1,253 results match your criteria Journal for Healthcare Quality [Journal]


The ED-PACT Tool Initiative: Communicating Veterans' Care Needs After Emergency Department Visits.

J Healthc Qual 2019 Apr 12. Epub 2019 Apr 12.

Background: Communication failures between providers threaten patient safety.

Purpose: We developed, implemented, and formatively evaluated the ED-PACT Tool, which uses the Veterans Health Administration's (VA) electronic health record to send messages from emergency department (ED) providers to primary care patient-aligned care team (PACT) registered nurses (RNs) for Veterans discharged home from the ED with urgent or specific follow-up needs.

Methods: We used Plan-Do-Study-Act quality improvement methodology. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000195DOI Listing

Reducing Mortality and Avoiding Preventable ICU Utilization: Analysis of a Successful Rapid Response Program Using APR DRGs.

J Healthc Qual 2018 Mar 7. Epub 2018 Mar 7.

Raleigh, NC.

Even though rapid response teams (RRTs) have been widely adopted, reports about their efficacy in reducing mortality have been conflicting, both in terms of outcomes, and standardization of measures. Our data demonstrate that it is possible to detect significant changes within the patient population while overall mortality rates appear not to change. Our focus will be on three indicators: unplanned transfers to the ICU as an RRT outcomes measure, changes in ICU patient utilization, and mortality. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1945-1474.2010.00084.xDOI Listing

A Quality Improvement Project to Improve Sepsis-Related Outcomes at an Integrated Healthcare System.

J Healthc Qual 2019 Mar 14. Epub 2019 Mar 14.

Hospitals are encouraged to take steps to improve outcomes for patients with sepsis, a leading cause of morbidity and mortality. A retrospective analysis examined data (n = 4,475) from three health systems to better determine the impact of a 10-month sepsis quality improvement program that consisted of clinical alerts, audit and feedback, and staff education. Compared with the control group, the intervention group significantly decreased length of stay and costs per stay. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000193DOI Listing

Effectiveness of Implementing a Predischarge Order to Discharge Patients Before 11 a.m.

J Healthc Qual 2019 Mar 15. Epub 2019 Mar 15.

Barriers to early discharges include poor communication among the healthcare team and families, pending laboratory test results, delays in discharge orders, medical reconciliation list, and patient transport. The baseline data at our hospital in October 2017 (N = 1,021) showed that 5% of patients were discharged before 11 a.m. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000194DOI Listing

Veterans Health Administration Primary Care Provider Adherence to Prescribing Guidelines for Systemic Hormone Therapy in Menopausal Women.

J Healthc Qual 2019 Mar/Apr;41(2):99-109

Background: Systemic hormone therapy (HT) is effective for treating menopausal symptoms but also confers risks. Therefore, experts have developed clinical guidelines for its use.

Purpose: We assessed primary care guideline adherence in prescribing systemic HT, and associations between adherence and provider characteristics, in four Veterans Health Administration (VA) facilities. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000183DOI Listing
March 2019
1 Read

Reducing Cancellations and Optimizing Surgical Scheduling of Ophthalmology Cases at a Veterans Affairs Medical Center.

J Healthc Qual 2019 Mar/Apr;41(2):83-90

Preventable causes of ophthalmology surgical case cancellations were identified, and interventions were implemented to improve operating room utilization at our Veterans Affairs (VA) Medical Center. A retrospective review of 269 patients with cancellations from 2013 to 2015 was performed. Interventions implemented from September 2014 to March 2015 were evaluated followed by in-depth chart reviews to identify demographics and wait-time intervals. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000187DOI Listing

Reducing Rejected Fecal Immunochemical Tests Received in the Laboratory for Colorectal Cancer Screening.

J Healthc Qual 2019 Mar/Apr;41(2):75-82

Background: Colorectal cancer (CRC) screening decreases CRC incidence; however, many patients are not successfully screened.

Purpose: To improve screening rates at our institution by decreasing the rate of rejected fecal immunochemical tests (FITs), a means of CRC screening, from 28.6% to <10% by December 2017. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000181DOI Listing

Forward.

Authors:
Carolyn Clancy

J Healthc Qual 2019 Mar/Apr;41(2):67

Deputy Under Secretary for Health for Discovery, Education and Affiliate Networks, Department of Veterans Affairs, Veterans Health Administration, Washington, DC.

