Joint Commission journal on quality and safety最新文献_第9页

Improved Clinical Outcomes for Fee-for-Service Physician Practices Participating in a Diabetes Care Collaborative 参与糖尿病护理合作的按服务收费医师实践改善临床结果

Joint Commission journal on quality and safety Pub Date : 2004-04-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30020-1

Rob Benedetti M.D. (Medical Director), Barb Flock R.H.I.T., C.P.H.Q. (Director of Quality Improvement), Steve Pedersen (Research Assistant and Graduate Student), Melissa Ahern M.B.A., Ph.D. (Associate Professor)

{"title":"Improved Clinical Outcomes for Fee-for-Service Physician Practices Participating in a Diabetes Care Collaborative","authors":"Rob Benedetti M.D. (Medical Director), Barb Flock R.H.I.T., C.P.H.Q. (Director of Quality Improvement), Steve Pedersen (Research Assistant and Graduate Student), Melissa Ahern M.B.A., Ph.D. (Associate Professor)","doi":"10.1016/S1549-3741(04)30020-1","DOIUrl":"10.1016/S1549-3741(04)30020-1","url":null,"abstract":"<div><h3>Background</h3><p>The Rockwood Clinic in Spokane, Washington, participated in the Washington State Diabetes Collaborative, which promoted spread of the Chronic Care Model. Eleven participating providers managed care for 698 patients with diabetes, while 19 nonparticipating providers had 1,300 patients.</p></div><div><h3>Implementing the Chronic Care Model</h3><p>Rockwood upgraded its clinical information system to allow for creation of a patient registry to track clinical measures and generate performance reports. Components included a referral mechanism to facilitate more frequent use of diabetes educators, monthly reports, and sharing of results and updated clinical information from consulting specialists. Rockwood created a self-management tool kit and implemented patient goal setting and group visits.</p></div><div><h3>Outcome Measures</h3><p>Seven of the 12 patient outcomes were significantly better for participating providers (<em>p</em> < .05). Two favorable outcomes, eye examinations and blood pressure < 130/85mmHg, were significantly associated with greater participation levels at <em>p</em> < .05.</p></div><div><h3>Discussion</h3><p>Implementing the Chronic Care Model to improve care, using quality improvement staff and administrative support, required fundamental changes in the system of care delivery. These changes were designed to refocus diabetes care efforts at Rockwood on prevention rather than acute care episodes.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 4","pages":"Pages 187-194"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30020-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24468513","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}

引用次数: 53

Preventing Pressure Ulcers in Connecticut Hospitals by Using the Plan-Do-Study-Act Model of Quality Improvement 使用计划-执行-研究-行动的质量改进模式预防康涅狄格州医院的压疮

Joint Commission journal on quality and safety Pub Date : 2004-04-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30022-5

Courtney H. Lyder N.D., Jackie Grady M.S. (Director of Analysis), Deepak Mathur M.P.H., Marcia K. Petrillo M.A. (Chief Executive Officer), Thomas P. Meehan M.D., M.P.H. (Chief Medical Officer)

{"title":"Preventing Pressure Ulcers in Connecticut Hospitals by Using the Plan-Do-Study-Act Model of Quality Improvement","authors":"Courtney H. Lyder N.D., Jackie Grady M.S. (Director of Analysis), Deepak Mathur M.P.H., Marcia K. Petrillo M.A. (Chief Executive Officer), Thomas P. Meehan M.D., M.P.H. (Chief Medical Officer)","doi":"10.1016/S1549-3741(04)30022-5","DOIUrl":"10.1016/S1549-3741(04)30022-5","url":null,"abstract":"<div><h3>Background</h3><p>Seventeen hospitals and the Peer Review Organization of Connecticut (Qualidigm) attempted to increase early identification of high-risk patients and utilization of pressure ulcer preventive measures.</p></div><div><h3>Methods</h3><p>A multihospital retrospective cohort study with medical record abstraction was used to obtain a total of 1,955 (baseline) and 891 (follow-up) patients aged 65 years and older discharged after treatment for pneumonia, cerebrovascular disease, or congestive heart failure with a length of stay ≥ five days. During a nine-month period, the hospitals conducted four plan-do-study-act improvement cycles and shared their results in conference calls and group meetings.</p></div><div><h3>Results</h3><p>Statistically significant increases were noted from baseline (1/1/96–12/31/96) to follow-up (10/1/97–3/31/98) in identification of high-risk patients, repositioning of bed-bound or chair-bound patients, nutritional consults in malnourished patients, and staging of acquired Stage II pressure ulcers. Daily skin assessments occurred at a high rate in both periods. There were no statistically significant changes in other processes of care, pressure ulcer incidence, or mortality.</p></div><div><h3>Discussion</h3><p>Performance of four pressure ulcer prevention processes of care increased concurrently with a multifaceted improvement intervention.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 4","pages":"Pages 205-214"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30022-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24468515","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}

引用次数: 35

Nuts! I Can’t Figure Out How to Use My Life-Saving Epinephrine Auto-Injector! 坚果!我不知道如何使用救命的肾上腺素自动注射器!

