2,378 results on '"Quality Improvement standards"'
Search Results
2. Pro: Perioperative Echocardiography Accreditation Will Improve Quality and Should Be Pursued by Cardiac Anesthesia Programs.
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Farmer BE and Richter EW
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- Humans, Anesthesiology standards, Anesthesiology methods, Cardiac Surgical Procedures standards, Quality Improvement standards, Accreditation standards, Anesthesia, Cardiac Procedures standards, Anesthesia, Cardiac Procedures methods, Echocardiography standards, Echocardiography methods, Perioperative Care standards, Perioperative Care methods
- Abstract
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests and/or personal relationships that may be considered potential competing interests: E. Richter serves as an Associate Editor for the Journal of Cardiothoracic and Vascular Anesthesia and was not involved in the editorial review or the decision to publish this article. E. Richter is also a member of the Advanced PTE Exam Writing Committee and PTE Certification Committee for the National Board of Echocardiography.
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- 2024
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3. Facilitating routine data collection to improve clinical quality and research in Interventional Psychiatry: The CARE Network.
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Dong V, Brettell L, Massaneda-Tuneu C, Rita Barreiros A, Vinh Cao T, Kelly C, Zeng Y, Aoki N, Tor PC, Bayes A, Branjerdporn G, Sarma S, Kwan E, Waite S, Mohan T, Hussain S, Gálvez V, Weiss A, Bull M, Lou Chatterton M, Mihalopoulos C, Glozier N, Hadzi-Pavlovic D, Hopwood M, Mitchell P, Power B, Sara G, Wells K, Loo C, and Martin D
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- Humans, Mental Disorders therapy, Quality Improvement standards, Mental Health Services standards, Biomedical Research standards, Australia, Psychiatry standards, Data Collection standards, Data Collection methods
- Abstract
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: E.K. declares honoraria from the Lundbeck institute outside the submitted work. S.H. declares honoraria from the Lundbeck Institute for a conference scientific committee. N.G. declares honoraria from Servier Laboratories and Lundbeck Institute, has served on advisory boards for Servier Laboratories, Esia, Seqirus and Lundbeck, and is supported by grants from the NHMRC (grant nos. 1105089 and 2014381) and ARC (grant no. CE20010025). M.H. declares honoraria and research funding from Janssen Australia outside of this work. P.M. declares remuneration from Janssen Australia for lectures and advisory board membership. All other authors declare no conflict of interest.
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- 2024
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4. 2024 Update to the 2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures.
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Kittleson MM, Breathett K, Ziaeian B, Aguilar D, Blumer V, Bozkurt B, Diekemper RL, Dorsch MP, Heidenreich PA, Jurgens CY, Khazanie P, Koromia GA, and Van Spall HGC
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- Humans, United States, Treatment Outcome, Consensus, Quality Improvement standards, Outcome and Process Assessment, Health Care standards, Heart Failure diagnosis, Heart Failure therapy, Heart Failure physiopathology, Quality Indicators, Health Care standards, Cardiology standards, American Heart Association
- Abstract
This document describes performance measures for heart failure that are appropriate for public reporting or pay-for-performance programs and is meant to serve as a focused update of the "2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures." The new performance measures are taken from the "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines" and are selected from the strongest recommendations (Class 1 or Class 3). In contrast, quality measures may not have as much evidence base and generally comprise metrics that might be useful for clinicians and health care organizations for quality improvement but are not yet appropriate for public reporting or pay-for-performance programs. New performance measures include optimal blood pressure control in patients with heart failure with preserved ejection fraction, the use of sodium-glucose cotransporter-2 inhibitors for patients with heart failure with reduced ejection fraction, and the use of guideline-directed medical therapy in hospitalized patients. New quality measures include the use of sodium-glucose cotransporter-2 inhibitors in patients with heart failure with mildly reduced and preserved ejection fraction, the optimization of guideline-directed medical therapy prior to intervention for chronic secondary severe mitral regurgitation, continuation of guideline-directed medical therapy for patients with heart failure with improved ejection fraction, identifying both known risks for cardiovascular disease and social determinants of health, patient-centered counseling regarding contraception and pregnancy risks for individuals with cardiomyopathy, and the need for a monoclonal protein screen to exclude light chain amyloidosis when interpreting a bone scintigraphy scan assessing for transthyretin cardiac amyloidosis.
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- 2024
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5. [Regional Comprehensive Care for People with Mental Disorders - An Opportunity for Transparency and Innovative Evaluation].
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Priebe S and Brieger P
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- Humans, Germany, Quality Improvement standards, Quality Improvement organization & administration, Regional Medical Programs organization & administration, Community Mental Health Services organization & administration, Intersectoral Collaboration, Outcome and Process Assessment, Health Care standards, Quality Assurance, Health Care standards, Quality Assurance, Health Care organization & administration, Mental Disorders therapy, Mental Disorders psychology, National Health Programs, Comprehensive Health Care organization & administration
- Abstract
Against the background of the discussion about a comprehensive regional mental health care service, the essay discusses the possibility of a comprehensive, transparent and meaningful evaluation. Proposals for how structures, processes, and outcomes may be assessed are presented. We argue for collecting data that are transparent and actionable on all levels of care organisations. The suggested evaluation would be innovative, meaningful for individual patients, services, health care organisations and whole regions, and thus a way for a data-driven ongoing quality improvement., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
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- 2024
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6. Enhancing Outcomes in Clinical Practice: Lessons Learned in the Quality Improvement Trenches.
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Hansen EE, Chiem JL, Low DK, Rampersad SE, and Martin LD
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- Humans, Treatment Outcome, Quality Improvement standards
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Competing Interests: Conflicts of Interest: See Disclosures at the end of the article.
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- 2024
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7. The EUropean PErioperative MEdical Networking (EUPEMEN) project and recommendations for perioperative care in colorectal surgery: a quality improvement study.
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Pesce A, Ramírez JM, Fabbri N, Martínez Ubieto J, Pascual Bellosta A, Arroyo A, Sánchez-Guillén L, Whitley A, Kocián P, Rosetzka K, Bona Enguita A, Ioannidis O, Bitsianis S, Symeonidis S, Anestiadou E, Teresa-Fernandéz M, and Carlo Vittorio F
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- Humans, Europe, Enhanced Recovery After Surgery standards, Perioperative Care standards, Quality Improvement standards, Colorectal Surgery standards
- Abstract
Background: Despite consensus supporting enhanced recovery programs, their full implementation in such a context is difficult due to conventional practices within various groups of professionals. The goal of the EUropean PErioperative MEdical Networking (EUPEMEN) project was to bring together the expertise and experience of national clinical professionals who have previously helped deliver major change programs in their countries and to use them to spread enhanced recovery after surgery protocols (ERAS) in Europe. The specific aim of this study is to present and discuss the key points of the proposed recommendations for colorectal surgery., Materials and Methods: Five partners from university hospitals in four European countries developed the project as partners. Following a non-systematic review of the literature, the European consensus panel generated a list of recommendations for perioperative care in colorectal surgery. A list of recommendations was formulated and distributed to collaborators at each center to allow modifications or additional statements. These recommendations were then discussed in three consecutive meetings to share uniform ERAS protocols to be disseminated., Result: The working group developed (1) the EUPEMEN online platform to offer, free of charge, evidence-based standardized perioperative care protocols, learning activities, and assistance to health professionals interested in enhancing the recovery of their patients; (2) the preparation of the EUPEMEN Multimodal Rehabilitation manuals; (3) the training of the trainers to teach future teachers; and (4) the dissemination of the results in five multiplier events, one for each partner, to promote and disseminate the protocols., Conclusion: The EUPEMEN project allowed the sharing of the expertise of many professionals from four different European countries with the objective of training the new generations in the dissemination of ERAS protocols in daily clinical practice through a new learning system. This project was proposed as an additional training tool for all the enhanced recovery program teams., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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8. Patient-Reported Outcome Measures in Routine Clinical Practice: Practical Guidance for Institutional Review Boards.
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Bachmann JM, Shiflet MA, Palacios JR, Turer RW, Wallace GH, Rosenbloom ST, and Rice TW
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- Humans, Surveys and Questionnaires standards, Ethics Committees, Research standards, Patient Reported Outcome Measures, Quality Improvement standards
- Abstract
The use of patient-reported outcome measures (PROMs) is increasingly common in routine clinical practice. As tools to quantify symptoms and health status, PROMs play an important role in focusing health care on outcomes that matter to patients. The uses of PROM data are myriad, ranging from clinical care to survey-based research and quality improvement. Discerning the boundaries between these use cases can be challenging for institutional review boards (IRBs). In this article, we provide a framework for classifying the three primary PROM use cases (clinical care, human subjects research, and quality improvement) and discuss the level of IRB oversight (if any) necessary for each. One of the most important considerations for IRB staff is whether PROMs are being used primarily for clinical care and thus do not constitute human subjects research. We discuss characteristics of PROMs implemented primarily for clinical care, focusing on: data platform; survey location; questionnaire length; patient interface; and clinician interface. We also discuss IRB oversight of projects involving the secondary use of PROM data that were collected during the course of clinical care, which span human subjects research and quality improvement. This framework provides practical guidance for IRB staff as well as clinicians who use PROMs as communication aids in routine clinical practice., (© 2024 The Authors. Ethics & Human Research published by Wiley Periodicals LLC on behalf of The Hastings Center.)
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- 2024
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9. Impact of mentoring on the implementation of the quality management system in clinical laboratories in Burkina Faso, West Africa.
