American Journal of Medical Quality最新文献

{"title":"Evaluation of a New Hospital Building's Impact on Clinical Outcomes and Consumer Experience in Medical Inpatients.","authors":"Dylan C Koundakjian,&nbsp;Bradley J Tompkins,&nbsp;Allen B Repp","doi":"10.1097/JMQ.0000000000000119","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000119","url":null,"abstract":"<p><p>Hospitals often seek to improve the effectiveness and experience of care through new building construction. However, the association between the built hospital environment, patient outcomes, and patient experience remains unclear. This retrospective matched cohort study leveraged natural experimental conditions to characterize major clinical outcomes and patient experience in medicine patients admitted to a new hospital building incorporating evidence-based design features compared with controls admitted to legacy buildings. Among patients discharged between June 1, 2019, and March 1, 2020, there were no significant differences in intensive care unit transfer, inpatient mortality, 30-day readmission, 30-day mortality, or length of stay. However, discharge from the new hospital building was associated with a higher percentage of top box scores on the Hospital Consumer Assessment of Healthcare Providers and Systems overall hospital rating item (60% vs 76%, P = 0.02). Further studies are needed to identify specific hospital design features that influence patient experience and clinical outcomes.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 3","pages":"122-128"},"PeriodicalIF":1.4,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9524603","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":"Identification of Patient Safety Threats in a Post-Intensive Care Clinic.","authors":"Kevin J Karlic,&nbsp;Thomas S Valley,&nbsp;Leigh M Cagino,&nbsp;Hallie C Prescott,&nbsp;Theodore J Iwashyna,&nbsp;Rima A Mohammad,&nbsp;Mari Pitcher,&nbsp;Evan Haezebrouck,&nbsp;Jakob I McSparron","doi":"10.1097/JMQ.0000000000000118","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000118","url":null,"abstract":"<p><p>The extent to which postintensive care unit (ICU) clinics may improve patient safety for those discharged after receiving intensive care remains unclear. This observational cohort study conducted at an academic, tertiary care medical center used qualitative survey data analyzed via conventional content analysis to describe patient safety threats encountered in the post-ICU clinic. For 83 included patients, safety threats were identified for 60 patients resulting in 96 separate safety threats. These were categorized into 7 themes: medication errors (27%); inadequate medical follow-up (25%); inadequate patient support (16%); high-risk behaviors (5%); medical complications (5%); equipment/supplies failures (4%); and other (18%). Of the 96 safety threats, 41% were preventable, 27% ameliorable, and 32% were neither preventable nor ameliorable. Nearly 3 out of 4 patients within a post-ICU clinic had an identifiable safety threat. Medication errors and delayed medical follow-up were the most common safety threats identified; most were either preventable or ameliorable.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 3","pages":"117-121"},"PeriodicalIF":1.4,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159998/pdf/nihms-1886885.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9524604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Physician Self-Perceptions Affect the Impact of Peer Comparison Feedback on Opioid Prescribing.","authors":"Joshua M Liao,&nbsp;Chuxuan Sun,&nbsp;Xiaowei S Yan,&nbsp;Mitesh S Patel,&nbsp;Dylan S Small,&nbsp;William M Isenberg,&nbsp;Howard M Landa,&nbsp;Barbara L Bond,&nbsp;Charles A L Rareshide,&nbsp;Kevin G Volpp,&nbsp;M Kit Delgado,&nbsp;Victor J Lei,&nbsp;Zijun Shen,&nbsp;Amol S Navathe","doi":"10.1097/JMQ.0000000000000117","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000117","url":null,"abstract":"<p><p>Peer comparison feedback is a promising strategy for reducing opioid prescribing and opioid-related harms. Such comparisons may be particularly impactful among underestimating clinicians who do not perceive themselves as high prescribers relative to their peers. But peer comparisons could also unintentionally increase prescribing among overestimating clinicians who do not perceive themselves as lower prescribers than peers. The objective of this study was to assess if the impact of peer comparisons varied by clinicians' preexisting opioid prescribing self-perceptions. Subgroup analysis of a randomized trial of peer comparison interventions among emergency department and urgent care clinicians was used. Generalized mixed-effects models were used to assess whether the impact of peer comparisons, alone or combined with individual feedback, varied by underestimating or