BMJ Open Quality最新文献

{"title":"Improving compliance with curative radiotherapy for cervical cancer in a high-volume centre in India: a bundled workflow (AID-CARE) quality improvement project.","authors":"Sreenivasa Rao Bonala, Bala Venkata Subramanian, Cherwin Venati, Henita Selvamary, Naveen Bhargav Talatoti, Gongada Sindhu","doi":"10.1136/bmjoq-2025-003874","DOIUrl":"10.1136/bmjoq-2025-003874","url":null,"abstract":"<p><p>Timely completion of curative chemoradiotherapy within 56 days is a key determinant of oncological outcomes in cervical cancer; however, achieving this target remains challenging in high-volume public-sector settings in low- and middle-income countries (LMICs). At a tertiary public-sector cancer centre in South India, routine clinical observations identified poor compliance with recommended radiotherapy timelines, with delays and treatment defaults occurring at multiple points along the care pathway. In response, a quality improvement project was undertaken to improve treatment timeliness and completion.A retrospective baseline audit confirmed substantial delays and high default rates among patients receiving curative-intent external beam radiotherapy, followed by intracavitary brachytherapy. Root cause analysis identified system-, staff- and patient-related factors contributing to poor compliance. Based on these findings, a bundled workflow intervention (AID-CARE) was developed, incorporating early brachytherapy assessment, planned interdigitation, accelerated schedules for delayed cases, structured patient counselling, staff education and prospective patient tracking. The intervention was implemented using sequential Plan-Do-Study-Act cycles, followed by a prospective re-audit and sustainment phase. The primary outcomes were compliance with an overall treatment time of ≤56 days and treatment default rates assessed over time using run charts.At baseline, only 18.6% of patients completed treatment within 56 days, whereas 46.2% defaulted and 35.2% experienced prolonged treatment duration. Following implementation, compliance with the recommended treatment timeline improved to 70.1%, with a marked reduction in treatment defaults to 6.2%. These improvements were maintained during the sustainment phase. No increase in acute treatment-related toxicity was noted.This quality improvement initiative demonstrates that a structured, workflow-driven and resource-conscious approach can substantially and sustainably improve compliance with recommended radiotherapy timelines for cervical cancer in high-volume public-sector settings, with potential applicability to similar centres in LMICs.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395850","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":"Psychological safety and shared decision-making for patient engagement in care quality.","authors":"Tatsuya Fukami","doi":"10.1136/bmjoq-2026-004224","DOIUrl":"10.1136/bmjoq-2026-004224","url":null,"abstract":"<p><strong>Background: </strong>Patient engagement is increasingly recognised as a core component of healthcare quality and safety. However, many patients remain reluctant to voice concerns, ask questions or participate meaningfully in clinical decisions. While patient safety initiatives have traditionally focused on preventing errors through system-level controls, less attention has been paid to the relational conditions that enable patients to contribute actively to safety and quality in everyday care.</p><p><strong>Objective: </strong>This narrative review aims to conceptualise psychological safety and shared decision-making (SDM) as interdependent mechanisms that enable patient engagement and shape patient experience and to examine how their absence contributes to defensive medical practices.</p><p><strong>Methods: </strong>We conducted a narrative review of interdisciplinary literature spanning patient safety science, quality improvement, patient experience research and organisational psychology. Conceptual frameworks and illustrative clinical examples were synthesised to clarify how psychological safety and SDM function together within routine clinical encounters.</p><p><strong>Results: </strong>Psychological safety enables patients to express concerns, uncertainty and preferences without fear of dismissal or negative judgement, while SDM provides a structured process through which patient values and clinical evidence can jointly inform decisions. When these relational mechanisms are weak or absent, defensive medical practices-often framed as actions taken 'just to be safe'-may proliferate. Although intended to reduce risk, such practices can undermine patient engagement by limiting dialogue, increasing anxiety and reinforcing paternalistic decision-making. In contrast, integrating psychological safety and SDM reframes patient engagement as an active safety mechanism that supports learning, transparency and trust.