Joint Commission journal on quality and safety Pub Date : 2004-04-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30024-9

Laura Lin Gosbee M.A.Sc. (Human Factors Engineering consultant)

{"title":"Nuts! I Can’t Figure Out How to Use My Life-Saving Epinephrine Auto-Injector!","authors":"Laura Lin Gosbee M.A.Sc. (Human Factors Engineering consultant)","doi":"10.1016/S1549-3741(04)30024-9","DOIUrl":"10.1016/S1549-3741(04)30024-9","url":null,"abstract":"<div><h3>Background</h3><p>Epinephrine auto-injectors for food allergy emergency treatment is used as a case study to illustrate how human factors in device design has an impact on proper management of anaphylaxis. Because timely injection is so crucial, epinephrine comes in preloaded syringes or auto-injectors that patients can carry with them. However, many factors influence whether treatment is carried out properly.</p></div><div><h3>Human Factors Engineering (HFE) Analysis</h3><p>The incidence of incorrectly using auto-injectors is not isolated; studies have shown that a significant proportion of patients, and even physicians, do not know how to correctly use the devices. Some auto-injectors appear to be modeled with a metaphor in mind (a pen), but they do not appear and operate consistently with the metaphor. In addition, the device is difficult to transport. The portability issue creates a challenge that cannot be adequately addressed with traditional intervention measures—reminders or more education. They are all human factors issues and require human factors-based interventions.</p></div><div><h3>Summary</h3><p>Although education and training in how to use an auto-injector are important for effective management of anaphylaxis, a poorly designed device can lead to incorrect operation of such a device. HFE can improve device design so that it is reliably and correctly used even with minimal training. Manufacturers, allergists/immunologists, and pharmacists all have critical roles to play to ensure the correct use of this life-saving device.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 4","pages":"Pages 220-223"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30024-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24469054","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}

引用次数: 27

Introduction to the Human Factors Engineering Series 人因工程系列导论

Joint Commission journal on quality and safety Pub Date : 2004-04-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30023-7

John Gosbee M.D., M.S.

引用次数: 29

Editorial Advisory Board 编辑顾问委员会

Joint Commission journal on quality and safety Pub Date : 2004-04-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30089-4

引用次数: 0

Improving Care for the Ventilated Patient 改善对通气病人的护理

Joint Commission journal on quality and safety Pub Date : 2004-04-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30021-3

Sean M. Berenholtz M.D., M.H.S. (Assistant Professor), Shelley Milanovich R.N., A.C.N.P. (Acute Care Nurse Practitioner), Amanda Faircloth R.N., B.S.N. (Staff Nurse), Donna T. Prow R.N., B.S.N. (Nurse Manager), Karen Earsing R.N., M.S. (Nurse Manager), Pamela Lipsett M.D. (Professor of Surgery), Todd Dorman M.D. (Associate Professor), Peter J. Pronovost M.D., Ph.D. (Associate Professor)