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Yenyetou D, Sanou I, Madingar PD, Ouattara C, Zongo E, Zongo Z, Ouedraogo AS, and Sangare I
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- Burkina Faso, Humans, Laboratories, Clinical standards, Laboratories, Clinical organization & administration, Mentoring standards, Mentoring organization & administration, Quality Improvement standards, Quality Improvement organization & administration
- Abstract
In Burkina Faso, the implementation of the quality management system remains weak in diagnostic laboratories. Integrating mentoring into the life of clinical diagnostic laboratories, a qualified mentor is essential for quality system control. The objective of this study was to evaluate the impact of the mentoring process on quality improvement. Mentoring process was implemented at nine laboratories. The process consisted of a one-week mentor stay in the laboratory as one visit, with four in total. The SLIPTA checklist was used as a measurement tool. Two audits were performed (before and after the implementation of the mentoring process. The audit data were analyzed to estimate the effect of mentoring on quality improvement. A score difference of 24.55% was found significant between the two audits (paired Student's t-test p-value = 0.0002). The variables non-conformities, corrective/preventive actions, and facilities/safety have factored more than eight points between the two audits. However, the management/customer service and information one have only slightly increased (2.27 and 0.63, respectively). Mentoring has improved the quality management system in laboratories. However, some points of the process need to be improved to bring these laboratories toward international accreditation.
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- 2024
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10. Reducing Stimulant Prescribing Error: A Quality Improvement Initiative in Pediatric Outpatient Setting.
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Watthanathiraphapwong N, Traipidok P, Charleowsak P, Tassanakijpanich N, and Thongseiratch T
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- Humans, Child, Retrospective Studies, Male, Female, Adolescent, Ambulatory Care standards, Outpatients, Thailand, Child, Preschool, Registries statistics & numerical data, Practice Patterns, Physicians' standards, Practice Patterns, Physicians' statistics & numerical data, Quality Improvement standards, Attention Deficit Disorder with Hyperactivity drug therapy, Central Nervous System Stimulants therapeutic use, Medication Errors prevention & control
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Objective: To evaluate the impact of the Songklanagarind ADHD Multidisciplinary Assessment and Care Team for Quality Improvement (SAMATI) initiative on reducing stimulant prescribing errors in a pediatric outpatient setting., Methods: A retrospective study examined attention deficit hyperactivity disorder (ADHD) registry data from January 2017 to June 2023 to assess the impact of the SAMATI initiative, implemented in early 2020. This initiative, integrating multiple components such as audit and feedback, clinical pharmacist involvement, and Electronic Medical Record utilization, aimed to enhance ADHD medication management. Using interrupted time series and control chart analyses, the study evaluated the initiative's effect on reducing stimulant prescribing errors. Additionally, parental satisfaction was measured to gauge the initiative's overall success., Results: Out of 282 patients enrolled, 267 were included in the final analysis after exclusions. Post-intervention analysis showed significant reductions in various prescribing errors per thousand prescriptions: prescribing without concern drug-condition interaction (443 to 145, p < 0.001), prescribing without adequate monitoring (115 to 14, p < 0.001), lack of regular office visits (98 to 21, p = 0.007), and inappropriate dosage (66 to 14, p = 0.05). Medication errors severity classification also showed significant changes, with notable decreases in classes C and D errors. Parental satisfaction improved from 84% to 95%., Conclusion: The SAMATI initiative significantly reduced stimulant prescribing errors and enhanced parental satisfaction in ADHD care management. This study demonstrates the potential of comprehensive quality improvement strategies in improving medication management in pediatric healthcare. Further research in diverse settings is warranted to confirm these findings., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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11. Strategies to improve screening colonoscopy quality for the prevention of colorectal cancer.
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Song JH and Kim ER
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- Humans, Predictive Value of Tests, Risk Factors, Colonic Polyps surgery, Colonic Polyps pathology, Adenoma prevention & control, Adenoma diagnosis, Colonoscopy standards, Colorectal Neoplasms prevention & control, Colorectal Neoplasms diagnosis, Quality Indicators, Health Care standards, Early Detection of Cancer standards, Early Detection of Cancer methods, Quality Improvement standards
- Abstract
The incidence and mortality of colorectal cancer (CRC) have decreased through regular screening colonoscopy, surveillance, and endoscopic treatment. However, CRC can still be diagnosed after negative colonoscopy. Such CRC is called interval CRC and accounts for 1.8-9.0% of all CRC cases. Most cases of interval CRC originate from missed lesions and incompletely resected lesions. Interval CRC can be minimized by improving the quality of colonoscopy. This has led to a growing interest in and demand for high-quality colonoscopy. It is important to reduce the risk of CRC and its associated mortality by improving the quality of colonoscopy. In this review article, we provide an overview of colonoscopy quality indicators, including bowel preparation adequacy, the cecal intubation rate, the adenoma detection rate, the colonoscopy withdrawal time, appropriate polypectomy, and complication of the procedure. Because colonoscopy is a highly endoscopist-dependent procedure, colonoscopists should be well-acquainted with quality indicators and strive to apply them in daily clinical practice for the prevention of CRC.
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- 2024
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12. Towards improving stroke services in Africa: Results from the Africa-UK Stroke Partnership [AUKSP] surveys.
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Jones SP, Spencer J, Adeniji O, Abd-Allah F, Ogunde G, Ebenezer AA, Kalaria R, Lightbody CE, Langhorne P, Melifonwu R, Naidoo P, Macaire Ossou-Nguiet P, Ogunniyi A, Olowoyo P, Owolabi MO, Sarfo FS, Walker R, Yaria J, Watkins C CL, and Akinyemi RO
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- Humans, Africa epidemiology, Delivery of Health Care, Integrated organization & administration, Delivery of Health Care, Integrated standards, Health Services Accessibility, Stroke therapy, Stroke diagnosis, Stroke epidemiology, Health Care Surveys, Quality Improvement standards, Quality Indicators, Health Care standards
- Abstract
Background: The African Stroke Organization (ASO) in partnership with the University of Central Lancashire's Stroke Research Team launched the Africa-UK Stroke Partnership (AUKSP). AUKSP undertook two (stroke expert and hospital Stroke Unit (SU)) on-line surveys mapping existing capacity and capability to deliver African stroke care., Methods: An on-line expert survey tool was sent to 139 stroke experts in 54 African countries October 2021-March 2022 and the hospital SU survey to 120 hospital SUs (identified from the expert survey) June-October 2022. Both survey tools were prepared according to the World Stroke Organisation's Roadmap for Delivering Quality Stroke Care. Completed responses were exported from Qualtrics into Microsoft excel and were analysed descriptively., Results: Forty-five expert responses and 62 hospital SU responses were analysed, representing 54(87%) public hospitals, 7(11%) private and 1(2%) charitable organization. In both surveys, three main priorities for improvement of stroke services were: a rapid and prompt stroke diagnosis; effective primary and secondary stroke prevention, and acute stroke management. Survey findings suggest that there is a low presence of national stroke surveillance systems and registries, and heterogeneity in availability of diagnostic services, SUs, endovascular treatments, and rehabilitation., Conclusion: Significant gaps exist in Africa's capacity and capability to deliver essential elements of effective and quality stroke care. Tackling these challenges requires urgent and sustained multi-stakeholder action including: government, administrators, policy makers and other partners. Our survey findings highlight key priority areas for multi-stakeholder engagement and crafting of a pragmatic, prioritized and context-sensitive African Stroke Action Plan., Competing Interests: Declaration of competing interest The Authors declare that there are no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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13. Errors and Misinterpretation of Society for Vascular Surgery's Vascular Quality Initiative Registry Data.
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Eldrup-Jorgensen J, Cronenwett JL, and Wadzinski J
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- Humans, Societies, Medical standards, Treatment Outcome, United States, Data Accuracy, Risk Factors, Quality Improvement standards, Registries, Quality Indicators, Health Care standards, Vascular Surgical Procedures standards
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- 2024
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14. Data-driven collaborative QUality improvement in Cardiac Rehabilitation (QUICR) to increase program completion: protocol for a cluster randomized controlled trial.
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Candelaria D, Redfern J, O'Neil A, Brieger D, Clark RA, Briffa T, Bauman A, Hyun K, Cunich M, Figtree GA, Cartledge S, and Gallagher R
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- Humans, Treatment Outcome, Time Factors, New South Wales, Cooperative Behavior, Victoria, Coronary Disease rehabilitation, Coronary Disease diagnosis, Guideline Adherence standards, Health Care Costs, Quality Improvement standards, Cardiac Rehabilitation standards, Multicenter Studies as Topic, Quality Indicators, Health Care standards, Randomized Controlled Trials as Topic
- Abstract
Background: Coronary heart disease (CHD) is the leading cause of deaths and disability worldwide. Cardiac rehabilitation (CR) effectively reduces the risk of future cardiac events and is strongly recommended in international clinical guidelines. However, CR program quality is highly variable with divergent data systems, which, when combined, potentially contribute to persistently low completion rates. The QUality Improvement in Cardiac Rehabilitation (QUICR) trial aims to determine whether a data-driven collaborative quality improvement intervention delivered at the program level over 12 months: (1) increases CR program completion in eligible patients with CHD (primary outcome), (2) reduces hospital admissions, emergency department presentations and deaths, and costs, (3) improves the proportion of patients receiving guideline-indicated CR according to national and international benchmarks, and (4) is feasible and sustainable for CR staff to implement routinely., Methods: QUICR is a multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT) with 12-month follow-up. Eligible CR programs (n = 40) and the individual patient data within them (n ~ 2,000) recruited from two Australian states (New South Wales and Victoria) are randomized 1:1 to the intervention (collaborative quality improvement intervention that uses data to identify and manage gaps in care) or control (usual care with data collection only). This sample size is required to achieve 80% power to detect a difference in completion rate of 22%. Outcomes will be assessed using intention-to-treat principles. Mixed-effects linear and logistic regression models accounting for clusters within allocated groupings will be applied to analyse primary and secondary outcomes., Discussion: Addressing poor participation in CR by patients with CHD has been a longstanding challenge that needs innovative strategies to change the status-quo. This trial will harness the collaborative power of CR programs working simultaneously on common problem areas and using local data to drive performance. The use of data linkage for collection of outcomes offers an efficient way to evaluate this intervention and support the improvement of health service delivery., Ethics: Primary ethical approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH01093), along with site-specific governance approvals., Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001239651 (30/11/2023) ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386540&isReview=true )., (© 2024. The Author(s).)
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- 2024
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15. Improving the quality of adenomyosis and racial disparities research.