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000189DOI Listing

Introduction to the Special Issue on Healthcare Quality Initiatives for Veterans.

J Healthc Qual 2019 Mar/Apr;41(2):65-66

Dean and Fay B. Ireland Endowed Chair in Nursing, University of Alabama at Birmingham (UAB) School of Nursing, Birmingham, AL Director of the Pan American Health Organization (PAHO)/World Health Organization (WHO) Collaborating Center on International Nursing, UAB, Birmingham, AL Chief Academic Officer of the University of Alabama at Birmingham Nursing Partnership between University of Alabama Health System and its Department of Nursing, and UAB School of Nursing, Birmingham, AL Associate Professor at the University of Alabama at Birmingham (UAB) School of Nursing, Birmingham, AL Director of Educationally Focused Partnerships within the Office of Clinical and Global Partnerships at UAB, Birmingham, AL Associate Editor, JHQ.

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000188DOI Listing

Text Message Quality Improvement Project for Influenza Vaccine in a Low-Resource Largely Latino Pediatric Population.

J Healthc Qual 2019 Feb 28. Epub 2019 Feb 28.

Children with asthma are targeted for influenza vaccine because of their vulnerability to complications, particularly those with low income or family preference for Spanish language. We used text messaging to encourage caregivers to vaccinate. Participants were children (aged >6 months), predominantly low income and Latino, with an asthma diagnosis attending a pediatric clinic. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000190DOI Listing
February 2019
1 Read

Shared Care During Breast and Colorectal Cancer Treatment: Is It Associated With Patient-Reported Care Quality?

J Healthc Qual 2019 Feb 27. Epub 2019 Feb 27.

There is growing evidence that shared care, where the oncologist, primary care physician, and/or other specialty physicians jointly participate in care, can improve the quality of patients' cancer care. This cross-sectional study of breast and colorectal cancer patients (N = 534) recruited from the New Jersey State Cancer Registry examined patient and health system factors associated with receipt of shared care during cancer treatment into the early survivorship phase. We also assessed whether shared care was associated with quality indicators of cancer care: receipt of comprehensive care, follow-up care instructions, and written treatment summaries. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000192DOI Listing
February 2019
1 Read

An Antimicrobial Stewardship Intervention Improves Adherence to Standard of Care for Staphylococcus aureus Bloodstream Infection.

J Healthc Qual 2019 Feb 26. Epub 2019 Feb 26.

Introduction: Staphylococcus aureus bloodstream infections (SABSI) are a major cause of morbidity and mortality in the United States, and proper management is important to effect cure and prevent metastatic foci of infection. We aimed to utilize our antimicrobial stewardship program (ASP) to improve practices at a large academic hospital system.

Methods: Our ASP implemented a SABSI educational campaign directed at the hospital medicine, cardiology, and infectious diseases divisions. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000191DOI Listing
February 2019
4 Reads

Contextual Factors Associated With Quality Improvement Success in a Multisite Ambulatory Setting.

J Healthc Qual 2019 Feb 4. Epub 2019 Feb 4.

The Model for Understanding Success in Quality (MUSIQ) is a framework of contextual factors for quality improvement (QI) projects. We sought to determine which MUSIQ contextual factors were associated with successful QI initiatives. In a cross-sectional survey study, at a 21-site, ambulatory, urban primary care network, a modified MUSIQ survey tool questionnaire was administered to QI team members. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000186DOI Listing
February 2019
9 Reads

Psychiatric Nurse Practitioner Residents Improve Quality and Mental Health Outcomes for Veterans Through Measurement-Based Care.

J Healthc Qual 2019 Mar/Apr;41(2):118-124

Introduction: Measurement-based care (MBC) is commonly used to manage medical illness, whereas only about 20% of psychiatric care providers use MBC. One aim of the partnership between the Birmingham Veterans Affairs Medical Center (BVAMC) and the University of Alabama at Birmingham School of Nursing (UAB SON) is to provide MBC to Veterans. The goal is to describe the efficacy of MBC in the treatment of Veterans by psychiatric-mental health nurse practitioner (PMHNP) residents. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000180DOI Listing
February 2019
1 Read

Gerofit Prehabilitation Pilot Program: Preparing Frail Older Veterans for Surgery.

