Bardach SH, Lichtenstein JD, Velcani F
… +4 more, Perry AN, Oliver BJ, Martin CF, Parsonnet J
Am J Med Qual
· 2024 Sep-Oct 01 · PMID 39268907
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This article explores the demand and utilization of a rural post-acute COVID syndrome clinic. Electronic health records were used to identify referrals between April 2021 and April 2022 and to describe characteristics of...This article explores the demand and utilization of a rural post-acute COVID syndrome clinic. Electronic health records were used to identify referrals between April 2021 and April 2022 and to describe characteristics of referred patients and referrals generated to specialty services. Of the 747 referrals received, 363 (48.6%) met the criteria for an appointment and were seen, the vast majority (89.6%) via Telehealth. Most patients resided in rural communities (63.1%) and were female (75.2%); mean age was 49, and 17% were hospitalized during their acute illness. Nearly half of patients (49%) had at least one pre-existing mental health diagnosis. Referrals to specialty care for further evaluation and/or intervention were most commonly to occupational therapy (27.3%), physical therapy (24.8%), psychiatry (19.8%), and neurology (17%). Telehealth expanded the availability of health care resources. Additional research on how to meet care needs, ameliorate symptoms, and aid recovery in rural communities is warranted.
Riesenberg LA, Davis JJ, Kaplan E
… +2 more, Ernstberger GC, O'Hagan EC
Am J Med Qual
· 2024 Sep-Oct 01 · PMID 39268906
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Handoffs involve the transfer of patient information and responsibility for care between health care professionals. The purpose of the current scoping review was (1) to describe handoff studies with education as part of...Handoffs involve the transfer of patient information and responsibility for care between health care professionals. The purpose of the current scoping review was (1) to describe handoff studies with education as part of the intervention and (2) to explore the role of handoff educational interventions in sustaining handoff improvements. This scoping review utilized previously published systematic reviews and a structured, systematic search of 5 databases (January 2006-June 2020). Articles were identified, and data were extracted by pairs of trained, independent reviewers. The search identified 74 relevant articles, most published after 2015 (70%) and conducted in the United States (76%). Almost all of the studies (99%) utilized instruction, 66% utilized skills practice, 89% utilized a memory aid, and 43% utilized reinforcement. However, few studies reported using education theory or followed accepted tenets of curriculum development. There has been a substantial increase over time in reporting actual handoff behavior change (17%-68%) and a smaller but important increase in reporting patient outcomes (11%-18%). Thirty-five percent of studies (26/74) had follow-up for 6 months or more. Twelve studies met the criteria for sustained change, which were follow-up for 6 months or more and achieving statistically significant improvements in either handoff skills/processes or patient outcomes at the conclusion of the study. All 12 studies with sustained change used multi-modal educational interventions, and reinforcement was more likely to be used in these studies than all others (75%, 9/12) versus (37%, 23/62), P = 0.015. Future handoff intervention efforts that include education should use education theory to guide development and include needs assessment and goals and measurable objectives. Educational interventions should be multi-modal and include reinforcement. Future research studies should measure actual handoff behavior change (skills/process) and patient outcomes, include follow-up for more than 6 months, and use education reporting guidelines.
Keller SC, Oladapo-Shittu O, Maragakis LL
… +6 more, Salinas AB, Helsel T, Hsu YJ, Rock C, Cosgrove SE, Centers for Disease Control and Prevention Epicenters Program
Am J Med Qual
· 2024 Sep-Oct 01 · PMID 39268905
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Patients managing central venous catheters (CVCs) outside of hospitals need training in CVC care. Using 3 focus groups, the study identified themes in how health care personnel (HCP) prepare patients and their caregivers...Patients managing central venous catheters (CVCs) outside of hospitals need training in CVC care. Using 3 focus groups, the study identified themes in how health care personnel (HCP) prepare patients and their caregivers for CVC care at home. Four major themes and 25 nested subthemes were identified: (1) providing the right amount of education at the right time, (2) tailoring education to patient needs, (3) developing patient education tools, and (4) managing differences in recommendations to patients. HCPs in the study ensured patients and caregivers learn what they need to know when they need to know it, using appropriate patient education tools. Patients and caregivers are largely responsible for CVC care and central line-associated bloodstream infection prevention outside of acute care hospitals and long-term care settings, and HCP take seriously their obligation to provide them with appropriate education and tools to best enhance their ability to keep themselves safe.
