BMJ Quality & Safety最新文献

{"title":"Grand rounds in methodology: improving the design of staggered implementation cluster randomised trials.","authors":"Samuel I Watson, Richard Hooper","doi":"10.1136/bmjqs-2025-018697","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018697","url":null,"abstract":"<p><p>The stepped-wedge cluster randomised trial is a popular design in implementation and health services research. All clusters, such as clinics or hospitals, start in the control state, and gradually switch over to treatment in a random order until all clusters have received the intervention. The design allows for the incorporation of an experiment into the gradual roll-out of an intervention across clusters. However, the traditional stepped-wedge layout may not be the best choice in many scenarios. In this article, we discuss modifications to the stepped-wedge design that maintain a staggered roll-out, but which may improve some key characteristics. We consider improving the timing of implementation periods, reducing the volume of data collection and allowing for the recruitment of clusters over the course of the trial.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to de-implementation of low-value cancer screening practices: a narrative review.","authors":"Jennifer H LeLaurin, Kathryn Pluta, Wynne E Norton, Ramzi G Salloum, Naykky Singh Ospina","doi":"10.1136/bmjqs-2025-018558","DOIUrl":"10.1136/bmjqs-2025-018558","url":null,"abstract":"<p><p>The continued use of low-value cancer screening practices not only represents healthcare waste but also a potential cascade of invasive diagnostic procedures and patient anxiety and distress. While prior research has shown it takes an average of 15 years to implement evidence-based practices in cancer control, little is known about how long it takes to de-implement low-value cancer screening practices. We reviewed evidence on six United States Preventive Services Task Force 'Grade D' cancer screening practices: (1) cervical cancer screening in women<21 years and >65 years, (2) prostate cancer screening in men≥70 years and (3) ovarian, (4) thyroid, (5) testicular and (6) pancreatic cancer screening in asymptomatic adults. We measured the time from a landmark publication supporting the guideline publication and subsequent de-implementation, defined as a 50% reduction in the use of the practice in routine care. The pace of de-implementation was assessed using nationally representative surveillance systems and peer-reviewed literature from the USA. We found the time to de-implementation of cervical cancer screening was 4 years for women<21 and 16 years for women>65. Prostate screening in men ≥70 has not reached a 50% reduction in use since the 2012 guideline release. We did not identify sufficient evidence to measure the time to de-implementation for ovarian, thyroid, testicular and pancreatic cancer screening in asymptomatic adults. Surveillance of low-value cancer screening is sparse, posing a clear barrier to tracking the de-implementation of these screening practices. Improving the systematic measurement of low-value cancer control practices is imperative for assessing the impact of de-implementation on patient outcomes, healthcare delivery and healthcare costs.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"547-555"},"PeriodicalIF":5.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/bmjqs-2025-018959","DOIUrl":"10.1136/bmjqs-2025-018959","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"e1"},"PeriodicalIF":5.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency and preventability of adverse drug events in the outpatient setting.","authors":"Rachel L Wasserman, Heba H Edrees, Mary G Amato, Diane L Seger, Michelle L Frits, Andrew Y Hwang, Christine Iannaccone, David W Bates","doi":"10.1136/bmjqs-2024-017098","DOIUrl":"10.1136/bmjqs-2024-017098","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist regarding adverse drug events (ADEs) in the outpatient setting. The objective of this study was to determine the incidence, severity, and preventability of ADEs in the outpatient setting and identify potential prevention strategies.</p><p><strong>Methods: </strong>We conducted an analysis of ADEs identified in a retrospective electronic health records review of outpatient encounters in 2018 at 13 outpatient sites in Massachusetts that included 13 416 outpatient encounters in 3323 patients. Triggers were identified in the medical record including medications, consultations, laboratory results, and others. If a trigger was detected, a further in-depth review was conducted by nurses and adjudicated by physicians to examine the relevant information in the medical record. Patients were included in the study if they were at least 18 years of age with at least one outpatient encounter with a physician, nurse practitioner or physician's assistant in that calendar year. Patients were excluded from the study if the outpatient encounter occurred in outpatient surgery, psychiatry, rehabilitation, and paediatrics.</p><p><strong>Results: </strong>In all, 5% of patients experienced an ADE over the 1-year period. We identified 198 ADEs among 170 patients, who had a mean age of 60. Most patients experienced one ADE (87%), 10% experienced two ADEs and 3% experienced three or more ADEs. The most frequent drug classes resulting in ADEs were cardiovascular (25%), central nervous system (14%), and anti-infective agents (14%). Severity was ranked as significant in 85%, 14% were serious, 1% were life-threatening, and there were no fatal ADEs. Of the ADEs, 22% were classified as preventable and 78% were not preventable. We identified 246 potential prevention strategies, and 23% of ADEs had more than one prevention strategy possibility.