BMJ Quality & Safety最新文献

{"title":"RECi-PE (REducing CT in Pulmonary Embolism Diagnosis): an emergency department quality intervention.","authors":"Jared S Anderson, Andrew Beck, Janette Baird, Timmy R Lin, Anthony M Napoli","doi":"10.1136/bmjqs-2024-018130","DOIUrl":"10.1136/bmjqs-2024-018130","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) is a potentially deadly disease and a diagnostic challenge in emergency departments (EDs). Established strategies exist for risk stratification and test stewardship for CT pulmonary angiography (CTPA). However, implementation of best practices has proven challenging, and rising CTPA utilisation increases costs, radiation exposure and ED crowding. We created a multimodal quality intervention to reduce excess CTPA studies and increase the use of d-dimer assays prior to CTPA. Balance measures included the rate of positive CTPA studies and ED returns within 72 hours of discharge.</p><p><strong>Methods: </strong>This was an observational, pre-post interventional design at three EDs. The intervention included an institutional PE diagnostic guideline, educational sessions, an electronic clinical decision support tool and monthly feedback to individual providers. Consecutive patient data were analysed 1 year pre and 1 year post an intervention on 21 November 2021. Analyses used Pearson χ², logistic regression generalised linear models and XmR statistical process control (SPC).</p><p><strong>Results: </strong>The study included 307 441 patient encounters, with 35 066 PE evaluations. CTPA utilisation decreased from 6.0% to 5.1% (p<0.01) of all patient encounters, and d-dimer use preceding CTPA increased from 36.6% to 56.3% (p<0.01). For both primary measures, SPC charts showed statistically significant special cause variation compared with the pre-intervention data. There was no significant change in the rate of positive CTPA studies (9.3% vs 10.4%, p=0.14) or 72-hour ED returns (3.0 vs 3.1%, p=0.6).</p><p><strong>Conclusions: </strong>A multimodal intervention was associated with reduced CTPA utilisation and increased use of d-dimer as the initial test in PE diagnosis, without any negative associated impact on balance measures. This strategy could be reproduced and implemented at other institutions looking to change practice.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"758-767"},"PeriodicalIF":6.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599409","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 hospitals' LGBTQ+ inclusion efforts on patient satisfaction from 2016 to 2023: a retrospective longitudinal observational study.","authors":"Hyunmin Yu, Matthew D McHugh, José A Bauermeister, Tari Hanneman, Heather Brom","doi":"10.1136/bmjqs-2024-018235","DOIUrl":"10.1136/bmjqs-2024-018235","url":null,"abstract":"<p><strong>Background: </strong>Given the emphasis on promoting inclusive policies, we investigated the relationship between US hospitals' inclusion efforts for lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender-diverse (LGBTQ+) populations and patient satisfaction from 2016 to 2023.</p><p><strong>Methods: </strong>This retrospective longitudinal observational study analysed 6 years of data between 2016 and 2023 from the Healthcare Equality Index (HEI), which measures hospitals' LGBTQ+ inclusion efforts, and the Hospital Consumer Assessment of Healthcare Providers and Systems, which measures patient satisfaction. Generalised estimating equations (GEE) were used to obtain population-averaged estimates of the association between hospitals' LGBTQ+ inclusion efforts-assessed by (1) their participation and (2) performance in the HEI (range: 0-100)-and patient satisfaction-measured by (1) patients' hospital rating (range: 0-100) and (2) willingness to recommend the hospital (range: 0-100). We accounted for hospital characteristics, including medical teaching status, specialised service capability, hospital size, ownership, system membership, region and metropolitan location.</p><p><strong>Results: </strong>Compared with hospitals that never participated in the HEI, those that occasionally participated reported a 0.33-point higher patient rating (p=0.019, 95% CI 0.05, 0.60) and a 0.49-point higher patient recommendation score (p=0.011, 95% CI 0.11, 0.87). Those who always participated reported a 1.30-point higher rating (p<0.001, 95% CI 0.89, 1.70) and a 1.90-point higher recommendation score (p<0.001, 95% CI 1.36, 2.44). Among hospitals that participated in the HEI, a 10-point increase in the total HEI score was associated with a 0.10-point increase in patient ratings (p=0.031, 95% CI 0.01, 0.20) and a 0.15-point increase in patient recommendations (p=0.023, 95% CI 0.02, 0.28).</p><p><strong>Conclusion: </strong>Hospitals engaging in LGBTQ+ inclusion efforts are associated with higher patient satisfaction.