J Healthc Qual 2019 Mar/Apr;41(2):91-98

Older Veterans are increasingly undergoing surgery and are at particularly high risk of postoperative morbidity and mortality. Prehabilitation has emerged as a method to improve postoperative outcomes by enhancing the patient's preoperative condition. We present data from our prehabilitation pilot project and plans for expansion and dissemination of a nationwide quality improvement effort. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000185DOI Listing
January 2019

Oregon's Coordinated Care Organization Experiment: Are Members' Experiences of Care Actually Changing?

J Healthc Qual 2019 Jan 18. Epub 2019 Jan 18.

In 2012, Oregon embarked on an ambitious plan to redesign financing and care delivery for Medicaid. Oregon's Coordinated Care Organizations (CCOs) are the first statewide effort to use accountable care principles to pay for Medicaid benefits. We surveyed 8,864 Medicaid-eligible participants approximately 1 year before and 12 months after CCO implementation to assess the impact of CCOs on member-reported outcomes. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000178DOI Listing
January 2019
7 Reads

Alerting Wisely: Reducing Inappropriate Blood Chemistry Panel Orders Using a Clinical Decision Support Tool.

J Healthc Qual 2019 Jan 3. Epub 2019 Jan 3.

The Choosing Wisely (CW) initiative provides recommendations for healthcare providers, aimed at reducing unnecessary or inappropriate tests and procedures. A clinical decision support (CDS) alert in the electronic health record was developed to reflect organizational CW guidelines regarding blood chemistry panel ordering in the primary care setting. An interrupted time series design was used to analyze the weekly proportion of inappropriate blood chemistry panel orders prior to and after implementation of the CDS alert in treatment and control groups. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000175DOI Listing
January 2019
12 Reads

Falls in Hospital Causing Injury.

J Healthc Qual 2019 Jan 3. Epub 2019 Jan 3.

Clinical Governance Unit, Nepean Blue Mountain Local Health District, Sydney, Australia Epidemiology, Executive Medical Services, Western Sydney Local Health District, Sydney, Australia.

Aims: To describe falls causing injury, types of injuries, and the reporting of these falls.

Methods: Administrative and incident reporting datasets between July 2012 and June 2017 were analyzed.

Results: Using both datasets, 5,653 falls were identified (3. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000179DOI Listing
January 2019
11 Reads

7 Is the New 8: Improving Adherence to Restrictive PRBC Transfusions in the Pediatric ICU.

J Healthc Qual 2019 Jan 3. Epub 2019 Jan 3.

Up to 30%-40% of children admitted to the pediatric intensive care unit (PICU) have anemia, and approximately 15% receive packed red blood cell (pRBC) transfusions. Current literature supports a pRBC transfusion threshold of hemoglobin less than or equal to seven for most PICU patients. Our objective was to determine pRBC transfusion rates, assess compliance with transfusion guidelines, understand patient-level variables that affect transfusion practices, and use cross-industry innovation to implement a practice strategy. Read More

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=01445442-900000000-9979
Publisher Site
http://dx.doi.org/10.1097/JHQ.0000000000000176DOI Listing
January 2019
7 Reads

A Student-Led, Multifaceted Intervention to Decrease Unnecessary Folate Ordering in the Inpatient Setting.

J Healthc Qual 2019 Jan 3. Epub 2019 Jan 3.

To reduce unnecessary laboratory testing, a three-phase intervention was designed by students to decrease serum folate laboratory testing in the inpatient setting. These included an educational phase, a personalized feedback phase, and the uncoupling of orders in the electronic medical record. Average monthly serum folate ordering decreased by 87% over the course of the intervention, from 98. Read More

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=01445442-900000000-9978
Publisher Site
http://dx.doi.org/10.1097/JHQ.0000000000000177DOI Listing
January 2019
11 Reads

Quality of Care and Preventive Screening Use in the CareFirst Patient-Centered Medical Home Program.

J Healthc Qual 2019 Jan 3. Epub 2019 Jan 3.

Despite their value, comprehensive diabetes care and screening for common cancers remain underutilized. We examined the association between participation in a patient-centered medical home (PCMH) program with strong financial incentives and receipt of preventive care in the first 5 years after program launch. Using multivariate regression analysis, we compared outcomes for adults under the care of participating primary care providers (PCPs) with adults under the care of nonparticipating PCPs. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000169DOI Listing
January 2019
15 Reads

Improving Colorectal Cancer Screening Rates in Patients Referred to a Gastroenterology Clinic.

