{"title":"Enhancing Healthcare Quality and Cost Savings Through Maryland's Value-Based Episode Quality Improvement Program.","authors":"Nimasha B Fernando, Alissa Wong, Shani Kamberi, Gene Ransom, Padmini Ranasinghe","doi":"10.1097/JHQ.0000000000000512","DOIUrl":"10.1097/JHQ.0000000000000512","url":null,"abstract":"<p><strong>Background: </strong>Maryland's Episode Quality Improvement Program (EQIP) incentivizes nonhospital practitioners to improve care quality and reduce healthcare costs through an episode-based payment framework.</p><p><strong>Methods: </strong>Results from EQIP's performance year one (January 1, 2022 to December 31, 2022) were published by the Maryland Chesapeake Regional Information System and the Maryland Health Services Cost Review Commission. Savings for every clinical episode category and type were determined by comparing an entity's 2022 spending to target prices.</p><p><strong>Results: </strong>Fifty entities enrolled in EQIP in 2022 and experienced a total savings of $11,763,026. Entities reported 37,758 clinical episodes and payments totaling $385,701,806, which was less than the target price of $397,464,832. Entities participated in 15 clinical episode types divided into three categories: Orthopedics (50%, 25 entities), Cardiology (40%, 20 entities), and Gastroenterology (34%, 17 entities). Orthopedics was the only clinical episode category with savings at a rate of 5.9%. Cardiology episodes had savings at a rate of -0.3%, and gastroenterology episodes had a rate of -1.8%.</p><p><strong>Conclusions: </strong>Episode Quality Improvement Program yielded cost savings in Maryland. Other states could learn from this model when implementing their own value-based care models. Policies that create an enabling environment for value-based care programs like EQIP should be supported.</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/PMC12888899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183248","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}
Fardad Behzadi, Jisoo Kim, Amir A Satani, Michelle Mai, Erik K Loken, Thomas F Flood, Raymond Y Huang, Rose L Wach, Jeffrey P Guenette
{"title":"Maintaining Neck Biopsy Diagnostic Yield and Time-to-Biopsy Through Volume Increase: A Quality Improvement Initiative.","authors":"Fardad Behzadi, Jisoo Kim, Amir A Satani, Michelle Mai, Erik K Loken, Thomas F Flood, Raymond Y Huang, Rose L Wach, Jeffrey P Guenette","doi":"10.1097/JHQ.0000000000000499","DOIUrl":"10.1097/JHQ.0000000000000499","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous ultrasound-guided core needle biopsies (CNB) and fine needle aspirations (FNA) provide high yield and minimal risk for neck pathology diagnosis. Organizational shifts led to the planned closing of a long-standing pathology FNA clinic and a potential doubling in biopsy volume for our neuroradiology neck biopsy service.</p><p><strong>Purpose: </strong>We formulated a quality improvement (QI) initiative with three goals for our service: (1) maintain or decrease mean days to biopsy, (2) maintain or decrease variation in days to biopsy, and (3) maintain diagnostic yield.</p><p><strong>Methods: </strong>We added physician assistants to the biopsy team and opened a community hospital biopsy clinic. Weekly neuroradiology neck CNB and FNA were tracked from September 4, 2023, to June 23, 2024.</p><p><strong>Results: </strong>As anticipated, biopsy volume nearly doubled (6.1 ± 2.4 to 12.1 ± 1.2 per week between the first and last 8 weeks, p = .006). Statistical process control methods showed special cause shorter mean times-to-biopsy (8.6 days from 9.6 days) and special cause reduced week-to-week variation (0.8 days from 2.0 days) attributable to our process changes without special cause change in diagnostic rate (90.1% across the project period).</p><p><strong>Conclusions: </strong>These results highlight the successful application of QI methodology to modify and monitor volume-driven adaptations in a medical procedure clinic.</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/PMC12516526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070742","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}
Maelys Amat, Dora Huang, Dru Ricci, James Benneyan, Sarah Flier, Hariharan Shanmugam, Scot Sternberg, Amie Pollack, Leonor Fernandez, Talya Salant, Mark Aronson, Gordon Schiff, Russell Phillips