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"718-728"},"PeriodicalIF":6.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572007","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":"Scoping review identifying interventions that have been tested to optimise the experience of people from ethnic minority groups receiving systemic anticancer therapy (SACT).","authors":"Jurga McLean, Pinkie Chambers, Luke Steventon, Susanne Cruickshank, Shereen Nabhani-Gebara","doi":"10.1136/bmjqs-2024-017560","DOIUrl":"10.1136/bmjqs-2024-017560","url":null,"abstract":"<p><strong>Background: </strong>Disparities have been identified in many aspects of the cancer care pathway for people from minority ethnic groups (MEGs). Adherence to systemic anticancer therapies (SACTs) has been shown to impact morbidity and mortality, and therefore, inequitable experiences can have a detrimental effect on outcomes.</p><p><strong>Objectives: </strong>To identify interventions that focused on improving the experiences and clinical outcomes in people from MEG receiving SACT treatments.</p><p><strong>Methods: </strong>A scoping review was conducted according to Arksey and O'Malley's methodological framework to map the available literature. A comprehensive search was performed using three electronic databases (Medline, Embase and CINAHL). Standard scoping review methodology following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was used. Studies were included that assessed interventions to improve MEG patients' experience with SACT. Study types included in the review were evaluation studies, randomised/non-randomised controlled trials and all observational studies. Exclusion criteria were applied to studies including opinion pieces, literature and systematic reviews, non-English studies, conference abstracts and studies that were not describing an intervention. Independent duplicate screening, study selection, data extraction and quality assessment were undertaken. Results of the studies were synthesised using a published equity framework.</p><p><strong>Results: </strong>Searches yielded 1356 articles. Nine studies were included after exclusion criteria were applied. Studies described six digital, two in-person and one hybrid intervention employing different research methodologies, ranging from randomised controlled trials (RCTs), feasibility studies and mixed methods studies. The majority of interventions in this study were delivered remotely, using digital platforms such as websites, recorded educational training materials as well as social media. These interventions were conducted in the USA and primarily targeted patients with early breast cancer from African American backgrounds.</p><p><strong>Conclusions: </strong>This scoping review showed that there has been a very small number of studies investigating interventions to optimise SACT treatment experiences in people from MEG. We found evidence of interventions incorporating the equity domains that reported improved patient engagement and experience. This new knowledge will help to implement future SACT interventions, addressing health inequities across the cancer continuum.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"768-780"},"PeriodicalIF":6.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498929","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":"Psycholinguistic tests predict real-world drug name confusion error rates: a cross-sectional experimental study.","authors":"Bruce L Lambert, Scott Ryan Schroeder, William L Galanter, Gordon D Schiff, Allen J Vaida, Michael J Gaunt, Michelle Bryson Opfermann, Christine Rash Foanio, Suzanne Falck, Nicole Mirea","doi":"10.1136/bmjqs-2024-017688","DOIUrl":"10.1136/bmjqs-2024-017688","url":null,"abstract":"<p><strong>Background: </strong>Wrong-drug medication errors are common. Regulators screen drug names for confusability, but screening methods lack empirical validation. Previous work showed that psycholinguistic tests on <i>pairs</i> of drug names are associated with real-world error rates in chain pharmacies. However, regulators evaluate <i>individual</i> names not <i>pairs</i>, and individual names can be confused with multiple drugs (eg, hydroxyzine with hydralazine but also hydrocet, thorazine, hydrochlorothiazide). This study examines whether an individual drug name's performance on psycholinguistic tests correlates with that name's sum total error rate in the real world.</p><p><strong>Methods: </strong>Nineteen pharmacists and 18 pharmacy technicians completed memory and perception tests assessing confusability of 77 drug names. Tests involved presenting a drug name to participants in conditions that hindered their ability to see, hear or remember the name. Participants typed the name they perceived and selected that name from a menu of alternatives. Error rates on the tests were assessed in relation to real-world rates, as reported by the patient safety organisation associated with a national pharmacy chain in the USA.