Joint Commission journal on quality and safety最新文献

{"title":"Do Complication Screening Programs Detect Complications Present at Admission?","authors":"James M. Naessens M.P.H. (Clinical Associate),&nbsp;Christopher G. Scott M.S. (Statistician),&nbsp;Todd R. Huschka (Data Analyst),&nbsp;David C. Schutt M.D. (Medical Director)","doi":"10.1016/S1549-3741(04)30015-8","DOIUrl":"10.1016/S1549-3741(04)30015-8","url":null,"abstract":"<div><h3>Background</h3><p>A study was undertaken to verify the accuracy of computer algorithms on administrative data to identify hospital complications. The assessment was based on a medical records indicator that differentiated hospital-acquired conditions from preexisting comorbidities.</p></div><div><h3>Methods</h3><p>The indicators for identifying potential hospital complications were applied to all secondary diagnoses to distinguish hospital-acquired from preexisting conditions for all 1997–1998 discharges.</p></div><div><h3>Results</h3><p>Of the 95 defined complication types, cases were found with secondary diagnoses that met the criteria for 71 different complications. Sixty-nine of these complications had one or more cases with the trigger diagnosis coded as an acquired condition. Thirty-five complications had at least 30 cases with acquired conditions. Hospital complications add greatly to costs; for example, postoperative septicemia increased the hospital bill by more than $25,000, added 13 hospital days to the stay, and increased hospital mortality by 16.6%.</p></div><div><h3>Conclusions</h3><p>Current complication algorithms identify many cases where the condition was actually present on hospital admission. This fact, coupled with the known variability in coding between institutions, makes comparisons between hospitals on many of the complications problematic. Collection of the present-on-admission flag significantly reduces the noise in monitoring complication rates.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 3","pages":"Pages 133-142"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30015-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40850879","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":"Characteristics of Successful Quality Improvement Teams: Lessons from Five Collaborative Projects in the VHA","authors":"Peter D. Mills Ph.D., M.S. (Associate Director, Field Office),&nbsp;William B. Weeks M.D., M.B.A., C.H.E.","doi":"10.1016/S1549-3741(04)30017-1","DOIUrl":"10.1016/S1549-3741(04)30017-1","url":null,"abstract":"<div><h3>Background</h3><p>A pre–post observational design was used to study the aggregate results of five national Breakthrough Series (BTS) collaboratives run within Veterans Health Administration (VHA) to identify the organizational, interpersonal, and systemic characteristics of successful improvement teams.</p></div><div><h3>Methods</h3><p>One hundred thirty-four medical quality improvement teams participated in five BTS collaboratives in the VHA between 1999 and 2002. Team characteristics were assessed using a team questionnaire before and after the BTS collaboratives.</p></div><div><h3>Results</h3><p>Fifty-seven percent of participating teams were rated as successful (a $ 20% improvement from baseline for at least two months before the collaboratives’ end). More high-performing medical quality improvement teams perceived their work to be part of their organization’s key strategic goals. By the end of the BTS collaboratives, high-performing teams had more front-line staff support and stronger team leadership.</p></div><div><h3>Discussion</h3><p>Strong organizational support, strong team leadership, and high levels of interpersonal team skills help medical quality improvement teams go further to improve clinical care. It is recommended that quality improvement teams become integrated with their organization’s key strategic goals, that improvement teams stay together, and that leadership and team training be provided to improve clinical outcomes.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 3","pages":"Pages 152-162"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30017-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40850881","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":"Using a Multihospital Survey to Examine the Safety Culture","authors":"Saul N. Weingart M.D., Ph.D. (Associate Director),&nbsp;Ken Farbstein M.P.P. (Principal),&nbsp;Roger B. Davis Sc.D. (Senior Biostatistician),&nbsp;Russell S. Phillips M.D. (Chief)","doi":"10.1016/S1549-3741(04)30014-6","DOIUrl":"10.1016/S1549-3741(04)30014-6","url":null,"abstract":"<div><h3>Background</h3><p>A culture of safety survey was used to study features of the safety culture and their relationship with patient safety indicators.