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Upson K and Gartner DR
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- Humans, Female, Quality Improvement standards, Biomedical Research standards, Adenomyosis diagnosis, Adenomyosis ethnology, Adenomyosis therapy, Healthcare Disparities ethnology, Healthcare Disparities standards
- Abstract
Competing Interests: Declaration of Interests D.R.G. reports funding from Robert Wood Johnson Foundation (grant number 78812) and Michigan Health Endowment Fund (grant number G-2204-150274); consulting fees from Commonwealth Fund; Honoraria from University of North Dakota; travel support from University of Michigan, University of Minnesota, and Harvard University; Interdisciplinary Association for Population Health Science – Committee member outside the submitted work. K.U. reports funding from NIH/NICHD R01HD112344, NIH/NINR R00NR017191 and Spectrum Health – Michigan State University Alliance Grant outside the submitted work.
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- 2024
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16. A Prospective Multicenter Comparison of Trauma and Injury Severity Score, American Society of Anesthesiologists Physical Status, and National Surgical Quality Improvement Program Calculator's Ability to Predict Operative Trauma Outcomes.
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Yeates EO, Nahmias J, Gabriel V, Luo X, Ogunnaike B, Ahmed MI, Melikman E, Moon T, Shoultz T, Feeler A, Dudaryk R, Navas-Blanco J, Vasileiou G, Yeh DD, Matsushima K, Forestiere M, Lian T, Dominguez OH, Ricks-Oddie JL, and Kuza CM
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- Humans, Prospective Studies, Male, Female, Middle Aged, Adult, Aged, Risk Assessment, Postoperative Complications mortality, Postoperative Complications etiology, Postoperative Complications diagnosis, Treatment Outcome, United States epidemiology, Risk Factors, Hospital Mortality, Anesthesiologists standards, Comorbidity, Trauma Centers standards, Wounds and Injuries surgery, Wounds and Injuries mortality, Wounds and Injuries diagnosis, Quality Improvement standards, Injury Severity Score, Length of Stay, Predictive Value of Tests
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Background: Trauma outcome prediction models have traditionally relied upon patient injury and physiologic data (eg, Trauma and Injury Severity Score [TRISS]) without accounting for comorbidities. We sought to prospectively evaluate the role of the American Society of Anesthesiologists physical status (ASA-PS) score and the National Surgical Quality Improvement Program Surgical Risk-Calculator (NSQIP-SRC), which are measurements of comorbidities, in the prediction of trauma outcomes, hypothesizing that they will improve the predictive ability for mortality, hospital length of stay (LOS), and complications compared to TRISS alone in trauma patients undergoing surgery within 24 hours., Methods: A prospective, observational multicenter study (9/2018-2/2020) of trauma patients ≥18 years undergoing operation within 24 hours of admission was performed. Multiple logistic regression was used to create models predicting mortality utilizing the variables within TRISS, ASA-PS, and NSQIP-SRC, respectively. Linear regression was used to create models predicting LOS and negative binomial regression to create models predicting complications., Results: From 4 level I trauma centers, 1213 patients were included. The Brier Score for each model predicting mortality was found to improve accuracy in the following order: 0.0370 for ASA-PS, 0.0355 for NSQIP-SRC, 0.0301 for TRISS, 0.0291 for TRISS+ASA-PS, and 0.0234 for TRISS+NSQIP-SRC. However, when comparing TRISS alone to TRISS+ASA-PS ( P = .082) and TRISS+NSQIP-SRC ( P = .394), there was no significant improvement in mortality prediction. NSQIP-SRC more accurately predicted both LOS and complications compared to TRISS and ASA-PS., Conclusions: TRISS predicts mortality better than ASA-PS and NSQIP-SRC in trauma patients undergoing surgery within 24 hours. The TRISS mortality predictive ability is not improved when combined with ASA-PS or NSQIP-SRC. However, NSQIP-SRC was the most accurate predictor of LOS and complications., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 International Anesthesia Research Society.)
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- 2024
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17. Screening for Quality of Life in a Neurology Tic Clinic Using Quality Improvement Methodology.
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Morgan B, Weisleder P, Patel AD, Parker W, Rose M, and Butz C
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- Humans, Child, Adolescent, Male, Neurology standards, Female, Ambulatory Care Facilities standards, Mass Screening standards, Electronic Health Records, Child, Preschool, Quality Improvement standards, Quality of Life, Tic Disorders diagnosis, Tic Disorders therapy
- Abstract
Background: Tic disorders in children often co-occur with other disorders that can significantly impact functioning. Screening for quality of life (QoL) can help identify optimal treatment paths. This quality improvement (QI) study describes implementation of a QoL measure in a busy neurology clinic to help guide psychological intervention for patients with tics., Methods: Using QI methodology outlined by the Institute for Healthcare Improvement, this study implemented the PedsQL Generic Core (4.0) in an outpatient medical clinic specializing in the diagnosis and treatment of tic disorders. Assembling a research team to design process maps and key driver diagrams helped identify gaps in the screening process. Conducting several plan-do-study-act cycles refined identification of patients appropriate to receive the measure. Over the three-year study, electronic health record notification tools and data collection were increasingly utilized to capture patients' information during their visit., Results: Over 350 unique patients were screened during the assessment period. Electronic means replaced paper measures as time progressed. The percentage of patients completing the measure increased from 0% to 51.9% after the initial implementation of process improvement, advancing to 91.6% after the introduction of electronic measures. This average completion rate was sustained for 15 months., Conclusions: Using QI methodology helped identify the pragmatics of implementing a QoL assessment to enhance screening practices in a busy medical clinic. Assessment review at the time of appointment helped inform treatment and referral decisions., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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18. Accreditation of stroke programs at the MENA + region; between aspiration and reality.
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Al Hashmi AM, Imam Y, Mansour OY, and Shuaib A
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- Humans, Middle East, Africa, Northern, Quality Improvement standards, Quality Indicators, Health Care standards, Healthcare Disparities standards, Developing Countries, Health Care Surveys, Program Evaluation, Accreditation standards, Stroke therapy, Stroke diagnosis
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Introduction: Despite global progress in stroke care, challenges persist, especially in Low- and Middle-Income countries (LMIC). The Middle East and North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO) Stroke Program Accreditation Initiative aims to improve stroke care regionally., Material & Method: A 2022 survey assessed stroke unit readiness in the Middle East and North Africa (MENA) + region, revealing significant regional disparities in stroke care between high-income and low-income countries. Additionally, it demonstrated interest in the accreditation procedure and suggested that regional stroke program accreditation will improve stroke care for the involved centers., Conclusion: An accreditation program that is specifically tailored to the regional needs in the MENA + countries might be the solution. In this brief review, we will discuss potential challenges faced by such a program and we will put forward a well-defined 5-step accreditation process, beginning with a letter of intent, through processing the request and appointment of reviewers, the actual audit, the certification decisions, and culminating in granting a MIENA-SINO tier-specific certificate with recertification every 5 years., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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19. Sustainable Approach to Justice, Equity, Diversity, and Inclusion Through Better Quality Measurement.
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Okeke N, Hennessey KC, Sitapati AM, Weisshaar D, Shah NP, Alicki R, and Haft H
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- Humans, Quality Improvement standards, Social Justice, Cultural Diversity, Health Status Disparities, Social Inclusion, United States, Diversity, Equity, Inclusion, Quality Indicators, Health Care standards, Healthcare Disparities standards, Electronic Health Records standards, Health Equity standards, Social Determinants of Health
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The US health care industry has broadly adopted performance and quality measures that are extracted from electronic health records and connected to payment incentives that hope to improve declining life expectancy and health status and reduce costs. While the development of a quality measurement infrastructure based on electronic health record data was an important first step in addressing US health outcomes, these metrics, reflecting the average performance across diverse populations, do not adequately adjust for population demographic differences, social determinants of health, or ecosystem vulnerability. Like society as a whole, health care must confront the powerful impact that social determinants of health, race, ethnicity, and other demographic variations have on key health care performance indicators and quality metrics. Tools that are currently available to capture and report the health status of Americans lack the granularity, complexity, and standardization needed to improve health and address disparities at the local level. In this article, we discuss the current and future state of electronic clinical quality measures through a lens of equity., Competing Interests: Disclosures Dr Shah receives consulting earnings from Novartis Pharmaceuticals, Amgen, Amarin, and Merck and research support from National Institutes of Health, Amgen, Novartis Pharmaceuticals, and Janssen. Dr Sitapati is an internal advisor for the U.S. Food and Drug Administration and acts as an unpaid consultant to nonprofit organizations the College of Healthcare Information Management Executives and the Kelee Foundation. The other authors report no conflicts.
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- 2024
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20. 5S management improves the service quality in the outpatient-emergency pharmacy: from management process optimisation to staff capacity enhancement.
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Huang WJ, Zhang MW, Li BY, Wang XH, Zhang CH, and Yu JG
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- Humans, Pharmacists standards, Emergency Service, Hospital standards, Workflow, Patient Satisfaction, Efficiency, Organizational standards, Pharmacy Service, Hospital standards, Pharmacy Service, Hospital methods, Quality Improvement standards
- Abstract
Objective: As a high-efficiency demanding department in a hospital, the outpatient pharmacy has a great need for quality improvement to provide superior medical service for patients. Little is known about the application of 5S management in a hospital pharmacy department. The aim of this study was to evaluate the impacts of 5S management on pharmaceutical service quality and staff capacity in the outpatient-emergency pharmacy., Methods: We carried out a 5S project in the outpatient-emergency pharmacy at a local hospital that involved processes including waste elimination, workplace standardisation, and optimisation of workflow and staff quality, and then evaluated the effects of the project., Results: The equipment and items in the outpatient-emergency pharmacy were sorted. All the drugs were categorised and put in order. The redesigned workspace and standardised workflow during the project improved the accuracy and efficiency of drug dispensing. The satisfaction rate of patients regarding the pharmaceutical service quality in the outpatient-emergency pharmacy was elevated, as well as the satisfaction rate of pharmacists about their work experiences. The optimisation of objective conditions also stimulated a positive working attitude and professional ability promotion of pharmacists in the outpatient-emergency pharmacy., Conclusions: In this study, the 5S management method has proven useful for quality and efficiency improvement in the outpatient-emergency pharmacy, and could be generalised to other departments in a hospital, which provides further evidence of the advantages of the Lean tool in healthcare system management., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
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21. A qualitative study evaluating the discharge process for vascular surgery patients to identify significant themes for organizational improvement.