{"title":"Evaluation of a Telephone Outreach Intervention on Colonoscopy Completion Rates for Patients With Rectal Bleeding.","authors":"Maelys Amat, Dora Huang, Dru Ricci, James Benneyan, Sarah Flier, Hariharan Shanmugam, Scot Sternberg, Amie Pollack, Leonor Fernandez, Talya Salant, Mark Aronson, Gordon Schiff, Russell Phillips","doi":"10.1097/JHQ.0000000000000514","DOIUrl":"10.1097/JHQ.0000000000000514","url":null,"abstract":"<p><strong>Background: </strong>Rectal bleeding is a common concern among primary care patients and a risk marker for colorectal cancer. Yet, primary care patients who present with rectal bleeding frequently do not complete timely colonoscopies. We sought to determine if a phone-based, scheduling intervention for patients presenting with rectal bleeding in primary care would improve the rate of scheduling and completion of ordered colonoscopies.</p><p><strong>Methods: </strong>We conducted a nonrandomized pre-post intervention study at an urban, academic, hospital-based primary care clinic. We included patients with a colonoscopy order for rectal bleeding who had not scheduled a colonoscopy within 2 weeks of the order date. We created a baseline cohort from August to October 2022 and an intervention cohort from November 2022 to June 2023. The pilot intervention involved up-to-3 outreach phone calls by a primary care-based phone service representative to study participants.</p><p><strong>Results: </strong>Compared to the baseline cohort, patients in the intervention cohort had a significantly higher rate of colonoscopy completion at 365 days ( p = .04). Higher rates in loop closure were seen across demographic cohorts.</p><p><strong>Discussion: </strong>Proactive, primary care-based, outreach phone calls increased rates of completion of colonoscopies ordered for rectal bleeding.</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":"145906982","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":"Impact of Empathic Language in Preappointment Communications on Appointment No-Show Rates.","authors":"Adam B Furtado, Arpita Lal, Donal Murray","doi":"10.1097/JHQ.0000000000000504","DOIUrl":"10.1097/JHQ.0000000000000504","url":null,"abstract":"<p><strong>Abstract: </strong>Medical appointment no shows cause a delay in a patient receiving the care that they need and cause a burden for the health care provider organization. The purpose of this project was to explore whether the use of empathic language in preappointment text message communications with a patient would affect appointment attendance rates. This project was conducted within a mental health treatment organization and included 419 patients scheduled for a virtual intake appointment during a 30-day period. The results indicated that adjusting the language used in preappointment text message communication with patients did not generate a statistically significant change in attendance rates. Additional findings point to possible gender differences, although sample size limitations affected the strength of these findings. The days of the scheduled appointments also seemed to affect attendance rates.</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":"145662486","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}
Yannay Khaikin, Harsukh Benipal, Jackie Thomas, Jodi L Shapiro, Andrea Page, Claire A Jones
{"title":"Eliminating Routine Maternal Blood Work After Cesarean Birth: A Quality Improvement Project.","authors":"Yannay Khaikin, Harsukh Benipal, Jackie Thomas, Jodi L Shapiro, Andrea Page, Claire A Jones","doi":"10.1097/JHQ.0000000000000491","DOIUrl":"10.1097/JHQ.0000000000000491","url":null,"abstract":"<p><strong>Objective: </strong>Low-value laboratories lead to healthcare inefficiencies, unnecessary interventions, and environmental waste. Maternal complete blood count (CBC) testing is routine after cesarean birth, but does not change clinical management in most cases. We aimed to decrease routine postpartum CBC testing at a tertiary-care hospital and replace it with targeted ordering for patients at increased risk of severe anemia.</p><p><strong>Methods: </strong>After reviewing baseline practices, we implemented a quality improvement intervention with two plan-do-study-act (PDSA) cycles. The intervention involved modification of the CBC order in the electronic postpartum order set and creation of ordering criteria: hemoglobin ≤110g/L, above average blood loss, or operating time. The primary outcome was the postpartum CBC draw proportion. Short- and long-term data were collected and evaluated using a run chart.</p><p><strong>Results: </strong>During PDSA2, we observed a reduction in CBC draws from 99% to 34% (n = 202). Nine patients met criteria for CBC but did not have a draw; none had signs or symptoms of anemia. Decrease in draws was stable at 1 year. Detection of severe anemia (≤70 g/L) was unchanged before and after intervention (2.4 vs. 2.3%, p = .88).</p><p><strong>Conclusions: </strong>Our intervention resulted in a significant and sustained change in postpartum CBC ordering. Similar initiatives should consider modifying ordering criteria to suit local trends.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12634146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034505","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}
