BMJ Open Quality最新文献

{"title":"1:1 observation and support: a quality improvement approach to reducing cost and improving therapeutic input.","authors":"David Thomas, Marie Little, Jessica Pawley","doi":"10.1136/bmjoq-2025-003439","DOIUrl":"10.1136/bmjoq-2025-003439","url":null,"abstract":"<p><p>Our quality improvement (QI) project aimed to reduce reliance on external temporary staff used for 1:1 observation and support within a recently merged acute, community and mental health National Health Service (NHS) Trust. Temporary staffing costs reached £2.7 million in the previous financial year. Between February 2022 and June 2024, we aimed to establish a more efficient and consistent approach, particularly within acute physical healthcare settings. The project focused on four main patient cohorts and the goal was to reduce temporary staffing costs by 25%. A multidisciplinary team, guided by the 7 Steps to QI methodology, developed and tested two key tools to standardise decision-making and reduce the need for temporary staff. The project was implemented in nine pilot areas across the Trust, leading to a reduction in staffing costs by £600,000 in the first year, with a further £1.2 million in the second year. Additionally, patient falls with harm decreased by 8%. Challenges arose due to communication barriers and the need for cultural change. By empowering local teams to make more informed decisions, the project demonstrated the value of standardised tools and staff training in enhancing both patient care and organisational sustainability.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879159","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":"Feasibility and acceptability of e-learning training about diabetes and insulin usage to Peruvian healthcare professionals.","authors":"Ana Maria Sandoval Barrantes, Ruth Iguiniz Romero, Isabel Amemiya Hoshi, Patricia Busta-Flores, Victoria Cavero, Liliana Hidalgo-Padilla, Mauricio Toyama, Jacqueline Dueñas Quispe, María Lazo Porras, Janeth Tenorio Mucha, María Karina Fernandez Urteaga, Jessica Hanae Zafra-Tanaka","doi":"10.1136/bmjoq-2025-003868","DOIUrl":"10.1136/bmjoq-2025-003868","url":null,"abstract":"<p><strong>Introduction: </strong>Insulin is fundamental for the management of diabetes. In Peru, limited training among healthcare professionals is an important barrier to insulin prescription and usage. Given the advantages of e-learning such as time flexibility, low cost and penetration, the Peruvian government launched an e-learning training on diabetes and insulin usage for healthcare professionals working in public facilities in December 2021. This study aims to assess the feasibility and acceptability of this initiative.</p><p><strong>Methods: </strong>We conducted a mixed-methods study with a sequential explanatory design to assess feasibility and acceptability of the e-learning training. We included all enrolled participants regardless of whether they completed the course. First, quantitative data were collected through online surveys. Then, qualitative data were collected through in-depth interviews. The data were analysed separately, but the results were interpreted together to triangulate findings.</p><p><strong>Results: </strong>This course reached 536 healthcare professionals at the national level, from which 338 (63.1%) completed the course. 304 (56.7%) of the participants lived outside Lima, the capital of Peru, and 285 (53.2%) worked in a primary care facility. Participants manifested high satisfaction with the course content and its applicability. However, some barriers to participation were found. Chiefly, family burden, workload, poor internet connection and the lack of protected training hours.</p><p><strong>Conclusion: </strong>The study highlights the feasibility of using e-learning to train healthcare professionals, particularly in underserved areas, offering flexibility and broad access. Some barriers need to be considered for future interventions that prevent dropouts.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879078","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":"Contribution of improved quality of early essential newborn care to neonatal mortality decline in Cambodia, 2010-2022: a retrospective observational study.","authors":"Sidonn Krang, Tung Rathavy, John Charles Scott Murray, Rattana Kim, Sano Phal, Priya Mannava, Kannitha Cheang, Y Meng Chhour, Howard Lawrence Sobel","doi":"10.1136/bmjoq-2025-003920","DOIUrl":"10.1136/bmjoq-2025-003920","url":null,"abstract":"<p><strong>Introduction: </strong>Between 2005 and 2010, reductions in newborn mortality fell behind those for maternal and under-five child mortality in Cambodia. To improve newborn outcomes, we developed and scaled-up early essential newborn care (EENC) nationally using a new clinical coaching and data-based quality improvement approach. This study aimed to determine EENC's contribution to Cambodia's observed neonatal mortality decline between 2010 and 2022.