BMJ Quality & Safety最新文献

{"title":"Digital quality measure of potentially avoidable emergency presentations among patients with colorectal cancer.","authors":"Natalia Khalaf, Basim Ali, Andrew Zimolzak, Yan Liu, Li Wei, Fasiha Kanwal, Hardeep Singh","doi":"10.1136/bmjqs-2025-019084","DOIUrl":"10.1136/bmjqs-2025-019084","url":null,"abstract":"<p><strong>Background: </strong>We previously developed a digital quality measure (dQM) of emergency presentations (EPs) in colorectal cancer (CRC) and found it to be associated with worse outcomes. Potentially avoidable EPs were common in this cohort, but identifying them required time-intensive chart reviews. We aimed to enhance the existing dQM to automate the detection of potentially avoidable EPs.</p><p><strong>Materials and methods: </strong>We defined potentially avoidable EPs as those preceded by a CRC red flag (iron-deficiency anaemia or haematochezia ≥60 days prior, or positive stool-based screening test ≥180 days prior). The enhanced dQM was applied to a national cohort of incident CRC cases diagnosed in the Veterans Affairs healthcare system from 2017 to 2021. We examined associations with cancer stage, treatment and mortality.</p><p><strong>Results: </strong>The enhanced dQM had a positive predictive value of 92% (95% CI 85.5% to 95.7%) for identifying potentially avoidable EPs. Among 9096 CRC cases, 28.1% were identified as EPs. Of these, 31.6% were classified as potentially avoidable. These patients were more likely to have advanced-stage disease (adjusted OR 1.50; 95% CI 1.27 to 1.78), less likely to receive treatment (adjusted OR 0.58; 95% CI 0.48 to 0.70) and had higher mortality (adjusted HR 1.58; 95% CI 1.40 to 1.79) compared with other patients with CRC.</p><p><strong>Conclusions: </strong>The enhanced dQM accurately identified potentially avoidable EPs, which were associated with worse outcomes. This measure is unique in its focus on cases of preventable care delays, which can help guide future efforts to improve diagnostic timeliness and reduce EPs among patients with CRC.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197824","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":"Less continuity with more complaints: a repeated cross-sectional study of the association between relational continuity of care and patient complaints in English general practice.","authors":"Jinyang Chen, Panos Kasteridis, Zecharias Anteneh, Sheila Greenfield, Fiona Scheibl, Kamil Sterniczuk, Brian H Willis, Iestyn Williams, Tom Marshall","doi":"10.1136/bmjqs-2025-018989","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018989","url":null,"abstract":"<p><strong>Objective: </strong>Relational continuity of care is associated with better patient experience and health outcomes. In England, relational continuity of primary care has been declining over a decade, coinciding with an increase in patient complaints. This study investigates the relationship between relational continuity of care and patient complaints.</p><p><strong>Methods: </strong>Cross-sectional analysis of linked practice-level data in the English National Health Service (NHS) (2016/2017-2022/2023) obtained from NHS Digital and General Practice Patient Survey (GPPS). A negative binomial model was used to investigate the association between the proportion of patients never or almost never seeing their preferred general practitioner (GP) and new written complaints per 10 000 patients, with adjustment for patient demographics, socioeconomic status, care experiences, practice care capacity and care quality. Mediation analysis was further conducted to examine patients' lost trust and unmet clinical needs as potential mechanisms.</p><p><strong>Results: </strong>A 10 percentage point increase in the proportion of patients reporting low continuity was associated with 1.34 more new complaints per 10 000 patients (95% CI 1.23 to 1.46). The association may be stronger after than before the pandemic, among general practices with historically better continuity, and in more deprived areas. The findings were robust in using different measures of relational continuity, adjusting for primary case demand-supply mismatches, implementing a Poisson model with practice fixed effects and excluding ethnicity from the model specification. Mediation analysis showed that neither lost trust nor unmet care needs were important mediators of the effects of low continuity.</p><p><strong>Conclusion: </strong>Self-reported low continuity of primary care is associated with more patient complaints in England. Future research should explore potential underlying mechanisms and establish whether the same relationship exists between objectively measured relational continuity and patient complaints.