</p><p><strong>Results: </strong>Mean error rate on the psycholinguistic tests was positively correlated with the log-adjusted real-world error rate (r=0.50, p<0.0001). Linear and mixed effects logistic regression analyses indicated that the lab-measured error rates significantly predicted the real-world error rates and vice versa.</p><p><strong>Conclusions: </strong>Lab-based psycholinguistic tests are associated with real-world drug name confusion error rates. Previous work showed that such tests were associated with error rates of specific look-alike sound-alike <i>pairs</i>, and the current work showed that lab-based error rates are also associated with an <i>individual</i> drug's <i>overall error rate</i>. Taken together, these studies validate the use of psycholinguistic tests in assessing the confusability of proposed drug names.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"729-736"},"PeriodicalIF":6.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555746","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":"Results of a healthcare transition learning collaborative for emerging adults with sickle cell disease: the ST3P-UP study transition quality improvement collaborative.","authors":"Ifeyinwa Osunkwo, Jennifer S Cornette, Laura Noonan, Cheryl Courtlandt, Sarah Mabus, Patience H White, Margaret McManus, Myra M Robinson, Michelle L Wallander, James R Eckman, Elna Saah, Ofelia A Alvarez, Mark Goodwin, Leila Jerome Clay, Payal Desai, Raymona H Lawrence","doi":"10.1136/bmjqs-2024-017725","DOIUrl":"10.1136/bmjqs-2024-017725","url":null,"abstract":"<p><strong>Background: </strong>Individuals with sickle cell disease (SCD) experience poor clinical outcomes while transitioning from paediatric to adult care. Standards for SCD transition are needed. We established a Quality Improvement (QI) Collaborative that aimed to improve the quality of care for all young adults with SCD by establishing a standardised SCD transition process. This study evaluates the implementation of the Six Core Elements (6CE) of Health Care Transition, which was a fundamental component of the cluster-randomised Sickle Cell Trevor Thompson Transition Project (ST3P-UP) study.</p><p><strong>Methods: </strong>A central QI team trained 14 ST3P-UP study sites on QI methodologies, 6CE and Got Transition's process measurement tool (PMT). Site-level QI teams included a transition coordinator, clinic physicians/staff, patients/parents with SCD and community representatives. Sites completed the PMT every 6 months for 54 months and monthly audits of 10 randomly-selected charts to verify readiness/self-care assessments and emergency care plans.</p><p><strong>Results: </strong>Of a possible 100, the aggregate mean (±SD) PMT score for paediatric clinics was 23.9 (±13.8) at baseline, 95.9 (±6.0) at 24 months and 98.9 (±2.1) at 54 months. The aggregate mean PMT score for adult clinics was 15.0 (±13.5) at baseline, 88.4 (±11.8) at 24 months and 95.8 (±6.8) at 54 months. The overall QI Collaborative PMT score improved by 402%. At baseline, readiness/self-care assessments were current for 38% of paediatric and 20% of adult patients; emergency care plans were current for 20% of paediatric and 3% of adult patients. Paediatric clinics had one median readiness assessment shift (76%) and four median emergency care plan shifts (65%, 77%, 79%, 84%). Adult clinics experienced three median self-care assessment shifts (58%, 63%, 70%) and two median emergency care plan shifts (57%, 70%).</p><p><strong>Conclusions: </strong>The ST3P-UP QI Collaborative successfully embedded the 6CE of Health Care Transition into routine care and increased administration of assessments and emergency care plans for transition-aged patients with SCD.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":"747-757"},"PeriodicalIF":6.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692327","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 effects of increasing nursing numbers on quality of newborn care in understaffed neonatal units in Kenya: a prospective intervention study.","authors":"Abdulazeez Imam, Mike English, Jalemba Aluvaala, Vincent Kagonya, Onesmus Onyango, Fred Were, Sebastian Fuller, Kenneth Karumba, Attakrit Leckcivilize, David Gathara, Michuki Maina","doi":"10.1136/bmjqs-2025-019024","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019024","url":null,"abstract":"<p><strong>Background: </strong>Newborn units in resource-constrained low-middle-income countries (LMICs) often have high neonatal mortality rates. Programmes to improve care quality often accept understaffing that directly affects care in these settings as a norm, and the effects of improving staff numbers are not studied. To address a major evidence gap, we examined the effects on quality of care of improving nurse staffing in four intermediate-level Kenyan newborn units.