</p></div><div><h3>Study Design</h3><p>Anonymous written surveys were collected from 455 of 1,027 (44%) workers at four Massachusetts hospitals. Respondents characterized their organizations’ patient safety, workplace safety, and features of a safety culture, such as leadership commitment, professional salience, presence of a nonpunitive environment, error reporting, and communication.</p></div><div><h3>Results</h3><p>Employees universally regarded patient safety as an essential part of their job. Two-thirds of workers worried at least once a day about making a mistake that could injure a patient; 43% said that the work load hindered their ability to keep patients safe. Workers’ overall assessment of patient safety was associated with their perceptions of workplace safety (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.02–3.43, <em>p</em> = .044) and leadership commitment to patient safety (OR 3.20, 95% CI 1.97–5.19, <em>p</em> &lt; .001). Incident reporting rates correlated with survey results, while adoption of best practices and expert opinion did not.</p></div><div><h3>Discussion</h3><p>Patient safety is salient to workers, who universally embraced patient safety as an essential part of their job. Independent indicators of patient safety did not line up neatly with safety culture survey results. Incident reporting rates correlated directly, while adoption of best practices and expert opinion varied inversely with survey results. The safety culture is a complex phenomenon that requires further study.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 3","pages":"Pages 125-132"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30014-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40850358","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":"Using Statewide Audit and Feedback to Improve Hospital Care in West Virginia","authors":"Charles P. Schade M.D., M.P.H. (Director of Scientific Support),&nbsp;Beckey Fain Cochran M.S.N. (Director of Quality Improvement),&nbsp;Mark K. Stephens M.D. (Principal Clinical Coordinator)","doi":"10.1016/S1549-3741(04)30016-X","DOIUrl":"10.1016/S1549-3741(04)30016-X","url":null,"abstract":"<div><h3>Background</h3><p>Audit and feedback systems have significantly improved medical care in numerous settings, and they appear to work by stimulating competition rather than through command and control.</p></div><div><h3>Methods</h3><p>The West Virginia Medical Institute (WVMI), a Medicare-designated Quality Improvement Organization (QIO), periodically collected quality information on five common conditions (acute myocardial infarction [AMI], heart failure, pneumonia, stroke, and atrial fibrillation) that cause hospitalization in Medicare beneficiaries. All 44 acute care hospitals in West Virginia were offered written and orally presented reports of quality performance from 1998 through 2001.</p></div><div><h3>Results</h3><p>All indicators appeared to improve statewide. Several—for example, aspirin at discharge for AMI patients and pneumococcal vaccine for pneumonia patients—improved by more than 10 absolute percentage points. Fourteen of 15 quality indicators showed significant improvement (<em>p</em> &lt; .05, paired <em>t</em>-test) in all hospitals between the before- and after-feedback periods. Seven of 13 indicators assessed during the entire study in the largest hospitals showed no significant trends in quality before feedback but significant increases (<em>p</em> &lt; .05, chi-square for trend) in the after-feedback period.</p></div><div><h3>Discussion</h3><p>The quality indicator changes reported can represent important health gains for West Virginia Medicare beneficiaries. Most of the improvement did not occur until after hospitals received feedback.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 3","pages":"Pages 143-151"},"PeriodicalIF":0.0,"publicationDate":"2004-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30016-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40850880","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":"Editorial Advisory Board","authors":"","doi":"10.1016/S1549-3741(04)30087-0","DOIUrl":"https://doi.org/10.1016/S1549-3741(04)30087-0","url":null,"abstract":"","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 2","pages":"Page 58"},"PeriodicalIF":0.0,"publicationDate":"2004-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30087-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92019578","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":"Senior Executive Adopt-a-Work Unit: A Model for Safety Improvement","authors":"Peter J. Pronovost M.D., Ph.D. (Associate Professor),&nbsp;Brad Weast M.H.A. (Administrative Resident—U.S. Air Force),&nbsp;Kate Bishop M.H.A. (Administrative Fellow),&nbsp;Lore Paine M.S.N. (Safety Coordinator),&nbsp;Richard Griffith M.H.A. (Administrative Resident—U.S. Air Force),&nbsp;Beryl J. Rosenstein M.D. (Vice President for Medical Affairs),&nbsp;Richard P. Kidwell