Irving Jorge, Miriam Weismann, Justin Brady, Chi Zhang, Kayla Li Haydon, David Etzioni, Yu-Hui Chang, Zhi Ven Fong, Nabil Wasif
{"title":"Are Safety Net Hospitals Reimbursed Fairly Under Hospital Value-Based Purchasing-Prioritizing Satisfaction Over Outcomes?","authors":"Irving Jorge, Miriam Weismann, Justin Brady, Chi Zhang, Kayla Li Haydon, David Etzioni, Yu-Hui Chang, Zhi Ven Fong, Nabil Wasif","doi":"10.1097/JHQ.0000000000000490","DOIUrl":"10.1097/JHQ.0000000000000490","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Medicare and Medicaid Services (CMS) reimburse hospitals through the Hospital Value-Based Purchasing Program (HVBP) based on clinical outcomes, safety, efficiency, and patient satisfaction, currently weighted equally. The aim is to explore whether adjusting these weights could address reimbursement inequities for safety net hospitals (SNH).</p><p><strong>Methods: </strong>We assessed 2,731 non-federal hospitals using CMS payment files. They were divided into SNH and non-SNH based on their DSH (Disproportionate Share Hospital) status in 2020. We compared both groups' 2020 HVBP scores to ensure data accuracy and account for COVID-19 impacts.</p><p><strong>Results: </strong>SNHs had lower person and community engagement domain scores (6.9) compared to non-SNHs (8.87, p<0.001), resulting in lower HVBP total performance scores (TPS) (p<0.001) and lower 2020 HVBP adjustment factors (p<0.001). Changing the TPS weights to 35% for clinical outcomes and safety, 25% for efficiency, and 5% for patient and community engagement improved TPS for SNH.</p><p><strong>Conclusions: </strong>Prioritizing clinical outcomes and safety measures can ease financial pressure on SNH.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975284","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}
Meghan M Ramic, Karen M Comiskey, Lisa J Dorow, Elizabeth R Keller, Ahmed M Abbasi, Kathleen M Baker, Krista Mathews, Kevin M Okapal, Omer A Yousif, Jacob J Varga, Anthony M Miniaci
{"title":"Reducing Heart Failure Readmission Through Collaboration: An Acute Care and Post-Acute Success Story.","authors":"Meghan M Ramic, Karen M Comiskey, Lisa J Dorow, Elizabeth R Keller, Ahmed M Abbasi, Kathleen M Baker, Krista Mathews, Kevin M Okapal, Omer A Yousif, Jacob J Varga, Anthony M Miniaci","doi":"10.1097/JHQ.0000000000000495","DOIUrl":"10.1097/JHQ.0000000000000495","url":null,"abstract":"<p><strong>Introduction: </strong>Heart failure (HF) is one of the most common diagnoses in the United States during hospitalization. The incidence of HF is expected to increase in the future, coinciding with the expected increase in the utilization of post-acute care facilities. Recent studies have demonstrated that the implementation of an original Heart Failure Disease Management Program (HFDMP) has a significant potential to decrease readmissions. The Department of Internal Medicine at two acute care hospitals coordinated with a post-acute facility for the implementation of an HFDMP quality improvement project.</p><p><strong>Methods: </strong>The interdisciplinary team developed the HFDMP, which included formalized training for the entire resident care staff, redesigning the post-acute facility's dietary manual, strengthening the postdischarge appointments workflow, creating a dedicated HF unit, identifying additional patient care supplies needed to care for residents with HF, and identifying metrics to monitor after implementation to determine success.</p><p><strong>Results: </strong>Before the implementation of the program, the 30-day readmission rate of the HF hospital was 20%. After implementation, only one resident was readmitted for non-HF-related conditions, corresponding to a 30-day readmission rate of 2.78%.</p><p><strong>Conclusions: </strong>The implementation of similar HFDMPs at post-acute care facilities across the country represents a significant opportunity to decrease 30-day readmissions and improve resource utilization.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287276","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}
Marina E Robson Chase, Madeline J Anderson, Wesley A Stephens, Andrew M Harris, Melissa R Newcomb