</p><p><strong>Conclusions: </strong>Despite efforts to prioritise patient safety, medication-related harms are still frequent. These results underscore the need for further patient safety improvement in the outpatient setting.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"499-506"},"PeriodicalIF":5.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A realist review of how, why, for whom and in which contexts quality improvement in healthcare impacts inequalities.","authors":"Lucy Lara Johnson, Geoff Wong, Isla Kuhn, Graham P Martin, Anuj Kapilashrami, Laura Lennox, Georgia Bell Black, Matthew Hill, Ryan Swiers, Hashum Mahmood, Linda Jones, Jude Beng, John Ford","doi":"10.1136/bmjqs-2024-017386","DOIUrl":"10.1136/bmjqs-2024-017386","url":null,"abstract":"<p><strong>Introduction: </strong>Quality improvement (QI) is aimed at improving care. Equity is one of the six domains of healthcare quality, as defined by the Institute of Medicine. If this domain is ignored, QI projects have the potential to maintain or even worsen inequalities.</p><p><strong>Aims and objectives: </strong>We aimed to understand why, how, for whom and in which contexts QI approaches increase, or do not change health inequalities in healthcare organisations.</p><p><strong>Methods: </strong>We conducted a realist review by first developing an initial programme theory, then searching MEDLINE, Embase, CINAHL, PsychINFO, Web of Science and Scopus for QI projects that considered health inequalities. Included studies were analysed to generate context-mechanism-outcome configurations (CMOCs) and develop an overall programme theory.</p><p><strong>Results: </strong>We screened 6259 records. Thirty-six records met our inclusion criteria, the majority of which were from the USA. We developed CMOCs covering four clusters: values and understanding, resources, data, and design. Five of these described circumstances in which QI may increase inequalities and 15 where it may reduce inequalities. We found that QI projects that are values-led and incorporate diverse, patient-led data into design are more likely to address health inequalities. However, when staff and patients cannot engage fully with equity-focused projects, due to practical or technological barriers, QI projects are more likely to worsen inequalities.</p><p><strong>Conclusions: </strong>The potential for QI projects to positively impact inequalities depends on embedding equity-focused values across organisations, ensuring sufficient and appropriate resources are provided to staff delivering QI, and using diverse disaggregated data alongside considered user involvement to inform and assess the success of QI projects. Policymakers and practitioners should ensure that QI projects are used to address inequalities.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"537-546"},"PeriodicalIF":5.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practitioners retiring or relocating and its association with healthcare use and mortality: a cohort study using Norwegian national data.","authors":"Kristin Hestmann Vinjerui, Andreas Asheim, Kjartan Sarheim Anthun, Fredrik Carlsen, Bente Prytz Mjølstad, Sara Marie Nilsen, Kristine Pape, Johan Håkon Bjørngaard","doi":"10.1136/bmjqs-2023-017064","DOIUrl":"10.1136/bmjqs-2023-017064","url":null,"abstract":"<p><strong>Background: </strong>Continuity in the general practitioner (GP)-patient relationship is associated with better healthcare outcomes. However, few studies have examined the impact of permanent discontinuities on all listed patients when a GP retires or relocates.</p><p><strong>Aim: </strong>To investigate changes in the Norwegian population's overall healthcare use and mortality after discontinuity due to Regular GPs retiring or relocating.</p><p><strong>Methods: </strong>Linking national registers, we compared days with healthcare use and mortality for matched individuals affiliated with Regular GPs who retired or relocated versus continued. We included list patients 3 years prior to exposure and followed them up to 5 years after. We assessed changes over time employing a difference-in-differences design with Poisson regression.</p><p><strong>Results: </strong>From 2011 to 2020, we identified 819 Regular GPs retiring and 228 moving, affiliated with 1 165 295 people. Relative to 3 years before discontinuity, the rate ratio (RR) of daytime GP contacts, increased 3% (95% CI 2 to 4) in year 1 after discontinuity, corresponding to 148 (95% CI 54 to 243) additional contacts per 1000 patients. This increase persisted for 5 years. Out-of-hours GP contacts increased the first year, RR 1.04 (95% CI 0.99 to 1.09), corresponding to 16 (95% CI -5 to 37) contacts per 1000 patients. Planned hospital contacts increased 3% (95% CI 2 to 4) in year 1, persisting into year 5. Acute hospital contacts increased 5% (95% CI 3 to 7), primarily in the first year. These 1-year effects corresponded to 51 (95% CI 18 to 83) planned and 13 (95% CI 7 to 18) acute hospital contacts per 1000 patients. Mortality was unchanged up to 5 years after discontinuity.</p><p><strong>Conclusion: </strong>Regular GPs retirement and relocation were associated with small to moderate increases in healthcare use among listed patients, while mortality was unaffected.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"520-528"},"PeriodicalIF":5.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Under-reporting of falls in hospitals: a multisite study in South Korea.","authors":"Insook Cho, Joon-Myoung Kwon, Whasuk Choe, Jiseon Cho, Sook Hyun Park, David W Bates","doi":"10.1136/bmjqs-2024-017993","DOIUrl":"10.1136/bmjqs-2024-017993","url":null,"abstract":"<p><strong>Background: </strong>Inpatient falls are adverse events that often result in injury due to complex interactions between the hospital environment and patient risk factors and remain a significant problem in clinical settings.