International journal for quality in health care : journal of the International Society for Quality in Health Care最新文献

{"title":"Development and validation of a machine learning-based model for predicting fall-related injury risk in hospitalized patients.","authors":"Shiyu Wang, Xiaomei Zhang, Yi Qin, Xiuqun Xu, Linjing Du, Panpan Xu, Jiahui Yu, Yanqing Li, Lingyan Yang","doi":"10.1093/intqhc/mzag128","DOIUrl":"10.1093/intqhc/mzag128","url":null,"abstract":"<p><strong>Background: </strong>Falls are among the most common adverse events in hospitalized patients, with about 30% leading to injury. We developed a machine learning model to predict which in-hospital fall events would lead to patient injury, thereby supporting post-fall risk stratification.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 410 patients who had experienced falls at a tertiary general hospital in China. Among them, 134 patients (32.7%) had fall-related injuries. The dataset was divided into training and test sets at a 7:3 ratio by outcome-stratified random sampling. Least absolute shrinkage and selection operator regression was used for feature selection to identify relevant predictors. Four machine learning models-logistic regression, random forest, extreme gradient boosting, and support vector machine-were developed and assessed. Model performance was evaluated in the test set using the area under the receiver operating characteristic curve, Brier score, and calibration curves. According to model performance, the optimal model was selected, and multivariable logistic regression analysis was then performed to determine independent risk factors.</p><p><strong>Results: </strong>In the test cohort, the logistic regression model showed the strongest predictive ability [area under the receiver operating characteristic curve = 0.863, 95% confidence interval (CI): 0.785-0.941; Brier score = 0.142]. Five independent risk factors were detected, including impaired consciousness [odds ratio (OR) = 3.35, 95% CI: 1.58-7.10], reduced muscle strength (OR = 3.93, 95% CI: 1.87-8.26), use of high-risk medications (OR = 10.07, 95% CI: 5.05-20.07), ward-related environmental hazards (OR = 3.30, 95% CI: 1.63-6.69), and hypocalcemia (OR = 2.10, 95% CI: 1.05-4.19). Based on this model, a nomogram was developed, and decision curve analysis indicated a positive net clinical benefit within the threshold probability range of 0.10-0.80.</p><p><strong>Conclusion: </strong>A prediction model based on five routinely collected clinical variables was developed to estimate fall-related injury risk after an in-hospital fall. The logistic regression model showed a favorable balance among predictive performance, calibration, interpretability, and clinical feasibility. This model may help support post-fall injury risk stratification, triage for further assessment, and monitoring decisions in hospitalized patients who have already experienced a fall.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultural determinants and strategic priorities for medication safety in acute care: a multidisciplinary Delphi study.","authors":"Neville Schembri, Hannah-Kim Grima Formosa, Kevin Holmes, Marie Clare Cassar, Shane Desselle, Timothy F Chen, Maria Cordina, Lorna Bonnici West","doi":"10.1093/intqhc/mzag125","DOIUrl":"10.1093/intqhc/mzag125","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Organizational culture, defined as the shared values, assumptions, and norms that influence behavior within organizations, is widely recognized as a key determinant of patient safety in healthcare systems. Within acute care settings, medication safety represents a critical component of patient safety and depends on the ability of healthcare professionals to recognize risks, communicate openly, and intervene before errors result in patient harm. However, medication use is inherently interdisciplinary and requires effective coordination between multiple professional groups. Understanding how organizational culture influences medication safety practices across healthcare professions is therefore essential to inform governance, policy, and improvement strategies. This study aimed to achieve expert consensus on the organizational cultural factors influencing medication safety practices, barriers to medication error reporting, and strategies to strengthen medication safety in acute healthcare settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A modified electronic Delphi method was used to synthesize expert perspectives. A multidisciplinary panel of 41 healthcare professionals practicing in Malta's acute care system was invited to participate, including nurses, midwives, medical doctors, and pharmacists. In Round 1, participants completed an exploratory qualitative questionnaire consisting of three open-ended questions addressing cultural influences on medication safety, barriers to error reporting, and potential improvement strategies. Responses were analyzed using inductive content analysis, generating thematic categories that informed the development of 20 structured