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Vogel TR, Kruse RL, Schlesselman C, Doss E, Camazine M, and Popejoy LL
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- Humans, Prospective Studies, Patient Readmission, Attitude of Health Personnel, Process Assessment, Health Care organization & administration, Process Assessment, Health Care standards, Patient Discharge, Vascular Surgical Procedures, Qualitative Research, Quality Improvement standards, Focus Groups
- Abstract
Objective: Transition from the hospital to an outpatient setting is a multifaceted process requiring coordination among a variety of services and providers to ensure a high-quality discharge. Vascular surgery patients comprise a complex population that experiences high unplanned readmission rates. We performed a qualitative study to identify themes for process improvement for vascular surgery patients. A validated discharge process, RED (Re-Engineered Discharge), was used to identify additional actionable themes to create a more efficient discharge process tailored specifically to the vascular surgery population., Methods: A prospective, qualitative analysis at a tertiary center using a semi-structured focus group interview guide was performed to evaluate the current discharge process and identify opportunities for improvement. Focus groups were Zoom recorded, transcribed into electronic text files, and were loaded into Dedoose qualitative software for analysis using a directed content analysis approach. Two researchers independently thematically coded each transcript, starting with accepted discharge components to identify new thematic categories. Prior to analysis, all redundancy of codes was resolved, and all team members agreed on text categorization and coding., Results: Eight focus groups with a total of 38 participants were conducted. Participants included physicians ( n = 13), nursing/ancillary staff ( n = 14), advanced nurse practitioners ( n = 2), social worker/dietitian/pharmacist ( n = 3), and patients ( n = 6). Transcript analyses revealed facilitators and barriers to the discharge process. In addition to traditional RED components, unique concepts pertinent to vascular surgery patients included patient complexity, social determinants of health, technology literacy, complexity of ancillary services, discharge appropriateness, and use of advanced nurse practitioners for continuity., Conclusions: Specific themes were identified to target and enhance the future vRED (vascular Re-Engineered Discharge) bundle. Thematic targets for improvement include increased planning, organization, and communication prior to discharge to address vascular surgery patients' multiple comorbidities, extensive medication lists, and need for complex ancillary services at the time of discharge. Other thematic barriers discovered to improve include provider awareness of patient health literacy, patient understanding of complex discharge instructions, patient technology barriers, and intrinsic social determinants of health in this population. To address these discovered barriers, organizational targets to improve include enhanced social support, the use of advanced nurse practitioners for education reinforcement, and increased coordination. These results provide a framework for future quality improvement targeting the vascular surgery discharge process., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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22. A strategy to improve adherence to guideline-directed medical therapy (GDMT) and the role of the multidisciplinary team in a heart-failure programme.
- Author
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AlHabeeb W, Alayoubi F, Hayajneh A, Ullah A, and Elshaer F
- Subjects
- Humans, Retrospective Studies, Female, Male, Middle Aged, Aged, Saudi Arabia, Treatment Outcome, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Time Factors, Practice Patterns, Physicians' standards, Program Evaluation, Interdisciplinary Communication, Angiotensin Receptor Antagonists therapeutic use, Quality Improvement standards, Quality Indicators, Health Care standards, Adrenergic beta-Antagonists therapeutic use, Cardiovascular Agents therapeutic use, Pharmacists, Patient Care Team, Guideline Adherence, Heart Failure drug therapy, Heart Failure physiopathology, Heart Failure therapy, Heart Failure diagnosis, Practice Guidelines as Topic
- Abstract
Background: Heart failure (HF) patients place a heavy burden on the healthcare system because of their frequent need for in-patient treatment, emergency room visits and subsequent hospital stays. To provide proper care and effective therapy, practitioners have streamlined delivery techniques such as clinical pathways, checklists and pocket manuals. However, a description of the establishment of a disease-management programme, including a multidisciplinary team of physicians, clinical pharmacists and nurse specialists is required. The aim of this study was to highlight the role of the multidisciplinary team in a heart-failure programme by assessing the improvement in adherence to guideline-directed medical therapy., Methods: A retrospective, observational research was undertaken on patients with HF at a cardiac centre in Riyadh, to observe the HF patients' management before (January to December 2014) and after (January to December 2015) the establishment of a programme., Results: The use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers was 75.59% in 2014 at discharge and 81.17% in 2015 ( p = 0.249). Beta-blockers use at release increased from 87.83% in 2014 to 94.53% in 2015 ( p = 0.021). The flu vaccine was given to 48.24% of patients in 2014 and 75.13% of the patients in 2015 ( p < 0.001). The pneumococcal vaccine was administered to 44.22% of patients in 2014 and 75.13% of patients in 2015 ( p < 0.001). The ejection fraction improved from 30.21% in the first month to 39.56% in the 12th month ( p = 0.001) in patients managed in 2015., Conclusion: The multidisciplinary heart-failure programme resulted in a positive effect, in the form of improved patient care after including the clinical pharmacist and nurse specialist.
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- 2024
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23. The Volume and Cost of Quality Metric Reporting.
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Saraswathula A, Merck SJ, Bai G, Weston CM, Skinner EA, Taylor A, Kachalia A, Demski R, Wu AW, and Berry SA
- Subjects
- Humans, Delivery of Health Care economics, Delivery of Health Care standards, Delivery of Health Care statistics & numerical data, Retrospective Studies, Adult, United States epidemiology, Insurance Claim Review economics, Insurance Claim Review standards, Insurance Claim Review statistics & numerical data, Patient Safety economics, Patient Safety standards, Patient Safety statistics & numerical data, Economics, Hospital statistics & numerical data, Hospitals standards, Hospitals statistics & numerical data, Hospitals supply & distribution, Quality Improvement economics, Quality Improvement standards, Quality Improvement statistics & numerical data, Quality of Health Care economics, Quality of Health Care statistics & numerical data, Public Reporting of Healthcare Data
- Abstract
Importance: US hospitals report data on many health care quality metrics to government and independent health care rating organizations, but the annual cost to acute care hospitals of measuring and reporting quality metric data, independent of resources spent on quality interventions, is not well known., Objective: To evaluate externally reported inpatient quality metrics for adult patients and estimate the cost of data collection and reporting, independent of quality-improvement efforts., Design, Setting, and Participants: Retrospective time-driven activity-based costing study at the Johns Hopkins Hospital (Baltimore, Maryland) with hospital personnel involved in quality metric reporting processes interviewed between January 1, 2019, and June 30, 2019, about quality reporting activities in the 2018 calendar year., Main Outcomes and Measures: Outcomes included the number of metrics, annual person-hours per metric type, and annual personnel cost per metric type., Results: A total of 162 unique metrics were identified, of which 96 (59.3%) were claims-based, 107 (66.0%) were outcome metrics, and 101 (62.3%) were related to patient safety. Preparing and reporting data for these metrics required an estimated 108 478 person-hours, with an estimated personnel cost of $5 038 218.28 (2022 USD) plus an additional $602 730.66 in vendor fees. Claims-based (96 metrics; $37 553.58 per metric per year) and chart-abstracted (26 metrics; $33 871.30 per metric per year) metrics used the most resources per metric, while electronic metrics consumed far less (4 metrics; $1901.58 per metric per year)., Conclusions and Relevance: Significant resources are expended exclusively for quality reporting, and some methods of quality assessment are far more expensive than others. Claims-based metrics were unexpectedly found to be the most resource intensive of all metric types. Policy makers should consider reducing the number of metrics and shifting to electronic metrics, when possible, to optimize resources spent in the overall pursuit of higher quality.
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- 2023
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24. Evaluating a co-designed care bundle to improve patient safety at discharge from adult and adolescent mental health services (SAFER-MH and SAFER-YMH): protocol for a non-randomised feasibility study.
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Tyler N, Angelakis I, Keers RN, Planner C, Hodkinson A, Giles SJ, Grundy A, Kapur N, Armitage C, Blakeman T, Campbell SM, Robinson C, Leather J, and Panagioti M
- Subjects
- Adolescent, Adult, Humans, Feasibility Studies, State Medicine, Young Adult, Mental Health Services standards, Patient Care Bundles standards, Patient Discharge standards, Patient Safety standards, Quality Improvement standards
- Abstract
Introduction: Patients being discharged from inpatient mental wards often describe safety risks in terms of inadequate information sharing and involvement in discharge decisions. Through stakeholder engagement, we co-designed, developed and adapted two versions of a care bundle intervention, the SAFER Mental Health care bundle for adult and youth inpatient mental health settings (SAFER-MH and SAFER-YMH, respectively), that look to address these concerns through the introduction of new or improved processes of care., Methods and Analysis: Two uncontrolled before-and-after feasibility studies, where all participants will receive the intervention. We will examine the feasibility and acceptability of the SAFER-MH in inpatient mental health settings in patients aged 18 years or older who are being discharged and the feasibility and acceptability of the SAFER-YMH intervention in inpatient mental health settings in patients aged between 14 and 18 years who are being discharged. The baseline period and intervention periods are both 6 weeks. SAFER-MH will be implemented in three wards and SAFER-YMH in one or two wards, ideally across different trusts within England. We will use quantitative (eg, questionnaires, completion forms) and qualitative (eg, interviews, process evaluation) methods to assess the acceptability and feasibility of the two versions of the intervention. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients/wards should be included., Ethics and Dissemination: Ethical approval was obtained from the National Health Service Cornwall and Plymouth Research Ethics Committee and Surrey Research Ethics Committee (reference: 22/SW/0096 and 22/LO/0404). Research findings will be disseminated with participating sites and shared in various ways to engage different audiences. We will present findings at international and national conferences, and publish in open-access, peer-reviewed journals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
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25. Reconciliation Payments in the Bundled Payments for Care Improvement Advanced Program and Reductions in Clinical Spending Needed for CMS to Avoid Financial Losses.