</p><p><strong>Conclusions: </strong>Reframing patient engagement as a core safety and quality mechanism highlights the importance of psychological safety and SDM in everyday clinical practice. Rather than treating patient experience as a downstream outcome, healthcare organisations should recognise it as an integral component of safe, high-quality care. Embedding psychologically safe communication and SDM into routine decision-making may reduce reliance on defensive medicine while promoting safer, more participatory and more respectful healthcare.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395910","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":"Implementation of a brief intensive education programme in quality improvement.","authors":"Robert Potter, Siddarth Raj, Leila Quffa, Naginder Singh, Hannah Kiziltug, Tanya Hall, Wei-Lin Allen, Pratheeban Nambyiah, Matthew Heron, Cheng Ong, Satya Krishna Ramachandran","doi":"10.1136/bmjoq-2025-004096","DOIUrl":"10.1136/bmjoq-2025-004096","url":null,"abstract":"<p><p>Training in quality improvement (QI) and patient safety remains highly variable despite regulatory mandates. We describe a novel, intensive 5-day experiential QI education programme for postgraduate trainees that integrates real-world observation, brief didactic sessions and workshop-based improvement work, supplemented by creative storytelling and team-based development of campaign media products. First-year anaesthesia residents conducted over 100 structured operating room observations and interviews, collected quantitative and qualitative data on distractions and presented improvement proposals that they developed to institutional stakeholders along with narrative campaign videos. Postcourse evaluations demonstrated a significant increase in trainee confidence in QI methodology and presentation, with participants valuing the experiential and creative elements over traditional didactic instruction. This model demonstrates the feasibility, reproducibility and educational value of immersive, short-duration QI training in authentic clinical settings and suggests a promising alternative to longer, resource-intensive curricula.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395835","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":"Implementation of a nurse-led visit and follow-up for patients with myeloproliferative neoplasms: a quality improvement project.","authors":"Daniela Berardinelli, Carmen Fava, Federica Sinisi, Inga Ventimiglia, Ilaria Maglione, Andrea Ricotti, Cristina Mentone, Valentina Bonuomo, Selene Grano, Sara Campagna, Paola Di Giulio, Valerio Dimonte","doi":"10.1136/bmjoq-2025-003632","DOIUrl":"10.1136/bmjoq-2025-003632","url":null,"abstract":"<p><strong>Background: </strong>Myeloproliferative neoplasms (MPNs) are chronic haematological disorders with a significant symptom burden and implications for quality of life. Traditional physician-led outpatient models often lack sufficient time for in-depth symptom monitoring and patient engagement. This quality improvement project aimed to implement (1) a structured nurse-led visit within a haematology outpatient clinic in northern Italy, (2) routine symptom monitoring and (3) evaluation of patient-related experience.</p><p><strong>Methods: </strong>The nurse-led visit was integrated into routine 1-day hospital activities and focused on a structured comprehensive symptom assessment, health education and self-management support. Patient-reported outcomes to assess physical, psychological, nutritional and functional aspects and patient satisfaction as patient-reported experience measures were collected using validated tools and recorded on a patient symptom diary with patients' self-care recommendations. The Plan-Do-Study-Act cycle and the person-centred care framework guided the intervention design and iterative improvement.</p><p><strong>Results: </strong>Over the first 6 months, 102 patients underwent nurse-led visits with a high adherence rate and follow-up compliance. Patients reported high satisfaction with the nurse-led visit, with a mean score of 9.6±0.75 points on a 0-10 points visual scale. The intervention optimised waiting times, promoted patient activation and strengthened nurse-physician collaboration. No adverse events occurred.</p><p><strong>Conclusions: </strong>The implementation of nurse-led visits was feasible, sustainable and highly accepted by patients. This approach aims to enhance symptom management, patient engagement and care coordination for individuals with MPNs and may prove to be a promising model for broader implementation in chronic disease management.