statements grouped into four domains: organizational safety culture and psychological safety; workforce and operational pressures; reporting culture and barriers; and strategies to strengthen medication safety. In Round 2, participants rated the importance of each statement using a five-point Likert scale. Consensus was predefined as ≥70% agreement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 28 out of 41 healthcare professionals participated in Round 1 (68.3% response rate), including nurses (n = 15), midwives (n = 5), medical doctors (n = 5), and pharmacists (n = 3). Round 1 identified seven categories grouped into four domains, with blame culture emerging as a key barrier to medication error reporting. In Round 2 (n = 25/41; 61.0% response rate), consensus (≥70%) was reached for all but one statement. The strongest consensus centered on psychological safety, open communication, and adequate staffing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Findings indicate that medication safety is shaped primarily by organizational culture and systemic conditions rather than technical safeguards alone. Establishing a psychologically safe, non-punitive environment supported by engaged leadership and appropriate workforce conditions is fundamental for encouraging transparent reportin","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing learning health care systems with best practice meetings: a mixed-methods study with insights from the Dutch Institute for Clinical Auditing.","authors":"Felix Hers, Lisanne E van Rangelrooij, Janne van den Hurk, Lars van de Sanden, Willemien J van Driel, Grard A P Nieuwenhuijzen, Barend M E Mees, Mira S Staphorst, Mark M J Nielen, Michel W J M Wouters","doi":"10.1093/intqhc/mzag111","DOIUrl":"10.1093/intqhc/mzag111","url":null,"abstract":"<p><strong>Background: </strong>National clinical registries are widely used to benchmark quality indicators and improve care. Advancing registry-based auditing toward learning health care systems (LHCS) requires structural integration of continuous evaluation and improvement cycles. One way to operationalize the check phase of the Plan-Do-Check-Act cycle is through best practice meetings (BPMs), in which health care professionals transparently discuss inter-hospital variation in clinical outcomes and formulate targeted improvement actions. Since 2018, the Dutch Institute for Clinical Auditing (DICA) has organized BPMs across multiple registries. This study provides the first descriptive overview of the structure, participant experiences, and facilitators and barriers to the organization and conduct of BPMs.</p><p><strong>Methods: </strong>A descriptive mixed-methods study was conducted. Data on session characteristics (e.g. number, topics, format) and follow-up actions were obtained through a survey among coordinators of DICA registries. Participant satisfaction scores from evaluations of BPMs held between 2018 and 2025 were retrospectively extracted, where available. Semi-structured interviews were held with four registry coordinators and one project manager. Interviews were thematically analysed to identify facilitators and barriers to the organization and conduct of BPMs.</p><p><strong>Results: </strong>In total, 55 BPMs were held across 14 registries. Most were national and multidisciplinary. Frequently discussed topics included length of stay, treatment waiting times, Textbook Outcome, and mortality. Best practices and/or quality improvement actions were formulated for 22 of 55 BPMs (40%). The mean participant satisfaction score was 4.0 on a 5.0-point Likert scale. Five themes were identified through thematic analysis of interviews: preparation, setting and format, learning climate, implementation, and cyclical learning. Facilitators included sharing data in advance, skilled moderation, an open and safe atmosphere, and recurring themes; barriers included an online setting that hampered interaction, concerns regarding data quality, and discussion of too many topics during a single meeting.</p><p><strong>Conclusion: </strong>BPMs appear to be a feasible and well-accepted instrument to support data-driven quality improvement across hospitals. Implementation of BPMs could support LHCS by operationalizing the learning cycle from benchmarking to shared learning, action planning, and follow-up. Future research should evaluate whether BPMs lead to implementation of improvement actions and measurable changes in clinical outcomes.