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Ryan AM, Shashikumar SA, Chopra Z, Joynt Maddox KE, and Buxbaum JD
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- Humans, Patient Readmission economics, United States, Centers for Medicare and Medicaid Services, U.S. economics, Quality Improvement standards, Patient Care Bundles economics, Patient Care Bundles standards
- Published
- 2023
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26. Improvements in Adverse Event Rates Among Hospitalized Patients.
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Eldridge N
- Subjects
- Humans, Hospitalization statistics & numerical data, Quality Improvement standards
- Published
- 2023
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27. Association of Hospital Participation in Bundled Payments for Care Improvement Advanced With Medicare Spending and Hospital Incentive Payments.
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Shashikumar SA, Gulseren B, Berlin NL, Hollingsworth JM, Joynt Maddox KE, and Ryan AM
- Subjects
- Aged, Humans, Cross-Sectional Studies, Ethnicity statistics & numerical data, Hospitals standards, Hospitals statistics & numerical data, Minority Groups statistics & numerical data, United States epidemiology, Social Marginalization, Medicare economics, Medicare standards, Motivation, Patient Care Bundles economics, Patient Care Bundles standards, Patient Care Bundles statistics & numerical data, Hospital Costs statistics & numerical data, Quality Improvement economics, Quality Improvement standards, Quality Improvement statistics & numerical data
- Abstract
Importance: Bundled Payments for Care Improvement Advanced (BPCI-A) is a Centers for Medicare & Medicaid Services (CMS) initiative that aims to produce financial savings by incentivizing decreases in clinical spending. Incentives consist of financial bonuses from CMS to hospitals or penalties paid by hospitals to CMS., Objective: To investigate the association of hospital participation in BPCI-A with spending, and to characterize hospitals receiving financial bonuses vs penalties., Design, Setting, and Participants: Difference-in-differences and cross-sectional analyses of 4 754 139 patient episodes using 2013-2019 US Medicare claims at 694 participating and 2852 nonparticipating hospitals merged with hospital and market characteristics., Exposures: BPCI-A model years 1 and 2 (October 1, 2018, through December 31, 2019)., Main Outcomes and Measures: Hospitals' per-episode spending, CMS gross and net spending, and the incentive allocated to each hospital., Results: The study identified 694 participating hospitals. The analysis observed a -$175 change in mean per-episode spending (95% CI, -$378 to $28) and an aggregate spending change of -$75.1 million (95% CI, -$162.1 million to $12.0 million) across the 428 670 episodes in BPCI-A model years 1 and 2. However, CMS disbursed $354.3 million (95% CI, $212.0 million to $496.0 million) more in bonuses than it received in penalties. Hospital participation in BPCI-A was associated with a net loss to CMS of $279.2 million (95% CI, $135.0 million to $423.0 million). Hospitals in the lowest quartile of Medicaid days received a mean penalty of $0.41 million; (95% CI, $0.09 million to $0.72 million), while those in the highest quartile received a mean bonus of $1.57 million; (95% CI, $1.09 million to $2.08 million). Similar patterns were observed for hospitals across increasing quartiles of Disproportionate Share Hospital percentage and of patients from racial and ethnic minority groups., Conclusions and Relevance: Among US hospitals measured between 2013 and 2019, participation in BPCI-A was significantly associated with an increase in net CMS spending. Bonuses accrued disproportionately to hospitals providing care for marginalized communities.
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- 2022
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28. Preparing for Pandemics and Other Health Threats: Societal Approaches to Protect and Improve Health.
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Frieden TR and McClelland A
- Subjects
- Humans, COVID-19 prevention & control, SARS-CoV-2, Pandemics prevention & control, Public Health methods, Public Health standards, Quality Improvement standards, Disaster Planning methods, Disaster Planning standards
- Published
- 2022
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29. Improving Prior Authorization in Medicare Advantage.
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Anderson KE, Darden M, and Jain A
- Subjects
- Medicaid, United States, Medicare Part C standards, Prior Authorization standards, Quality Improvement standards
- Published
- 2022
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30. Physicians and EMS Who Responded to Mass Shootings Develop Consensus Recommendations for Improving Care.
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Ruder K
- Subjects
- Consensus, Humans, United States, Emergency Responders, Firearms, Mass Casualty Incidents, Physicians, Quality Improvement standards, Wounds, Gunshot therapy
- Published
- 2022
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31. Clinical Decision Support to Prevent Acute Kidney Injury After Cardiac Catheterization: Moving Beyond Process to Improving Clinical Outcomes.
- Author
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Gottlieb ER and Mendu M
- Subjects
- Humans, Retrospective Studies, Risk Factors, Treatment Outcome, Acute Kidney Injury etiology, Acute Kidney Injury prevention & control, Cardiac Catheterization adverse effects, Decision Support Systems, Clinical standards, Quality Improvement standards
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- 2022
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32. Improving Quality of Care and Outcomes for Pediatric Patients With End-stage Kidney Disease: The Importance of Pediatric Nephrology Expertise.
- Author
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Leonard MB and Grimm PC
- Subjects
- Child, Humans, Nephrology standards, Pediatrics standards, Quality of Health Care standards, Treatment Outcome, Kidney Failure, Chronic therapy, Quality Improvement standards
- Published
- 2022
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33. Refining a capability development framework for building successful consumer and staff partnerships in healthcare quality improvement: A coproduced eDelphi study.
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Cox R, Kendall M, Molineux M, Miller E, and Tanner B
- Subjects
- Attitude of Health Personnel, Community Participation, Cooperative Behavior, Health Facilities, Humans, Leadership, Quality of Health Care organization & administration, Quality of Health Care standards, Delivery of Health Care organization & administration, Delivery of Health Care standards, Health Knowledge, Attitudes, Practice, Quality Improvement organization & administration, Quality Improvement standards
- Abstract
Background: The capability of consumers and staff may be critical for authentic and effective partnerships in healthcare quality improvement (QI). Capability frameworks describe core knowledge, skills, values, attitudes, and behaviours and guide learning and development at individual and organizational levels., Objective: To refine a capability framework for successful partnerships in healthcare QI which was coproduced from a scoping review., Design: A two-round eDelphi design was used. The International Expert Panel rated the importance of framework items in supporting successful QI partnerships, and suggested improvements. They also rated implementation options and commented on the influence of context., Participants: Seven Research Advisory Group members were recruited to support the research team. The eDelphi panel included 53 people, with 44 (83%) and 42 (77. 8%) participating in rounds 1 and 2, respectively. They were from eight countries and had diverse backgrounds., Results: The Research Advisory Group and panel endorsed the framework and summary diagram as valuable resources to support the growth of authentic and meaningful partnerships in QI across healthcare contexts, conditions, and countries. A consensus was established on content and structure. Substantial rewording included a stronger emphasis on growth, trust, respect, inclusivity, diversity, and challenging the status quo. The final capability development framework included three domains: Personal Attributes, Relationships and Communication, and Principles and Practices. The Equalizing Decision Making, Power, and Leadership capability was foundational and positioned across all domains. Ten capabilities with twenty-seven capability descriptions were also included. The Principles and Practices domain, Equalizing Decision Making, Power, and Leadership capability, and almost half (44.4%) of the capability descriptions were rated as more important for staff than consumers (p < .01). However, only the QI processes and practices capability description did not meet the inclusion threshold for consumers. Thus, the framework was applicable to staff and consumers., Conclusion: The refined capability development framework provides direction for planning and provision of learning and development regarding QI partnerships., Patient or Public Contribution: Two consumers were full members of the research team and are coauthors. A Research Advisory Group, inclusive of consumers, guided study execution and translation planning. More than half of the panel were consumers., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)
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- 2022
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34. Keys to improving the informed consent process in research: Highlights of the i-CONSENT project.
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Fons-Martinez J, Ferrer-Albero C, and Diez-Domingo J
- Subjects
- Humans, Biomedical Research standards, Comprehension, Informed Consent standards, Quality Improvement standards
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- 2022
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35. Improvements in Hospital Adverse Event Rates: Achieving Statistically Significant and Clinically Meaningful Results.
- Author
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Padula WV and Pronovost PJ
- Subjects
- Hospitalization statistics & numerical data, Hospitals standards, Hospitals statistics & numerical data, Medical Errors prevention & control, Medical Errors statistics & numerical data, Patient Safety standards, Patient Safety statistics & numerical data, Quality Improvement standards, Quality Improvement statistics & numerical data, Risk Management standards, Risk Management statistics & numerical data
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- 2022
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36. Protocol for an intervention development and pilot implementation evaluation study of an e-health solution to improve newborn care quality and survival in two low-resource settings, Malawi and Zimbabwe: Neotree.
