American Journal of Medical Quality最新文献

{"title":"Validation of the Algorithmic Prediction of Failure Modes in Health Care Methodology: Applied to the Department of Sterile Supply and Equipment.","authors":"Ayala Kobo-Greenhut,&nbsp;Ortal Sharlin,&nbsp;Tatyana Fishman,&nbsp;Liron Daniel,&nbsp;Hilel Frankenthal,&nbsp;Vered H Eisenberg,&nbsp;Eyal Zimlichman,&nbsp;Dina Orkin","doi":"10.1097/JMQ.0000000000000095","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000095","url":null,"abstract":"<p><p>Failure mode and effect analysis (FMEA) is a leading tool for risk management in health care. The term \"blanket\" approach FMEA describes a comprehensive simultaneous look at the variety of interrelated factors that may directly and indirectly affect patient safety. Applying FMEA with the \"blanket\" approach is not common, due to FMEA's limitations. Algorithmic prediction of failure modes in health care (APFMH) is leaner and enables the application of the \"blanket\" approach, but, like FMEA, it lacks formal validation. The authors set out to validate the APFMH method while applying a \"blanket\" approach. They analyzed the sterile supply handling at a 1900-bed academic medical center. The study's first step took place in the operating room (OR) aspect of the process. An APFMH analysis was performed using the \"blanket\" approach, to identify the hazards and define the common root causes for predicted hazards. The second step took place a year later at the sterile supply and equipment department (SSED) and aimed to validate these root causes, thus validating the reliability of APFMH. The \"blanket\" approach analysis with the APFMH method consisted of categorization into 3 risk-dimensions: patient safety, equipment damage, and time management. Root causes were defined for 8 high-ranking hazards. All the root causes for failures, identified by APFMH at the OR department, were revealed as actual hazards in the processes of the SSED. The independent findings at the SSED level validated the list of identified hazards that was formed at the target department (ie, the OR). APFMH methodology is a lean in time and human resources process that ensures comprehensive hazard analysis, which can include the \"blanket\" approach, and which was validated in this study. The authors suggest using the APFMH methodology for any organizational analysis method that requires the inclusion of \"blanket\" approaches.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 1","pages":"23-28"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10016471","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":"Clinician Perceptions of Receiving Different Forms of Feedback on their Opioid Prescribing.","authors":"Tamar Klaiman,&nbsp;Maria N Nelson,&nbsp;Xiaowei S Yan,&nbsp;Amol S Navathe,&nbsp;Mitesh S Patel,&nbsp;Farah Refai,&nbsp;M Kit Delgado,&nbsp;David R Pagnotti,&nbsp;Joshua M Liao","doi":"10.1097/JMQ.0000000000000092","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000092","url":null,"abstract":"<p><p>Opioid misuse represents a major public health issue in the United States. One driver is overprescription for acute pain, with the size of initial prescription associated with subsequent long-term use. However, little work has been done to elicit clinician feedback about interventions to reduce opioid prescribing. To address this knowledge gap, qualitative analyses were conducted with clinicians who participated in a randomized controlled trial in which clinicians received monthly emailed feedback notifications about their opioid prescribing behaviors. Semistructured telephone interviews were conducted (N = 12) with urgent care (N = 7) and emergency department (N = 5) clinicians who participated in the trial between November 2020 and April 2021. Clinicians appreciated feedback about their prescribing behavior and found comparative data with peer clinicians to be most useful. Sharing opioid prescribing feedback data with clinicians can be an acceptable way to address opioid prescribing among emergency and urgent care clinicians.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 1","pages":"1-8"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10370866","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":"Before-After Study of a Checklist to Improve Acute Care to ICU Handoffs.","authors":"Katherine G Hicks, Lois Downey, Addy Elketami, Elizabeth L Nielsen, Ruth A Engelberg, Ann L Jennerich","doi":"10.1097/JMQ.0000000000000091","DOIUrl":"10.1097/JMQ.0000000000000091","url":null,"abstract":"<p><p>Transferring care of a patient is a critical process. The objective of this study was to evaluate a checklist to standardize handoffs from acute care to the intensive care unit (ICU). This was a single-center, before-after study of a checklist to standardize transfers of patients from acute care to the medical-cardiac ICU. Clinicians completed surveys about handoffs before and after checklist implementation. The association between study period and survey data was analyzed using multivariable logistic regression with cross-classified multilevel models. Surveys were completed by 179 clinicians. After checklist implementation, handoffs were more likely to occur in the ICU (OR 17.23; 95% CI, 1.81-164.19) and cover patient treatment preferences (OR 2.73; 95% CI, 1.12-6.66). However, checklist uptake was suboptimal (30% of responses indicated checklist use). Implementation of a checklist during acute care to ICU transfers is challenging. Signals suggesting process improvement warrant additional study.