J.D. (Managing Attorney of Claims and Litigation),&nbsp;Karen B. Haller Ph.D., R.N. (Vice President of Nursing & Patient Care Services),&nbsp;Richard Davis Ph.D. (Senior Director of Operations Integration)","doi":"10.1016/S1549-3741(04)30007-9","DOIUrl":"10.1016/S1549-3741(04)30007-9","url":null,"abstract":"<div><h3>Background</h3><p>At The Johns Hopkins Hospital (JHH), the patient safety committee created a safety program that focused on encouraging staff in selected units to identify and eliminate potential errors in the patient care environment. As part of this program, senior hospital executives each adopted an intensive care unit and worked with the unit staff to identify issues and to empower staff to address safety issues.</p></div><div><h3>JHH Patient Safety Program</h3><p>The program consisted of eight steps, which together require six months for implementation: (1) conduct a culture survey; (2) educate staff on the science of safety; (3) identify staff safety concerns through a staff safety survey; (4) implement the senior executive adopt-a-work unit program; (5) implement improvements; (6–7) document results, share stories, and disseminate results; and (8) resurvey staff.</p></div><div><h3>Results</h3><p>The senior executive adopt-a-work unit program was successful in identifying and eliminating hazards to patient safety and in creating a culture of safety.</p></div><div><h3>Discussion</h3><p>The program can be broadly implemented. The keys to program success are the active role of an executive advocate and staff’s willingness to openly discuss safety issues on the units. Regular meetings between the advocates and the units have provided a forum for enhancing executive awareness, increasing staff confidence and trust in executive involvement, and swiftly and effectively addressing areas of potential patient harm.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 2","pages":"Pages 59-68"},"PeriodicalIF":0.0,"publicationDate":"2004-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30007-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24413223","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":"Time-Between Control Charts for Monitoring Asthma Attacks","authors":"Farrokh Alemi Ph.D. (Acting Assistant Dean of Graduate Health Science),&nbsp;Duncan Neuhauser Ph.D. (Professor)","doi":"10.1016/S1549-3741(04)30011-0","DOIUrl":"10.1016/S1549-3741(04)30011-0","url":null,"abstract":"<div><h3>Background</h3><p>The monitoring of peak expiratory flow rate (PEFR) is crucial for effective management of asthma. Daily PEFR monitoring is recommended, yet the data are rarely used by patients to help them understand their progress or by clinicians to modify treatment plans. Time-between control charts, which have been shown to be specially suited for monitoring rare events, can be used to monitor asthma attacks.</p></div><div><h3>Methods</h3><p>Each patient is asked to record his or her PEFR value once a day, and these data are used to construct the control chart. PEFR data for three previously reported cases are presented and used to illustrate the control chart methodology.</p><p>If duration of consecutive attacks is plotted and the observed duration exceeds the upper control limit (UCL), the patient is getting worse. If length of consecutive symptom-free days is plotted and the observed duration exceeds the UCL, the patient is getting better. In both circumstances, the clinician and the patient explore what brought about the prolonged recovery or periods of deterioration. The object is to increase time until the next attack.</p></div><div><h3>Discussion</h3><p>Using time-between control charts in monitoring asthma attacks has the advantage of providing a visual display of data that, unlike eyeballing of trends, clarifies when patients should seek additional clinical advice. The control limit allows clinicians and patients to ignore random variations and focus on real changes in underlying patterns of asthma attacks.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 2","pages":"Pages 95-102"},"PeriodicalIF":0.0,"publicationDate":"2004-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30011-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24413227","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":"Case Studies from Two Collaboratives on Diabetes in Washington State","authors":"Donna M. Daniel Ph.D. (Health Services Research Associate),&nbsp;Jan Norman R.D., C.D.E. (Manager),&nbsp;Connie Davis A.R.N.P., M.N. (Associate Director),&nbsp;Helan Lee M.P.H. (Health Data Analyst),&nbsp;Michael F. Hindmarsh M.A. (Manager),&nbsp;David K. McCulloch M.D., F.R.C.P. (Endocrinologist),&nbsp;Edward H. Wagner M.D., M.P.H.,&nbsp;Jonathan R. Sugarman M.D., M.P.H. (President and CEO)","doi":"10.1016/S1549-3741(04)30012-2","DOIUrl":"10.1016/S1549-3741(04)30012-2","url":null,"abstract":"","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 