- Author
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Wilson E, Gannon H, Chimhini G, Fitzgerald F, Khan N, Lorencatto F, Kesler E, Nkhoma D, Chiyaka T, Haghparast-Bidgoli H, Lakhanpaul M, Cortina Borja M, Stevenson AG, Crehan C, Sassoon Y, Hull-Bailey T, Curtis K, Chiume M, Chimhuya S, and Heys M
- Subjects
- Algorithms, Decision Support Systems, Clinical standards, Health Resources, Humans, Infant, Newborn, Malawi, Mobile Applications, Pilot Projects, Poverty, Program Development economics, Program Development standards, Quality of Health Care economics, Quality of Health Care standards, Zimbabwe, Infant Health economics, Infant Health standards, Postnatal Care economics, Postnatal Care methods, Postnatal Care standards, Quality Improvement economics, Quality Improvement standards, Telemedicine economics, Telemedicine methods, Telemedicine standards
- Abstract
Introduction: Every year 2.4 million deaths occur worldwide in babies younger than 28 days. Approximately 70% of these deaths occur in low-resource settings because of failure to implement evidence-based interventions. Digital health technologies may offer an implementation solution. Since 2014, we have worked in Bangladesh, Malawi, Zimbabwe and the UK to develop and pilot Neotree: an android app with accompanying data visualisation, linkage and export. Its low-cost hardware and state-of-the-art software are used to improve bedside postnatal care and to provide insights into population health trends, to impact wider policy and practice., Methods and Analysis: This is a mixed methods (1) intervention codevelopment and optimisation and (2) pilot implementation evaluation (including economic evaluation) study. Neotree will be implemented in two hospitals in Zimbabwe, and one in Malawi. Over the 2-year study period clinical and demographic newborn data will be collected via Neotree, in addition to behavioural science informed qualitative and quantitative implementation evaluation and measures of cost, newborn care quality and usability. Neotree clinical decision support algorithms will be optimised according to best available evidence and clinical validation studies., Ethics and Dissemination: This is a Wellcome Trust funded project (215742_Z_19_Z). Research ethics approvals have been obtained: Malawi College of Medicine Research and Ethics Committee (P.01/20/2909; P.02/19/2613); UCL (17123/001, 6681/001, 5019/004); Medical Research Council Zimbabwe (MRCZ/A/2570), BRTI and JREC institutional review boards (AP155/2020; JREC/327/19), Sally Mugabe Hospital Ethics Committee (071119/64; 250418/48). Results will be disseminated via academic publications and public and policy engagement activities. In this study, the care for an estimated 15 000 babies across three sites will be impacted., Trial Registration Number: NCT0512707; Pre-results., Competing Interests: Competing interests: MH, YS, EK and FF are trustees of the Neotree charity (www.neotree.org) but receive no financial payment from this role. CC was a trustee of the Neotree charity until 2018 and received no financial payment for this role., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
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- 2022
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37. The Center for Medicare and Medicaid Innovation-Toward Value-Based Care.
- Author
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McDonough JE and Adashi EY
- Subjects
- Medicaid standards, Medicare standards, United States, Centers for Medicare and Medicaid Services, U.S. organization & administration, Centers for Medicare and Medicaid Services, U.S. standards, Organizational Innovation, Quality Improvement organization & administration, Quality Improvement standards
- Published
- 2022
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38. Preoperative Management of Medications for Psychiatric Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement.
- Author
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Oprea AD, Keshock MC, O'Glasser AY, Cummings KC 3rd, Edwards AF, Zimbrean PC, Urman RD, and Mauck KF
- Subjects
- Cardiology standards, Consensus, Humans, Postoperative Complications prevention & control, Preoperative Care methods, Mental Disorders drug therapy, Perioperative Care standards, Practice Guidelines as Topic, Quality Improvement standards, Societies, Medical statistics & numerical data
- Abstract
There is a lack of guidelines for preoperative management of psychiatric medications leading to variation in care and the potential for perioperative complications and surgical procedure cancellations on the day of surgery. The Society for Perioperative Assessment and Quality Improvement identified preoperative psychiatric medication management as an area in which consensus could improve patient care. The aim of this consensus statement is to provide recommendations to clinicians regarding preoperative psychiatric medication management. Several categories of drugs were identified including antidepressants, mood stabilizers, anxiolytics, antipsychotics, and attention deficit hyperactivity disorder medications. Literature searches and review of primary and secondary data sources were performed for each medication/medication class. We used a modified Delphi process to develop consensus recommendations for preoperative management of individual medications in each of these drug categories. While most medications should be continued perioperatively to avoid risk of relapse of the psychiatric condition, adjustments may need to be made on a case-by-case basis for certain drugs., (Copyright © 2021 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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39. Reducing Unnecessary Respiratory Viral Testing to Promote High-Value Care.
- Author
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Ostrow O, Savlov D, Richardson SE, and Friedman JN
- Subjects
- Adolescent, Antiviral Agents therapeutic use, Child, Child, Preschool, Female, Hospitals, Pediatric trends, Humans, Infant, Infant, Newborn, Influenza, Human drug therapy, Influenza, Human epidemiology, Male, Microbial Sensitivity Tests standards, Microbial Sensitivity Tests trends, Ontario epidemiology, Oseltamivir therapeutic use, Quality Improvement trends, Respiratory Tract Infections drug therapy, Respiratory Tract Infections epidemiology, Respiratory Tract Infections virology, Viral Load trends, Hospitals, Pediatric standards, Influenza, Human diagnosis, Quality Improvement standards, Respiratory Tract Infections diagnosis, Viral Load standards
- Abstract
Background and Objectives: Viral respiratory infections are common in children, and practice guidelines do not recommend routine testing for typical viral illnesses. Despite results often not impacting care, nasopharyngeal swabs for viral testing are frequently performed and are an uncomfortable procedure. The aim of this initiative was to decrease unnecessary respiratory viral testing (RVT) in the emergency department (ED) and the pediatric medicine wards (PMWs) by 50% and 25%, respectively, over 36 months., Methods: An expert panel reviewed published guidelines and appropriate evidence to formulate an RVT pathway using plan-do-study-act cycles. A multifaceted improvement strategy was developed that included implementing 2 newer, more effective tests when testing was deemed necessary; electronic order modifications with force functions; audit and feedback; and education. By using statistical process control charts, the outcomes analyzed were the percentage of RVT ordered in the ED and the rate of RVT ordered on the PMWs. Balancing measures included return visits leading to admission and inpatient viral nosocomial outbreaks., Results: The RVT rate decreased from a mean of 3.0% to 0.5% of ED visits and from 44.3 to 30.1 per 1000 patient days on the PMWs and was sustained throughout the study. Even when accounting for the new rapid influenza test available in the ED, a 50% decrease in overall ED RVT was still achieved without any significant impact on return visits leading to admission or inpatient nosocomial infections., Conclusions: Through implementation of a standardized, electronically integrated RVT pathway, a decrease in unnecessary RVT was successfully achieved. Audit and feedback, reminders, and biannual education all supported long-term sustainability of this initiative., Competing Interests: FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose., (Copyright © 2022 by the American Academy of Pediatrics.)
- Published
- 2022
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40. Preoperative Management of Medications for Neurologic Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement.
- Author
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Oprea AD, Keshock MC, O'Glasser AY, Cummings KC 3rd, Edwards AF, Hunderfund AL, Urman RD, and Mauck KF
- Subjects
- Cardiology standards, Humans, Postoperative Complications prevention & control, Preoperative Care methods, Consensus, Nervous System Diseases therapy, Perioperative Care standards, Practice Guidelines as Topic, Quality Improvement standards, Societies, Medical statistics & numerical data
- Abstract
Neurologic diseases are prevalent in patients undergoing invasive procedures; yet, no societal guidelines exist as to best practice in management of perioperative medications prescribed to treat these disorders. The Society for Perioperative Assessment and Quality Improvement tasked experts in internal medicine, anesthesiology, perioperative medicine, and neurology to provide evidence-based recommendations for preoperative management of these medications. The aim of this review is not only to provide consensus recommendations for preoperative management of patients on medications for neurologic disorders, but also to serve as an educational guide to perioperative clinicians. While, in general, medications for neurologic disorders should be continued preoperatively, an individualized approach may be needed in certain situations (eg, holding anticonvulsants on day of surgery if electroencephalographic mapping is planned during epilepsy surgery). Pertinent interactions with commonly used drugs in anesthesia practice, as well as considerations for targeted laboratory testing or perioperative drug substitutions, are addressed as well., (Copyright © 2021 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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41. A Quality Improvement Bundle to Improve Outcomes in Extremely Preterm Infants in the First Week.
- Author
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Travers CP, Gentle S, Freeman AE, Nichols K, Shukla VV, Purvis D, Dolma K, Winter L, Ambalavanan N, Carlo WA, and Lal CV
- Subjects
- Academic Medical Centers trends, Female, Humans, Infant, Infant, Newborn, Intracranial Hemorrhages diagnosis, Male, Treatment Outcome, Academic Medical Centers standards, Infant, Extremely Premature growth & development, Intracranial Hemorrhages mortality, Intracranial Hemorrhages therapy, Perinatal Mortality trends, Quality Improvement standards
- Abstract
Objectives: Our objective with this quality improvement initiative was to reduce rates of severe intracranial hemorrhage (ICH) or death in the first week after birth among extremely preterm infants., Methods: The quality improvement initiative was conducted from April 2014 to September 2020 at the University of Alabama at Birmingham's NICU. All actively treated inborn extremely preterm infants without congenital anomalies from 22 + 0/7 to 27 + 6/7 weeks' gestation with a birth weight ≥400 g were included. The primary outcome was severe ICH or death in the first 7 days after birth. Balancing measures included rates of acute kidney injury and spontaneous intestinal perforation. Outcome and process measure data were analyzed by using p-charts., Results: We studied 820 infants with a mean gestational age of 25 + 3/7 weeks and median birth weight of 744 g. The rate of severe ICH or death in the first week after birth decreased from the baseline rate of 27.4% to 15.0%. The rate of severe ICH decreased from a baseline rate of 16.4% to 10.0%. Special cause variation in the rate of severe ICH or death in the first week after birth was observed corresponding with improvement in carbon dioxide and pH targeting, compliance with delayed cord clamping, and expanded use of indomethacin prophylaxis., Conclusions: Implementation of a bundle of evidence-based potentially better practices by using specific electronic order sets was associated with a lower rate of severe ICH or death in the first week among extremely preterm infants., Competing Interests: FINANCIAL DISCLOSURE: Golden Week Program is trademarked with the US Patent and Trademark Office (serial number 87856747). The authors have indicated they have no financial relationships relevant to this article to disclose., (Copyright © 2022 by the American Academy of Pediatrics.)
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- 2022
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42. Safely Reducing Hospitalizations for Anaphylaxis in Children Through an Evidence-Based Guideline.