Cunningham AT, Waters A, Shah D
… +2 more, Arefi P, Sifri RD
Am J Med Qual
· 2024 Sep-Oct 01 · PMID 39268904
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Primary care provider and staff burnout is high, although less research exists comparing burnout by role. The objectives of this study were to characterize primary care provider and staff wellness and burnout and provide...Primary care provider and staff burnout is high, although less research exists comparing burnout by role. The objectives of this study were to characterize primary care provider and staff wellness and burnout and provide suggestions to improve wellness in a large network. Survey items included demographics, the Perceived Stress Reactivity Subscale, abbreviated Maslach Burnout Inventory, Mini-Z burnout survey, self-reported wellness, and one open-ended question asking what would improve their work-related wellness. Surveys were disseminated in February 2021, October 2021, and June 2022. Responses were analyzed by demographic categories. Open-ended responses were coded. In total 1015 responses were recorded (29.5% response rate). Burnout varied by role and campus. The 677 open-ended comments had six main themes for improving wellness: Staffing, Health System, Practice, Training, Incentives, and Miscellaneous. Primary care providers/staff reported varying, consistent levels of burnout. They suggested practice and system-level changes including increased staffing, schedule changes and improved communication.
Ross DH, Wozniak AW, Markossian T
… +3 more, Kellberg G, Gazi SK, Smith K
Am J Med Qual
· 2024 Sep-Oct 01 · PMID 39268903
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An individualized management program for patients with sickle cell disease (SCD) was created to reduce health care utilization and cost. The program was implemented to standardize the management of patients with SCD. SCD...An individualized management program for patients with sickle cell disease (SCD) was created to reduce health care utilization and cost. The program was implemented to standardize the management of patients with SCD. SCD encounters from January 2010 to December 2020 were reviewed for analysis. Preintervention utilization of inpatient, emergency room, and outpatient settings was compared to postintervention. There were 7114 encounters analyzed. Outpatient encounters increased from 36.5% to 70.9%; inpatient encounters decreased from 38.6% to 20.3%; and emergency department visits decreased from 20.3% to 8.8%. The number of high inpatient utilizers decreased 8.4% and the number of individuals who received any emergency care decreased 11.9%. When comparing average charges per time period, the median charge per encounter decreased by $1838 postintervention compared to preintervention. This newly implemented SCD program demonstrated success through shifting the care of the SCD patient to the outpatient setting rather than the emergency department or inpatient hospitalizations.
Razick D, Amani N, Ali L
… +3 more, Bachir M, Salem A, Khatri V
Am J Med Qual
· 2024 Sep-Oct 01 · PMID 39160759
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Within the realm of health care quality assessment, quality assurance and safety grading systems play a vital role in gauging hospital performance and communicating results to the general public. The primary objective of...Within the realm of health care quality assessment, quality assurance and safety grading systems play a vital role in gauging hospital performance and communicating results to the general public. The primary objective of this review is to analyze the hospitals in California through the lens of Leapfrog Safety Grades and discuss the complex interplay of geographical location, hospital size, and larger system affiliation status. Leapfrog Safety Grades, hospital characteristics, and geographic information were collected. Hospitals were categorized by geographic region, size, rural/urban classification, and larger system affiliation status. Of the 284 hospitals included in the study, 95 were given a grade of A, 68 given a grade of B, 93 given a grade of C, 23 given a grade of D, 2 given a grade of F, and 3 were not graded. The vast majority of hospitals in California were classified as urban, with 183 falling under this category. The average number of hospital beds and SD was 227 ± 47.57. On average, hospitals that received a grade of D were significantly smaller in size than those that received a grade of A, while hospitals that received a grade of B or C were similar in size. A total of 107 hospitals were affiliated with a larger health care system. About 70% of hospitals affiliated with a system received an A or B grade, while 50% of unaffiliated hospitals received an A or B grade. Results of this study demonstrate a need for improving health care access and quality in medically underserved urban and rural areas. Hospitals affiliated with a larger health care system received higher grades than unaffiliated hospitals, suggesting that affiliation may also play a role in the implementation and mitigation of factors that contribute to Leapfrog Safety Grades.
Am J Med Qual
· 2024 Nov-Dec 01 · PMID 39160754
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For centuries, fables have been used as teaching aids that bring simple lessons to life through storytelling. The extensive research of John Kotter has been distilled into fable form in the book "Our Iceberg is Melting."...For centuries, fables have been used as teaching aids that bring simple lessons to life through storytelling. The extensive research of John Kotter has been distilled into fable form in the book "Our Iceberg is Melting." Here, we will describe an instance of applying Kotter's eight-step model to overcome relational tension between anesthesiologists and nurse anesthetists and a resultant culture of collaboration at 2 of the authors' academic medical centers.