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Independent pharmacist prescribing: how it can work and how to support its implementation.","authors":"Deonne Dersch-Mills, Ezequiel Garcia Elorrio","doi":"10.1093/intqhc/mzag097","DOIUrl":"10.1093/intqhc/mzag097","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Historically informed quality improvement: applying historical insights from Black women's maternity care to contemporary health service redesign.","authors":"Jennifer Creese, Bharathy Kumaravel, Kellie Moss, Maxine Chapman, Natalie Darko, Floretta Cox, Ruw Abeyratne","doi":"10.1093/intqhc/mzag113","DOIUrl":"10.1093/intqhc/mzag113","url":null,"abstract":"<p><strong>Background: </strong>Quality improvement aims to systematically devise solutions to complex issues and problems in services and systems. However, many quality improvement initiatives aim to address outcomes rooted in historical policy and practice, where organizational memory may be long lost. A solid foundational understanding of past practice and policy is important to contextualize the present and highlight previous changes with sustained impact. However, it can also help to show deteriorating performance and suggest potential proven interventions which may be suitable to re-explore and identify areas which remain unchanged and problematic over the years, despite the best efforts of healthcare staff, leaders, and policymakers, indicating where deeper systemic and cultural change is required beyond the quality improvement approach.</p><p><strong>Methods: </strong>This paper introduces a tool and approach, the historically informed quality improvement (HIQI) matrix for mapping evidence around contemporary healthcare service quality against historical data on the same services to identify key areas for policy retention, intervention evaluation, quality improvement, and cultural change. The paper illustrates the tool's use through a worked example of Black (African, African-Caribbean, and Mixed) ethnic minority women's experiences in maternity care amid a backdrop of inequalities in maternity outcomes. Ten oral history interviews with Black women who used local hospital trust maternity services 1984-2004 were conducted, alongside focus groups with 11 Black women who had used the same services in the past 12 months.</p><p><strong>Results: </strong>In the worked example, using the HIQI tool identified that friendly and caring midwives were the heart of a positive birth experience; improvements in satisfaction were evident, resulting from proactive hiring of midwives from similar racial/ethnic groups to mothers, and increased attention to maternal mental health. However, connection to staff and time between appointments had deteriorated over the years, and women had less confidence in what to expect in pregnancy. Issues around racial and unconscious bias and lack of voice were a prominent theme across the years, suggesting these are deep-seated issues that require broader institutional and societal cultural change and are unreliable targets for quality improvement approaches. Three quality-improvement projects for the hospital trust were identified through the use of the HIQI tool.</p><p><strong>Conclusion: </strong>The HIQI approach detailed in this paper enables quality improvement practitioners to develop a richer understanding of changes to services over the years and develop evidence-based plans for quality improvement and service evaluation. The approach also highlights core issues which are deep-seated within the institution, requiring a comprehensive culture change strategy alongside quality improvement efforts.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving surgical patients' safety in African hospitals: exploring healthcare professionals' experiences of Phase 1 of the '5Rs to Rescue' programme.","authors":"Charles Fadipe, Rowan Duys, Gillian J Bedwell, Pierre Barker, Godfrey Barabona, Bruce M Biccard, Ryan Ellis, Adam Hewit-Smith, Fitsum Kilfe, Marianne E McPherson, Busisiwe Mrara, Ezile Ninise, Rupert M Pearse, Rafael Shayo, Timothy J Stephens","doi":"10.1093/intqhc/mzag110","DOIUrl":"10.1093/intqhc/mzag110","url":null,"abstract":"<p><strong>Background: </strong>The mortality rate of surgical patients in Africa is twice the global average. Pan-African studies have identified that this excess mortality is driven by deaths arising from postoperative complications. Preventable deaths can be reduced with enhanced monitoring in the postoperative period. This study reports on the first of a two-phase Quality Improvement (QI) programme, '5 Rs to Rescue', designed to reduce failure to rescue for surgical patients in Africa.</p><p><strong>Methods: </strong>Using a QI approach, we co-produced a failure to rescue intervention with stakeholders across four African countries (Ethiopia, South Africa, Tanzania, and Uganda). These initial interventions were as follows: (i) Risk assessment using a validated tool, (ii) Recognition of patient deterioration using an early warning system (EWS), (iii) Response to patient deterioration (using locally defined protocols, (iv) Reassessment using an EWS, and (v) Reflection on care provided. These were tested and refined in clinical practice at nine hospitals through QI approaches. We interviewed frontline staff, project leaders, and QI advisors at the end of Phase 1 to learn from their experience to refine the intervention prior to Phase 2. Deductive thematic analysis was used, sensitized by constructs from the Consolidated Framework for Implementation Research (CFIR).