- Author
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Gaffney LK, Porter J, Gerling M, Schneider LC, Stack AM, Shah D, and Michelson KA
- Subjects
- Adolescent, Anaphylaxis diagnosis, Anaphylaxis epidemiology, Boston epidemiology, Child, Child, Preschool, Evidence-Based Medicine trends, Female, Guideline Adherence standards, Guideline Adherence trends, Hospitals, Pediatric trends, Humans, Male, Quality Improvement trends, Anaphylaxis therapy, Evidence-Based Medicine standards, Hospitalization trends, Hospitals, Pediatric standards, Practice Guidelines as Topic standards, Quality Improvement standards
- Abstract
Background: Emergency department visits for anaphylaxis have increased considerably over the past few decades, especially among children. Despite this, anaphylaxis management remains highly variable and contributes to significant health care spending. On the basis of emerging evidence, in this quality improvement project we aimed to safely decrease hospitalization rates, increase the use of cetirizine, and decrease use of corticosteroids for children with anaphylaxis by December 31, 2019., Methods: A multipronged intervention strategy including a revised evidence-based guideline was implemented at a tertiary children's teaching hospital by using the Model for Improvement. Statistical process control was used to evaluate for changes in key measures. Length of stay and unplanned return visits within 72 hours were monitored as process and balancing measures, respectively. As a national comparison, hospitalization rates were compared with other hospitals' data from the Pediatric Health Information System., Results: Hospitalizations decreased significantly from 28.5% to 11.2% from preimplementation to implementation, and the balancing measure of 72-hour revisits was stable. The proportion of patients receiving cetirizine increased significantly from 4.2% to 59.7% and use of corticosteroids decreased significantly from 72.6% to 32.4% in patients without asthma. The proportion of patients meeting length of stay criteria increased from 53.3% to 59.9%. Hospitalization rates decreased nationally over time., Conclusions: We reduced hospitalizations for anaphylaxis by 17.3% without concomitant increases in revisits, demonstrating that unnecessary hospitalizations can be safely avoided. The use of a local evidence-based guideline paired with close outcome monitoring and sustained messaging and feedback to clinicians can effectively improve anaphylaxis management., Competing Interests: FINANCIAL DISCLOSURES: The authors have indicated they have no financial relationships relevant to this article to disclose., (Copyright © 2022 by the American Academy of Pediatrics.)
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- 2022
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43. Effect of a Quality Improvement Bundle to Standardize the Use of Intravenous Fluids for Hospitalized Pediatric Patients: A Stepped-Wedge, Cluster Randomized Clinical Trial.
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Rooholamini SN, Jennings B, Zhou C, Kaiser SV, Garber MD, Tchou MJ, and Ralston SL
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- Adolescent, Child, Child, Preschool, Cluster Analysis, Female, Fluid Therapy instrumentation, Humans, Infant, Infant, Newborn, Male, Patient Care Bundles instrumentation, Patient Care Bundles methods, Pediatrics methods, Pediatrics standards, Quality Improvement trends, Reference Standards, Fluid Therapy methods, Hospitalization trends, Patient Care Bundles standards, Quality Improvement standards
- Abstract
Importance: Given that hypotonic maintenance intravenous fluids (IVF) may cause hospital-acquired harm, in November 2018, the American Academy of Pediatrics released a clinical practice guideline recommending the use of isotonic IVF for patients aged 28 days to 18 years without contraindications. No recommendations were made regarding laboratory monitoring; however, unnecessary laboratory tests may contribute to health care waste and harm patients., Objective: To examine the effect of a quality improvement intervention bundle on (1) increasing the mean proportion of hours per hospital day with exclusive isotonic IVF use to at least 80% and (2) decreasing the mean proportion of hospital days with laboratory tests obtained., Design, Setting, and Participants: This stepped-wedge, cluster randomized clinical trial (Standardization of Fluids in Inpatient Settings [SOFI]) was sponsored by a national quality improvement collaborative and was conducted across 106 US pediatric hospitals. The SOFI intervention period was from September 2019 to March 2020., Interventions: Hospital sites were exposed to educational materials, a clinical algorithm and order set for IVF use, electronic medical record interventions to reduce laboratory testing, and "harms of overtesting" cards., Main Outcomes and Measures: Primary outcomes were mean proportion of hours per hospital day receiving exclusive isotonic IVF and mean proportion of hospital days with laboratory test values obtained. Secondary measures included total IVF duration per hospital day, daily patient weight measurement while receiving IVF, serum sodium testing, and adverse events. Baseline data were collected for 2 months; intervention period data, 7 months. Outcomes were analyzed using linear mixed-effects regression models., Results: A total of 106 hospitals were randomly assigned to 1 of 3 intervention start dates (wedges), and 100 hospitals (94%) completed the study. In total, 5215 hospitalizations were reviewed before the intervention, and 6724 hospitalizations were reviewed after the intervention. Prior to interventions, the mean (SD) proportion of hours per day with exclusive isotonic IVF use was 88.5% (31.7%). Interventions led to an absolute increase of 5.4% (95% CI, 3.9%-6.9%) above baseline in exclusive isotonic IVF use but did not change the proportion of hospital days during which a laboratory test value was obtained (estimated difference, 0.1%; 95% CI, -1.5% to 1.7%; P = .90), IVF use duration (estimated difference, -1.2%; 95% CI, -2.9% to 0.4%), serum sodium testing, or adverse events. There was an absolute increase of 4.4% (95% CI, 2.6%-6.2%) in the mean proportion of hospital days with a patient weight measurement while receiving IVF., Conclusions and Relevance: In this stepped-wedge, cluster randomized clinical trial, an intervention bundle significantly improved the use of isotonic maintenance IVF without a concomitant increase in adverse events or electrolyte testing. Further work is required to deimplement laboratory testing., Trial Registration: ClinicalTrials.gov Identifier: NCT03924674.
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- 2022
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44. How to assure the quality of clinical records? A 7-year experience in a large academic hospital.
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Scarpis E, Brunelli L, Tricarico P, Poletto M, Panzera A, Londero C, Castriotta L, and Brusaferro S
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- Anesthesia standards, Humans, Academic Medical Centers standards, Documentation standards, Electronic Health Records standards, Hospital Information Systems standards, Pain Management standards, Quality Assurance, Health Care standards, Quality Improvement standards
- Abstract
Introduction: Clinical record (CR) is the primary tool used by healthcare workers (HCWs) to record clinical information and its completeness can help achieve safer practices. CR is the most appropriate source in order to measure and evaluate the quality of care. In order to achieve a safety climate is fundamental to involve a responsive healthcare workforce thorough peer-review and feedbacks. This study aims to develop a peer-review tool for clinical records quality assurance, presenting the seven-year experience in the evolution of it; secondary aims are to describe the CR completeness and HCWs' diligence toward recording information in it., Methods: To assess the completeness of CRs a peer-review tool was developed in a large Academic Hospital of Northern Italy. This tool included measurable items that examined different themes, moments and levels of the clinical process. Data were collected every three months between 2010 and 2016 by appointed and trained HCWs from 42 Units; the hospital Quality Unit was responsible for of processing and validating them. Variations in the proportion of CR completeness were assessed using Cochran-Armitage test for trends., Results: A total of 9,408 CRs were evaluated. Overall CR completeness improved significantly from 79.6% in 2010 to 86.5% in 2016 (p<0.001). Doctors' attitude showed a trend similar to the overall completeness, while nurses improved more consistently (p<0.001). Most items exploring themes, moments and levels registered a significant improvement in the early years, then flattened in last years. Results of the validation process were always above the cut-off of 75%., Conclusions: This peer-review tool enabled the Quality Unit and hospital leadership to obtain a reliable picture of CRs completeness, while involving the HCWs in the quality evaluation. The completeness of CR showed an overall positive and significant trend during these seven years., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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45. Effects of the World Health Organization Safe Childbirth Checklist on Quality of Care and Birth Outcomes in Aceh, Indonesia: A Cluster-Randomized Clinical Trial.
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Kaplan LC, Ichsan I, Diba F, Marthoenis M, Muhsin M, Samadi S, Richert K, Susanti SS, Sofyan H, and Vollmer S
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- Checklist, Female, Humans, Indonesia, Pregnancy, Quality Improvement standards, World Health Organization, Delivery, Obstetric standards, Maternal Health Services organization & administration, Patient Care Team organization & administration, Pregnancy Complications prevention & control, Pregnancy Outcome epidemiology
- Abstract
Importance: To address major causes of perinatal and maternal mortality, the World Health Organization developed the Safe Childbirth Checklist (SCC), which to our knowledge has been rigorously evaluated only in combination with high-intensity coaching., Objective: To evaluate the effect of the SCC with medium-intensity coaching on health care workers' performance of essential birth practices., Design, Setting, and Participants: This cluster randomized clinical trial without blinding included 32 hospitals and community health centers in the province of Aceh, Indonesia (a medium-resource setting) that met the criterion of providing at least basic emergency obstetric and newborn care. Baseline data were collected from August to October 2016, and outcomes were measured from March to April 2017. Data were analyzed from January 2020 to October 2021., Interventions: After applying an optimization method, facilities were randomly assigned to the treatment or control group (16 facilities each). The SCC with 11 coaching visits was implemented during a 6-month period., Main Outcomes and Measures: For the primary outcome, clinical observers documented whether 36 essential birth practices were applied at treatment and control facilities at 1 or more of 4 pause points during the birthing process (admission to the hospital, just before pushing or cesarean delivery, soon after birth, and before hospital discharge). Probability models for binary outcome measures were estimated using ordinary least-squares regressions, complemented by Firth logit and complier average causal effect estimations., Results: Among the 32 facilities that participated in the trial, a significant increase of up to 41 percentage points was observed in the application of 5 of 36 essential birth practices in the 16 treatment facilities compared with the 16 control facilities, including communication of danger signs at admission (treatment: 136 of 155 births [88%]; control: 79 of 107 births [74%]), measurement of neonatal temperature (treatment: 9 of 31 births [29%]; control: 1 of 20 births [5%]), newborn feeding checks (treatment: 22 of 34 births [65%]; control: 5 of 21 births [24%]), and the rate of communication of danger signs to mothers and birth companions verbally (treatment: 30 of 36 births [83%]; control: 14 of 22 births [64%]) and in a written format (treatment: 3 of 24 births [13%]; control: 0 of 16 births [0%])., Conclusions and Relevance: In this cluster randomized clinical trial, health facilities that implemented the SCC with medium-intensity coaching had an increased rate of application for 5 of 36 essential birth practices compared with the control facilities. Medium-intensity coaching may not be sufficient to increase uptake of the SCC to a satisfying extent, but it may be worthwhile to assess a redesigned coaching approach prompting long-term behavioral change and, therefore, effectiveness., Trial Registration: isrctn.org Identifier: ISRCTN11041580.