J Healthc Qual 2019 Jan 3. Epub 2019 Jan 3.

Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related death in the United States. Colonoscopy and fecal immunochemistry testing (FIT) are the primary recommended CRC screening modalities. The purpose of this study is to improve rates of CRC screening in Veterans and County hospital patients referred to gastroenterology fellow's clinics. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000170DOI Listing
January 2019
7 Reads

Improving Nonvocal Critical Care Patients' Ease of Communication Using a Modified SPEACS-2 Program.

J Healthc Qual 2019 Jan 3. Epub 2019 Jan 3.

Objective: To evaluate the feasibility and impact of implementing the "study of patient-nurse effectiveness with assisted communication strategies-2" (SPEACS-2); a program to facilitate communication with nonvocal patients.

Study Design: The plan-do-study-act quality improvement methodology guided the implementation of a modified SPEACS-2 program within a pre and posttest design. The Ease of Communication Scale (ECS) measured patients' communication difficulty, and care processes measured the program's success. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000163DOI Listing
January 2019
11 Reads

Human-Centered Design of a Low Molecular Weight Heparin Order Set to Reduce Medication Errors.

J Healthc Qual 2019 Jan/Feb;41(1):e7-e12

Inpatient anticoagulation medication errors for venous thromboembolism (VTE) therapy are common. Our VTE Team identified frequent dosing and duplicate order errors for therapeutic-dose low molecular weight heparin, which (lacking computerized physician order entry) was ordered using blank forms. To decrease such errors, a nonmandatory order form with weight-based dosing and prechecked orders discontinuing existing injectable anticoagulation was developed using human-centered design innovation principles/processes emphasizing end-user engagement in all phases: observation, exploring solutions, and rapid prototyping/feedback. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000171DOI Listing
January 2019
12 Reads

Decreasing Adverse Events in Pediatric Patients With End-Stage Renal Disease.

J Healthc Qual 2019 Jan/Feb;41(1):59-64

Children with end-stage renal disease (ESRD) are at a higher risk of adverse events when they live at a distance from a pediatric facility with specialty services specific to the disease process. At a children's hospital in the southeast, a dialysis unit provides care for 27 patients with chronic ESRD. Nineteen of the 27 patients live more than 1 hour away from the children's hospital. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000172DOI Listing
January 2019
6 Reads

Multidisciplinary Approach to Improve Sepsis Outcomes.

J Healthc Qual 2018 Nov 2. Epub 2018 Nov 2.

Severe sepsis and septic shock cause significant morbidity and mortality with health care costs approximating $17 billion annually. The Surviving Sepsis Campaign 2012 recommended time-sensitive care bundles to improve outcomes for patients with sepsis. At our community teaching hospital, a review of sepsis management for patients admitted to a medical intensive care unit (ICU) between December 2015 and March 2016 found 70. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000166DOI Listing
November 2018
16 Reads

Understanding Quality of Care and Satisfaction With Sexual and Reproductive Healthcare Among Young Men.

J Healthc Qual 2018 Nov/Dec;40(6):354-366

Objective: Sexual and reproductive healthcare (SRHC) guidelines recommend the delivery of quality preventive SRHC to males beginning in adolescence. A quality of care (QOC) framework was used to examine factors associated with young male's perceptions of QOC and satisfaction with care, which can influence their engagement and use of SRHC.

Methods: Cross-sectional surveys were conducted from August 2014 to September 2016 with 385 male patients aged 15-24 years, recruited from primary care and sexually transmitted disease (STD) clinics. Read More

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=01445442-201811000-0000
Publisher Site
http://dx.doi.org/10.1097/JHQ.0000000000000149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224152PMC
November 2019
10 Reads

Impact of a Resident-Centered Interprofessional Quality Improvement Intervention on Acute Care Length of Stay.

J Healthc Qual 2018 Oct 26. Epub 2018 Oct 26.

Competency in interprofessional quality improvement and performance measurement is required by the Accreditation Council for Graduate Medical Education. We implemented an interprofessional quality improvement project to support trainee involvement in systems-level improvement to reduce hospital length of stay and engage trainees in efforts to improve the validity and reliability of clinical documentation contributing to risk-adjusted performance measures. The intervention had three components: daily interprofessional disposition huddles to discuss discharge needs, medical documentation curriculum to improve clinical data accuracy, and scheduled coding huddles to provide real-time feedback on documentation. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000156DOI Listing
October 2018
16 Reads

Preventing Central Line-Associated Bloodstream Infections in the Intensive Care Unit: Application of High-Reliability Principles.

