{"title":"Quality Coordinators' Perspectives on Quality Improvement in Primary Healthcare in Kosovo: A Qualitative Study.","authors":"Ardita Baraku, Gordana Pavleković","doi":"10.1097/JHQ.0000000000000431","DOIUrl":"10.1097/JHQ.0000000000000431","url":null,"abstract":"<p><strong>Aims: </strong>This qualitative descriptive study provides insights into the experiences of quality coordinators (QCs) in primary healthcare to inform policy and practice actions and empower QCs to enhance healthcare quality.</p><p><strong>Methods: </strong>We conducted focus group discussions with purposefully selected QCs to understand their motivations, job experiences, factors influencing healthcare quality, and suggestions for quality improvement. Content analysis and deductive coding were used to scrutinize the responses and answer the research questions.</p><p><strong>Results: </strong>The QCs thought highly about their job performance and were motivated by both extrinsic and intrinsic factors. Clinical audits, collegial reviews, and managerial support positively affected QCs' performance. In contrast, a lack of managerial support, limited working hours, and changes in organizing work caused the opposite. Empowerment and external support positively influenced healthcare quality, whereas lack of resources, managerial support, or training had a negative influence. Suggestions to improve quality include the role of QCs, external supervision, and centralization of the QCs' network.</p><p><strong>Conclusion: </strong>Appointing QCs alone does not guarantee quality improvement. It is essential to ensure that QCs have the appropriate skills, tools, management support, and open communication channels. Further research is required to evaluate the effects of sex and age on QCs' performance.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"e49-e55"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859298","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}
Sheetal Vasundara Mathai, Samuel J Apple, Xiaobao Xu, Li Pang, Elie Flatow, Ari Friedman, Saul Rios, Cesar Joel Benites Moya, Majd Al Deen Alhuarrat, Matthew Parker, Seth I Sokol, Robert T Faillace
{"title":"Differential Mortality Among Heart Failure Patients Across Different COVID-19 Surges in New York City.","authors":"Sheetal Vasundara Mathai, Samuel J Apple, Xiaobao Xu, Li Pang, Elie Flatow, Ari Friedman, Saul Rios, Cesar Joel Benites Moya, Majd Al Deen Alhuarrat, Matthew Parker, Seth I Sokol, Robert T Faillace","doi":"10.1097/JHQ.0000000000000421","DOIUrl":"10.1097/JHQ.0000000000000421","url":null,"abstract":"<p><strong>Abstract: </strong>Learning from the healthcare system's response to the COVID-19 pandemic is essential to better prepare for potential future crises. We sought to assess mortality rates for patients admitted for acute decompensated heart failure (HF) and to analyze which factors demonstrated a statistically significant correlation with this primary endpoint. We performed a retrospective analysis of patients hospitalized with a primary diagnosis of acute decompensated HF within the New York City Health and Hospitals 11-hospital system across the different COVID surge periods. Mortality information was collected in 4,405 participants (mean [SD] age 70.54 [14.44] years, 1885 [42.87%] female).The highest mortality existed in the first surge (9.02%), then improved to near prepandemic levels (3.65%) in the second (3.91%) and third surges (5.94%, p < 0.0001). In-hospital mortality inversely correlated with receipt of a COVID-19 vaccination, but had no correlation with left ventricular ejection fraction or the number of vaccination doses. Mortality for acute decompensated HF patients improved after the first surge, suggesting that hospitals adequately adapted to provide quality care. As future infectious outbreaks may occur, emergency preparedness must ensure that adequate focus and resources remain for other clinical entities, such as HF, to ensure optimal care is delivered across all areas of illness.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"197-202"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425802","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}
Rick Foust, Stephen Clarkson, Megan Nordberg, Joanna Joly, Russell Griffin, Jori May