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243712","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":"Widespread inappropriate prescribing for older people with reduced kidney function: what are the harms and how do we tackle them? A scoping review for primary care.","authors":"Owen Thomas, Liz Glidewell, Sarah Alderson, David K Raynor, Su Wood","doi":"10.1136/bmjqs-2025-018736","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018736","url":null,"abstract":"<p><strong>Background: </strong>Increasing age is associated with reductions in kidney function and increasing polypharmacy. Most medicines are eliminated through the kidney, meaning older patients are at risk of medication accumulation and toxicity. This scoping review synthesised: (1) the prevalence at which older patients with reduced kidney function in primary care are exposed to inappropriate prescribing; (2) its associated harms; (3) the reasons for this occurring; and (4) the interventions used to improve prescribing practices.</p><p><strong>Methods: </strong>This scoping review searched 'Medline', 'Embase', 'PsycINFO', 'CINAHL' and 'Web of Science' for publications before October 2024. References were managed on EndNote V.X5 and thematic data analysis was undertaken on Microsoft Excel. Common themes were identified, summary statistics were calculated and insights were summarised through a narrative technique.</p><p><strong>Results: </strong>43 relevant studies explored the scale of inappropriate prescribing, estimating prevalences of patient exposure ranging from 0.6% to 49.1% (median 24.9%). Five studies explored the associated harm from inappropriate prescribing, but only one study assessed harm as a primary outcome. Eight studies that assessed difficulties in following prescribing guidelines in reduced kidney function suggested that a lack of awareness and trusted guidelines are fundamental problems. While 13 studies evaluated interventions for improving prescribing in reduced kidney function, only two demonstrated evidence of effectiveness and only one intervention was theoretically informed.</p><p><strong>Conclusions: </strong>Despite significant heterogeneity in study characteristics, it is clear that the prevalence of inappropriate prescribing for older people is uncomfortably high. There is a lack of evidence linking this to associated adverse outcomes, as well as identifying the causative issues driving this behaviour and the preventative interventions that could prevent harm.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243659","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":"Advancing AI in healthcare: three strategic roles for quality and safety leaders.","authors":"Jeffrey Rakover, Marina Lynne Renton, Pierre Barker, Gareth Kantor","doi":"10.1136/bmjqs-2025-019050","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019050","url":null,"abstract":"","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231444","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":"Barriers and facilitators to reducing overuse of thyroid function testing: a mixed-methods study.","authors":"Annabel Jane Chapman, Aneesa Khan, Jordyn Thompson, Vernon Curran, Jessica Otte, Sana Ghaznavi, Greg Carney, Kate Campbell, Vivian Lam, Caldon Saunders, Ken Bassett, Colin Dormuth, I Fan Kuo, Anshula Ambasta","doi":"10.1136/bmjqs-2025-019042","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019042","url":null,"abstract":"<p><strong>Background: </strong>Thyroid function laboratory testing is often overused. Tailored de-implementation interventions require an understanding of underlying barriers and facilitators contributing to overuse.</p><p><strong>Methods: </strong>We performed a mixed-methods study exploring barriers and facilitators of appropriate thyroid function testing using surveys and focus groups conducted between June and October 2023 in British Columbia, Canada. Quantitative survey data were summarised using simple statistics, and open-ended survey questions were summarised using summative content analysis. Focus group transcripts were analysed using thematic analysis. Key themes were mapped onto the combined Theoretical Domains Framework and Capability, Opportunity, Motivation-Behaviour model.</p><p><strong>Results: </strong>230 practitioners completed the survey (1.4% response rate), and 53 practitioners attended a total of six focus groups. Three themes emerged around barriers from synthesising the results: patient expectations, practitioner knowledge gaps and health system factors. Patient expectations were linked to non-specific symptoms, recommendations from alternate care providers, increased interest in hormone testing and internet searches, leading to patient requests for more testing and/or referrals to specialists. Knowledge gaps included use of specialised tests, interpretation of free hormone results, frequency of thyroid testing and screening in asymptomatic, pregnant and postpartum patients. Health system barriers included lack of practitioner time, lack of family doctors leading more patients to seek care from alternative providers, existing order sets and ordering processes, and existing culture of ordering practices. Identified facilitators of behaviour change towards appropriate thyroid testing included educational resources for practitioners and patients, leveraging of health information systems for seamless viewing of prior test results, reflexive testing and provision of personalised practitioner feedback.