overestimating prescriber status. Underestimating and overestimating prescribers were defined as those who self-reported relative prescribing amounts that were lower and higher, respectively, than actual relative baseline amounts. The primary outcome was pills per opioid prescription. Among 438 clinicians, 54% (n = 236) provided baseline prescribing self-perceptions and were included in this analysis. Overall, 17% (n = 40) were underestimating prescribers whereas 5% (n = 11) were overestimating prescribers. Underestimating prescribers exhibited a differentially greater decrease in pills per prescription compared to nonunderestimating clinicians when receiving peer comparison feedback (1.7 pills, 95% CI, -3.2 to -0.2 pills) or combined peer and individual feedback (2.8 pills, 95% CI, -4.8 to -0.8 pills). In contrast, there were no differential changes in pills per prescription for overestimating versus nonoverestimating prescribers after receiving peer comparison (1.5 pills, 95% CI, -0.9 to 3.9 pills) or combined peer and individual feedback (3.0 pills, 95% CI, -0.3 to 6.2 pills). Peer comparisons were more impactful among clinicians who underestimated their prescribing compared to peers. By correcting inaccurate self-perceptions, peer comparison feedback can be an effective strategy for influencing opioid prescribing.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 3","pages":"129-136"},"PeriodicalIF":1.4,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9891184","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":"Is It Time to Follow the Lawyers: Should Hospitals Extract Themselves From US News & World Report Rankings?","authors":"Grant Sinson,&nbsp;Julie Kolinski,&nbsp;Carrie Alme,&nbsp;Siddhartha Singh","doi":"10.1097/JMQ.0000000000000116","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000116","url":null,"abstract":"","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 3","pages":"160-161"},"PeriodicalIF":1.4,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9518852","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 Time to Defibrillation Following Ventricular Tachycardia (VTach) and Ventricular Fibrillation (VFib) Cardiac Arrest: A Multicenter Retrospective and Prospective Quality Improvement Study.","authors":"Sairamya Bodempudi,&nbsp;Lisa Wus,&nbsp;Juergen Kloo,&nbsp;Patrick Zeniecki,&nbsp;James Coromilas,&nbsp;Frances Mae West,&nbsp;Yair Lev","doi":"10.1097/JMQ.0000000000000102","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000102","url":null,"abstract":"<p><p>The goal of this study was to identify how often 2 independent centers defibrillated patients within the American Heart Association recommended 2-minute time interval following ventricular fibrillation/ventricular tachycardia arrest. A retrospective chart review revealed significant delays in defibrillation. Simulation sessions and modules were implemented to train nursing staff in a single nursing unit at a Philadelphia teaching hospital. Recruited nurses completed a code blue simulation session to establish a baseline time to defibrillation. They were then given 2 weeks to complete an online educational module. Upon completion, they participated in a second set of simulation sessions to assess improvement. First round simulations resulted in 33% with delayed defibrillation and 27% no defibrillation. Following the module, 77% of the second round of simulations ended in timely defibrillation, a statistically significant improvement ( P < 0.00001). Next steps involve prospective collection of the code blue data to analyze improvement in real code blue events.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 2","pages":"73-80"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10013939","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":"National Documentation and Coding Practices of Noncompliance: The Importance of Social Determinants of Health and the Stigma of African-American Bias.","authors":"Joseph M Geskey,&nbsp;Jodi Kodish-Wachs,&nbsp;Heather Blonsky,&nbsp;Samuel F Hohman,&nbsp;Steve Meurer","doi":"10.1097/JMQ.0000000000000112","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000112","url":null,"abstract":"<p><p>Patient records serve many purposes, one of which includes monitoring the quality of care provided that they can be analyzed through coding and documentation. Z-codes can provide additional information beyond a specific clinical disorder that may still warrant treatment. Social Determinants of Health have specific Z-codes that may help clinicians address social factors that may contribute to patients' health care outcomes. However, there are Z-codes that specify patient noncompliance which has a pejorative connotation that may stigmatize patients and prevent clinicians from examining nonadherence from a social determinant of health perspective. A retrospective