{"title":"Iron Deficiency Among Hospitalized Patients With Congestive Heart Failure.","authors":"Rick Foust, Stephen Clarkson, Megan Nordberg, Joanna Joly, Russell Griffin, Jori May","doi":"10.1097/JHQ.0000000000000432","DOIUrl":"10.1097/JHQ.0000000000000432","url":null,"abstract":"<p><strong>Introduction: </strong>Studies have demonstrated the efficacy of intravenous (IV) iron when administered to patients with congestive heart failure (CHF) and iron deficiency (ID). We aimed to better understand the adherence of treatment for ID among a population with CHF, with particular interest in high-risk groups not often studied due to inadequate recruitment.</p><p><strong>Methods: </strong>A retrospective chart review at our institution was conducted from January 1, 2012, to July 7, 2021. Analysis included hospitalized patients with CHF and ID and dividing these patients into two time periods based on changes in iron treatment patterns and treatment between sexes.</p><p><strong>Results: </strong>Four thousand eight hundred thirteen patients were included in this study. During the \"early era,\" 7.0% of patients with CHF and ID received IV iron compared with 20.9% of \"late-era\" patients. Female patients with ID were statistically less likely to receive IV iron when compared with male patients, both unadjusted (0.66, confidence interval [CI] 0.55-0.79, p < .0001) and adjusted (0.72, CI 0.59-0.87, p < .0001) for covariates.</p><p><strong>Conclusion: </strong>This study illustrates improved adherence to treatment for ID among hospitalized population with CHF and ID over time but persistent undertreatment remains. Future studies will need to identify the barriers to treating female patients with CHF and ID to reduce these disparities.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"220-227"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248843","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}
Rebecca Afford, Megan Chan, Rana Garelnabi, Fariba Haji Ali Akbari, Sam M Wiseman
{"title":"Improving First Case Operating Room Efficiency.","authors":"Rebecca Afford, Megan Chan, Rana Garelnabi, Fariba Haji Ali Akbari, Sam M Wiseman","doi":"10.1097/JHQ.0000000000000433","DOIUrl":"10.1097/JHQ.0000000000000433","url":null,"abstract":"<p><strong>Introduction: </strong>Improving transition to the operating room (OR) can enhance healthcare efficiency. Our aim was to determine whether adopting a communication board (CB) for first case surgical patients reduced delays to OR.</p><p><strong>Methods: </strong>A retrospective observational study was conducted from April to October 2021. We calculated differences in surgical daycare (SDC) departure time before and after implementation of the CB, differences in departure whether the CB was used or not, delay in variability between surgical specialties, and overall adoption of the CB.</p><p><strong>Results: </strong>After CB adoption, 13% of first cases left SDC by predefined target times. The mean delay in transfer was 18:51 minutes. When the CB was used, cases were on average 10:43 late, compared with 26:00 when it was not used. Otolaryngology had the shortest delays while plastic surgery had the longest. Reasons for delays included staffing delays, holds, and pending laboratory results.</p><p><strong>Conclusions: </strong>Introducing a CB significantly reduced delays in transferring first case surgical patients from SDC to the OR.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"228-234"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872399","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}
Rebecca L Trotta, Anne E Shoemaker, S Ryan Greysen, Marie Boltz
{"title":"Pilot Process Evaluation of the Supporting Older Adults at Risk Model: A RE-AIM Approach.","authors":"Rebecca L Trotta, Anne E Shoemaker, S Ryan Greysen, Marie Boltz","doi":"10.1097/JHQ.0000000000000435","DOIUrl":"10.1097/JHQ.0000000000000435","url":null,"abstract":"<p><strong>Abstract: </strong>Despite evidence supporting transitional care models, hospitals report challenges implementing and sustaining them. The Discharge to Assess (D2A) Model is an innovative solution to this problem but required translation from a national health system context to an U.S.-based context. We translated the central tenets of the D2A model to establish the Supporting Older Adults at Risk (SOAR) Model, which unfolds in three phases: Prepare, Transition, and Support. The purpose of this project was to conduct a process evaluation of the SOAR Model in practice using the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Forty patients completed all SOAR Model components for a Reach of 21%. Patients averaged 80 years of age, 53% were female, and 64% Black/AA. SOAR significantly improved discharge before noon, time to first home visit, and use of the in-house pharmacy. SOAR also improved length of hospital stay, emergency department visits, and readmissions. Twenty-one of the 26 Implementation measures unfolded with 75% or greater fidelity. Sixteen of the 24 Adoption measures unfolded with 75% or greater fidelity. COVID-19 limited Maintenance. Given the model unfolds across settings over time, requiring adoption from interprofessional team members, patients, and families, future work should focus on improving reach and adoption.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"e26-e39"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922095","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}
Parker A Rhoden, Luke Hall, Michelle Stancil, Windsor Westbrook Sherrill