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381563","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":"Closing the gap in postoperative delirium detection: addressing low screening rates in the surgical recovery room.","authors":"Shubham Dave, Marcela Vizcaychipi, John Paul, Isabel Diez Martin","doi":"10.1136/bmjoq-2025-003647","DOIUrl":"10.1136/bmjoq-2025-003647","url":null,"abstract":"<p><p>Postoperative delirium (POD) is a common complication that increases the incidence of a variety of adverse patient outcomes. Routine screening of high-risk patients can mitigate these risks. This quality improvement (QI) project took place at Chelsea and Westminster Hospital using the Plan-Do-Study-Act (PDSA) cycle methodology. The project aimed to implement a routine POD screening programme as recommended by the National Institute for Health and Care Excellence (NICE).The first cycle formalised a trust-wide guideline specific to perioperative delirium assessment. The second cycle made delirium tools easier to access on trust systems and embedded them into existing clinical workflows.The primary outcome of baseline and post-intervention POD screening rates was compared using Fisher's exact test. Screening rates for 246 high-risk POD patients (as defined by NICE guidelines) admitted to Chelsea and Westminster Hospital between January and May 2025 were included for analysis. The secondary outcomes were self-reported nursing measures (confidence in delirium screening and perceived guideline clarity). Pre- and post-intervention survey scores were compared using the Mann-Whitney U test. Post-intervention surveys were also used to assess the perceived long-term feasibility of interventions.POD screening rates increased from a baseline of 2.3% to 71.64% (p<0.0001) in the post-intervention period. Of those screened, 17.5% (n=11) of patients screened positive for POD. Reported confidence and clarity of guidelines increased (p<0.0001) to a median (IQR) of 10/10 (8.75-10). Long-term feasibility scores achieved a median (IQR) score of 9/10 (8-10).The formalisation of a delirium guideline and its integration with clinical workflows significantly increased screening rates and nursing confidence while detecting previously unrecognised cases of POD. This project's interventions can be adopted by trusts facing similar challenges. Limitations included the likelihood of observer bias, the use of a surrogate marker as a primary outcome and a small sample size, which limits the robustness of statistical analysis.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374565","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":"Patient-centred approach to improve colorectal cancer screening (CRC) in resource-limited communities.","authors":"Omar Arman, Jessica L Reynolds, Gregory D Gudleski, Smita Bakhai","doi":"10.1136/bmjoq-2025-004024","DOIUrl":"10.1136/bmjoq-2025-004024","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this quality improvement initiative was to increase colorectal cancer (CRC) screening rates from 17.75% and 28.45% to 40% in patients aged 45-49 years and 50-75 years, respectively, at a resource-limited primary care clinic within 1 year. We identified a major gap in CRC screening in both age groups (45-49 and 50-75 years).</p><p><strong>Methods: </strong>We implemented multifaceted, patient-centred interventions in a community clinic serving a diverse population. The intervention incorporated the use of stool-based testing (faecal immunochemical test and multi-targeted stool DNA test), colonoscopy referrals, patient navigation, multilingual education, electronic health record alerts and a real-time tracking dashboard. The primary outcome measure was CRC screening completion rates. Colonoscopy and stool test completion rates were the process measures.</p><p><strong>Results: </strong>In 45-49 years, we observed a sustainable, steady increase in CRC screening rates from 17.75% (n=400) to 41.25% during the study period and 59.50% 6 months poststudy, with a median rate of 52.38% in a run chart and a mean of 37.00% in the statistical process control (SPC) chart. In 50-75 years, we observed a sustainable increase in CRC screening rate from 28.45% (n=2879) to 46.16% during the study period and to 61.06% 6 months poststudy, with a median rate of 55.47% in a run chart and mean of 43.00% in a SPC chart. In 45-49 years, colonoscopy completion rates increased from the baseline rate of 25.93% (n=108) to 37.04% during the study period and to 43.52% 6 months poststudy. In 50-75 years, colonoscopy completion rates increased from the baseline rate of 74.01% (n=654) to 92.05% during the study period and to 97.55% 6 months poststudy.</p><p><strong>Conclusions: </strong>We exceeded our goals to increase CRC screening in both age groups. Patient-centred care and system-integrated interventions may substantially increase CRC screening among underserved individuals.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366769","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":"Australian and New Zealand nurses' understanding and application of aseptic technique in clinical contexts: a cross-sectional mixed-method study.","authors":"Hannah M Kent, Joanne M Lewis, Sonja A Dawson, Brett G Mitchell","doi":"10.1136/bmjoq-2025-003921","DOIUrl":"10.1136/bmjoq-2025-003921","url":null,"abstract":"<p><strong>Introduction: </strong>Aseptic technique remains fundamental in nursing practice and is essential in reducing hospital-acquired infections. Research shows that opportunities for nurses to update their knowledge and skills of aseptic technique are limited, and understanding of core principles can be inconsistent across healthcare and educational settings. Our aim was to capture the current understanding and application of aseptic technique among nurses in Australia and New Zealand.