</p><p><strong>Results: </strong>We interviewed 11 frontline staff, seven national project leads and five QI advisors. From the CFIR-based coding, two cross-cutting, higher-order themes were developed to describe the participant's experience. Theme 1 centred around the substantial relational work involved in leading the 5Rs project. Surgeons reported the recurrent communication required to engage, train, and motivate all the necessary stakeholders. Surgical and nursing hierarchies were poorly linked in many settings, initially hampering these relational efforts. Theme 2 centred on the complexity of the 5Rs tools being introduced into complex, and already overstretched systems. A long period was required for nurses and doctors to become familiarized with the proposed '5Rs' tools. Although their value was broadly accepted, not all tools were a good fit for all the project settings. Potential solutions to overcome barriers identified in Phase 2 included a longer QI programme, more emphasis on involving nurse leaders and selection of a less complicated 'EWS' for detecting patient deterioration.</p><p><strong>Conclusion: </strong>Developing a multifaceted intervention that fits within complex, resource-limited contexts is a major challenge for efforts to improve patient care. This Phase 1 evaluation has provided actionable learning, targeting specific barriers, to be incorporated into an improved failure to rescue QI programme being developed in Phase 2.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons learned from nationwide perinatal audit of severe postpartum haemorrhage in the Netherlands.","authors":"Lisa Broeders, Steven V Koenen, Nicole de Vocht, Thomas van den Akker, Ageeth N Rosman","doi":"10.1093/intqhc/mzag119","DOIUrl":"10.1093/intqhc/mzag119","url":null,"abstract":"<p><strong>Background: </strong>Severe postpartum haemorrhage (PPH) remains a leading and largely preventable cause of maternal morbidity and mortality worldwide. Delayed recognition, inappropriate fluid replacement, and suboptimal clinical management contribute to adverse outcomes. Clinical audit can identify deficiencies in care and stimulate quality improvement. In the Netherlands, a nationwide perinatal audit system enables multidisciplinary review of maternity care to enhance collaboration and optimize clinical practice. This study reports the first nationwide audit of severe PPH management in the Netherlands and aims to identify improvable care factors and draw lessons for clinical care.</p><p><strong>Methods: </strong>In the Netherlands, perinatal audit is nationally coordinated and based on a set of periodic clinical themes. In 2020-3, one such theme was severe PPH, defined as blood loss of ≥2500 ml in the first 24 h after birth or blood loss requiring hysterectomy. Local multidisciplinary audit sessions were held within 'perinatal cooperation groups', comprised maternity care professionals working within a region. During audit sessions, anonymized case reports were reviewed, and areas for improvement of clinical care were identified and documented. Audit findings were analysed quantitatively to group improvable care factors regarding clinical management provided to women sustaining severe PPH. In addition, narrative excerpts from audit reports were used descriptively to provide context to the findings.</p><p><strong>Results: </strong>In 116 women sustaining severe PPH, the audit revealed 234 improvable care factors, mostly related to nonadherence to guidelines and standards (47.8%), organization of care (22.3%), and communication and documentation between care professionals and patients (17.1%). Common issues included absence or ambiguity of local management protocols, unclear allocation of responsibilities among team members, limited capacity in terms of staffing and available labour rooms, and incomplete communication and documentation around referral between/within echelons. Nearly half of the improvable care factors were stated by local audit panellists to be likely or possibly associated with severe PPH.</p><p><strong>Conclusion: </strong>Audit of PPH care revealed several areas for improvement in the Netherlands, including ensuring sufficient staffing and labour room capacity and updating of national and local management protocols.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuity of care: listening to patients' judgements on the quality of care.","authors":"Richard Baker, Andrew W Murphy, Paul O'Connor","doi":"10.1093/intqhc/mzag108","DOIUrl":"10.1093/intqhc/mzag108","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacist-led continuity of care interventions for patients receiving oral anticancer therapy: a systematic review and meta-analysis.","authors":"Ting Liu, Xingyu Long, Junhao Luo, Qing Wang, Jie Xiao, Zhaojian Wang, Lin Wang, Wenzheng Xie, Ke Sai, Wenhui Zhang, Ping Xu","doi":"10.1093/intqhc/mzag066","DOIUrl":"10.1093/intqhc/mzag066","url":null,"abstract":"<p><strong>Background: </strong>The shift of cancer care to the home setting via oral anticancer therapy has introduced significant challenges to continuity of care and patient safety. Despite its promise, there remains a lack of comprehensive research that characterizes the components of pharmacist interventions and evaluates their impact on clinical outcomes and quality indicators across the continuity of care.