{"title":"EHR Smart Phrases Used as Enrollment Mechanism in Diabetes Self-Management Support Programs: Preliminary Outcomes.","authors":"Parker A Rhoden, Luke Hall, Michelle Stancil, Windsor Westbrook Sherrill","doi":"10.1097/JHQ.0000000000000438","DOIUrl":"10.1097/JHQ.0000000000000438","url":null,"abstract":"<p><strong>Abstract: </strong>Diabetes in the United States is increasing rapidly. Innovative strategies are needed for diabetes prevention and self-management. This study assessed the usability, acceptability, and awareness of an electronic health record (EHR) tool for referring patients to a community-based diabetes self-management support program. Mixed-methods approaches were used, using EHR data and key informant interviews to assess the implementation of this quality improvement (QI) process intervention. The implementation of a smart phrase tool within the EHR led to a substantial increase in referrals (773) to the Health Extension for Diabetes (HED) program. Clinical health care professionals have actively used the referral mechanism; they reported using smart phrases to increase efficiency in patient care. Lack of training and program awareness was identified as a barrier to adoption. Awareness of the HED program and .HEDREF smart phrase was limited, but improved with targeted QI and training interventions. The .HEDREF smart phrase demonstrated effectiveness in increasing patient referrals to the HED program, highlighting the potential of EHR tools to streamline documentation and promote patient engagement in diabetes self-management. Future research should focus on broader health care contexts, patient perspectives, and integration of technology for optimal patient outcomes.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"46 4","pages":"235-244"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460178","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":"Implementing Behavioral Optimization and Outcomes Support Team in a Medical/Surgical Telemetry Unit.","authors":"Chikaodi Kay, Marilyn Miller, Brandon Buckingham","doi":"10.1097/JHQ.0000000000000436","DOIUrl":"10.1097/JHQ.0000000000000436","url":null,"abstract":"<p><strong>Background: </strong>A community hospital reported 21 staff assaults with injuries and 242 emergency response code green (CG) calls for violent behaviors, resulting in a loss of time in the 2022 fiscal year. Evidence has shown that exposure to violent behavior can compromise effective patient care and lead to job dissatisfaction, high turnover, and higher healthcare costs.</p><p><strong>Purpose: </strong>This quality improvement project aims to develop and implement behavioral optimization and outcome support team (BOOST) in a medical-surgical telemetry unit to reduce patient-to-staff assaults/injuries.</p><p><strong>Methods: </strong>BOOST was piloted for 15 weeks; process data included staff knowledge and satisfaction with BOOST; outcome data included the number of BOOST and CG calls and staff assaults/injuries. The team members included registered psychiatric nurses, nursing supervisors, and security officers. Data were collected and analyzed weekly using a run chart.</p><p><strong>Results: </strong>The survey data demonstrated increased staff knowledge of the behavioral response team and staff satisfaction with the BOOST implementation. No staff injuries or assaults were reported during the BOOST implementation.</p><p><strong>Conclusions: </strong>Behavioral optimization and outcome support team was effective in de-escalating patients and the team provided support to nursing staff. BOOST utilization can effectively reduce assaults and injuries in the workplace.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"e40-e48"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863796","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}
Anne H VanBuren, Tricia M Montgomery, John R McConaghy, Jeffrey Lawrence, Nazhat Taj-Schaal, Melissa Unger, Nate R Rogers
{"title":"Ambulatory Quality Improvement Despite COVID-19: Blueprint for a Successful System for Continuous Improvement.","authors":"Anne H VanBuren, Tricia M Montgomery, John R McConaghy, Jeffrey Lawrence, Nazhat Taj-Schaal, Melissa Unger, Nate R Rogers","doi":"10.1097/JHQ.0000000000000444","DOIUrl":"10.1097/JHQ.0000000000000444","url":null,"abstract":"<p><strong>Abstract: </strong>In this article, we describe our experience developing and implementing a multipronged approach to improve performance across a strategic subset of quality measures within primary care. Detailed techniques include data visualization and analytics, process reengineering, team engagement, visual project management, continuous improvement methods and training, and incentives and recognition. We achieved positive change across 12 high priority measures which we deemed the \"High Value Framework (HVF)\" by fostering a collaborative, nonpunitive, problem-solving culture. We focused on measures that had the greatest potential for impact from a clinical, reimbursement, and reputational perspective. More importantly, we sustained gains despite the challenges posed by the COVID-19 pandemic, thereby demonstrating programmatic resilience and high process reliability. This systematic approach serves as a practical blueprint for other healthcare entities seeking to navigate the complexities of quality improvement in a dynamic environment. The model provides a strategic framework for prioritizing and standardizing quality measures, effectively engaging stakeholders, and managing organizational change. Our model emerged from a need to address real-world operational challenges, rather than as an academic or theoretical exercise, and was developed independently of existing literature on measure prioritization and standardization at the time of its inception.