</p><p><strong>Conclusions: </strong>Interventions to reduce overutilisation of thyroid testing should include easily accessible physician educational and feedback resources, patient educational materials and changes to laboratory ordering processes and information systems. Future studies should develop and evaluate the use of these intervention elements in British Columbia.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231484","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":"Understanding factors influencing sustainability and sustainment of evidence-based bronchiolitis management of infants in Australian and New Zealand hospital settings: a qualitative process evaluation.","authors":"Victoria Ramsden, Franz E Babl, Libby Haskell, Catherine Wilson, Elizabeth McInnes, Sandy Middleton, Lisa Kuhn, Alexandra Wallace, Elyssia Bourke, Faye Jordan, Julian Wong, Kai Steinmann, Lauren Shumack, Lisa Kane, Natalie Phillips, Paige Marsh, Shefali Jani, Trevor Kuang, Yvonne Janiszewski, Ed Oakley, Anna Lithgow, Peter Wilson, Rachel Schembri, Stuart Dalziel, Emma Tavender","doi":"10.1136/bmjqs-2025-019007","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019007","url":null,"abstract":"<p><strong>Background: </strong>The 2017 Paediatric Research in Emergency Departments International Collaborative (PREDICT) Bronchiolitis Knowledge Translation (KT) Study, a cluster randomised trial in 26 Australasian hospitals, found targeted interventions provided over one bronchiolitis season effectively de-implemented five low-value practices (salbutamol, glucocorticoids, chest radiography, antibiotics and epinephrine) by 14.1% (adjusted risk difference, 95% CI 6.5% to 21.7%; p<0.001). A 2-year follow-up study found de-implementation was sustained. This process evaluation aimed to identify factors that influenced sustainability of de-implementation of these five low-value practices in PREDICT Bronchiolitis KT Study intervention hospitals and examine fidelity and/or adaptation of the targeted interventions over 4 years post intervention delivery (sustainment).</p><p><strong>Methods: </strong>Semistructured qualitative interviews were conducted, over 2021 and 2022, with a purposive sample of emergency department (ED) and paediatric inpatient clinicians. Data were analysed thematically into facilitators and barriers using the Consolidated Framework for Sustainability Constructs in Healthcare (CFSCH). The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies was used to explore fidelity and adaptation.</p><p><strong>Results: </strong>50 clinicians (nurses: n=26; doctors: n=24) from 12 intervention hospitals were interviewed. Eight themes were identified and mapped to three CFSCH domains: (1) organisational setting; (2) initiative design and delivery and (3) people involved. Facilitators were a culture of evidence-based practice, ongoing multimodal education, strong clinical leadership as unofficial champions and the previous effectiveness of the PREDICT Bronchiolitis KT Study interventions. Barriers were lack of paediatric trained ED staff, assumptions by senior clinicians that junior doctors can provide evidence-based bronchiolitis management, bronchiolitis not a current improvement priority and lack of bronchiolitis education sessions. Use of the targeted interventions reduced over time and, when used, was adapted locally.</p><p><strong>Conclusion: </strong>This study provides insights into factors influencing the sustainability of de-implementation of low-value care in acute care settings. Fostering an evidence-based practice culture, supported by senior leadership and ongoing multimodal education, supports sustainability of improvements in this setting.</p><p><strong>Trial registration number: </strong>Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231514","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":"Evaluating the impact of a collaborative quality initiative on surgical disparities: a retrospective analysis of surgical outcomes.","authors":"Erin Isenberg, Shukri Dualeh, Nicholas Kunnath, Andrew Ibrahim, Michael Thompson, Michael Englesbe, Calistah M Harbaugh","doi":"10.1136/bmjqs-2025-018893","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018893","url":null,"abstract":"<p><strong>Background: </strong>Collaborative quality initiatives (CQIs), such as the Michigan Surgical Quality Collaborative (MSQC), have invested significant resources to improve surgical outcomes over time. This study aimed to assess whether CQI efforts translated to equitable improvements for vulnerable and non-vulnerable patients alike.</p><p><strong>Methods: </strong>We performed a retrospective observational study of patients who underwent an operation at one of 73 MSQC hospitals between 2014 and 2023. The coprimary exposures were the Distressed Communities Index (DCI), race and payer. DCI is a community index at the zip code level ranging from prosperous to distressed based on socioeconomic variables. Outcomes included 30-day complications, emergency department (ED) visits and readmissions, estimated using a logistic regression model adjusting for patient and hospital characteristics.