J Healthc Qual 2018 Nov/Dec;40(6):392-397

This department column highlights translation of research into healthcare quality practice. Achieving the highest quality in healthcare requires organizations to understand care delivery and to proactively mitigate risks in care delivery processes. The purpose of this article is to describe a quality initiative that used principles of high reliability to develop a zero tolerance culture for central line-associated bloodstream infections in an intensive care unit at an independent, nonprofit acute care community hospital. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000164DOI Listing
October 2018
18 Reads

Readmission of High-Risk Discharged Patients at a Tertiary Hospital in Korea.

J Healthc Qual 2018 Oct 22. Epub 2018 Oct 22.

This study aims to investigate the readmission rates of major disease groups as stated by the Centers for Medicare and Medicaid Services and to identify risk factors related to readmission in Korea. We studied 2,973 patients discharged from a 2,200-bed tertiary referral hospital in South Korea, from April 1, 2016, to March 31, 2017. Using electronic medical records, we calculated the 30-day readmission rates of seven diseases: acute myocardial infarction, chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia, stroke, coronary artery bypass graft (CABG), and total hip arthroplasty/total knee arthroplasty. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000151DOI Listing
October 2018
11 Reads

Narcotic Pain Control for Ureterolithiasis Is Associated With Unnecessary Repeat Imaging in the Emergency Department.

J Healthc Qual 2018 Oct 24. Epub 2018 Oct 24.

A subset of patients with ureteral stones who present to the emergency department (ED) will return with recurring symptoms and will receive unnecessary repeat imaging. We retrospectively identified 112 patients from 2012 to 2016 diagnosed with at least one ureteral stone on computerized tomography (CT) at our institution who returned to the ED within 30 days. Patients were stratified based on the presence or absence of repeat CT scan imaging. Read More

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=01445442-900000000-9979
Publisher Site
http://dx.doi.org/10.1097/JHQ.0000000000000165DOI Listing
October 2018
4 Reads

Consumers' Association of Hospital Reputation With Healthcare Quality.

J Healthc Qual 2018 Oct 24. Epub 2018 Oct 24.

Why consumers consistently rank hospital reputation as one of the most important factors when selecting health care services remains unknown. We hypothesized that this is explained by consumers associating reputation with objective quality. We performed a cross-sectional, US population-based survey of consumers (N = 23,410) exploring this association. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000167DOI Listing
October 2018
24 Reads

Development of a Multistep Hypertension Quality Improvement Program in an Academic General Medicine Practice.

J Healthc Qual 2018 Oct 8. Epub 2018 Oct 8.

Hypertension is a common problem and a major risk factor for cardiovascular disease. It is unclear whether efforts to control blood pressure (BP) known to be effective in integrated healthcare systems can be successfully implemented in an academic setting. We describe our experience implementing a multistep quality improvement program within an academic general medicine practice aimed at improving BP among patients with uncontrolled hypertension. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000158DOI Listing
October 2018
2 Reads

Decreasing the Time to Administration of First Dose of Antibiotics in Children With Severe Sepsis.

J Healthc Qual 2019 Jan/Feb;41(1):32-38

Objectives: To measure difference in median time to antibiotic administration in severe sepsis before and after making process changes and clinical outcomes such as duration of hospitalization and mortality.

Methods: The study was carried out in the emergency department in children <17 years of age with severe sepsis/septic shock. In phase 1, data were collected and reasons for delayed antibiotic administration were identified. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000141DOI Listing
September 2018
9 Reads

Predictors of 30-day Postdischarge Readmission to a Multistate National Sample of State Psychiatric Hospitals.

Authors:
Glorimar Ortiz

J Healthc Qual 2018 Sep 19. Epub 2018 Sep 19.

Background: Early discharge from psychiatric inpatient care may pose challenges for the patient's recovery and may incite a rapid return to the hospital. This study identified demographic, clinical, and the continuing of care characteristics associated with rapid readmission into a sample of psychiatric inpatient hospitals.