{"title":"Improving Care for the Ventilated Patient","authors":"Sean M. Berenholtz M.D., M.H.S. (Assistant Professor), Shelley Milanovich R.N., A.C.N.P. (Acute Care Nurse Practitioner), Amanda Faircloth R.N., B.S.N. (Staff Nurse), Donna T. Prow R.N., B.S.N. (Nurse Manager), Karen Earsing R.N., M.S. (Nurse Manager), Pamela Lipsett M.D. (Professor of Surgery), Todd Dorman M.D. (Associate Professor), Peter J. Pronovost M.D., Ph.D. (Associate Professor)","doi":"10.1016/S1549-3741(04)30021-3","DOIUrl":"10.1016/S1549-3741(04)30021-3","url":null,"abstract":"<div><h3>Context</h3><p>Despite evidence that the use of specific interventions can decrease morbidity and mortality for patients receiving mechanical ventilation, a gap exists between best evidence and practice. A prospective cohort study was conducted in a surgical intensive care unit (ICU) that included all patients who were mechanically ventilated. The study was designed to ensure that for 90% of ventilator days, patients receive processes associated with improved outcomes, including semirecumbent positioning, daily interruption of sedative-drug infusions, peptic ulcer disease prophylaxis, and deep venous thrombosis prophylaxis.</p></div><div><h3>Intervention</h3><p>The improvement model included three interventions: (1) administering a questionnaire to identify barriers to compliance with the four care processes,(2) implementing an educational intervention, and (3) implementing a checklist to be completed daily during ICU rounds to ask providers whether patients were receiving these therapies.</p></div><div><h3>Results</h3><p>Overall, 80% of nurses did not know there was evidence to support at least one of the four therapies. During the study period (March 4–April 29, 2002), the percentage of ventilator days on which patients received all four care processes increased from 30% to 96% (<em>p</em> < .001).</p></div><div><h3>Discussion</h3><p>Evidence-based therapies for mechanically ventilated patients can reduce morbidity, mortality, and costs of care.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 4","pages":"Pages 195-204"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30021-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24468514","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}

引用次数: 111

Adapting Root Cause Analysis to Chronic Medical Conditions 使根本原因分析适应慢性疾病

Joint Commission journal on quality and safety Pub Date : 2004-04-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30019-5

Anupam Goel M.D., Charles D. MacLean M.D. (Associate Professor), Dana Walrath Ph.D. (Assistant Professor), Alan Rubin M.D. (Research Associate Professor), Dryver Huston Ph.D. (Professor), Marilee C. Jones M.A. (Research Assistant), Tracey Niquette M.S.N. (Nurse Practitioner and Research Assistant Professor), Amanda G. Kennedy Pharm.D. (Research Assistant Professor), Robert W. Beardall M.D., M.P.H. (Adjunct Assistant Professor), Benjamin Littenberg M.D. (Henry and Carleen Tufo Professor)

{"title":"Adapting Root Cause Analysis to Chronic Medical Conditions","authors":"Anupam Goel M.D., Charles D. MacLean M.D. (Associate Professor), Dana Walrath Ph.D. (Assistant Professor), Alan Rubin M.D. (Research Associate Professor), Dryver Huston Ph.D. (Professor), Marilee C. Jones M.A. (Research Assistant), Tracey Niquette M.S.N. (Nurse Practitioner and Research Assistant Professor), Amanda G. Kennedy Pharm.D. (Research Assistant Professor), Robert W. Beardall M.D., M.P.H. (Adjunct Assistant Professor), Benjamin Littenberg M.D. (Henry and Carleen Tufo Professor)","doi":"10.1016/S1549-3741(04)30019-5","DOIUrl":"10.1016/S1549-3741(04)30019-5","url":null,"abstract":"<div><h3>Background</h3><p>Root cause analysis (RCA), used to study the conditions leading to acute accidents, was adapted to analyze adverse events in chronic medical conditions.</p></div><div><h3>Methods</h3><p>RCA was modified to investigate “trigger events”—markers of potential adverse events—in outpatient diabetes care. For 20 cases with the trigger event of hypoglycemia evidenced by an A1C of ≥ 11%, a multidisciplinary team reviewed the findings of medical record abstractions, provider interviews, and patient interviews for each case. The RCA team identified active failures, error-producing conditions, latent conditions, and defenses leading to the trigger event in each case.</p></div><div><h3>Results</h3><p>The methodology identified potential root causes of persistent hyperglycemia. Latent conditions, error-producing conditions, and active failures occurred at the assessment, planning, and implementation phases of a diabetes visit. Recurring failure modes were identified within and across cases.</p></div><div><h3>Conclusion</h3><p>RCA can be used to study trigger events in medical care for chronic conditions. Although the data collection occurs months after the event, this methodology can identify variations in chronic care and stimulate discussion about potential solutions.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 4","pages":"Pages 175-186"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30019-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24468512","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}

引用次数: 12

Enhancing the Traditional Hospital Design Process: A Focus on Patient Safety 改进传统医院设计流程:关注患者安全

Joint Commission journal on quality and safety Pub Date : 2004-03-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30013-4

John G. Reiling M.A., M.B.A. (President/Chief Executive Officer), Barbara L. Knutzen B.S.N., M.P.A. (Chief Operating Officer), Thomas K. Wallen A.I.A. (Principal), Susan McCullough R.N. (Director), Ric Miller (President), Sonja Chernos M.P.H. (Patient Safety Research Coordinator)

