Woody","doi":"10.1097/JHQ.0000000000000464","DOIUrl":"10.1097/JHQ.0000000000000464","url":null,"abstract":"Introduction: Careful preoperative patient preparation for orthopedic foot and ankle surgery can help manage postoperative expectations and avoid suboptimal outcomes. Our quality improvement initiative aimed to reduce emergency department (ED) visits within 30 days postsurgery by enhancing preoperative education.Methods: We focused on four outcomes associated with receipt of written preoperative information: (1) related ED visits within 30 days of surgery, (2) average number of patient portal messages, (3) phone calls initiated by patients, and (4) staff team experience survey results. All patients undergoing foot and ankle surgery by two surgeons at one institution from July 2023 to January 2024 were included.Results: Through a series of six plan, do, study, act (PDSA) cycles lasting 1 month each, we evaluated 431 patients (55.9% female, 61.4% White, 92.4% English speakers). Patients who received written preoperative information were significantly less likely to present to the ED for related concerns within 30 days of surgery compared with those receiving no written preoperative information ( p = .0068). In addition, we observed fewer portal messages and phone calls from patients receiving written preoperative information ( p = .3644, p = .0541).Conclusions: An increase in the use of standardized written preoperative information yields decreased ED visits and frequency of inquiries from patients through portal messages and phone calls.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060779","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 Composite Score Reflecting an Initiative to Reduce Harm, Protect Patients, and Promote Safety. 综合评分反映了减少伤害、保护患者和促进安全的举措。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-02-01 Epub Date: 2024-10-09 DOI: 10.1097/JHQ.0000000000000457

Katelynd Smith, Julia McAvoy, John D Six, Lisa Goss

引用次数: 0

Continuous Quality Improvement in Social Needs Screening: Evaluation of an Intervention in Bariatric Specialty Care. 社会需求筛查的持续质量改进：肥胖专科护理干预的评估。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-02-01 Epub Date: 2025-02-06 DOI: 10.1097/JHQ.0000000000000461

Claire Chang, Samantha Cooley, Bradley Iott, Jordan Greene, Dilhara Muthukuda, Renuka Tipirneni

{"title":"Continuous Quality Improvement in Social Needs Screening: Evaluation of an Intervention in Bariatric Specialty Care.","authors":"Claire Chang, Samantha Cooley, Bradley Iott, Jordan Greene, Dilhara Muthukuda, Renuka Tipirneni","doi":"10.1097/JHQ.0000000000000461","DOIUrl":"10.1097/JHQ.0000000000000461","url":null,"abstract":"Introduction: With growing recognition of the influence that social risks, such as food insecurity and housing instability, have on individual and population health, social risk screening and social care interventions have proliferated across the health system. Social needs intervention research on screening and referral in specialty care is limited, despite evidence that social needs influence access to and outcomes of surgical and specialty care.Methods: This study is a qualitative, formative evaluation of a quality improvement-oriented social needs screening and referral pilot program implemented in a bariatric surgery practice and aims to share lessons related to the structure and process components of a quality improvement (QI) framework.Results: Semistructured interviews revealed variation in patient eligibility for resources and highlighted the need for enhanced staff capacity and data system integration. In addition, process-related themes including patient hesitation toward referrals, variability in screening pathways, and uncertainty surrounding communication practices emerged in qualitative analyses.Conclusions: Implementation of social needs screening and referral programs in specialty care setting is feasible but requires unique structure and process-related considerations. Incorporating QI infrastructure into these programs allows for continuous evaluation of program processes and can be used to evaluate the impact of these programs on health outcomes.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366353","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

Pharmacist-Led Population Health Initiative to Address Statin Care Gaps: A Quality Improvement Project. 药剂师主导的解决他汀类药物护理差距的人口健康倡议：一个质量改进项目。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-02-01 DOI: 10.1097/JHQ.0000000000000465