Methods: Cross-sectional analysis of 60,254 discharges from state psychiatric hospitals. Read More

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=01445442-900000000-9980
Publisher Site
http://dx.doi.org/10.1097/JHQ.0000000000000162DOI Listing
September 2018
6 Reads

Patients' Perspectives on Reasons for Unplanned Readmissions.

J Healthc Qual 2018 Aug 30. Epub 2018 Aug 30.

Massachusetts has one of the highest rates of 30-day readmissions in the country. To identify patient-reported factors that may contribute to readmissions, we conducted semi-structured interviews with patients with unplanned readmissions within 30 days of inpatient discharge from the medicine services at an urban medical center between June and August 2016. Interviews with patients and/or proxies were conducted in English, Spanish, Mandarin, or Cantonese, then translated to English if necessary, transcribed verbatim, and deidentified. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000160DOI Listing
August 2018
7 Reads

How Measurement Variability Affects Reporting of a Single Readmission Metric.

J Healthc Qual 2018 Aug 30. Epub 2018 Aug 30.

Readmissions are an important quality measure for public reporting, payment, and collaborative research. Lack of measure standardization may lead to inconsistent reporting of outcomes across study sites. In this study, we examined the impact of measurement variability on reporting of a single readmission metric, 30-day all-condition readmission rates (ARRs). Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000152DOI Listing
August 2018
19 Reads

Reducing Phlebotomy Utilization With Education and Changes to Computerized Provider Order Entry.

J Healthc Qual 2018 Aug 30. Epub 2018 Aug 30.

Introduction: Daily phlebotomy is often a standard procedure in hospitalized patients. Recently, this practice has begun receiving attention as a potential target for efforts focused on eliminating overuse. Several organizations have published their efforts in this arena. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000150DOI Listing
August 2018
4 Reads

Improving the Transition of Care Process for Veterans Hospitalized at Non-VHA Facilities.

J Healthc Qual 2019 Mar/Apr;41(2):68-74

Veterans receiving primary care through the Veterans Health Administration (VHA) are at increased risk of adverse outcomes when transitioning from a non-VHA hospitalization to VHA primary care. We intervened to improve these care transitions through identifying Veterans at a partnered community hospital, use of a multidisciplinary patient-structured discharge information sheet for community case managers to effectively communicate with VHA clinics, and implementation of a VHA site process for receiving information. We evaluated the intervention on two endpoints: the percentage-relevant documentation was received at the VHA before follow-up appointment and the rate Veterans attended a follow-up appointment at the VHA. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000159DOI Listing
September 2018
3 Reads

Designing Large-Scale Improvement: Using an Academic-Practice Partnership to Enhance Care Transitions.

J Healthc Qual 2018 Sep/Oct;40(5):318-325

This department column highlights translation of research into healthcare quality practice. Achieving the highest quality in healthcare requires organizations to understand care delivery and to develop and design process efficiencies. The improvement process may be enhanced through a partnership between the healthcare facility and an affiliated school of nursing. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000154DOI Listing
September 2018
2 Reads

Strategically Applying New Criteria for Use Improves Management of Peripheral Intravenous Catheters.

J Healthc Qual 2018 Sep/Oct;40(5):274-282

Peripheral intravenous catheters (PIVCs) are common devices used across many healthcare settings. This quality improvement project aims to proactively remove PIVCs as soon as possible by empowering nurses and providers to clinically evaluate the necessity of every PIVC on a daily basis on a general hospital medical unit. Specific criteria were established to assess PIVC necessity. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000148DOI Listing
September 2018
3 Reads

"THINK" Before You Order: Multidisciplinary Initiative to Reduce Unnecessary Lab Testing.

J Healthc Qual 2018 Aug 17. Epub 2018 Aug 17.

Inappropriate daily lab testing can have adverse effects on patients, including anemia, pain, and interruption of sleep. We implemented a student-led, multifaceted intervention featuring clinician education, publicity campaign, gamification, and system changes, including a novel nurse-driven protocol to reduce unnecessary daily lab testing in a teaching hospital. We applied a quasi-experimental interrupted time series design with a segmented regression analysis to estimate changes before and after our 14-month intervention with a comparison to a control surgical unit. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000157DOI Listing
August 2018
40 Reads

Developing a Quality Measurement Strategy in an Academic Primary Care Setting: An Environmental Scan.

