Journal for Healthcare Quality最新文献

{"title":"The Evolution of a Professional Standard for Healthcare Quality.","authors":"Stephanie Mercado","doi":"10.1097/JHQ.0000000000000522","DOIUrl":"10.1097/JHQ.0000000000000522","url":null,"abstract":"","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786573","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":"An Integrated Health System's Approach to Improving Human Papillomavirus Vaccination Rates Through a Systemwide Implementation Strategy.","authors":"Caroline B Zimmerman, Justin Ramos, Mark G Parker, Omar Hasan, Lauren Atkinson, Motahareh Tavakolikashi, Gavin Welch, Melissa Keeport","doi":"10.1097/JHQ.0000000000000510","DOIUrl":"10.1097/JHQ.0000000000000510","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus (HPV) vaccination rates lag behind other recommended adolescent vaccines. Practice- and clinician-based interventions to improve HPV vaccination rates are known to be effective in improving completion rates.</p><p><strong>Purpose: </strong>The aim is to determine whether implementing bundled interventions across an integrated health system would result in systemwide improvements in HPV vaccination rates.</p><p><strong>Methods: </strong>We assessed the impact of multilevel interventions across an integrated health system to increase HPV vaccination rates between 2019 and 2024 in a large and predominantly rural state. We analyzed the effects of implementing sequential bundles of interventions over multiple years, including efforts focused on quality improvement, physician leadership, electronic medical record enhancements, clinical decision support tools, and communications.</p><p><strong>Results: </strong>Human papillomavirus vaccination completion rates improved from 46.2% in December 2019 to 55.4% in December 2024 (+9.2 percentage points), comparing favorably with changes in national rates during the same interval. These findings demonstrate that the interventions had a statistically significant impact on HPV vaccination rates in 13 year olds.</p><p><strong>Conclusions: </strong>By applying multilevel interventions, a system-wide implementation strategy can be successful in increasing HPV vaccination rates across an integrated health system.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565996","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":"Clinical Effectiveness Strategies to Improve Patient Outcomes After Pectus Excavatum Repair.","authors":"Marisa E Schwab, Sarah Cohen, Hannah K Bassett, Dalia Michel, Claudia A Algaze, Mohammad Esfahanian, Julie Good, Stephanie D Chao","doi":"10.1097/JHQ.0000000000000508","DOIUrl":"10.1097/JHQ.0000000000000508","url":null,"abstract":"<p><strong>Background: </strong>Target-based care (TBC) uses institutional data to create a shared mental model of anticipated postoperative milestones. This study evaluated the impact of a clinical effectiveness strategy, combining TBC with a clinical pathway and decision support, on outcomes in patients undergoing pectus excavatum repair.</p><p><strong>Methods: </strong>This was a prospective study at a quaternary children's hospital between 2022 and 2024. Patients undergoing repair from 2018 to 2021 were historical controls. Target-based care included displaying bedside targets for length of stay (LOS) (outcome metric), Foley catheter and patient-controlled analgesia (PCA) discontinuation (process metrics), and a multidisciplinary evidence-based clinical pathway with an electronic order set.</p><p><strong>Results: </strong>Overall, 91 patients were included: 52 preintervention and 39 postintervention. Median LOS decreased from 3 to 1.8 days (95% confidence interval [CI] 0.8-1.6, p < .05). The proportion of patients who met the LOS target of 2 days increased from 44.2% to 91.8% ( p < .05). The mean time to PCA discontinuation decreased from 1.6 to 0.8 days (95% CI 34.8-118.7, p < .05). The time to Foley catheter removal diminished from 22.2 to 17.1 hour (95% CI 0.6-9.6, p < .05).</p><p><strong>Conclusions: </strong>A data-driven TBC with a clinical pathway had an immediate and sustained impact on patient care. Length of stay, PCA discontinuation, and time to Foley discontinuation decreased after TBC.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702441","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":"The Dugout: Reimagined Team-Based Triage in the Emergency Department.","authors":"Benjamin L Cooper, Carrie A Bakunas, Tina E Chacko, Jenna Clark, Kunal M Sharma, Angela R Steen","doi":"10.1097/JHQ.0000000000000503","DOIUrl":"10.1097/JHQ.0000000000000503","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) crowding is a crisis of an overstrained health care system that is associated with poor patient outcomes and dissatisfaction. We aimed to assess the effect of an interdisciplinary, provider-led triage team, \"the Dugout,\" on ED length of stay (LOS), door-to-provider (DTP), and left without being seen (LWBS) rates.