{"title":"Enhancing the Traditional Hospital Design Process: A Focus on Patient Safety","authors":"John G. Reiling M.A., M.B.A. (President/Chief Executive Officer), Barbara L. Knutzen B.S.N., M.P.A. (Chief Operating Officer), Thomas K. Wallen A.I.A. (Principal), Susan McCullough R.N. (Director), Ric Miller (President), Sonja Chernos M.P.H. (Patient Safety Research Coordinator)","doi":"10.1016/S1549-3741(04)30013-4","DOIUrl":"10.1016/S1549-3741(04)30013-4","url":null,"abstract":"<div><h3>Background</h3><p>In 2002 St. Joseph’s Community Hospital (West Bend, WI), a member of <em>Synergy</em>Health, brought together leaders in health care and systems engineering to develop a set of safety-driven facility design principles that would guide the hospital design process.</p></div><div><h3>Designing for Safety</h3><p>Hospital leadership recognized that a cross-departmental team approach would be needed and formed the 11-member Facility Design Advisory Council, which, with departmental teams and the aid of architects, was responsible for overseeing the design process and for ensuring that the safety considerations were met. The design process was a team approach, with input from national experts, patients and families, hospital staff and physicians, architects, contractors, and the community.</p></div><div><h3>Outcome</h3><p>The new facility, designed using safety-driven design principles, reflects many innovative design elements, including truly standardized patient rooms, new technology to minimize falls, and patient care alcoves for every patient room. The new hospital has been designed with maximum adaptability and flexibility in mind, to accommodate changes and provide for future growth. The architects labeled the innovative design The Synergy Model, to describe the process of shaping the entire building and its spaces to work efficiently as a whole for the care and safety of patients.</p></div><div><h3>Conclusion</h3><p>Construction began on the new facility in August 2003 and is expected to be completed in 2005.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 3","pages":"Pages 115-124"},"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)30013-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40850356","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}

引用次数: 49

Clinical Practice Guidelines and Performance Indicators as Related—But Often Misunderstood—Tools 临床实践指南和绩效指标作为相关但经常被误解的工具

Joint Commission journal on quality and safety Pub Date : 2004-03-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30018-3

Ann S. O’Malley M.D., M.P.H. (Assistant Professor), Carolyn Clancy M.D. (Director), Joe Thompson M.D., M.P.H. (Associate), Ravikiran Korabathina (Medical student), Gregg S. Meyer M.D., M.Sc.

{"title":"Clinical Practice Guidelines and Performance Indicators as Related—But Often Misunderstood—Tools","authors":"Ann S. O’Malley M.D., M.P.H. (Assistant Professor), Carolyn Clancy M.D. (Director), Joe Thompson M.D., M.P.H. (Associate), Ravikiran Korabathina (Medical student), Gregg S. Meyer M.D., M.Sc.","doi":"10.1016/S1549-3741(04)30018-3","DOIUrl":"10.1016/S1549-3741(04)30018-3","url":null,"abstract":"<div><h3>Background</h3><p>Widespread variation in medical practice indicates that existing scientific evidence is often not translated into appropriate clinical care. Two tools have evolved that try to address this variation: clinical practice guidelines (CPGs) and performance indicators (PIs).</p></div><div><h3>Tensions Between CPGs and PIs</h3><p>CPGs present available evidence that is subsequently reviewed and frequently adopted by professional organizations, so that clinicians may judge whether specific management recommendations are appropriate for each patient. PIs are devised to measure and document performance to motivate organizations to improve through the use of common metrics.</p></div><div><h3>Implications of These Tensions</h3><p>The increasingly widespread use of PIs with CPGs (and clinicians’ confusion of them with CPGs) risks lowering the standards of clinical care. PIs are not intended to set optimal standards of care for any individual patient. Clinicians should not restrict their quality monitoring to a focus on PIs because they could miss important opportunities to learn and to improve the care they deliver to their individual patients.</p></div><div><h3>Conclusion</h3><p>Tensions between CPGs and PIs do not mean that these tools should be abandoned but rather that they need to be refined. Recognition of the imperfections of CPGs and PIs should not blind clinicians to the ultimate goals of these tools—to promote quality (through changes in practice and/or selection) and ensure that medical care is based on scientific evidence.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 3","pages":"Pages 163-171"},"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)30018-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40850882","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}

引用次数: 27

Editorial Advisory Board 编辑顾问委员会

Joint Commission journal on quality and safety Pub Date : 2004-03-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30088-2

引用次数: 0