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- 2021
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46. Preoperative Management of Gastrointestinal and Pulmonary Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement.
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Pfeifer KJ, Selzer A, Whinney CM, Rogers B, Naik AS, Regan D, Mendez CE, Urman RD, and Mauck K
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- Gastrointestinal Agents adverse effects, Humans, Perioperative Care methods, Perioperative Care standards, Preoperative Care methods, Respiratory System Agents adverse effects, Gastrointestinal Agents therapeutic use, Preoperative Care standards, Quality Improvement standards, Respiratory System Agents therapeutic use
- Abstract
Perioperative medication management is integral to preoperative optimization but remains challenging because of a paucity of literature guidance. Published recommendations are based on the expert opinion of a small number of authors without collaboration from multiple specialties. The Society for Perioperative Assessment and Quality Improvement (SPAQI) recognized the need for consensus recommendations in this area as well as the unique opportunity for its multidisciplinary membership to fill this void. In a series of articles within this journal, SPAQI provides preoperative medication management guidance based on available literature and expert multidisciplinary consensus. The aim of this consensus statement is to provide practical guidance on the preoperative management of gastrointestinal and pulmonary medications. A panel of experts with anesthesiology, perioperative medicine, hospital medicine, general internal medicine, and medical specialty experience was drawn together and identified the common medications in each of these categories. The authors then used a modified Delphi approach to review the literature and to generate consensus recommendations., (Copyright © 2021 Mayo Foundation for Medical Education and Research. All rights reserved.)
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- 2021
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47. Accreditation as a qualified surgeon improves surgical outcomes in laparoscopic distal gastrectomy.
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Kikuchi S, Kagawa T, Kuroda S, Nishizaki M, Takata N, Kuwada K, Shoji R, Kakiuchi Y, Mitsuhashi T, Umeda Y, Noma K, Kagawa S, and Fujiwara T
- Subjects
- Aged, Blood Loss, Surgical prevention & control, Blood Loss, Surgical statistics & numerical data, Female, Gastrectomy education, Humans, Japan, Laparoscopy education, Learning Curve, Male, Middle Aged, Operative Time, Postoperative Complications epidemiology, Postoperative Complications prevention & control, Retrospective Studies, Treatment Outcome, Accreditation standards, Clinical Competence standards, Gastrectomy methods, Gastrectomy standards, Laparoscopy methods, Laparoscopy standards, Quality Improvement standards, Quality of Health Care standards, Stomach Neoplasms surgery, Surgeons standards
- Abstract
Purpose: The Endoscopic Surgical Skill Quantification System for qualified surgeons (QSs) was introduced in Japan to improve surgical outcomes. This study reviewed the surgical outcomes after initial experience performing laparoscopic distal gastrectomy (LDG) and evaluated the improvement in surgical outcomes following accreditation as a QS., Methods: Eighty-seven consecutive patients who underwent LDG for gastric cancer by a single surgeon were enrolled in this study. The cumulative sum method was used to analyze the learning curve for LDG. The surgical outcomes were evaluated according to the two phases of the learning curve (learning period vs. mastery period) and accreditation (non-QS period vs. QS period)., Results: The learning period for LDG was 48 cases. Accreditation was approved at the 67th case. The operation time and estimated blood loss were significantly reduced in the QS period compared to the non-QS period (230 vs. 270 min, p < 0.001; 20.5 vs. 59.8 ml, p = 0.024, respectively). Furthermore, the major complication rate was significantly lower in the QS period than in the non-QS period (0 vs. 10.6%, p = 0.044)., Conclusions: Experience performing approximately 50 cases is required to reach proficiency in LDG. After receiving accreditation as a QS, the surgical outcomes, including the complication rate, were improved., (© 2021. Springer Nature Singapore Pte Ltd.)
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- 2021
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48. The Learning Health System: The Tools Are Here-Why Aren't We Moving Forward?
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Corley DA and Kilbourne A
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- Attitude of Health Personnel, Clinical Competence standards, Clinical Decision-Making, Diffusion of Innovation, Evidence-Based Medicine standards, Humans, Patient Safety standards, Professional Practice Gaps standards, Quality Assurance, Health Care standards, Quality Improvement standards, Quality Indicators, Health Care standards, Guideline Adherence standards, Learning Health System standards, Practice Guidelines as Topic standards, Practice Patterns, Physicians' standards
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- 2021
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49. Improving clinical documentation of evaluation and management care and patient acuity improves reimbursement as well as quality metrics.
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Seligson MT, Lyden SP, Caputo FJ, Kirksey L, Rowse JW, and Smolock CJ
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- Aged, Aged, 80 and over, Allied Health Personnel standards, Documentation standards, Female, Humans, Insurance, Health, Reimbursement standards, Male, Middle Aged, Patient Care Management standards, Quality Assurance, Health Care standards, Quality Improvement economics, Quality Improvement standards, Quality Indicators, Health Care standards, Retrospective Studies, United States, Vascular Surgical Procedures standards, Allied Health Personnel economics, Documentation economics, Health Care Costs standards, Insurance, Health, Reimbursement economics, Patient Acuity, Patient Care Management economics, Quality Assurance, Health Care economics, Quality Indicators, Health Care economics, Vascular Surgical Procedures economics
- Abstract
Objective: Accurate documentation of patient care and acuity is essential to determine appropriate reimbursement as well as accuracy of key publicly reported quality metrics. We sought to investigate the impact of standardized note templates by inpatient advanced practice providers (APPs) on evaluation and management (E/M) charge capture, including outside of the global surgical package (GSP), and quality metrics including case mix index (CMI) and mortality index (MI). We hypothesized this clinical documentation initiative as well as improved coding of E/M services would result in increased reimbursement and quality metrics., Methods: A documentation and coding initiative on the heart and vascular service line was initiated in 2016 with focus on improving inpatient E/M capture by APPs outside the GSP. Comprehensive training sessions and standardized documentation templates were created and implemented in the electronic medical record. Subsequent hospital care E/M (current procedural terminology codes 99231, 99232, 99233) from the years 2015 to 2017 were audited and analyzed for charge capture rates, collections, work relative value units (wRVUs), and billing complexity. Data were compared over time by standardizing CMS values and reimbursement rates. In addition, overall CMI and MI were calculated each year., Results: One year following the documentation initiative, E/M charges on the vascular surgery service line increased by 78.5% with a corresponding increase in APP charges from 0.4% of billable E/M services to 70.4% when compared with pre-initiative data. The charge capture of E/M services among all inpatients rose from 21.4% to 37.9%. Additionally, reimbursement from CMS increased by 65% as total work relative value units generated from E/M services rose by 78.4% (797 to 1422). The MI decreased over the study period by 25.4%. Additionally, there was a corresponding 5.6% increase in the cohort CMI. Distribution of E/M encounter charges did not vary significantly. Meanwhile, the prevalence of 14 clinical comorbidities in our cohort as well as length of stay (P = .88) remained non-statistically different throughout the study period., Conclusions: Accurate clinical documentation of E/M care and ultimately inpatient acuity is critical in determining quality metrics that serve as important measures of overall hospital quality for CMS value-based payments and rankings. A system-based documentation initiative and expanded role of inpatient APPs on vascular surgery teams significantly improved charge capture and reimbursement outside the GSP as well as CMI and MI in a consistently complex patient population., (Published by Elsevier Inc.)
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- 2021
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50. Home health agency adoption of quality improvement activities and association with performance.
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Shetty KD, Robbins MW, Saliba D, Campbell KN, Castora-Binkley M, and Damberg CL
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- Centers for Medicare and Medicaid Services, U.S., Humans, Medical Informatics, Motivation, Organizational Culture, Surveys and Questionnaires, United States, Home Care Agencies organization & administration, Home Care Agencies standards, Medicare standards, Quality Improvement standards, Quality Indicators, Health Care standards
- Abstract
Background: The Centers for Medicare & Medicaid Services (CMS) Home Health Quality Reporting Program (HHQRP) uses performance measurement to spur improvements in home health agencies' (HHAs') quality of care. We examined quality improvement (QI) activities HHAs reported making to improve on HHQRP quality measures, and whether reported QI activities were associated with better measure performance., Methods: We used responses (N = 1052) from a Web- and mail-based survey of a stratified random sample of HHAs included in CMS Home Health Compare in October 2019. We estimated national adoption rates for 27 possible QI activities related to organizational culture, health information technology, care process redesign, provider incentives, provider training, changes to staffing responsibilities, performance monitoring, and measure-specific QI initiatives and technical assistance. We used multivariate linear regression to examine the associations between HHA characteristics and QI adoption, and between QI adoption and CMS Home Health Quality of Patient Care Star Rating., Results: HHAs reported implementing an average of 16 QI activities (interquartile range 11-19 activities). Larger HHA size was associated with adopting 1.6 additional QI activities (p < 0.001). HHAs with higher proportions of disabled, black, or Hispanic patients adopted QI activities at similar or higher rates as other HHAs. Of the 27 QI activities, 23 were considered helpful by more than 80% of adopting HHAs. Compared with adopting 44% of QI activities (10th percentile among HHAs), adopting 89% of QI activities (90th percentile) was associated with a 0.4-star higher Star Rating (95% confidence interval 0.2-0.6)., Conclusions: HHAs report implementing a significant number of QI activities in response to CMS measurement programs; implementation of a greater number of activities is associated with better performance on publicly reported measures. To guide future HHA QI investments, work is needed to identify the optimal combination of QI activities and the specific QI activities that yield the greatest performance improvements., (© 2021 The American Geriatrics Society.)
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- 2021
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