</p><p><strong>Methods: </strong>Standard indicators in the EENC monitoring and evaluation framework were calculated from programme records, nationally representative population-based surveys and facility-based assessments using standardised methods. The Lives Saved Tool (LiST) was used to model newborn lives saved 2010-2022 using facility estimates of care quality.</p><p><strong>Results: </strong>Newborn mortality declined from 27 to 8/1000 live births (70.4%) comparing 2010 and 2022. The average annual rate of newborn mortality decline accelerated by 33% after EENC introduction in 2012 compared with the previous 10 years, with greatest declines among high-risk groups (poorest, rural, uneducated and with low birth interval). Between 2010 and 2022, EENC was integrated into national and subnational policies, standards and implementation plans and introduced to 87.6% of birth facilities. The average birth practice score rose to 72.9% (95% CI 59.0% to 83.4%) in 2022, from 6% (95% CI 1.7% to 20.1%) in 2011. Significant improvements were seen in application of clean birth environments, immediate drying and stimulation, thermal protection (immediate and prolonged skin to skin contact), delayed cord clamping and clean cord care. LiST modelling estimated that EENC interventions averted 21 704 Cambodian newborn deaths (range 17 694-26 450) during 2010-2022 and were responsible for 75.3% (range 69.5%-80.5%) of the observed national mortality reduction.</p><p><strong>Conclusion: </strong>A new approach to EENC programme implementation led to sustained country-wide improvements in evidence-based practices around birth. Improved care quality was associated with 69.5-80.5% of the observed neonatal mortality decline in Cambodia between 2010 and 2022.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872967","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":"Assessing patient and client safety culture across integrated health and social care services: a cross-sectional study in Finland.","authors":"Marja Hult, Arja Pekonen, Sanna Koskinen, Jaana Lojander, Jaakko Varpula, Mari Kangasniemi","doi":"10.1136/bmjoq-2025-003882","DOIUrl":"10.1136/bmjoq-2025-003882","url":null,"abstract":"<p><strong>Background: </strong>Patient safety culture is a critical component of healthcare quality, influencing both staff behaviour and patient outcomes. While it has been widely studied in hospital settings, less is known about its variation across integrated health and social care systems.</p><p><strong>Objective: </strong>To examine patient and client safety culture within a well-being services county in Finland from the perspective of employees.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted using the Finnish version of the Hospital Survey on Patient Safety Culture (SOPS 2.0) and the Net Safety Score (NSS). The sample included 2623 staff members from hospital, social and health and elderly services. Descriptive statistics, analysis of variance, Pearson correlations and linear regressions were used to analyse differences and associations.</p><p><strong>Results: </strong>Among the SOPS dimensions, teamwork received the highest positive ratings (71.1%), whereas handoffs and information exchange scored the lowest (22.6%). Significant differences were observed across service areas, with elderly services consistently reporting lower scores. All safety culture dimensions were significantly correlated with the NSS. Regression analysis identified teamwork, staffing and work pace and organisational learning as the strongest significant predictors of the NSS in all the service areas. The overall proportion of positive responses for NSS was 52.6%. The model explained 47.4% of the variance in NSS in hospital services, 47.0% in elderly services and 35.8% in social and health services.</p><p><strong>Conclusions: </strong>Patient and client safety culture varies significantly across service areas, with elderly services requiring targeted support. The NSS is a valid and practical tool for capturing staff perceptions of safety and can complement broader safety culture assessments. Its simplicity enables frequent monitoring and timely interventions, supporting continuous improvement in healthcare safety.