</p><p><strong>Methods: </strong>This review searched PubMed, EMBASE, and Web of Science from inception to December 2024, including studies that implemented pharmacist-led interventions for patients receiving oral anticancer therapy and reported at least one outcome measure in economic, clinical, or humanistic domains. A meta-analysis was conducted using R, calculating the mean difference effect size for continuous outcomes and the odds ratio for dichotomous outcomes.</p><p><strong>Results: </strong>A total of 27 studies evaluating pharmacist-led interventions in patients receiving oral anticancer therapy were identified through systematic searches, including randomized controlled trials, non-randomized controlled trials, and cohort studies. The study identified 11 pharmacist interventions distributed across four main domains, namely patient education and behavioral support, symptom and toxicity management, medication therapy management, and healthcare access support. The meta-analysis revealed that pharmacist interventions tend to improve medication adherence and treatment persistence. However, the impact on clinical endpoints and the incidence of drug-related problems remained heterogeneous. Evidence regarding their impact on economic burden, quality of life, health beliefs and knowledge remained limited.</p><p><strong>Conclusions: </strong>Pharmacist-led interventions may contribute to quality indicators, specifically treatment adherence and persistence in oral anticancer therapy management. While these improvements are associated with patient safety and treatment effectiveness, current evidence is insufficient to confirm a direct translation into superior clinical endpoints. Further studies are needed to confirm the effectiveness of pharmacist-led interventions in cancer patients and to comprehensively evaluate the value of continuity of care.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating an integrated quality improvement and research approach: the Just Cos Initiative.","authors":"Jaclyn Bishop, Ella Ottrey, Alison Fitzgerald, Jake Romein, Michele Conlin","doi":"10.1093/intqhc/mzag041","DOIUrl":"10.1093/intqhc/mzag041","url":null,"abstract":"<p><strong>Background: </strong>Health service staff have been criticized for implementing practices (e.g. a new procedure, new checklist) into care because they seem like 'good ideas' yet may not have the evidence to support them. The Just Cos Initiative (Just Cos) was developed based on a Learning Health System approach to address this problem. It encourages staff to think critically about their work practices and provides a pathway for staff to submit queries about potentially low-value or non-evidence based/informed (low-value) practice. Just Cos then integrates internal audit data and external research evidence with stakeholder consensus and puts that knowledge into practice using quality improvement methods. The aim of this study is to evaluate whether this integrated quality improvement and research approach can identify low-value practices and where identified, whether these practices can be minimized. It is important to adopt and evaluate systematic approaches to identifying low-value practices in health so that the patient care is delivered optimally and risks are minimized.</p><p><strong>Methods: </strong>This study was a multi-method evaluation utilizing the RE-AIM framework. Submissions received over 14 months were collated from a Just Cos submission log. Implementation of Just Cos was explored through nine semi-structured interviews with staff who either submitted a Just Cos request or otherwise participated in at least one element of the Just Cos process.</p><p><strong>Results: </strong>Twelve unique Just Cos submissions were received from nursing (7), allied health (3), executive (1), and management (1). Two submissions identified a low-value practice that required practice change. Policy changes (e.g. clarification of a process or approach) occurred in four submissions. No change to practice or policy was required in three, and three submissions did not complete the Just Cos process. Participants described Just Cos as giving staff a 'voice' and that they valued being able to update practices. The use of centralized resources to review submissions saved time for busy staff, and protected individuals from any criticism for raising the concern.</p><p><strong>Conclusion: </strong>An integrated model using research evidence combined with quality improvement identified two low-value practices that required practice change. It provided a psychologically safe mechanism through which staff could be curious about their practice. There is the opportunity to scale this approach to further improve the uptake of evidence based or informed practices within the healthcare setting.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}