</p><p><strong>Methods: </strong>We used a before-and-after design. The setting is an urban, teaching, adult and pediatric 63-bed emergency department with a total annual volume more than 90,000 and an admission rate of 35%. Data were collected on adult patients (18 years and older) who presented during a similar 6-month period before (October 2023-March 2024) and after (October 2024-March 2025) implementation of the Dugout.</p><p><strong>Results: </strong>There were 34,106 and 31,704 adult encounters in the pre- and postimplementation periods, respectively. The Dugout was associated with a reduction in LWBS from 14.1% to 3.0% ( p < .001). DTP decreased from a median of 59 to 38 minutes ( p < .001). The median overall ED LOS decreased from 448 to 429 minutes ( p < .001), and the LOS for discharged patients decreased from 407 to 344 minutes ( p < .001).</p><p><strong>Conclusions: </strong>The introduction of a dedicated, interdisciplinary team stationed in the triage area was associated with reduced LWBS, DTP, and ED LOS.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145394588","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":"Health Literacy and Cardiac Medication Education: A Quality Improvement Study Using Teach-Back.","authors":"Inderbir Padda, Sneha A Sebastian, Khushal Choudhary, Paul Karroum, Inderjeet Bharaj, Harshan Atwal, Sonam Chandi, Charles Sineri, Philip Otterbeck, Robert Macfadyen","doi":"10.1097/JHQ.0000000000000497","DOIUrl":"10.1097/JHQ.0000000000000497","url":null,"abstract":"<p><strong>Background: </strong>Limited qualitative research has explored clinician behaviors that enhance communication with patients who have limited health literacy (HL). Teach-back is a patient-centered strategy used to confirm understanding and close HL gaps.</p><p><strong>Purpose: </strong>This quality improvement initiative aimed to improve patient understanding of newly prescribed cardiac medications at discharge on a telemetry unit in a university-affiliated community hospital in New York. The goal was to increase the percentage of patients who understood the indication and side effects of their new medications to at least 85% by January 2024, using the Plan-Do-Study-Act framework.</p><p><strong>Methods: </strong>Fifty eligible patients (mean age 71.7 years) admitted between November 2023 and January 2024 were considered. Inclusion criteria included a newly prescribed cardiac medication, intact cognition, English fluency, and discharge to home. Patients completed a baseline questionnaire assessing knowledge of medication purpose and side effects. Those with knowledge gaps received tailored education using plain language, followed by a teach-back session. Patients were asked to explain the medication's purpose and risks in their own words. Follow-up interviews 2-4 weeks postdischarge reassessed retention using the same framework.</p><p><strong>Results: </strong>At baseline, 54% of patients understood the medication's purpose, and only 26% were aware of potential adverse effects. After the intervention, 92% accurately explained both indication and side effects, and 74% retained the information at follow-up. Standardized protocols and blinded follow-up interviews helped minimize selection and reporting bias.</p><p><strong>Conclusions: </strong>The teach-back method significantly improved patient comprehension and short-term retention of discharge medication instructions. It is a feasible, low-cost strategy that can be effectively implemented in inpatient cardiology settings to address HL-related communication gaps and support safer transitions of care.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514454","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":"Improvement and Implementation Science to Optimize Statin Therapy in Primary Prevention.","authors":"Sameer Acharya, Jillian Senner, Kanwal Ejaz, Yashashwi Pokharel","doi":"10.1097/JHQ.0000000000000501","DOIUrl":"10.1097/JHQ.0000000000000501","url":null,"abstract":"<p><strong>Introduction: </strong>Less than 1/5 th of eligible patients are prescribed statins for primary prevention in the United States.