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839194","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":"Enhancing awareness of safe medication prescribing to improve patient care in Singapore General Hospital.","authors":"Hui Sin Cheng, Li Zhen Ye, Magdalene Kim Choo Ng, Jenny Yi Chen Hsieh","doi":"10.1136/bmjoq-2025-003672","DOIUrl":"10.1136/bmjoq-2025-003672","url":null,"abstract":"<p><p>Unsafe medication practices remain a leading cause of avoidable harm globally, with an estimated annual cost of US$42 billion. At Singapore General Hospital, 32 preventable medication errors were reported in Ward 64A/C between July and December 2022, of which 81.3% were medication-ordering errors, highlighting prescribing as a key priority for improvement. The project aimed to reduce reported medication-ordering errors in Ward 64A/C from a baseline median of three per month to zero between January and December 2023.Using the Model for Improvement framework, two Plan-Do-Study-Act cycles were implemented. The first introduced structured training for junior doctors, ward-based reminders and a peer-led 'Prescribing Champion' role to improve prescribing awareness and medication-order verification. The second engaged speech therapists to integrate swallowing assessments into prescribing decisions, reducing errors from inappropriate modification of oral medications. Interventions were supported by senior leadership and reinforced through educational materials and real-time feedback.The project achieved its goal, with reported medication-ordering errors reduced to zero during the intervention and sustained through August 2024. Based on local estimates of medication-related harm, the reduction in reported medication-ordering errors may have contributed to cost avoidance of approximately SGD 18 000 annually. Staff feedback suggested engagement with prescribing safety practices, while informal patient feedback suggested greater reassurance and understanding of medication changes. The initiative was extended to Ward 46 in September 2023, where similar reductions in reported medication-ordering errors were observed. Prescribing safety training was subsequently embedded into the hospital-wide Postgraduate Year 1 induction programme.This project suggests that structured education, peer support and multidisciplinary collaboration may contribute to reductions in reported medication-ordering errors and sustained improvement in busy wards. The lessons learnt from this project may inform the design and implementation of similar medication safety initiatives aimed at strengthening prescribing practices and reducing medication-related harm.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839225","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":"Timely care for tiny lives: quality improvement for golden hour management bundle.","authors":"Sonali Tanpure, Atul Londhe, Laxmikant Deshmukh, Amol Joshi, John Biswas","doi":"10.1136/bmjoq-2025-003924","DOIUrl":"10.1136/bmjoq-2025-003924","url":null,"abstract":"<p><strong>Background: </strong>Preterm babies face a high risk of hypothermia, respiratory distress and hypoglycaemia soon after birth. The golden hour-the first 60 min of life-has been shown to improve outcomes with evidence-based, timely interventions. An audit in our neonatal intensive care unit (NICU) in central India showed that only 7.7% of preterms received the golden hour management bundle (GHMB).</p><p><strong>Methods: </strong>This quasi-experimental study was conducted between May 2023 and May 2025 in inborn preterms <34 weeks. A multidisciplinary team used process mining and root cause analysis to identify delays in GHMB. Multiple plan-do-study-act (PDSA) cycles were conducted, including revised delivery room transfer policies, dedicated resident role allocation, thermal care practices, ventilator and consumables buffer stock and preprepared intravenous cannula trays. Data were collected prospectively and analysed using time-motion analysis and statistical process control charts.</p><p><strong>Results: </strong>A total of 294 preterms were studied. The median time to complete GHMB decreased from 107 min at baseline to 55 min in the sustainability phase (p<0.001). The percentage of preterms receiving GHMB rose from 7.7% to 71.7%. The rate of moderate hypothermia at admission decreased from 100% to 12.1%. Timely intravenous fluid administration improved from 12.5% to 80.4%, and medications within the first hour increased from 4.1% to 71%.</p><p><strong>Conclusion: </strong>Process mining helped identify and reduce rate-limiting steps as well as reorganise and reassign tasks, thereby improving the proportion of preterms receiving GHMB.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824898","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":"Improving compliance with placental histopathology through labour ward storage and clear referral criteria: a two-site quality improvement report.","authors":"Lisa Story, Anangsha Kumar, Dee Laker, Spyros Bakalis, Colette McGilchrist, Daniel Cromb, Andreas Marnerides, Rebecca Smith, Ashleigh McDonald, Paul Cawley","doi":"10.1136/bmjoq-2026-004321","DOIUrl":"10.1136/bmjoq-2026-004321","url":null,"abstract":"<p><p>Placental histopathology is central to good perinatal care, offering insight into antepartum and intrapartum events, informing neonatal management and supporting counselling for future pregnancies. Despite clear national guidance, many placentas that meet criteria are not sent for evaluation. Reasons are multifactorial, including inconsistent awareness of indications and unclear post-delivery processes. Two UK maternity units, St Thomas' Hospital in London and the Royal Berkshire