</p><p><strong>Objectives: </strong>This study aimed to identify (1) practice variations and key issues ranging from hospital fall management protocols to incident detection, and (2) potential approaches to address these challenges.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Four general hospitals in South Korea.</p><p><strong>Methods: </strong>Qualitative and quantitative data were analysed using the Donabedian quality outcomes model. Data were collected retrospectively during 2015-2023 from four general hospitals on local practice protocols, patient admission and nursing data from electronic records, and incident self-reports. Content analysis of practice protocol and manual chart reviews for hospital falls incidents was conducted at each site. Quantitative analyses of nursing activities and analysis of patient falls prevention interventions were also conducted at each site.</p><p><strong>Results: </strong>There were variations in fall definitions, risk-assessment tools and inclusion and exclusion criteria among the local fall management protocols. The original and modified versions of the heuristic tools performed poorly to moderately, with areas under the receiver operating characteristic curve of 0.54~0.74 and 0.59~0.80, respectively. Preventive intervention practices varied significantly among the sites, with risk-targeted and tailored interventions delivered to only 1.15%~49.5% of at-risk patients. Fall events were not recorded in self-reporting systems and nursing notes for 29.5%~90.6% and 4.4%~17.1% of patients, respectively.</p><p><strong>Conclusion: </strong>Challenges in fall prevention included weaknesses in the design and implementation of local fall protocols and low-quality incident self-reporting systems. Systematic and sustainable solutions are needed to help reduce hospital fall rates and injuries.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"491-498"},"PeriodicalIF":5.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why hospital falls prevention remains a global healthcare priority.","authors":"Meg E Morris","doi":"10.1136/bmjqs-2025-018760","DOIUrl":"10.1136/bmjqs-2025-018760","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"489-490"},"PeriodicalIF":5.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic evaluations of quality improvement interventions: towards simpler analyses and more informative publications.","authors":"Teryl K Nuckols","doi":"10.1136/bmjqs-2024-018349","DOIUrl":"10.1136/bmjqs-2024-018349","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"557-562"},"PeriodicalIF":5.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the Patient-Reported Indicator Surveys (PaRIS) conceptual framework to monitor and improve the performance of primary care for people living with chronic conditions.","authors":"Jose M Valderas, Ian Porter, Jimmy Martin-Delgado, Mieke Rijken, Judith de Jong, Oliver Groene, Janika Bloemeke-Cammin, Rosa Sunol, Rachel Williams, Marta Ballester, Katherine de Bienassis, Candan Kendir, Frederico Guanais, Dolf de Boer, Michael van den Berg","doi":"10.1136/bmjqs-2024-017301","DOIUrl":"10.1136/bmjqs-2024-017301","url":null,"abstract":"<p><p>BackgroundThe Organisation for Economic Co-operation and Development (OECD) Patient-Reported Indicator Surveys (PaRIS) initiative aims to support countries in improving care for people living with chronic conditions by collecting information on how people experience the quality and performance of primary and (generalist) ambulatory care services. This paper presents the development of the conceptual framework that underpins the rationale for and the instrumentation of the PaRIS survey.</p><p><strong>Methods: </strong>The guidance of an international expert taskforce and the OECD Health Care Quality Indicators framework (2015) provided initial specifications for the framework. Relevant conceptual models and frameworks were then identified from searches in bibliographic databases (Medline, EMBASE and the Health Management Information Consortium). A draft framework was developed through narrative review. The final version was codeveloped following the participation of an international Patient advisory Panel, an international Technical Advisory Community and online international workshops with patient representatives.</p><p><strong>Results: </strong>85 conceptual models and frameworks were identified through searches. The final framework maps relationships between the following domains (and subdomains): patient-reported outcomes (symptoms, functioning, self-reported health status, health-related quality of life); patient-reported experiences of care (access, comprehensiveness, continuity, coordination, patient safety, person centeredness, self-management support, trust, overall perceived quality of care); health and care capabilities; health behaviours (physical activity, diet, tobacco and alcohol consumption), sociodemographic characteristics and self-reported chronic conditions; delivery system characteristics (clinic, main healthcare professional); health system, policy and context.</p><p><strong>Discussion: </strong>The PaRIS conceptual framework has been developed through a systematic, accountable and inclusive process. It serves as the basis for the development of the indicators and survey instruments as well as for the generation of specific hypotheses to guide the analysis and interpretation of the findings.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"529-536"},"PeriodicalIF":5.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}