{"title":"A Quality Improvement Initiative Designed to Increase Veteran Choice and Consult Retention.","authors":"Marina E Robson Chase, Madeline J Anderson, Wesley A Stephens, Andrew M Harris, Melissa R Newcomb","doi":"10.1097/JHQ.0000000000000494","DOIUrl":"10.1097/JHQ.0000000000000494","url":null,"abstract":"<p><strong>Introduction: </strong>To improve access to care, the Veterans Administration (VA) offers eligible veterans the choice to receive Community Care (CC). Local changes to CC scheduling coincided with a decrease in expected surgical volumes. This project aimed to increase the retention of CC eligible veterans from 66% to 76% by September 2024, while prioritizing veteran autonomy.</p><p><strong>Methods: </strong>The quality improvement team learned CC eligible veterans were not offered a choice between community and VA care during scheduling. A decentralized and individualized scheduling process was developed to ensure veteran choice was respected and to increase consult retention. Consult retention rates were measured as the intervention was progressively scaled across surgical disciplines.</p><p><strong>Results: </strong>With the new scheduling process, retention rate increased from 66.1% to 69.3% and veteran choice was respected for over 5,500 veterans.</p><p><strong>Conclusions: </strong>As both private and VA networks explore strategies to retain patients within their health systems, a decentralized scheduling approach may not significantly affect retention rates. However, this project highlights how easily complex health care processes can lose sight of patient-centered care, which must remain the ultimate goal.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975297","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 Impact of Primary Disease on Patient Satisfaction in Outpatient Care: A Nationwide Analysis.","authors":"Jinhee Park, Jinhyun Kim","doi":"10.1097/JHQ.0000000000000480","DOIUrl":"10.1097/JHQ.0000000000000480","url":null,"abstract":"<p><strong>Background: </strong>Patient satisfaction is a key indicator of health care quality, yet the impact of primary diseases on outpatient satisfaction remains underexplored. This study examined whether the primary disease independently influences patient satisfaction.</p><p><strong>Methods: </strong>We retrospectively analyzed 8,259 outpatient experience records from clinics (n = 6,347), hospitals (n = 1,374), and tertiary hospitals (n = 538) using data from the 2023 Medical Service Experience Survey in Korea. The primary diseases for outpatient visit were categorized into 50 specific conditions grouped under 9 disease categories. Multivariate analyses were conducted, adjusting for demographic and health care-related factors.</p><p><strong>Results: </strong>The primary disease was identified as an independent factor affecting satisfaction. Patients with cancer, particularly those with thyroid and breast cancer, reported the highest satisfaction, whereas patients with depression or bipolar disorder had the lowest. In addition, different diseases independently influenced satisfaction to varying degrees. Factors such as medical provider's manner (especially nurses) and facility convenience were also significantly associated with satisfaction.</p><p><strong>Conclusions: </strong>Although the precise mechanisms remain unclear, the primary disease should be considered an important determinant of patient satisfaction. Future research should take into account the impact of specific diseases on patient satisfaction when designing studies or interpreting results.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289701","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}
Thomas A Nahass, Payal D Parikh, Christopher Gilligan, Stephen O'Mahony, Michael L Loftus, Nancy E Holecek, Ruric Andy Anderson, Kenneth M Granet
{"title":"Navigating an Intravenous Fluid Shortage Crisis: A Health System's Response to a Hurricane-Induced Supply Disruption.","authors":"Thomas A Nahass, Payal D Parikh, Christopher Gilligan, Stephen O'Mahony, Michael L Loftus, Nancy E Holecek, Ruric Andy Anderson, Kenneth M Granet","doi":"10.1097/JHQ.0000000000000484","DOIUrl":"10.1097/JHQ.0000000000000484","url":null,"abstract":"<p><strong>Introduction: </strong>Hurricane Helene's disruption of Baxter's North Carolina manufacturing facility in September 2024 created significant supply disruptions and an urgent need to reduce intravenous fluid (IVF) usage across our 12 acute care hospital health system.</p><p><strong>Methods: </strong>Our approach combined an integrated informatics and operational response that included real-time electronic health record monitoring, clinical decision support tools, and hospital-level operational interventions.</p><p><strong>Results: </strong>We achieved and sustained a peak 44% reduction in IVF usage while maintaining quality metrics.</p><p><strong>Conclusions: </strong>Analysis of 68,430 patient encounters demonstrated no significant changes in acute kidney injury or mortality rate, although demonstrating a reduction in length of stay. This study describes the rationale and impact of our approach and provides a framework for healthcare systems facing similar supply chain disruptions.</p>","PeriodicalId":48801,"journal":{"name":"Journal for Healthcare Quality","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12634143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289700","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}