de la Serna S, Prathivadhi-Bhayankaram S, Anderson R
… +11 more, Zandvakili A, Day J, Hines M, Vather-Wu N, Salomone J, Zeithamel M, Meyer M, Brettell L, Johnson K, Zetumer S, Hupp D
Am J Med Qual
· 2024 Jul-Aug 01 · PMID 39046913
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Paudel R, Lessard S, Jaekel C
… +3 more, Albrecht P, Forati AM, Heiderscheit C
Am J Med Qual
· 2024 Jul-Aug 01 · PMID 39038274
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Regulatory bodies in the United States have implemented quality metrics aimed at improving outcomes for patients with severe sepsis and septic shock. The current study was a quality improvement (QI) project in a communit...Regulatory bodies in the United States have implemented quality metrics aimed at improving outcomes for patients with severe sepsis and septic shock. The current study was a quality improvement (QI) project in a community-based academic center aimed at improving adherence to sepsis quality metrics, time to antibiotic administration, and patient outcomes. Electronic health record systems were utilized to capture sepsis-related data. Regular audits and feedback sessions were conducted to identify areas for improvement, with a focus on the timely administration of antibiotics. Interventions included improving access to antibiotics, transitioning from intravenous piggyback to intravenous push formulations, and providing continuous staff education and training. This multidisciplinary QI initiative led to significant improvements in the mortality index, length of stay index, and direct cost index for patients with sepsis. Targeted multidisciplinary QI interventions resulted in improved quality metrics and patient outcomes.
Am J Med Qual
· 2024 Jul-Aug 01 · PMID 38992908
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There is a continued need to improve the quality of health care services and the health outcomes associated with that care. Quality improvement model and the Learning Health System framework have emerged as potential met...There is a continued need to improve the quality of health care services and the health outcomes associated with that care. Quality improvement model and the Learning Health System framework have emerged as potential methods to achieve the goals of better care and enhanced outcomes. Few practical tools and approaches have been developed to assist with the initiation of quality improvement and development of a Learning Health System. The Department of Veterans Affairs developed and deployed a national system to assist and organize improvement projects and serve as a database for learning. During its first 5 years of use, 7397 quality improvement projects were completed using the electronic tool. National implementation of a structured tool for quality improvement is possible.
Plugge T, Breviu A, Lappé K
… +2 more, Sakaeda M, Raaum S
Am J Med Qual
· 2024 Jul-Aug 01 · PMID 38992902
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The purpose of this study is to inform the curriculum for Entrustable Professional Activity 13 through analysis of fourth year medical student patient safety event assignments. From 2016 to 2021, students were asked to i...The purpose of this study is to inform the curriculum for Entrustable Professional Activity 13 through analysis of fourth year medical student patient safety event assignments. From 2016 to 2021, students were asked to identify a patient safety event and indicate if the event required an incident report. Assignments were reviewed and coded based on Joint Commission incident definitions. Qualitative analysis was performed to evaluate incident report justification. There were 473 student assignments included in the analysis. Assignments reported incidents regarding communication, medical judgment, medication errors, and coordination of care. Students indicated only 18.0% (85/473) would warrant an incident report. Justification for not filing an incident report included lack of harm to the patient or that it was previously reported. Students were able to identify system issues but infrequently felt an incident report was required. Justifications for not filing an incident report suggest a need for a curriculum focused on the value of reporting near misses and hazardous conditions.
Shah P, Mishra A, Larkin C
… +2 more, Soltes T, Vidovich MI
Am J Med Qual
· 2024 Jul-Aug 01 · PMID 38976455
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The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 expanded veteran's access to community care leading to increased utilization of non-Veterans Affairs (VA) care and prom...The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 expanded veteran's access to community care leading to increased utilization of non-Veterans Affairs (VA) care and prompting concerns about the sustainability and cost-effectiveness of this care model for the VA. This study seeks to explore veterans' attitudes toward ridesharing services as a means of accessing VA-based cardiovascular care. This cross-sectional, quality improvement study utilized a 7-question survey administered to patients in an urban VA Heart Center to assess transportation preferences and opinions on ridesharing. Participants were more likely to support ridesharing if they held a positive opinion of rideshare ( P = 0.024), felt safe utilizing rideshare ( P = 0.025), or were undergoing invasive procedures ( P = 0.007). Distance traveled did not influence support of ridesharing ( P = 0.617). In conclusion, investing in ridesharing for veterans may provide a cost-effective means to improve VA access and continuity of care regardless of distance.