Danielle Raymer, Anna Everhart, Danielle Baker

{"title":"Pharmacist-Led Population Health Initiative to Address Statin Care Gaps: A Quality Improvement Project.","authors":"Danielle Raymer, Anna Everhart, Danielle Baker","doi":"10.1097/JHQ.0000000000000465","DOIUrl":"10.1097/JHQ.0000000000000465","url":null,"abstract":"Background: Evidence-based guidelines recommend statins as first-line therapy to reduce the risk of cardiovascular events in patients with cardiovascular disease and/or diabetes. The Centers for Medicare and Medicaid Services assess compliance with these guidelines through performance and process quality measures.Purpose: To describe innovative practices to address statin use care gaps, to identify successes and challenges of a pharmacist-led statin initiative, and share quality improvement opportunities related to statin quality metrics.Methods: A retrospective review was conducted in 2023 of patients enrolled in Medicare Advantage value-based care contracts in a large health system. The primary outcome measures were the percentage of patients identified with statin care gaps who met the criteria for statin treatment and the percentage of patients who accepted pharmacist-led recommendations to initiate statin therapy. Outcomes were analyzed using descriptive statistics.Results: Among those with statin care gaps, 42% met criteria for pharmacist-led statin initiation. Of those who met criteria, 22% accepted pharmacist's recommendation to initiate statin therapy.Conclusions: Pharmacist-led statin initiation is effective; however, systematic barriers remain to improve statin quality performance. These results can help others adopt innovative practices that target statin care gaps and assess opportunities for quality improvement.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"47 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460323","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

State-Level Hospital Quality in the United States: Analyzing Variation and Trends From 2013 to 2021. 美国州级医院质量：分析 2013 年至 2021 年的差异和趋势。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-02-01 DOI: 10.1097/JHQ.0000000000000462

Arjun Teotia, Brent D Fulton, Dan R Arnold, Richard M Scheffler

{"title":"State-Level Hospital Quality in the United States: Analyzing Variation and Trends From 2013 to 2021.","authors":"Arjun Teotia, Brent D Fulton, Dan R Arnold, Richard M Scheffler","doi":"10.1097/JHQ.0000000000000462","DOIUrl":"10.1097/JHQ.0000000000000462","url":null,"abstract":"Objective: This study develops a hospital quality index to analyze state-level variations in hospital quality in the United States from 2013 to 2021, using data from 3,000 hospitals from the Centers for Medicare & Medicaid Services (CMS) Hospital Compare data set.Design: The quality index combines three risk-adjusted measures from the CMS Hospital Compare: 30-day readmission rate, 30-day mortality rate, and patient experience. Each measure is converted into a z-score, weighted by hospital beds, and averaged to form the final index, which has a mean of 0 and a standard deviation of 1.Results: In 2021, the average U.S. hospital quality measures were 15.1% for readmissions, 11.2% for mortality, and 69.7% for patient experience. There was significant state-level heterogeneity. The quality index ranged from -0.54 to 0.57. Eight states notably outperformed the U.S. average, with Utah leading. Conversely, 14 states underperformed. From 2013 to 2021, there was an average annual improvement in readmissions (0.08pp) and mortality (0.12pp), but a decline in patient experience (0.27pp).Conclusions: The study highlights improvements in hospital quality over time but underscores disparities at the state level. The quality index provides a valuable tool for understanding and addressing these variations in hospital care quality.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"47 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460328","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

Implementation of an Evidence-Based Treatment Protocol and Order Set for Alcohol Withdrawal Syndrome. 实施基于证据的戒酒综合症治疗方案和医嘱集。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2024-11-01 Epub Date: 2024-07-24 DOI: 10.1097/JHQ.0000000000000452

Nathan Robert Luzum, Anna Beckius, Thomas W Heinrich, Kimberly Stoner

{"title":"Implementation of an Evidence-Based Treatment Protocol and Order Set for Alcohol Withdrawal Syndrome.","authors":"Nathan Robert Luzum, Anna Beckius, Thomas W Heinrich, Kimberly Stoner","doi":"10.1097/JHQ.0000000000000452","DOIUrl":"10.1097/JHQ.0000000000000452","url":null,"abstract":"Background: Alcohol withdrawal syndrome (AWS) is highly prevalent in hospital inpatients. Recent evidence supports use of phenobarbital and gabapentin in certain patients, and screening tools for severe withdrawal risk can be used to guide care. Inpatients with AWS should also be considered for evidence-based treatment for alcohol use disorder (AUD).Purpose: The purpose of this quality improvement study was to monitor clinical outcomes and prescribing habits after updating an electronic order set for inpatient AWS management at a large, academic hospital.Methods: Protocol updates included use of the Prediction of Alcohol Withdrawal Severity Scale, phenobarbital and gabapentin protocols, and linkage to treatment resources. Data were collected for 10 months before and 14 months after implementation.Results: Intensive care unit (ICU) transfer rate decreased by 2.3%, whereas length of stay and readmissions were not significantly different. In patients treated with the order set, ICU transfer and length of stay outcomes were superior. Patients treated through the order set were more likely to receive evidence-based treatment for AWS and AUD.Conclusions: Electronic order sets can promote evidence-based practice for AWS. The updated protocol will remain in place at the study institution, with future efforts focused on education and ease of use to increase order set utilization.","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"340-347"},"PeriodicalIF":0.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761927","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