American Journal of Medical Quality最新文献

{"title":"Primary Care Provider and Staff Wellness and Burnout Levels and Suggestions to Improve Wellness: Analysis of Survey Findings","authors":"Amy T. Cunningham, Alexa Waters, Dhruvi Shah, Pouya Arefi, Randa D. Sifri","doi":"10.1097/jmq.0000000000000201","DOIUrl":"https://doi.org/10.1097/jmq.0000000000000201","url":null,"abstract":"<p>Primary care provider and staff burnout is high, although less research exists comparing burnout by role. The objectives of this study were to characterize primary care provider and staff wellness and burnout and provide suggestions to improve wellness in a large network. Survey items included demographics, the Perceived Stress Reactivity Subscale, abbreviated Maslach Burnout Inventory, Mini-Z burnout survey, self-reported wellness, and one open-ended question asking what would improve their work-related wellness. Surveys were disseminated in February 2021, October 2021, and June 2022. Responses were analyzed by demographic categories. Open-ended responses were coded. In total 1015 responses were recorded (29.5% response rate). Burnout varied by role and campus. The 677 open-ended comments had six main themes for improving wellness: Staffing, Health System, Practice, Training, Incentives, and Miscellaneous. Primary care providers/staff reported varying, consistent levels of burnout. They suggested practice and system-level changes including increased staffing, schedule changes and improved communication.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214352","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 Post-Acute COVID-19 Syndrome (PACS) Clinic in Rural New England","authors":"Shoshana H. Bardach, Jonathan D. Lichtenstein, Frida Velcani, Amanda N. Perry, Brant J. Oliver, Christina F. Martin, Jeffrey Parsonnet","doi":"10.1097/jmq.0000000000000202","DOIUrl":"https://doi.org/10.1097/jmq.0000000000000202","url":null,"abstract":"<p>This article explores the demand and utilization of a rural post-acute COVID syndrome clinic. Electronic health records were used to identify referrals between April 2021 and April 2022 and to describe characteristics of referred patients and referrals generated to specialty services. Of the 747 referrals received, 363 (48.6%) met the criteria for an appointment and were seen, the vast majority (89.6%) via Telehealth. Most patients resided in rural communities (63.1%) and were female (75.2%); mean age was 49, and 17% were hospitalized during their acute illness. Nearly half of patients (49%) had at least one pre-existing mental health diagnosis. Referrals to specialty care for further evaluation and/or intervention were most commonly to occupational therapy (27.3%), physical therapy (24.8%), psychiatry (19.8%), and neurology (17%). Telehealth expanded the availability of health care resources. Additional research on how to meet care needs, ameliorate symptoms, and aid recovery in rural communities is warranted.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214356","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":"Preparation of Patients for Central Venous Catheter Care in the Home: Perspectives From Health Care Personnel","authors":"Sara C. Keller, Opeyemi Oladapo-Shittu, Lisa L. Maragakis, Alejandra B. Salinas, Taylor Helsel, Yea-Jen Hsu, Clare Rock, Sara E. Cosgrove, For the Centers for Disease Control and Prevention Epicenters Program","doi":"10.1097/jmq.0000000000000203","DOIUrl":"https://doi.org/10.1097/jmq.0000000000000203","url":null,"abstract":"<p>Patients managing central venous catheters (CVCs) outside of hospitals need training in CVC care. Using 3 focus groups, the study identified themes in how health care personnel (HCP) prepare patients and their caregivers for CVC care at home. Four major themes and 25 nested subthemes were identified: (1) providing the right amount of education at the right time, (2) tailoring education to patient needs, (3) developing patient education tools, and (4) managing differences in recommendations to patients. HCPs in the study ensured patients and caregivers learn what they need to know when they need to know it, using appropriate patient education tools. Patients and caregivers are largely responsible for CVC care and central line-associated bloodstream infection prevention outside of acute care hospitals and long-term care settings, and HCP take seriously their obligation to provide them with appropriate education and tools to best enhance their ability to keep themselves safe.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214353","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":"Standardized Management of Sickle Cell Disease Patients and the Effects on Care Utilization and Costs","authors":"Dylan H. Ross, Amy W. Wozniak, Talar Markossian, Gail Kellberg, Sadia K. Gazi, Kevin Smith","doi":"10.1097/jmq.0000000000000199","DOIUrl":"https://doi.org/10.1097/jmq.0000000000000199","url":null,"abstract":"<p>An individualized management program for patients with sickle cell disease (SCD) was created to reduce health care utilization and cost. The program was implemented to standardize the management of patients with SCD. SCD encounters from January 2010 to December 2020 were reviewed for analysis. Preintervention utilization of inpatient, emergency room, and outpatient settings was compared to postintervention. There were 7114 encounters analyzed. Outpatient encounters increased from 36.5% to 70.9%; inpatient encounters decreased from 38.6% to 20.3%; and emergency department visits decreased from 20.3% to 8.8%. The number of high inpatient utilizers decreased 8.4% and the number of individuals who received any emergency care decreased 11.9%. When comparing average charges per time period, the median charge per encounter decreased by $1838 postintervention compared to preintervention. This newly implemented SCD program demonstrated success through shifting the care of the SCD patient to the outpatient setting rather than the emergency department or inpatient hospitalizations.