Journal for Healthcare Quality最新文献_第2页

Improving Ambulatory Smoking Cessation Counseling Across a Large Academic Internal Medicine Department. 在一个大型学术内科改进门诊戒烟咨询。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-04-01 DOI: 10.1097/JHQ.0000000000000472

John Rose, Ayomide Osunjimi, Kristine Madsen, Karunakar Dirisala, Sadia Ali, Trushil Shah, Puneet Bajaj

{"title":"Improving Ambulatory Smoking Cessation Counseling Across a Large Academic Internal Medicine Department.","authors":"John Rose, Ayomide Osunjimi, Kristine Madsen, Karunakar Dirisala, Sadia Ali, Trushil Shah, Puneet Bajaj","doi":"10.1097/JHQ.0000000000000472","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000472","url":null,"abstract":"Abstract: Smoking is a preventable cause of death and morbidity. A department-wide quality improvement initiative was implemented to increase smoking cessation counseling and referral rates as part of a composite metric, which was tied to a faculty incentive. Eligible individuals were current smokers seen in any of 52 internal medicine clinics for a 12-month period. An infographic, a quality improvement newsletter, and outreach to leadership were used to increase awareness about the metric to stakeholders and to provide example workflows. To satisfy the metric, clinic staff offered a nicotine cessation clinic referral to tobacco users at the time of rooming in. If patients agreed, a referral order was pended for the provider to sign. If patients did not agree, literature on smoking cessation was appended to a patient's after-visit summary. Smoking cessation counseling was then documented in the electronic medical record. Rates were serially monitored at the individual clinic and health system level on a centralized, cloud-based dashboard. For a 12-month period, the composite of smoking cessation counseling and referral rates rose from a baseline of 8.6% to 25.6%. Referrals to nicotine cessation clinics increased during the first half of the period but did not during the second half.","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":"144103066","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

Using Broken Windows Theory to Examine Flow Disruptions in Surgical Care: A Multispecialty Comparison. 用破窗理论检查外科护理中的血流中断：一项多专业比较。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-04-01 Epub Date: 2025-02-06 DOI: 10.1097/JHQ.0000000000000469

Asfandyar Khan, Scott A Shappell, Albert J Boquet

{"title":"Using Broken Windows Theory to Examine Flow Disruptions in Surgical Care: A Multispecialty Comparison.","authors":"Asfandyar Khan, Scott A Shappell, Albert J Boquet","doi":"10.1097/JHQ.0000000000000469","DOIUrl":"10.1097/JHQ.0000000000000469","url":null,"abstract":"Introduction: Minimally invasive innovations enhance procedural technology. However, healthcare quality demands addressing mental and physical workloads. This study analyzes flow disruptions uncovering specialty-specific patterns and systemic weaknesses, to enhance quality, processes, and patient safety.Methods: Twenty-five cardiovascular, 40 orthopedic, 65 trauma care, and 30 neurosurgical cases were examined. The data were categorized using human factor taxonomy, and descriptive statistics were applied.Results: Comparing the four specialties using RIPCORD TWA taxonomy, cardiovascular and trauma care were translated into one disruption every 2.2 minutes, followed by neurosurgery with one disruption every 2.7 minutes and orthopedics with one disruption every 3.7 minutes. Interruptions were the highest percentage for cardiovascular and orthopedics, with 54% and 46% of flow disruptions. Trauma care was heavily affected by communication flow disruption with 33%. Layout and coordination issues accumulate 26% of flow disruptions in neurosurgery.Conclusions: Cardiovascular, orthopedics, trauma care, and neurosurgery each feature distinct workflows, risks, and teamwork dynamics, demanding tailored process improvements. By analyzing flow disruptions and systemic weaknesses, this study highlights patterns unique to each specialty, advocating for tailored interventions to enhance communication, coordination, layout optimization, and equipment usability for improved surgical safety and quality.","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":"143366578","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

Improving Job Completion in Acute Medical Units Through Role-Specific Documentation: A Quality Improvement Project. 通过角色特定文件提高急症医疗单位的工作完成度：一个质量改进项目。