</p><p><strong>Results: </strong>Among 344 135 patients, the mean age (SD) was 54.7 (17.6) years and 50.7% were female. From 2014 to 2023, 30-day complications decreased for all groups stratified by DCI, race and payer. There was a disparity in complications between public versus privately insured patients (11.4% vs 9.2%, p<0.001) that significantly narrowed by the end of the study period (7.3% vs 6.6%, p=0.01). ED visits demonstrated baseline disparities by DCI (10.5% vs 7.5%, p<0.001), payer (11.1% vs 6.7%, p<0.001) and race (11.0% vs 8.2%, p<0.001). The disparity significantly narrowed by payer only (9.5% vs 6.4%, p<0.001). Readmissions decreased for all groups stratified by DCI, race and payer, but there were no significant changes in the disparities over time.</p><p><strong>Conclusions: </strong>Our study examining surgical outcomes for a statewide CQI found that disparities in outcomes narrowed over time. Quality collaboratives may effectively improve equity in surgical outcomes, but specific attention to persistent disparities is needed to close remaining gaps.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231449","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":"Impact of medical safety huddles on patient safety: a stepped-wedge cluster randomised study.","authors":"Meiqi Guo, Mark Bayley, Xiang Y Ye, Richard Dunbar-Yaffe, Chris Fortin, Katharyn Go, Alyssa Macedo, John Matelski, Amanda Mayo, Jordan Pelc, Lawrence R Robinson, Leahora Rotteau, Jesse Wolfstadt, Peter Cram, Lauren Linett, Christine Soong","doi":"10.1136/bmjqs-2025-019170","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019170","url":null,"abstract":"<p><strong>Background: </strong>Medical safety huddles are short, structured meetings for physicians to proactively discuss and respond to profession-specific patient safety concerns, with the goal of decreasing future adverse events. Prior observational studies found associations with improved patient safety outcomes, but no randomised controlled studies have been conducted.</p><p><strong>Objective: </strong>The primary objective was to determine the impact of medical safety huddles on adverse events. Secondary objectives included the fidelity of huddle implementation and the impact on patient safety culture among physicians.</p><p><strong>Design: </strong>Stepped-wedge cluster randomised trial with four sequences, and each hospital site was a cluster.</p><p><strong>Setting: </strong>Inpatient oncology, surgery and rehabilitation programmes in four academic hospitals.</p><p><strong>Participants: </strong>Physicians in participating programmes.</p><p><strong>Intervention: </strong>Medical safety huddles were adapted for local context and implemented sequentially based on a computer-generated random sequence every 2 months after a 4-month control period. All sites remained in the intervention phase for at least 9 months.</p><p><strong>Main outcome and measures: </strong>The primary outcome was the rate of adverse events, as determined through blinded chart audits of 912 randomly selected patients. The fidelity of implementation was assessed through the huddle attendance rate, number of safety issues raised in the huddles and number of actions taken in response. Patient safety culture was assessed using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety.</p><p><strong>Results: </strong>The adjusted rate of adverse events (per 1000 patient days) in the postintervention phase was 12% lower compared with preintervention (RR: 0.88; 95% CI: 0.80 to 0.98; p=0.016). The odds of having adverse events posthuddle implementation were 17% lower in the postintervention period compared with preintervention (OR intervention vs control: 0.83; 95% CI: 0.80 to 0.87; p<0.001). The mean huddle attendance rate at each site ranged from 30% to 85%, and the mean number of issues raised per huddle and the mean number of actions taken per huddle ranged from 1.6 to 3.1. The mean (SD) overall patient safety rating increased from 2.3 (0.53) to 2.8 (0.88), p=0.010. The mean per cent (SD) positive score for the composite measures of 'Organisational learning' increased significantly from 35% (26%) to 54% (23%), p=0.00, 'Response to error' 37% (24%) to 52% (22%), p=0.025 and 'Communication about error' 36% (28%) to 64% (42%), p=0.016 after implementation.</p><p><strong>Conclusions and relevance: </strong>Medical safety huddles decreased adverse events and may improve patient safety culture through engaging physicians.</p><p><strong>Trial registration number: </strong>NCT05365516.