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"251-258"},"PeriodicalIF":0.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960484","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 Qualitative Study of Factors Influencing Hospital Participation in the Healthcare Equality Index.","authors":"V Peter Abdow, Julian K Marable, Eileen S Moore","doi":"10.1097/JHQ.0000000000000426","DOIUrl":"10.1097/JHQ.0000000000000426","url":null,"abstract":"<p><strong>Abstract: </strong>Gender and sexual minority individuals experience higher rates of mistreatment and discrimination in healthcare compared with their non-lesbian, gay, bisexual, transgender, queer, and other nonheterosexual (LGBTQ+) peers. The Healthcare Equality Index (HEI) aims to create more inclusive environments and to provide metrics for quality improvement. Currently, only one adult hospital in the District of Columbia has earned the highest recognition from the HEI. Our institution is part of the same regional health system as this hospital, yet has never been evaluated by the HEI. This study explores the knowledge, attitudes, and perceptions surrounding the HEI at our institution to assess the feasibility of its participation. During the study period of July 2021 to June 2022, a total of 12 physicians, administrators, and educators from both hospitals and our affiliated school of medicine were interviewed. All participants expressed support after HEI requirements and improving inclusivity for LGBTQ+ patients. Participants at the other hospital cited unanimous support amongst hospital administrators as key for successful HEI implementation. Participants also mentioned cost, staff shortages, and the school of medicine's religious affiliation as potential barriers to this goal. Ultimately, hospital implementation of HEI guidelines is feasible despite shifting institutional priorities and resource limitations through greater stakeholder buy-in and streamlining a systemwide approach.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":"177-187"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425801","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}
Helen Jingshu Jin, Jennifer Koichopolos, Bradley Moffat, Patrick Colquhoun, Bronagh Morgan, Launa Elliot, Robert Sibbald, Terry Zwiep
{"title":"General Surgery Resuscitation Preference Documentation: A Quality Improvement Initiative.","authors":"Helen Jingshu Jin, Jennifer Koichopolos, Bradley Moffat, Patrick Colquhoun, Bronagh Morgan, Launa Elliot, Robert Sibbald, Terry Zwiep","doi":"10.1097/JHQ.0000000000000439","DOIUrl":"10.1097/JHQ.0000000000000439","url":null,"abstract":"<p><strong>Background/purpose: </strong>Documentation of resuscitation preferences is crucial for patients undergoing surgery. Unfortunately, this remains an area for improvement at many institutions. We conducted a quality improvement initiative to enhance documentation percentages by integrating perioperative resuscitation checks into the surgical workflow. Specifically, we aimed to increase the percentage of general surgery patients with documented resuscitation statuses from 82% to 90% within a 1-year period.</p><p><strong>Methods: </strong>Three key change ideas were developed. First, surgical consent forms were modified to include the patient's resuscitation status. Second, the resuscitation status was added to the routinely used perioperative surgical checklist. Finally, patient resources on resuscitation processes and options were updated with support from patient partners. An audit survey was distributed mid-way through the interventions to evaluate process measures.</p><p><strong>Results: </strong>The initiatives were successful in reaching our study aim of 90% documentation rate for all general surgery patients. The audit revealed a high uptake of the new consent forms, moderate use of the surgical checklist, and only a few patients for whom additional resuscitation details were added to their clinical note.</p><p><strong>Conclusions: </strong>We successfully increased the documentation percentage of resuscitation statuses within our large tertiary care center by incorporating checks into routine forms to prompt the conversation with patients early.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":"46 3","pages":"188-195"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872984","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}