</p><p><strong>Method: </strong>We undertook a cross-sectional mixed-method survey design. Registered and enrolled nurses working in Australian or New Zealand healthcare or nursing education facilities were eligible to participate and were recruited between December 2024 and February 2025. Participants completed an anonymous online survey, informed by outcomes of a scoping review and adapted from existing surveys. Descriptive analysis was performed, with thematic analysis undertaken for open-ended questions.</p><p><strong>Results: </strong>In total 328 responses were received, primarily from Australia (n=275) and New Zealand (n=53). Respondents were predominantly from the public sector (62%), with 65% having more than 10 years of experience. While nearly all recognised the importance of aseptic technique for infection prevention, considerable variation was evident in how principles were described and applied. Terminology such as 'clean', 'sterile' and 'aseptic' was commonly misunderstood, and 48% of participants were unsure if their facility used a framework to guide aseptic technique. Less than half (47.2%) of nurses reported being reassessed on their aseptic technique skills in the past 5 years.</p><p><strong>Conclusions: </strong>These findings reveal variability in nurses' understanding and practice of aseptic technique, highlighting opportunities for system-level improvement. Establishing standardised, evidence-based definitions and principles, supported by governance, may strengthen education, policy and clinical practice and promote patient safety. Further research is needed to reach a consensus on these definitions and principles.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359393","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":"Using AI to identify in-hospital falls: a comparative analysis with incident reports and manual chart review.","authors":"Wendy Lm Leurs, Marjolein Groeneveld, Bram Haan, Loes As Lammers, Arthur Ra Bouwman, Carolien Mj van der Linden","doi":"10.1136/bmjoq-2025-003786","DOIUrl":"10.1136/bmjoq-2025-003786","url":null,"abstract":"<p><strong>Introduction: </strong>Falls remain a problem in hospitalised patients, especially in older adults. In-hospital falls occasionally lead to injuries. Currently, the rate of falls in hospitals is monitored using incident reports, which often leads to underreporting. Recently, natural language processing (NLP) models gained interest. In this study, an NLP model (AI algorithm) to detect falls in nursing records was evaluated.</p><p><strong>Methods: </strong>In this retrospective study conducted in a large teaching hospital in the Netherlands, hospitalised patients aged 18 years and older were included. Data were collected from free text in nursing records; all data were manually checked for fall incidents. For comparative analysis, the AI algorithm and incident reports were used. A descriptive comparison of the three different methods is provided by using absolute counts. For analysis, descriptive statistics and an area under the curve (AUC) were calculated. For time efficiency a comparative analysis was performed.</p><p><strong>Results: </strong>76 fallers and 1547 non-fallers with a total of 30 615 nursing records were included. Using manual chart review, a total of 124 falls were identified. The AI algorithm showed good sensitivity (79.8%), good specificity (98.3%), excellent negative predictive value (NPV, 99.9%) and moderate positive predictive value (PPV, 16.4%). Incident reports had a sensitivity of 37.0% and a specificity of 99.9%, with a good PPV and NPV (97.9% and 99.7%, respectively). The AI algorithm had good discriminatory ability with an AUC of 0.891; incident reports had a moderate discriminatory ability with an AUC of 0.685. Utilising the algorithm, only 604 nursing records needed to be manually reviewed to identify 79.2% of all fall incidents, a higher detection rate than that achieved through incident reports (36.8% of all fall incidents). The semi-automated workflow using the AI algorithm requires significantly less time compared with incident reports, with a 92.6% reduction in time.</p><p><strong>Conclusion: </strong>The AI algorithm has a good discriminatory ability to timely detect in-hospital falls. Using this technique, more falls are identified than by using incident reports, while the administrative burden of nursing personnel is reduced. Moreover, it will enable more effective, near real-time preventive measurements.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148326839","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":"Value operating system: a practical framework to measure outcomes-per-cost at the episode level.","authors":"Bruno Fuchs, Bettina Vogel, Gabriela Studer, Philip Heesen","doi":"10.1136/bmjoq-2025-004073","DOIUrl":"10.1136/bmjoq-2025-004073","url":null,"abstract":"<p><strong>Objective: </strong>To specify a value operating system (VOS) and its executable metric-the Value Index (VI)-that expresses risk-adjusted outcomes-per-episode-cost on a 0-100 scale with 95% CIs, including transparency guardrails and equity checks, and to outline two prospective exemplars for clinical deployment.