Hospital in Reading, identified local variations in practice that led to placentas not being appropriately sent. At St Thomas' Hospital, a baseline audit performed as part of a preterm birth research study revealed only 80% of eligible deliveries had placental examination. At the Royal Berkshire Hospital, a coroner's inquest after an unexpected neonatal death, highlighted the absence of indicated placental histology, prompting a recommendation for 48-hour retention of all placentas. A quality improvement project using Plan Do Study Act cycles was implemented at both sites. Interventions included installation of dedicated labour ward fridges for 48-hour storage with temperature monitoring, targeted education on indications for placental histology and daily cross-checking of neonatal admissions to ensure eligible placentas were sent. The primary outcome was the proportion of placentas meeting criteria sent for histopathology, focusing on deliveries <32 weeks and intrauterine deaths >18 weeks. National investigation reports at St Thomas' Hospital were also reviewed for missing histology. Labour ward storage proved feasible and effective. At the Royal Berkshire Hospital, submission rates improved from 88% to 97% for intrauterine deaths and from 71% to 100% for very preterm births. At St Thomas' Hospital, preterm submissions increased from 80% to 96% after education and 98% after storage, with intrauterine death remaining at 100%. Missing histology in national investigations reduced from 12% to 0%. Short-term placental storage is a low-cost, scalable intervention aligned with national maternity safety priorities.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825293","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":"Growing pains: adult subspecialist perspectives on improving transition from paediatric to adult care for youth with complex health conditions.","authors":"Sarah Malecki, Chioma Nwebube, Julia Orkin, Ilana Halperin, Naba Khan, Tomisin John, Hans Katzberg, Amanda Steiman, Rano Matta, Tarek Abdelhalim, Danielle M Andrade, Natasha Bollegala, Shaelynne Bush, Clodagh Ryan, Kimberly Colapinto, Eleni Dimaraki, Hanna Faghfoury, Jennifer Fu, Natasha Gakhal, Kate Gent, Chana Korenblum, Perla Lansang, Iliana C Lega, Mary Jane Lim-Fat, Jessica Liu, Susan Miranda, Geetha Mukerji, Christian Pagnoux, Eryn Vandepoele, Ophir Vinik, Karla Wentzel, Darryl Yates, Eyal Cohen, Alene Toulany","doi":"10.1136/bmjoq-2026-004387","DOIUrl":"10.1136/bmjoq-2026-004387","url":null,"abstract":"<p><strong>Background: </strong>Transition from paediatric to adult healthcare is particularly challenging for youth and their caregivers with complex health conditions, in part due to loss of paediatric supports and fragmentation of care, contributing to adverse outcomes. To date, transition research and policy has been largely driven by paediatric providers. Adult provider insights are critical to inform gaps in care, transition planning and enable innovative and sustainable interventions.</p><p><strong>Objective: </strong>To describe adult subspecialist perspectives on barriers, facilitators and opportunities to improve the transition from paediatric to adult care for youth with complex health conditions.</p><p><strong>Methods: </strong>An adult subspecialty advisory panel was convened as part of a quality improvement initiative, with physicians from the University of Toronto's Department of Medicine who participated in three virtual meetings through nomination and stakeholder mapping. The first meeting focused on identifying current challenges and opportunities in transition to adult care; the second generated recommendations based on experiential knowledge and the third reviewed case studies to identify gaps and potential solutions. Discussions were recorded, transcribed and analysed using thematic qualitative analysis.</p><p><strong>Results: </strong>Adult subspecialists identified five key areas for improvement: (1) preparing patients and families for the realities of adult care; (2) bridging communication gaps between paediatric and adult systems; (3) moving beyond age-based transition toward flexible, readiness-informed care; (4) strengthening collaboration among adult providers caring for young adults; and (5) addressing structural and infrastructure barriers within adult care systems.</p><p><strong>Conclusion: </strong>Adult care physicians expressed and validated that young adults have unique care needs during their transition to adult care. They highlighted the need for stronger cross-system collaboration, resources and investment to ensure effective transition. These findings highlight barriers in implementing current paediatric-led transition standards and provide a foundation for system-level, disease-agnostic approaches to improve continuity of care across the paediatric-adult divide.