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214351","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":"Handoff Education Interventions: A Scoping Review Focused on Sustaining Improvements","authors":"Lee Ann Riesenberg, Joshua J. Davis, Elle Kaplan, Grace C. Ernstberger, Emma C. O’Hagan","doi":"10.1097/jmq.0000000000000204","DOIUrl":"https://doi.org/10.1097/jmq.0000000000000204","url":null,"abstract":"<p>Handoffs involve the transfer of patient information and responsibility for care between health care professionals. The purpose of the current scoping review was (1) to describe handoff studies with education as part of the intervention and (2) to explore the role of handoff educational interventions in sustaining handoff improvements. This scoping review utilized previously published systematic reviews and a structured, systematic search of 5 databases (January 2006–June 2020). Articles were identified, and data were extracted by pairs of trained, independent reviewers. The search identified 74 relevant articles, most published after 2015 (70%) and conducted in the United States (76%). Almost all of the studies (99%) utilized instruction, 66% utilized skills practice, 89% utilized a memory aid, and 43% utilized reinforcement. However, few studies reported using education theory or followed accepted tenets of curriculum development. There has been a substantial increase over time in reporting actual handoff behavior change (17%–68%) and a smaller but important increase in reporting patient outcomes (11%–18%). Thirty-five percent of studies (26/74) had follow-up for 6 months or more. Twelve studies met the criteria for sustained change, which were follow-up for 6 months or more and achieving statistically significant improvements in either handoff skills/processes or patient outcomes at the conclusion of the study. All 12 studies with sustained change used multi-modal educational interventions, and reinforcement was more likely to be used in these studies than all others (75%, 9/12) versus (37%, 23/62), <em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">P</em> = 0.015. Future handoff intervention efforts that include education should use education theory to guide development and include needs assessment and goals and measurable objectives. Educational interventions should be multi-modal and include reinforcement. Future research studies should measure actual handoff behavior change (skills/process) and patient outcomes, include follow-up for more than 6 months, and use education reporting guidelines.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142214355","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":"Integration of Advance Care Planning in Outpatient Heart Failure Management: A Prospective Quality Improvement Initiative in a Tertiary Hospital","authors":"Vincent D. Salvador, Michelle Richard, Sarah Stevenson, Jeannie Ursillo, Jennifer Robitaille, Kristin Hogan, Jacob Joseph, Wen-Chih Wu","doi":"10.1097/jmq.0000000000000182","DOIUrl":"https://doi.org/10.1097/jmq.0000000000000182","url":null,"abstract":"","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250592","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":"Improving Lung Cancer Screening Program Enrollment at a Regional Veterans Affairs Medical Center: A Resident-led Quality Initiative","authors":"Alicia Bowles, Laura Miotke, Audrey York, Katarina Wrzos, Emily Beck","doi":"10.1097/jmq.0000000000000181","DOIUrl":"https://doi.org/10.1097/jmq.0000000000000181","url":null,"abstract":"","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250591","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":"Bypassing the Brick-and-Mortar Hospital: Increasing Direct Admissions from the Emergency Department to Inpatient Hospital-at-Home","authors":"Leah W. Webster, Matt D. Cox, Jacey R. Fazio, Heidi M. Felix, Holly R. Greenwell, Rachel M. Botella, Michael J. Maniaci, Ami A. Grek","doi":"10.1097/jmq.0000000000000186","DOIUrl":"https://doi.org/10.1097/jmq.0000000000000186","url":null,"abstract":"Home hospital programs continue to grow across the United States. There are limited studies around the process of patient selection and successful acquisition from the emergency department. The article describes how an interdisciplinary team used quality improvement methodology to significantly increase the number of admissions directly from the emergency department to the Advanced Care at Home program.","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140829227","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":"Improving Parental Knowledge of Medically Complex Neonates Through Scheduled Conferences","authors":"Serena Mooney, Sailaja Devagiri, Angela Puuri, Martha Naylor, Kelly Bear, Uduak S. Akpan","doi":"10.1097/jmq.0000000000000180","DOIUrl":"https://doi.org/10.1097/jmq.0000000000000180","url":null,"abstract":"Reports of parental dissatisfaction from incomplete or inconsistent information led to a quality improvement (QI) project to establish planned family conferences at 10 days and 1 month of life, for 50% of the medically complex neonates admitted to a neonatal intensive care unit within 1 year. A QI team instituted a system in which social workers scheduled family conferences and a neonatologist conducted the conferences. Team members tracked measures using statistical process control charts over 21 months. The QI team scheduled conferences for greater than 80% of eligible families, with an 86% completion rate on days 10 and 30, exceeding project goals of 50%. The majority of the families surveyed were satisfied with the meetings. Only 2% of parents surveyed found meetings burdensome, compared to 14% of physicians. A sustainable method for scheduling meetings and preparation for conferences, including the use of a template led to success.","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140835618","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":"QI Consultation Service: Piloting a Novel Approach to Improving Quality Improvement Initiatives in an Academic Psychiatry Department.","authors":"Patrick Ho, Christine Finn, William Torrey","doi":"10.1097/JMQ.0000000000000146","DOIUrl":"10.1097/JMQ.0000000000000146","url":null,"abstract":"","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10182841","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}