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 1","pages":"37-46"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9805500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007598","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":"Utilizing Inpatient Admissions to Increase HIV Screening During the COVID-19 Pandemic and Beyond.","authors":"Ilana Garcia-Grossman, Karen Hauser, Meredith Adamo, Sarah Flynn, Sarah Burbank, Catherine Crawford, Jennifer Davis, Emily Lydon, Gabriela Reed, Marta Kochanska, Kevin Guzman","doi":"10.1097/JMQ.0000000000000099","DOIUrl":"10.1097/JMQ.0000000000000099","url":null,"abstract":"","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 1","pages":"66-67"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9797120/pdf/jmq-38-66.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10019269","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":"Impact of a Clinician Incentive Program on Quality Measures Performance in a Medicare Shared Savings Accountable Care Organization.","authors":"Jessica Han,&nbsp;Anita Jathavedam,&nbsp;Mike Perepelyuk,&nbsp;Paul N Casale","doi":"10.1097/JMQ.0000000000000098","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000098","url":null,"abstract":"<p><p>Financial incentives are often used to encourage and reward clinicians for achieving specific outcomes; however, there is limited data on their effectiveness. This study evaluates the impact of NewYork Quality Care's Clinician Incentive Program on improving quality measure performance over 4 years. Clinicians including primary care physicians and specialists actively opted-in to an incentive program where their quality performance was evaluated and rewarded biannually. Using Medicare Shared Savings Program data extracted for quality measures (2016-2019), this study analyzes quality measure performance between clinicians who opted-in to the program compared to those who did not. Additional analysis was performed comparing primary care clinician and specialist performance. The analysis revealed that clinicians in the incentive program significantly outperform (P < 0.05) clinicians who chose not to join the program in 6 of the 7 quality measures. In addition, the program helped facilitate discussions with clinicians more broadly in population health efforts.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 1","pages":"29-36"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10370863","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":"Lessons From the Northeast COVID-19 Surge: Well-Being of the Health Care Workforce.","authors":"Sharon C Kiely,&nbsp;Susan Parisi,&nbsp;Heather Farley,&nbsp;Jonathan Ripp","doi":"10.1097/JMQ.0000000000000096","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000096","url":null,"abstract":"<p><p>The COVID-19 pandemic has had an unprecedented impact on the US health care system which was already experiencing higher levels of personal burnout among health care workers than the average US worker. Well-being efforts to support the workforce have become a critical countermeasure during the pandemic. This work was presented at the Thomas Jefferson University, College of Population Health Seminar Series: Clinical Lessons from the Northeast Surge, COVID-19: Spread the Science, not the Virus, held August 18, 2020. The entire series was held virtually from July 21 to September 29, 2020. The authors describe issues impacting health care workers during this early period of the pandemic with two examples of concrete strategies to approach well-being at the organizational level and lessons learned.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"38 1","pages":"57-62"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9797118/pdf/jmq-38-57.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10019265","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":"Sustainability of a Multifaceted Intervention to Improve Surrogate Decision Maker Documentation for Hospitalized Adults.","authors":"Jacob Luty,&nbsp;Garrett Waagmeester,&nbsp;Briana Ketterer,&nbsp;Sreevalli Atluru,&nbsp;Keane Toney,&nbsp;Michael Love,&nbsp;Kenneth DeVane,&nbsp;Scott Sallay,&nbsp;Matthew DiVeronica","doi":"10.1097/JMQ.0000000000000081","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000081","url":null,"abstract":"<p><p>Documenting surrogate decision makers (SDMs) is an important step in advance care planning (ACP) for hospitalized adults. The authors performed a quality improvement study of clinical and electronic health record (EHR) workflows aiming to increase SDM documentation for hospitalized