</p><p><strong>Design: </strong>Methods framework with prospective service evaluation and a predefined sensitivity plan (weight-elicitation variants; alternative risk models; cost-driver decomposition and subgroup equity).</p><p><strong>Setting: </strong>Hospital-based integrated practice unit with hub-and-spoke pathways for sarcoma care; real-world-time data flows.</p><p><strong>Participants: </strong>All consecutive episodes within the sarcoma care cycle eligible for routine audit (diagnosis through follow-up), without additional sampling beyond standard care.</p><p><strong>Interventions: </strong>(1) Cross-cycle optimisation versus intensification of preoperative therapy using VI to compare alternative pathways; (2) causal machine learning-assisted targeting of radiotherapy, using VI to evaluate net value in treated patients compared with candidates identified through the benefit model.</p><p><strong>Main outcome measures: </strong>Primary: VI (0-100) with 95% CIs. Secondary: component outcome and cost scores; cost-driver decomposition; data completeness/latency; subgroup equity.</p><p><strong>Results: </strong>We define the VOS architecture, VI formulation, uncertainty treatment and governance guardrails (prospective registration, transparency of component scores/weights, equity checks and antigaming rules). We provide operational playbooks for both exemplars, including reporting templates and a priori sensitivity analyses to ensure interpretability and comparability over time and across subgroups.</p><p><strong>Conclusions: </strong>VOS/VI deliver an auditable, episode-level value signal that links outcomes meaningful to patients with the full episode cost, enabling clinical teams to iteratively redesign pathways while maintaining stewardship. The prospective evaluations will test usability, fairness and impact on cost-drivers, supporting scale-up and value-aligned contracting.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148326833","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":"'The evidence is out there…': perspectives of healthcare providers on improving asthma and COPD prevention and care within a major health authority region of British Columbia, Canada.","authors":"Tina Afshar, Aneisha Collins-Fairclough, Pat Camp, Karen Rideout, Erin Shellington, Nardia Strydom, J Mark FitzGerald, Sian Hoe Cheong, Mary-Frances Ceccato, John Fleetham, Carmen Rempel, Phalgun Joshi, Christopher Carlsten","doi":"10.1136/bmjoq-2026-004189","DOIUrl":"10.1136/bmjoq-2026-004189","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma and chronic obstructive pulmonary disease (COPD) impose substantial morbidity and health system burden in Canada. Within Vancouver Coastal Health (VCH), a large and geographically diverse health authority in British Columbia, variation in service availability, access and care coordination creates barriers to prevention and high-quality chronic respiratory disease management. This project sought to document healthcare professionals' (HCPs') experiences and recommendations to inform a regional strategy to improve asthma and COPD care.</p><p><strong>Methods: </strong>We conducted a qualitative quality improvement project using occupation-specific virtual focus groups (March to September 2021) with HCPs involved in asthma and COPD prevention and care across VCH. Purposive sampling targeted diversity in profession, practice setting and geography (urban, suburban, rural and remote). Results were analysed thematically in NVivo using iterative coding and team-based refinement.</p><p><strong>Results: </strong>54 HCPs participated across 10 focus groups, including respiratory physicians (n=9), respiratory therapists (n=19), family physicians (n=11), nurse practitioners (n=2), nurses (n=7), pharmacists (n=6) and one registered dietitian (n=1). Themes aligned with a socio-ecological framework and spanned (1) patient-level barriers (financial insecurity, language barriers, comorbid mental health and substance use, medication beliefs and adherence, smoking and vaping), (2) health system barriers (limited access to spirometry and pulmonary rehabilitation, fragmented transitions and unlinked electronic records, workforce and resource constraints) and (3) environmental barriers (medication coverage and formulary restrictions, poor air quality as an exacerbation trigger). HCPs recommended expanding community-based services (including mobile diagnostics and rehabilitation), strengthening prevention and cessation supports, improving medication access and inhaler education, and building integrated pathways and information systems to support continuity across settings.</p><p><strong>Conclusions: </strong>Frontline HCP perspectives identify actionable, system-level opportunities to improve asthma and COPD prevention and care within a complex health authority. This work provides implementation-oriented insights to inform regional strategy and offers a replicable approach for engaging HCPs to strengthen chronic respiratory care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148326662","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}