</p><p><strong>Methods: </strong>We introduced three additional nurses to each of four newborn units. We measured nursing care provision using direct bedside observations with a validated structured checklist before and 6 months after intervention. Our primary outcome, changes in nurse-delivered care, was examined using descriptive analysis and multilevel modelling to adjust for confounding. We also examined the pattern of nursing care delivery and intervention fidelity.</p><p><strong>Results: </strong>We observed a total of 1872 hours of care, over 156 nursing shifts for 290 and 300 babies before and after our intervention, respectively, across our four neonatal units. Our intervention increased the nursing hours per patient per shift observed from 34 to 43 min associated with a 4.7% increase in our primary outcome, nurse-delivered care and an 8.4% increase in delivery of 10 tasks nurses prioritise (adjusted B-coefficient 0.047 (95% CI 0.028 to 0.066) and B-coefficient 0.084 (95% CI 0.053 to 0.115), respectively). Intervention strength was reduced by changes in existing nurses' deployment and an increase in workload.</p><p><strong>Conclusions: </strong>In very high workload settings in LMICs where nurses can only deliver a fraction of nursing care, staffing increases improve care delivery more obviously for high-priority tasks. These findings provide much needed evidence that increasing neonatal nurse staffing in under-resourced newborn units improves care quality.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145298569","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":"Diminishing returns: how treatment delays undermine the mortality benefits of high-quality stroke care.","authors":"Ruize Guo, Mengyang Liu, Qianni Li, Jingkun Li, Meina Liu","doi":"10.1136/bmjqs-2025-019307","DOIUrl":"https://doi.org/10.1136/bmjqs-2025-019307","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains a leading global cause of death, with treatment timeliness critically determining outcomes. Although the time-efficacy relationship in stroke care is well established, the interplay interaction between treatment delays, care quality and clinical outcomes remains poorly characterised, particularly across different healthcare settings.</p><p><strong>Methods: </strong>This nationwide study analysed data from 2 875 119 acute ischaemic stroke (AIS) hospitalisations (2020-2024). After stratifying patients by treatment delay quartiles (Q1-Q4), we performed propensity score matching to balance 24 baseline covariates. To evaluate the detrimental effects of treatment delay on therapeutic benefits, we used logistic regression and doubly robust causal modelling across delay groups. Patients whose overall delay fell within the fourth quartile and received low-quality care were identified as the high-risk group. Multivariable logistic regression was used to identify independent risk factors.</p><p><strong>Results: </strong>Low-quality care correlated with longer delays (overall: 1038 vs 981 min, p<0.0001). High-quality care achieved the greatest mortality reduction in Q1 (average treatment effect (ATE) 0.0036, 95% CI 0.0032 to 0.0041) compared with Q4 (ATE 0.0014, 95% CI 0.0012 to 0.0017). Thrombolysis delays had the strongest impact on mortality (Q1 ATE 0.0155, 95% CI 0.0087 to 0.0222; Q4 ATE 0.0068, 95% CI 0.0031 to 0.0106). High-risk subgroups for delayed, low-quality care included: Northwest residents (OR 1.5759, 95% CI 1.5613 to 1.5905), minor stroke (OR 1.8402, 95% CI 1.8302 to 1.8503), self-transport patients (OR 1.1392, 95% CI 1.1340 to 1.1443), and those with comorbidities (renal failure: OR 1.0948, 95% CI 1.0825 to 1.1073; asthma: OR 1.0861, 95% CI 1.0646 to 1.1080) (all p<0.0001).</p><p><strong>Conclusions: </strong>The benefits of high-quality care in reducing mortality risk were significantly diminished by delays in hospital admission, examination and thrombolysis. The timeliness and quality of AIS care are influenced by geographic location, admission National Institutes of Health Stroke Scale scores and comorbidity profiles. The highest priority populations for delay reduction and quality improvement were patients who did not use emergency medical services and those with multiple comorbidities.</p>","PeriodicalId":9077,"journal":{"name":"BMJ Quality & Safety","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145298648","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629350/pdf/","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":"OA","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":"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}