2","pages":"Pages 103-108"},"PeriodicalIF":0.0,"publicationDate":"2004-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30012-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24413228","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":"Improving Recognition of Depression in Primary Care: A Study of Evidence-Based Quality Improvement","authors":"Scott E. Sherman M.D., M.P.H. (Core Investigator),&nbsp;Audree Chapman M.S. (Project Manager),&nbsp;Daniel Garcia M.D. (Staff Physicians),&nbsp;Joel T. Braslow M.D., Ph.D. (Staff Physicians)","doi":"10.1016/S1549-3741(04)30009-2","DOIUrl":"10.1016/S1549-3741(04)30009-2","url":null,"abstract":"<div><h3>Background</h3><p>Depression’s high prevalence and large amount of potentially modifiable morbidity make it an excellent candidate for quality improvement (QI) techniques. Yet there is little evidence on how to promote adherence to evidence-based guidelines. A locally run research and QI project that was part of a larger National Institute of Mental Health–funded study to implement depression guidelines was implemented by a primary care team at a Department of Veterans Affairs (VA) ambulatory care center in 1997 and 1998.</p></div><div><h3>Development of the QI Intervention</h3><p>The plan to improve screening and recognition entailed systematically screening all patients attending the primary care clinic; sending computer reminders to clerical staff, nursing assistants, and primary care providers; and auditing team performance with monthly feedback.</p></div><div><h3>Results</h3><p>Once the intervention was in place, nearly all patients were screened. The primary care provider documented the assessment of whether a patient was depressed for nearly all patients who screened positive. Few resources were needed to maintain the project once it was implemented.</p></div><div><h3>Discussion</h3><p>An evidence-based QI intervention led to profound and lasting changes in primary care providers’ recognition of depression or depressive symptoms. The QI implementation continued for one year after the intervention’s end, but a new VA computerized medical record system uses similar computer-generated reminders.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 2","pages":"Pages 80-88"},"PeriodicalIF":0.0,"publicationDate":"2004-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30009-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24413225","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":"A State-Level Application of the Chronic Illness Breakthrough Series: Results from Two Collaboratives on Diabetes in Washington State","authors":"Donna M. Daniel Ph.D. (Health Services Research Associate),&nbsp;Jan Norman R.D., C.D.E. (Manager),&nbsp;Connie Davis A.R.N.P., M.N. (Associate Director),&nbsp;Helan Lee M.P.H. (Health Data Analyst),&nbsp;Michael F. Hindmarsh M.A. (Manager),&nbsp;David K. McCulloch M.D., F.R.C.P. (Endocrinologist),&nbsp;Edward H. Wagner M.D., M.P.H.,&nbsp;Jonathan R. Sugarman M.D., M.P.H. (President and CEO)","doi":"10.1016/S1549-3741(04)30008-0","DOIUrl":"10.1016/S1549-3741(04)30008-0","url":null,"abstract":"<div><h3>Background</h3><p>Breakthrough Series Collaboratives addressing chronic conditions have been conducted at the national level and in single health care delivery systems but not at the state level. Two state-level collaboratives were conducted: Diabetes Collaborative I (October 1999–November 2000) included 17 clinic teams from across the state, and Diabetes Collaborative II (February 2001–March 2002) included 30 teams and 6 health plans.</p></div><div><h3>Methods</h3><p>Both collaboratives took place in Washington State, where a diverse group of primary care practices participated, and health insurance plans partnered with the clinic teams. Teams individually tested and implement changes in their systems of care to address all components of the Chronic Care Model.</p></div><div><h3>Results</h3><p>All 47 teams completed the collaboratives, and all but one maintained a registry throughout the 13 months. Most teams demonstrated some amount of improvement on process and outcome measures that addressed blood sugar testing and control, blood pressure control, lipid testing and control, foot exams, dilated eye exams, and self-management goals.</p></div><div><h3>Conclusion</h3><p>The benefits of holding collaboratives more locally include increased technical support and increased participation, translating into wider implementation of prevention-focused, patient-centered care.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 2","pages":"Pages 69-79"},"PeriodicalIF":0.0,"publicationDate":"2004-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30008-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24413224","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}