Am J Med Qual
· 2024 Jul-Aug 01 · PMID 38976453
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The Agency of Healthcare Research and Quality Healthcare Innovations Exchange (IE) was developed to collect and report on innovative approaches to improving health care. The team reviewed 348 IE innovations including pat...The Agency of Healthcare Research and Quality Healthcare Innovations Exchange (IE) was developed to collect and report on innovative approaches to improving health care. The team reviewed 348 IE innovations including patient-reported satisfaction or experience measures. Innovations most often measured overall rating of care (61% of innovations), followed by access (52%) and provider-patient communication (12%). More than half used patient satisfaction surveys (n = 187) rather than patient experience surveys (n = 64). Innovations using patient experience surveys more often measured specific aspects of patient care, for example, access, versus a general overall rating of care. Most innovations using patient experience surveys administered nonvalidated, homegrown surveys, with few using the Agency of Healthcare Research and Quality-endorsed, psychometrically-tested CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey. The most common study design was postimplementation-only (65%), highlighting that methodological rigor used to assess patient-centeredness in the IE is low. Broad use of patient experience surveys and more rigorous evaluation study designs has increased some over time but is still lacking.
Korvink M, Choi H, Biondolillo M
… +6 more, Zrull L, Trail J, Martin J, Ballard A, Bain T, DeBehnke D
Am J Med Qual
· 2024 Jul-Aug 01 · PMID 38976403
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The objective was to investigate the relationship between social drivers of health (SDOH) and hospital performance within the 100 Top Hospitals study, exploring methods to recognize hospitals serving marginalized communi...The objective was to investigate the relationship between social drivers of health (SDOH) and hospital performance within the 100 Top Hospitals study, exploring methods to recognize hospitals serving marginalized communities. Publicly available data sourced from the Centers for Medicare and Medicaid Services and the 2023 100 Top Hospitals study was used. The study employed multivariable hierarchical generalized linear regression models to assess the association between an SDOH composite variable derived using principal component analysis and overall hospital performance measures within the 100 Top Hospitals study. The analysis revealed a statistically significant association between SDOH factors and study ranking results. The SDOH composite variable is a significant predictor of performance within the 100 Top Hospitals study. Accounting for SDOH is essential to recognize high-performing hospitals serving marginalized communities. The findings suggest a need for broader considerations of SDOH in hospital ranking methodologies across various industry programs.
Krishnan D, Kareddy A, Chen C
… +4 more, Kerbel R, Dowling E, Simon W, Dermenchyan A
Am J Med Qual
· 2024 Jul-Aug 01 · PMID 38915153
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The Healthcare Improvement and Innovation in Quality (THINQ) Collaborative is a uniquely designed program that engages undergraduate and postgraduate students to participate in improving health care and addressing import...The Healthcare Improvement and Innovation in Quality (THINQ) Collaborative is a uniquely designed program that engages undergraduate and postgraduate students to participate in improving health care and addressing important clinical problems. In 9 years, over 120 THINQ Fellows have been trained in quality improvement (QI) frameworks and methodologies focusing on research skills, social justice, leadership development, and problem-solving. Program evaluation has included surveying current and former THINQ Fellows about their experiences with the program and its subsequent impact on their careers. THINQ's research and outreach initiatives have contributed to improvements in workflows and clinical care on topics such as interdisciplinary team communication, discharge and care transition, sepsis management, and physician burnout. The THINQ Program has equipped future health care leaders to engage with and address QI issues in clinical practice. The structures, processes, and outcomes discussed here can guide other institutions in creating similar QI programs.
Damjanovska S, Watanabe S, Karb DB
… +2 more, Kurin M, Isenberg G
Am J Med Qual
· 2024 Jul-Aug 01 · PMID 38885415
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Inadequate inpatient bowel preparation can lead to repeat procedures, prolonged hospital stays, and increased financial burden. In this quality improvement project, the authors developed an electronic medical record (EMR...Inadequate inpatient bowel preparation can lead to repeat procedures, prolonged hospital stays, and increased financial burden. In this quality improvement project, the authors developed an electronic medical record (EMR)-based order set with precise instructions and anticipatory guidance for inpatient bowel preparation before colonoscopy. The current study is a nonrandomized intervention study. The authors compared 2 groups: an intervention group using a newly developed, consensus-based, standardized EMR bowel preparation order set and a control group using previously existing EMR bowel preparation orders. Bowel preparation outcomes were followed over the course of 16 months. The aim was to improve inpatient colonoscopy bowel preparation, as evaluated by the Boston Bowel Preparation Scale, procedure delays, and length of hospital stay. We additionally evaluated the groups' demographics and patient-level factors. A total of 459 inpatient colonoscopies were evaluated over a 16-month period. The intervention group consisted of 227 inpatient colonoscopies, while the control group consisted of 232. The intervention group showed superior Boston Bowel Preparation Scale score and decreased length of hospital stay. The number of adequate bowel preparations increased in the intervention group when compared to the control group from 77% to 86%. The creation of an EMR-based order set is a low-cost and sustainable action that can be easily implemented throughout a hospital system.