cross-sectional study was performed to examine the associations of patient and encounter characteristics with the coding of patient noncompliance. Included in the study were all patients >18 years of age who were admitted to hospitals participating in the Vizient Clinical Data Base (CDB) between January 1, 2019 and December 31, 2019. Almost 9 million US inpatients were included in the study. Of those, 6.3% had a noncompliance Z-code. Use of noncompliance Z-codes was associated with the following odds estimate ratio in decreasing order: the presence of a social determinant of health (odds ratio [OR], 4.817), African American race (OR, 2.010), Medicaid insurance (OR, 1.707), >3 chronic medical conditions (OR, 1.546), living in an economically distressed community (OR, 1.320), male gender (OR, 1.313), nonelective admission status (OR, 1.245), age <65 years (OR, 1.234). More than 1 in 15 patient hospitalizations had a noncompliance code. Factors associated with these codes are difficult, if not impossible, for patients to modify. Disproportionate representation of Africa-Americans among hospitalizations with noncompliance coding is concerning and urgently deserves further exploration to determine the degree to which it may be a product of clinician bias, especially if the term noncompliance prevents health care providers from looking into socioeconomic factors that may contribute to patient nonadherence.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 2","pages":"87-92"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ea/20/jmq-38-87.PMC9973443.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10014464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Survey-Based Analysis of the Language of the Prescription Bottles and Instructions for the Medications of Limited English Proficiency Patients.","authors":"Alexi Johnson,&nbsp;Lindsay Liles","doi":"10.1097/JMQ.0000000000000111","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000111","url":null,"abstract":"","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 2","pages":"113-114"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10073127","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":"Cleanliness of Lead Garments in the Operating Room.","authors":"Jane Yoon,&nbsp;Benjamin A Nwadike,&nbsp;Vinieth N Bijanki,&nbsp;Scott G Kaar","doi":"10.1097/JMQ.0000000000000103","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000103","url":null,"abstract":"","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 2","pages":"107-109"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10370893","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":"Promoting Safe Gun Storage Among Veterans to Prevent and Reduce Gun-Related Suicide and Accidents: A VA Resident Clinic Pilot Initiative.","authors":"Mitchell Dittus,&nbsp;Pronoma Srivastava,&nbsp;Lisa Fisher","doi":"10.1097/JMQ.0000000000000110","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000110","url":null,"abstract":"","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 2","pages":"104"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10017255","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":"Development and Implementation of a Practical Onboarding Curriculum for Physician Quality and Safety Leaders.","authors":"Caitlin Naureckas Li,&nbsp;Gregory A Leya,&nbsp;Elizabeth Mort,&nbsp;Emily Aaronson,&nbsp;Rajshri M Gartland","doi":"10.1097/JMQ.0000000000000106","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000106","url":null,"abstract":"<p><p>Physicians are increasingly asked to assume quality and safety (Q&S) leadership roles; prior experience varies, and onboarding training is limited. Semistructured interviews were completed with physician Q&S leaders; interview responses were analyzed using 2-step rapid analysis. Interview learnings informed development of a 2-day onboarding training and complementary digital resource repository. Attendees were surveyed to evaluate the training. Thirteen semistructured interviews with physician leaders from 6 academic medical centers demonstrated 61.5% had no formal Q&S training before assuming their role. Respondents identified a range of knowledge gaps. A 2-day virtual onboarding training and complementary digital repository were created. Attendee surveys demonstrated 96% (73/76) believed the training would be \"extremely\" or \"moderately\" helpful to others. Subject-matter familiarity across all content areas improved after the training. Using front-line stakeholder input, a pilot onboarding curriculum for Q&S leaders was created. Future work includes ongoing implementation and iterative improvement.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 2","pages":"81-86"},"PeriodicalIF":1.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10014442","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}