adults. The intervention included an ACP education module, audit and feedback, as well as workflow and EHR adaptations. The authors prospectively tracked SDM documentation using control charts and used chart review to assess secondary outcome, process, and balancing measures. SDM documentation significantly increased from 69.5% to 80.2% ( P < 0.001) for intervention patients, sustained over 3 years, and was unchanged for control patients (34.6% to 36.3%; P = 0.355). There were no significant differences in secondary ACP outcomes in intervention or control patients. Clinical and EHR adaptations increased SDM documentation for hospitalized adults with minimal risk, although did not affect other ACP metrics. Future studies are needed to determine the effects of such changes on goal-concordant care.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"37 6","pages":"495-503"},"PeriodicalIF":1.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10626512","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":"Portable Chest X-Ray Quality Improvement: Approach and Assessment.","authors":"Michael X Jin,&nbsp;Youjin Choi,&nbsp;Jonathan Mackow,&nbsp;Katherine Chung,&nbsp;Max Hao,&nbsp;Jolanta Norelli,&nbsp;Farshid Faraji,&nbsp;James Kang,&nbsp;Kush Purohit,&nbsp;Kevin Gilotra,&nbsp;Austin Young,&nbsp;Elaine Gould","doi":"10.1097/JMQ.0000000000000080","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000080","url":null,"abstract":"","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"37 6","pages":"558-559"},"PeriodicalIF":1.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10630769","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":"Demographics and Medical Comorbidities as Risk Factors for Increased Episode of Care Costs Following Lumbar Fusion in Medicare Patients.","authors":"Mark J Lambrechts,&nbsp;Nicholas Siegel,&nbsp;Brian A Karamian,&nbsp;Arun Kanhere,&nbsp;Khoa Tran,&nbsp;Andre M Samuel,&nbsp;Anthony Viola Iii,&nbsp;Andrew Tokarski,&nbsp;Anthony Santisi,&nbsp;Jose A Canseco,&nbsp;I David Kaye,&nbsp;Barrett Woods,&nbsp;Mark Kurd,&nbsp;Alan S Hilibrand,&nbsp;Christopher K Kepler,&nbsp;Alexander R Vaccaro,&nbsp;Gregory D Schroeder,&nbsp;Jeffrey Rihn","doi":"10.1097/JMQ.0000000000000088","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000088","url":null,"abstract":"<p><p>The objective was to evaluate medical comorbidities and surgical variables as independent risk factors for increased health care costs in Medicare patients undergoing lumbar fusion. Care episodes limited to lumbar fusions were retrospectively reviewed on the Centers of Medicare and Medicaid Innovation (CMMI) Bundled Payment for Care Improvement (BPCI) reimbursement database at a single academic institution. Total episode of care cost was also collected. A multivariable linear regression model was developed to identify independent risk factors for increased total episode of care cost, and logistic models for surgical complications and readmission. A total of 500 Medicare patients were included. Risk factors associated with increased total episode of care cost included transforaminal interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) (β = $5,399, P < 0.001) and ALIF+PLF (AP) fusions (β = $24,488, P < 0.001), levels fused (β = $3,989, P < 0.001), congestive heart failure (β = $6,161, P = 0.022), hypertension with end-organ damage (β = $10,138, P < 0.001), liver disease (β = $16,682, P < 0.001), inpatient complications (β = $4,548, P = 0.001), 90-day complications (β = $10,012, P = 0.001), and 90-day readmissions (β = $15,677, P < 0.001). The most common surgical complication was postoperative anemia, which was associated with significantly increased costs (β = $18,478, P < 0.001). Female sex (OR = 2.27, P = 0.001), AP fusion (OR = 2.59, P = 0.002), levels fused (OR = 1.45, P = 0.005), cerebrovascular disease (OR = 4.19, P = 0.003), cardiac arrhythmias (OR = 2.32, P = 0.002), and fluid electrolyte disorders (OR = 4.24, P = 0.002) were independent predictors of surgical complications. Body mass index (OR = 1.07, P = 0.029) and AP fusions (OR = 2.87, P = 0.049) were independent predictors of surgical readmission. Among medical comorbidities, congestive heart failure, hypertension with end-organ damage, and liver disease were independently associated with a significant increase in total episode of care cost. Interbody devices were associated with increased admission cost.</p>","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"37 6","pages":"519-527"},"PeriodicalIF":1.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10151675","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":"Thank You for Joining Us for \"Care After Covid\".","authors":"Dan M Westphal","doi":"10.1097/JMQ.0000000000000082","DOIUrl":"https://doi.org/10.1097/JMQ.0000000000000082","url":null,"abstract":"","PeriodicalId":7539,"journal":{"name":"American Journal of Medical Quality","volume":"37 6","pages":"560"},"PeriodicalIF":1.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10630816","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}