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Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality

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https://read.qxmd.com/read/31082932/thromboprophylaxis-after-hospitalization-for-joint-replacement-surgery
#1
Karen K Giuliano, Rachel Pozzar, Courtney Hatch
Venous thromboembolism (VTE) is a leading cause of mortality during the perioperative period, with individuals who have undergone hip and knee arthroplasty at the highest risk for VTE. The American College of Chest Physicians recommends 35 days of postoperative thromboprophylaxis and the use of intermittent pneumatic compression (IPC) therapy for mechanical compression after major orthopedic surgery. However, little research has described adherence to these recommendations during recovery at home. The purpose of this cross-sectional descriptive study was to describe thromboprophylaxis prescription, use, and education among patients discharged home after major orthopedic surgery...
May 8, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31082931/shared-medical-appointments-in-preoperative-joint-replacement-assessing-patient-and-healthcare-member-satisfaction
#2
Robert L Powell, Pamela J Biernacki
BACKGROUND: Shared medical appointments (SMAs) have proven to be effective in improving patient access and education while augmenting productivity. In shifting from a traditional visit model, patient and interdisciplinary healthcare team (IHCT) member satisfaction is imperative. Predominantly seen in primary care, SMA use in orthopedics is limited. After identification of access and productivity concerns, the SMA was implemented as a quality improvement project in a rural clinic. The lower extremity joint replacement (LEJR) population was chosen because of multiple preoperative appointments and costs on the healthcare system...
May 8, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31008828/the-ed-pact-tool-initiative-communicating-veterans-care-needs-after-emergency-department-visits
#3
Kristina M Cordasco, Hemen N Saifu, Hyun-Sung Song, Jonie J Hsiao, Mana Khafaf, Brian Doyle, Lisa V Rubenstein, Joya G Chrystal, Purnima Bharath, David A Ganz
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...
April 12, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/30883462/effectiveness-of-implementing-a-predischarge-order-to-discharge-patients-before-11-a-m
#4
Rajiv M Mallipudi, Qamar Khan, George U Mbolu, Lance Alquran, Bijal Mehta, Valerie Allusson
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., with the mean discharge processing time being 145 minutes. The goal of this study was to assess the effectiveness of using an electronic predischarge order to discharge more than 40% of patients before 11 a...
March 15, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/30883463/a-quality-improvement-project-to-improve-sepsis-related-outcomes-at-an-integrated-healthcare-system
#5
M Courtney Hughes, Andrea Roedocker, Jessica Ehli, Danaka Walz, Kim Froehlich, Landon White, Bill Binder
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. The intervention group increased sepsis bundle compliance by more than 40%...
March 14, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/30829884/text-message-quality-improvement-project-for-influenza-vaccine-in-a-low-resource-largely-latino-pediatric-population
#6
Elizabeth Sloand, Brigit VanGraafeiland, Annie Holm, Augusta MacQueen, Sarah Polk
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. Interactive text messages that described the vaccine and how to make an appointment were sent to parents in English or Spanish, January 2016 to April 2017...
February 28, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/30829854/shared-care-during-breast-and-colorectal-cancer-treatment-is-it-associated-with-patient-reported-care-quality
#7
Michelle Doose, Jennifer McGee-Avila, Antoinette M Stroup, Jeanne Ferrante, Baichen Xu, Natalia L Herman, Kitaw Demissie, Jennifer Tsui
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...
February 27, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/30817369/an-antimicrobial-stewardship-intervention-improves-adherence-to-standard-of-care-for-staphylococcus-aureus-bloodstream-infection
#8
James B Brock, David A Cretella, Jason J Parham
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...
February 26, 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31094954/introducing-a-clinical-documentation-specialist-to-improve-coding-and-collectability-on-a-surgical-service
#9
Maria Castaldi, John McNelis
INTRODUCTION: Inadequate electronic medical record (EMR) documentation remains a significant source of revenue loss. The Department of Surgery in a trauma and tertiary care teaching hospital developed a revenue optimization initiative for inpatients on general, vascular, and trauma surgery and surgical intensive care unit services to enhance clinical documentation and increase revenue capture. METHODS: Clinical documentation management program included six trained clinical documentation specialists (CDSs), five physician assistants (PAs), directors of health information management (HIM), and two surgical champions...
May 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31094953/effect-of-patient-and-provider-education-on-antibiotic-overuse-for-respiratory-tract-infections
#10
Erin Chiswell, Debra Hampton, Chizimuzo T C Okoli
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...