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197851","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":"Factors associated with well-being and burnout among US internal medicine physicians: a cross-sectional survey.","authors":"Nathan Houchens, M Todd Greene, Srijan Sen, Elizabeth Harry, David Ratz, Karen E Fowler, Sanjay Saint","doi":"10.1136/bmjqs-2025-018813","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018813","url":null,"abstract":"<p><strong>Objective: </strong>Because physician burnout negatively affects patients, organisations and those impacted, we aimed to identify and evaluate factors contributing to burnout among internal medicine physicians in the USA.</p><p><strong>Design: </strong>Cross-sectional survey conducted between 23 June 2023 and 8 May 2024.</p><p><strong>Setting: </strong>A national multicentre study conducted in the USA.</p><p><strong>Participants: </strong>Random sample of non-subspecialty internal medicine physicians identified through Physician Professional Data, a database maintained by the American Medical Association. Of 1421 eligible physicians, 629 (44.3%) responded.</p><p><strong>Main outcome measures: </strong>The 42-item survey collected data on multiple factors-professional environment, community and personal-hypothesised to influence well-being. Burnout domains, including emotional exhaustion, depersonalisation and reduced personal accomplishment, were measured using the Maslach Burnout Inventory-Human Services Survey.</p><p><strong>Results: </strong>A total of 9.8% (61/622) participants had extreme burnout as defined by meeting thresholds for all three burnout domains. In multivariable regression analysis, several aspects of the professional environment (eg, workload, lack of autonomy) were statistically significantly associated with elevated odds of burnout. Community factors statistically significantly associated with reduced odds of burnout included a supervisor who empowers and treats the physician with respect and dignity and greater support from organisational leaders. Mindful awareness and a sense of purpose were statistically significantly inversely associated with odds of burnout.</p><p><strong>Conclusion: </strong>Burnout among US internal medicine physicians is common and influenced by many factors. Interventions to elevate well-being should be multi-faceted and seek to reduce workload, augment autonomy, bolster support and perceptions of value from leaders and co-workers and foster environments conducive to mindful practice and sense of purpose.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181865","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":"International survey of people living with chronic conditions: development and evaluation of the PaRIS Patient Questionnaire (PaRIS-PQ) in 18 countries.","authors":"Jose M Valderas, Ian Porter, Jonathan P Evans, Monique Heijmans, Mieke Rijken, 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-2025-018548","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-018548","url":null,"abstract":"<p><strong>Background: </strong>The Patient Reported Indicator Surveys (PaRIS) initiative of the Organisation for Economic Co-operation and Development aimed to develop a valid and reliable instrument for self-reported assessment of health outcomes and experiences in primary and ambulatory care for people living with chronic conditions. This paper reports on the development and evaluation of the PaRIS Patient Questionnaire (PaRIS-PQ) in an 18-country field trial.</p><p><strong>Methods: </strong>Following systematic reviews of instruments measuring core domains in the PaRIS conceptual framework (outcomes, experiences, health and healthcare capabilities and health behaviours), four instruments for each domain were shortlisted, and their psychometric performance was assessed using the Evaluating the Measurement of Patient-Reported Outcomes tool. In a modified Delphi procedure, one instrument was selected for each domain, along with additional relevant items. The preliminary English questionnaire was translated and cognitively tested. Psychometric evaluation was conducted on field trial data at item (missingness, distribution, ceiling/floor effects) and scale level (reliability, structure, construct validity).</p><p><strong>Findings: </strong>217 instruments were identified measuring one or more of the domains of the conceptual framework. Following mapping and prioritisation, the first draft of the PaRIS-PQ included 118 items. In the field trial (18 countries, 10 894 patients) median completion time ranged 24-33 minutes. PaRIS-PQ performed well at item and scale level. Reliability was ≥0.70 for most relevant measures at patient level, but not at practice and country level. Validity was adequate overall. Removal of additional items (3) resulted in the final PaRIS-PQ (115 items).</p><p><strong>Interpretation: </strong>PaRIS-PQ demonstrates adequate psychometric performance for measuring experiences and outcomes of primary care for people living with chronic conditions. The instrument facilitates the collection of essential information for health policy and systems decision-making.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147749","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}