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825252","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":"Rollout of a care bundle for intracerebral haemorrhage across the North of England: a qualitative study.","authors":"Lisa Brunton, Paul Wilson, Adrian R Parry-Jones","doi":"10.1136/bmjoq-2025-004099","DOIUrl":"10.1136/bmjoq-2025-004099","url":null,"abstract":"<p><strong>Background: </strong>A care bundle was developed and implemented at a hospital in North West England to improve the management of intracerebral haemorrhage (ICH) and was associated with a 44% reduction in 30-day case fatality. It was scaled out to the other hyperacute stroke units (HASUs) in the region. Findings showed the bundle could be successfully implemented into new settings, but challenges impeded its implementation. The findings were used to develop an implementation strategy to support roll-out outside the region. The ABC-ICH care bundle was then scaled up as a quality improvement initiative across six regions in the North of England. This paper reports on the qualitative process evaluation that was conducted in parallel.</p><p><strong>Methods: </strong>Multiple qualitative methods (45 interviews, six meeting observations and a document analysis) were used to capture how the bundle was implemented in HASUs across the six regions. We used the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to theoretically inform the study.</p><p><strong>Findings: </strong>Key facilitators in the uptake of the bundle were the clarity of the intervention, its compatibility with clinicians' values, its perceived relative advantage compared with current ICH care and the ability to locally tailor protocols. Key barriers to implementing the care pathway (judicious referral to neurosurgery) included lack of recipients' skills and confidence and prevailing organisational cultural norms which meant that most clinicians continued to refer all patients regardless of whether they met eligibility criteria. Lack of routine monitoring of process targets by local implementation teams impeded use of plan-do-study-act cycles to further improve care. Local contextual issues impeded or enabled effective facilitation.</p><p><strong>Conclusion: </strong>The findings recognise the importance of understanding what happens when the bundle is introduced into new settings outside of its local context and identifies lessons for future national roll-out.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824016","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":"Improving diabetic kidney disease screening in a VA resident primary care clinic: a quality improvement initiative.","authors":"Kathie Zhang, Benjamin Reed Griffin, Jonathan B Chapman, Matthew D Soltys","doi":"10.1136/bmjoq-2026-004266","DOIUrl":"10.1136/bmjoq-2026-004266","url":null,"abstract":"<p><strong>Background: </strong>Annual screening for diabetic kidney disease (DKD) with serum creatinine and albuminuria is recommended by multiple clinical guidelines but screening rates remain low nationwide (<50%). The Veterans Health Administration has implemented quality improvement (QI) interventions that resulted in a significantly higher national DKD screening rate of 63%. However, the rate in the resident primary care clinic at the Iowa City Veterans Affairs (ICVA) was only 41%, suggesting that these interventions may not be as effective in resident clinics. Residents have unique schedules and time demands, thus QI initiatives targeting this transient physician population need to be appropriately tailored.</p><p><strong>Methods: </strong>An interprofessional working group aimed to increase the screening rate for DKD in the resident clinic from 41% to 65% over 8 months using Lean methodology. This non-randomised, prospective QI project was conducted at the resident primary care clinic at the ICVA, which serves approximately 3000 Veterans (including 750 with diabetes). Two sequential interventions were implemented: (1) a national electronic health record reminder and (2) a tailored, resident-specific, multifaceted approach involving incentives, gamification, workflow improvements, audit and feedback, and benchmarking. The primary outcome was monthly percentage of Veterans with both a urine albumin-to-creatinine ratio and serum creatinine tested in the past year. The process measure was weekly percentage of eligible Veterans tested for albuminuria within 1 day before or 7 days after a primary care appointment.</p><p><strong>Results: </strong>The percentage of compliant Veterans in the resident primary care clinic increased from 41% (239/590) in June 2023 to 66% (395/603) by March 2024. Weekly screening rates of eligible Veterans rose from 16% to 48%. The biggest improvement was seen after the resident-specific interventions.</p><p><strong>Conclusions: </strong>This project demonstrates the need for and effectiveness of tailored, resident-specific implementation strategies to achieve QI aims among these physicians.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788106","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}