May 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31094952/innovations-in-pressure-injury-reporting-creating-actionable-data-for-improvement
#11
Shea Polancich, Jason Williamson, Terri Poe, Amy Armstrong, Ross M Vander Noot
This department column highlights translation of research into health care quality practice. Achieving the highest quality of health care requires attention to developing and sustaining process efficiencies, and a thorough understanding of data and reporting. Mitigating or eliminating harm from pressure injuries may be more quickly achieved when accurate and consistent data are available for creating actionable interventions. The three aims of this project were to (1) confirm internally reported hospital acquired pressure injury data, (2) identify opportunities for improving the accuracy of internal reports, and (3) design and implement innovative quality informatics solutions for pressure injury reporting...
May 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31094951/development-of-a-multistep-hypertension-quality-improvement-program-in-an-academic-general-medicine-practice
#12
Mai-Khanh Bui-Duy, Shirley Wong, Rosemary Lam, Leah S Karliner
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. Ensuring medical assistants were correctly measuring BP provided the basis for accurate data entry into the electronic medical record (EMR); our EMR-based registry data allowed us to feedback primary care provider (PCP) level data on BP control for panel management, which resulted in improvements in BP for a substantial proportion of patients, particularly for those with more practice visits...
May 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31094950/-think-before-you-order-multidisciplinary-initiative-to-reduce-unnecessary-lab-testing
#13
Masih Shinwa, Adam Bossert, Iris Chen, Anna Cushing, Andrew S Dunn, Jashvant Poeran, Sally Weinstein, Hyung J Cho
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...
May 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31094949/how-measurement-variability-affects-reporting-of-a-single-readmission-metric
#14
Mark S Brittan, Elizabeth J Campagna, David Keller, Allison Kempe
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). We conducted a secondary database analysis of 2006-2008 Medicaid Analytic eXtract data merged from four states of children younger than 21 years. We calculated 30-day ARRs for this cohort using three previously described models varying in their inclusions and exclusions of index hospitalizations and readmissions...
May 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31094948/reducing-phlebotomy-utilization-with-education-and-changes-to-computerized-provider-order-entry
#15
Christopher Breen, Kevin Maguire, Amit Bansal, Stanley Russin, Sara West, Anju Dayal, Andrea Berger, Jordan Olson, Benjamin Hohmuth
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. Interventions have included education, feedback, and changes to computerized provider order entry (CPOE) but have yielded mixed results. METHODS: A quality improvement initiative to reduce the utilization of daily phlebotomy was conducted at a 505-bed Academic Medical Center...
May 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31094947/using-charlson-comorbidity-index-to-predict-short-term-clinical-outcomes-in-hospitalized-older-adults
#16
Liron Sinvani, Roshini Kuriakose, Sara Tariq, Andrzej Kozikowski, Vidhi Patel, Christopher Smilios, Meredith Akerman, Guang Qiu, Alex Makhnevich, Jessica Cohen, Gisele Wolf-Klein, Renee Pekmezaris
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. The CCI scores were compared, using the standard Deyo version and the Schneeweiss version...
May 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31094946/local-health-department-activities-to-reduce-emergency-department-visits-for-substance-use-disorders
#17
Priscilla Novak, Robin Bloodworth, Kerry Green, Jie Chen
The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation...
May 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/31094945/trends-in-avoidable-hospitalizations-for-diabetes-experience-of-a-large-clinically-integrated-health-care-system
#18
Maidah Yaqoob, Jihan Wang, Ann T Sweeney, Cynthia Wells, Virginia Rego, Bertrand L Jaber
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). Using established technical specifications, annual hospitalizations rates were calculated for four diabetes-related PQIs: uncontrolled diabetes, short-term complications, long-term complications, and lower extremity amputations...
May 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/30839493/veterans-health-administration-primary-care-provider-adherence-to-prescribing-guidelines-for-systemic-hormone-therapy-in-menopausal-women
#19
Kristina M Cordasco, Anita H Yuan, Marjorie J Danz, LaShawnta Jackson, Ellen F Yee, Lueng Sophia Tcheung, Donna L Washington
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. METHODS: We abstracted medical records associated with new and renewal systemic HT prescriptions examining adherence to guidelines for documenting indications and contraindications; prescribing appropriate dosages; and prescribing progesterone...
March 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
https://read.qxmd.com/read/30839492/reducing-cancellations-and-optimizing-surgical-scheduling-of-ophthalmology-cases-at-a-veterans-affairs-medical-center
#20
Valerie J Dawson, Jordan Margo, Natalia Blanco, Wuqaas M Munir
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. Interventions included scheduling surgeries electronically, by specialty, and with predetermined attending coverage...
March 2019: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
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