</p><p><strong>Methods: </strong>We conducted a quality improvement program augmented by contextually responsive implementation strategies (IS), Plan-Do-Study-Act cycles, and Lean Six Sigma Principles to optimize statin therapy among 40-75-year-old patients without atherosclerotic cardiovascular diseases (ASCVD) in primary prevention in resident internal medicine clinic. We conducted needs assessment; identified process measures, barriers to statin optimization using discussions; and rank ordered these barriers. We mapped multiple IS to the barriers using discussions/consensus over 2 years. We retrofitted the IS to the Expert Recommendations for Implementing Change (ERIC) taxonomy to facilitate IS reporting.</p><p><strong>Results: </strong>We noted significant improvement in process measures such as lipid panel orders (64.6% vs. 95.5%), its completion (78.6% vs. 95.3%), ASCVD risk score completion (3% vs. 91%), and statin therapy optimization (34.5% vs. 90%) over 2 years among eligible patients (baseline vs. final cohort, respectively; all p ≤ .001).</p><p><strong>Conclusions: </strong>Using improvement and implementation science to identify needs assessment, process measures, and barriers in statin optimization and mapping IS to the barriers can help improve statin optimization in primary prevention. Our reporting of IS using the ERIC taxonomy should further help operationalize IS in other contexts.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422978","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":"Standardizing Inventory Reduces Reprocessing Time and Costs Through Worker Task Familiarity in Medical Devices.","authors":"Ananya Pathak, Gurjovan Sahi, Jin Tong Du, Aazad Abbas, Ajay Shah, Johnathan R Lex, Albert Yee, Jeremie Larouche, Jay Toor","doi":"10.1097/JHQ.0000000000000511","DOIUrl":"10.1097/JHQ.0000000000000511","url":null,"abstract":"<p><strong>Background: </strong>Surgical instrument inventory optimization leads to sizable cost savings through tray reduction. Yet, a commonly overlooked benefit is the increase in efficiency stemming from reduced task variety for health care workers resulting from this reduction in inventory variety. We hypothesized that reducing the variety of surgical instrument trays would lead to significant improvement in reprocessing time, labor cost savings, and staff satisfaction.</p><p><strong>Methods: </strong>We conducted a 12-month observational study at an academic hospital's medical device reprocessing (MDR) department before and after inventory optimization. The evaluated outcome measures were MDR time saved, labor cost reduction, and worker satisfaction as measured by an anonymized survey.</p><p><strong>Results: </strong>After standardization, the results revealed that the time savings of new MDR technicians (14 ± 6.2 minutes) were significantly higher than the time savings of experienced MDR technicians (4.6 ± 5.7 minutes) ( p < .001). The total reprocessing cost savings equal $2,575.96 Canadian Dollars (CAD) annually. We found a higher satisfaction with the standardized tray among MDR technicians, with eight of nine new MDR technicians (89%) significantly preferring it, and 12 of 19 (63%) experienced MDR technicians \"somewhat\" preferring the standardized tray.</p><p><strong>Conclusion: </strong>Standardizing surgical trays enhances efficiency, reduces costs, and improves staff satisfaction, making it a valuable strategy in inventory management.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534863","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":"Enhanced Discharge Bundles to Reduce Length of Stay.","authors":"Rika Ohkuma, Yingjie Weng, Jill Weeks, Jason Hom, Jeffrey Chi, Rudolph Arthofer, Neera Ahuja","doi":"10.1097/JHQ.0000000000000498","DOIUrl":"10.1097/JHQ.0000000000000498","url":null,"abstract":"<p><strong>Introduction: </strong>Length of stay (LOS) is a critical metric for the efficient utilization of limited resources. A multidisciplinary task force in an academic hospital was created to optimize discharge planning with expanded resources to support a structured discharge process.</p><p><strong>Methods: </strong>Between January and June 2023, multiple interventions were implemented in Hospital Medicine group. Inpatient LOS and other process, outcome, and balancing measures in the post-intervention period (July to December 2023) were compared to those in the pre-intervention period (July to December 2022). The patient demographics and clinical characteristics were adjusted for confounding factors.