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.0000000000000463

David Bull, Marina Pagaki-Skaliora, Ava Rietdy, Gabriella Mukahanana, Asmita Raja, Ishwar Malhi

{"title":"Improving Job Completion in Acute Medical Units Through Role-Specific Documentation: A Quality Improvement Project.","authors":"David Bull, Marina Pagaki-Skaliora, Ava Rietdy, Gabriella Mukahanana, Asmita Raja, Ishwar Malhi","doi":"10.1097/JHQ.0000000000000463","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000463","url":null,"abstract":"Abstract: High-quality documentation is vital for efficient patient care. This study aimed to enhance documentation clarity in the acute medical unit (AMU) at our local institution and to improve job completion rates and reduce missed jobs per patient per day (JPD). From January 26 to April 10, 2024, we collected data on 606 patients and 2,298 jobs. Four collaborators documented patient plans using either Standard Documentation or a novel Role-Specific Documentation. Standard Documentation used a single \"Plan\" heading, while Role-Specific Documentation used specific headings for \"Doctors,\" \"Nurses,\" and \"MDT\" (Multidisciplinary Team). Data were analyzed using Student t-test (p < .05). Standard Documentation group documented 1,291 jobs for 345 patients; Role-Specific Documentation group documented 1,007 jobs for 261 patients. Role-Specific Documentation had fewer missed jobs (147 vs. 294, p = .0002) and a higher percentage of completed jobs (85.74% vs. 77.99%, p = .0003). Although total job completion showed no significant difference, Role-Specific Documentation had more completed JPD (3.47 vs. 2.94, p = .0052). The Role-Specific Documentation system improved job completion and reduced missed JPD. Despite fewer patients, the new system proved more efficient, suggesting potential for wider adoption. Future studies should explore the documentation methods' impact on clinical outcomes and operational metrics.","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":"144103067","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 Dedicated Hip Fracture Care Coordinator Is Associated With Improved Patient Outcomes and Hospital Quality Measures. 专门的髋部骨折护理协调员与改善患者预后和医院质量措施相关。

IF 0.9 4区医学

Journal for Healthcare Quality Pub Date : 2025-04-01 DOI: 10.1097/JHQ.0000000000000474

Lauren A Merrell, Sara J Solasz, Abhishek Ganta, Sanjit R Konda, Kenneth A Egol

{"title":"A Dedicated Hip Fracture Care Coordinator Is Associated With Improved Patient Outcomes and Hospital Quality Measures.","authors":"Lauren A Merrell, Sara J Solasz, Abhishek Ganta, Sanjit R Konda, Kenneth A Egol","doi":"10.1097/JHQ.0000000000000474","DOIUrl":"https://doi.org/10.1097/JHQ.0000000000000474","url":null,"abstract":"Abstract: This study aims to identify if there are significant differences in hospital quality measures between hip fracture patients who were treated under the management of a dedicated Hip Fracture Care Coordinator (HFCC) and those who were not. An institutional review board-approved hip fracture registry was queried for patients who were admitted at an orthopedic hospital under the care of HFCC from October 2021 to April 2023 (2.5 years). A comparison cohort of patients was obtained from reviewing patients in the 2.5 years (April 2019-October 2021) before the hiring of the HFCC. Univariable comparisons and multivariable regression analyses were conducted to assess the impact of the HFCC on outcomes such as hospital quality measures, inpatient complications, discharge location, and readmission and mortality rates. One thousand fifty-six hip fracture patients were identified: 532 (50.4%) without-HFCC and 524 (49.6%) HFCC. When controlling for covariates using binary logistic regression, the presence of an HFCC was associated with a higher likelihood of home discharge (odds ratio = 2.481, p < .001). Regression analyses demonstrated similar benefits of the HFCC with outcome variables such as intensive care unit stay (p < .001) and time to surgery (p < .001). This study demonstrates an association between the HFCC and improved outcomes for both patients and the hospital system.","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":"144103065","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

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

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

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