J Healthc Qual 2018 Nov/Dec;40(6):e90-e100

Purpose: The purpose of this project was to: (1) develop a strategy for primary care quality measurement using an environmental scan and interviews to identify best practices and candidate measures; (2) present recommendations to facilitate successful measurement.

Methods: Following stakeholder interviews and review of existing measures, we created a three-tiered recommendation system for selecting and implementing measures. We also developed a framework for reviewing and prioritizing measures and prepared a detailed project report. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000155DOI Listing
August 2018
3 Reads

Using Charlson Comorbidity Index to Predict Short-Term Clinical Outcomes in Hospitalized Older Adults.

J Healthc Qual 2018 Jul 30. Epub 2018 Jul 30.

This study examined the prognostic value of the Charlson Comorbidity Index (CCI) in predicting short-term clinical outcomes in hospitalized older adults. We conducted a retrospective cohort study of patients, older than 75 years, admitted to the medicine service at a large tertiary hospital (New York). We used the Enhanced International Classification of Disease, 9th Revision, Clinical Modification adaptation to abstract the CCI from electronic medical records. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000153DOI Listing
July 2018
5 Reads

"Hot Seat" Simulation Model for Conflict Resolution: A Pilot Study.

J Healthc Qual 2018 Jul/Aug;40(4):177-186

Background: Unresolved conflicts in health care threaten both clinician morale and quality of patient care. We piloted a training model that targeted clinicians' conflict resolution skills.

Methods: Sixty clinicians from local hospitals were randomized into an intervention group (n = 30), completing a 3-hour conflict resolution training session, and a control group (n = 30) without training. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000081DOI Listing
July 2018
11 Reads

Trends in Avoidable Hospitalizations for Diabetes: Experience of a Large Clinically Integrated Health Care System.

J Healthc Qual 2018 Jun 4. Epub 2018 Jun 4.

Prevention quality indicators (PQIs) are used in hospital discharge data sets to identify quality of care for ambulatory care-sensitive conditions, such as diabetes. We examined the impact of clinical integration efforts on diabetes-related PQIs in a large community-based health care organization. Inpatient and observation hospitalizations from nine acute care hospitals were trended over 5 years (2012-2016). Read More

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=01445442-900000000-9980
Publisher Site
http://dx.doi.org/10.1097/JHQ.0000000000000145DOI Listing
June 2018
5 Reads

Reducing Readmissions Post-tonsillectomy: A Quality Improvement Study on Intravenous Hydration.

J Healthc Qual 2018 Jul/Aug;40(4):217-227

Introduction: Dehydration is a potentially preventable complication post-tonsillectomy and can result in an Emergency Department visit and/or readmission. Our objectives were to identify risk factors for dehydration readmissions and develop interventions to prevent them.

Methods: We used retrospective chart reviews to determine if increased intravenous (IV) hydration post-tonsillectomy prevented hospital readmissions for dehydration. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000143DOI Listing
June 2018
9 Reads

Improving Geriatric Care Processes on Two Medical-Surgical Acute Care Units: A Pilot Study.

J Healthc Qual 2019 Jan/Feb;41(1):23-31

The Acute Care for Elders (ACE) Unit model improves cognitive and functional outcomes for hospitalized elders but reaches a small proportion of patients. To disseminate ACE Unit principles, we piloted the "Virtual ACE Intervention" that standardizes care processes for cognition and function without daily geriatrician oversight on two non-ACE units. The Virtual ACE Intervention includes staff training on geriatric assessments for cognition and function and on nurse-driven care algorithms. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000140DOI Listing
May 2018
9 Reads

Effect of Patient and Provider Education on Antibiotic Overuse for Respiratory Tract Infections.

J Healthc Qual 2018 May 18. Epub 2018 May 18.

Antibiotic overuse for respiratory tract infections (RTIs) in primary care (PC) is a known important contributor to the serious health threat of antibiotic resistance, yet remains a difficult problem to improve. The purpose of the study was to assess the effects of a combination patient and provider education program on antibiotic prescribing in RTIs in a rural primary care clinic. Utilizing a quasi-experimental pretest-posttest design, a retrospective electronic medical record review was conducted to determine if a patient and provider education program changed the rates of antibiotics being prescribed (immediate or delayed) during a visit for RTI for 207 randomly selected patients during the established evaluation time periods. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/JHQ.0000000000000144DOI Listing
May 2018
2 Reads