</p><p><strong>Results: </strong>The mean inpatient LOS was 5.8 days post-intervention compared with 6.5 days in the pre-intervention cohort. After adjusting for potential confounding factors, we found a significant reduction in inpatient LOS by 0.56 days ( p = .019), while it did not affect all-cause readmissions or emergency department (ED) visits within 30 days after discharge.</p><p><strong>Conclusions: </strong>Our multidisciplinary discharge bundle, appropriate case management support level and documentation enhancement seem to be a promising approach for coordinating discharge communication and subsequently reducing the LOS. Our plan is to scale this approach to other clinical areas, address identified care progression delays, and better manage the ED throughput to improve the care delivery system.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483454","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":"Keeping Track of DME Utilization-Lessons Learned.","authors":"Suzana Simoes, Kim B Smith","doi":"10.1097/JHQ.0000000000000505","DOIUrl":"10.1097/JHQ.0000000000000505","url":null,"abstract":"<p><strong>Background: </strong>Disability is a major problem facing older adults. Durable medical equipment (DME) is used to reduce disability. DME cost is projected to continue to grow. The Program of All-Inclusive Care for the Elderly (PACE) is a managed care program for individuals who live in the community while being nursing home eligible. The program's goal is to prevent or delay institutionalization by attending to participant's needs including the need for DME. The institution, through its interdisciplinary team, noticed that not all DME provided was used.</p><p><strong>Purpose: </strong>To understand DME utilization for PACE participants, to identify barriers to use, and to assess financial costs associated with DME nonutilization.</p><p><strong>Method: </strong>The institution developed a quality improvement project using the Plan-Do-Study-Act (PDSA) cycle to assess and understand DME nonutilization.</p><p><strong>Results: </strong>Although the financial goal of reducing costs related to DME nonutilization was not met, quality improvements were observed, including reduced barriers to utilization and changes in prescription patterns, indicating progress toward more appropriate and targeted DME use.</p><p><strong>Conclusions: </strong>Barriers to DME utilization are complex. An educational session for the interdisciplinary team led to quality improvements and underscored the importance of a person-centered approach to prescribing, coordinated team interventions, and ongoing education and monitoring.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"48 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183298","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":"Implementation of a Cardiopsychiatry Clinic for Cardiovascular Primary Prevention in Individuals with Severe Mental Illness.","authors":"Marina Delli Colli, Soham Rej, Daniel Frank, Kyle T Greenway, Michael Goldfarb","doi":"10.1097/JHQ.0000000000000500","DOIUrl":"10.1097/JHQ.0000000000000500","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals with severe mental illness (SMI), including schizophrenia, schizoaffective disorder, and bipolar disorder, face twice the risk of cardiovascular disease compared with the general population. However, disparities in cardiovascular care access persist. We established a cardiopsychiatry clinic to assess cardiovascular risk and initiate evidence-based treatment in this population.</p><p><strong>Methods: </strong>From November 2022 to July 2023, patients with SMI but no known cardiovascular disease were referred from outpatient psychiatry clinics to a tertiary care hospital in Canada. Cardiovascular risk factors were recorded, and the 10-year Framingham Risk Score was calculated. Treatment was initiated based on clinical guidelines.</p><p><strong>Results: </strong>Among 23 participants (mean age 52.6 ± 10.8 years; 30% female), schizophrenia was the most common SMI (65%). The mean Framingham Risk Score was 13.8% ± 8.1. Smoking (61%) and obesity (74%) were the most prevalent risk factors. More than half (57%) had newly identified cardiovascular risks, leading to pharmacological treatment initiation for metabolic syndrome/dyslipidemia (N = 7), hypertension (N = 7), and diabetes (N = 2).</p><p><strong>Conclusions: </strong>The cardiopsychiatry clinic is a pilot project that highlights the need for integrated cardiovascular screening and treatment for individuals with SMI. Larger studies are required to address persistent gaps in cardiovascular care for this high-risk population.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287308","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}