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Quality Improvement

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415 papers 100 to 500 followers
By Jamie Jarmul Md / PhD student at UNC - Chapel Hill, PhD in Health Policy and Management
Caroline A Bravo, Diego Llovet, Holly O Witteman, Laura Desveaux, Justin Presseau, Marianne Saragosa, Gratianne Vaisson, Shama Umar, Jill Tinmouth, Noah M Ivers
BACKGROUND: Providing clinical performance data to health professionals, a process known as audit and feedback, can play an important role in health system improvement. However, audit and feedback tools can only be effective if the targeted health professionals access and actively review their data. Email is used by Cancer Care Ontario, a provincial cancer agency, to promote access to a Web-based audit and feedback tool called the Screening Activity Report (SAR); however, current emails that lack behavior change content have been ineffective at encouraging log-in to the SAR...
September 4, 2018: JMIR Human Factors
Jeremy B Sussman, Robert G Holleman, Bradley Youles, Julie C Lowery
BACKGROUND: Implementation of new practice guidelines for statin use was very poor. OBJECTIVE: To test a multi-component quality improvement intervention to encourage use of new guidelines for statin use. DESIGN: Cluster-randomized, usual-care controlled trial. PARTICIPANTS: The study population was primary care visits for patients who were recommended statins by the 2013 guidelines, but were not receiving them. We excluded patients who were over 75 years old, or had an ICD9 or ICD10 code for end-stage renal disease, muscle pain, pregnancy, or in vitro fertilization in the 2 years prior to the study visit...
December 2018: Journal of General Internal Medicine
Farzaneh Dastan, Hamidreza Jamaati, Habib Emami, Rodabeh Haghgoo, Raha Eskandari, Seyedeh Shadab Hashemifard, Fatemeh Khoddami, Zahra Mirshafiei Langari
Albumin is known as a human blood product, with high cost and limited availability. Several studies have demonstrated the extent in which albumin is being utilized in controversial indications not supported or weakly supported by the available literature. To rationalize the use of albumin and to decrease the inappropriate cost of this expensive drug` a two phase study, with equal length of 66-days, comprising an observational drug utilization evaluation and a pharmacist-led audit and feedback interventional study, was conducted in a tertiary referral hospital in Tehran, Iran...
2018: Iranian Journal of Pharmaceutical Research: IJPR
Andrew M Heekin, John Kontor, Harry C Sax, Michelle S Keller, Anne Wellington, Scott Weingarten
OBJECTIVES: To determine whether utilization of clinical decision support (CDS) is correlated with improved patient clinical and financial outcomes. STUDY DESIGN: Observational study of 26,424 patient encounters. In the treatment group, the provider adhered to all CDS recommendations. In the control group, the provider did not adhere to CDS recommendations. METHODS: An observational study of provider adherence to a CDS system was conducted using inpatient encounters spanning 3 years...
August 2018: American Journal of Managed Care
Andrew S Boozary, Kaveh G Shojania
No abstract text is available yet for this article.
June 2018: BMJ Quality & Safety
Deepti Shanbhag, Ian D Graham, Karen Harlos, R Brian Haynes, Itzhak Gabizon, Stuart J Connolly, Harriette Gillian Christine Van Spall
BACKGROUND: The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success. METHODS: We searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction...
March 6, 2018: BMJ Open
Sajan Patel, Alvin Rajkomar, James D Harrison, Priya A Prasad, Victoria Valencia, Sumant R Ranji, Michelle Mourad
BACKGROUND: Audit and feedback improves clinical care by highlighting the gap between current and ideal practice. We combined best practices of audit and feedback with continuously generated electronic health record data to improve performance on quality metrics in an inpatient setting. METHODS: We conducted a cluster randomised control trial comparing intensive audit and feedback with usual audit and feedback from February 2016 to June 2016. The study subjects were internal medicine teams on the teaching service at an urban tertiary care hospital...
September 2018: BMJ Quality & Safety
Holly M Romero, Coral Ringer, Michael G Leu, Elaine Beardsley, Karen Kelly, Megan D Fesinmeyer, Wren L Haaland, James B Johnson, Darren Migita
OBJECTIVES: Seattle Children's Hospital sought to optimize the value equation for neonatal jaundice patients by creating a standard care pathway. METHODS: An evidence-based pathway for management of neonatal jaundice was created. This included multidisciplinary team assembly, comprehensive literature review, creation of a treatment algorithm and computer order sets, formulation of goals and metrics, roll-out of an education program for end users, and ongoing pathway improvement...
March 2018: Pediatrics
Sidika Kaya, Gulay Sain Guven, Seda Aydan, Onur Toka
Objective: To identify frequency of readmission after discharge from internal-medicine wards, readmission risk factors, and reasons and costs of readmission. Design: Prospective cohort study. Setting: A tertiary-care hospital in Turkey. Participants: 2622 adult patients discharged from internal-medicine wards of the hospital between 1 February 2015 and 31 January 2016. Main outcome measures: Thirty day all-cause readmission rates, reasons and costs of readmission...
June 1, 2018: International Journal for Quality in Health Care
Mahima Ashok, Dorothy Hung, Lucia Rojas-Smith, Michael T Halpern, Michael Harrison
BACKGROUND: Complex system interventions benefit from close attention to factors affecting implementation and resultant outcomes. This article describes a framework for examining these factors in process redesign (PR) and for assessing PR outcomes. METHODS: Using literature scans and expert comment on draft frameworks based on the Consolidated Framework for Implementation Research, a team of researchers developed the PR framework for the Agency for Healthcare Research and Quality...
January 2018: Quality Management in Health Care
Alexander B. Stone, Christina T. Yuan, Michael A. Rosen, Michael C. Grant, Lauren E. Benishek, Elizabeth Hanahan, Lisa H. Lubomski, Clifford Ko, Elizabeth C. Wick
No abstract text is available yet for this article.
March 1, 2018: JAMA Surgery
Daniel M Blonigen, Luisa Manfredi, Adrienne Heinz, Xiaoyu Bi, Paola Suarez, Andrea L Nevedal, Anita A Vashi, Christine Timko, Todd Wagner
OBJECTIVE: Use of psychiatric emergency services in emergency departments (EDs) and inpatient psychiatry units contributes substantially to the cost of mental health care. Among patients who utilize psychiatric emergency services, a small percentage ("high utilizers") contributes a disproportionate share of the total cost, yet little is known about the context of care for these patients. This study employed qualitative methods to identify barriers to and facilitators of reducing use of psychiatric emergency services among high utilizers...
April 1, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
Lewis Foxhall, Mark Moreno, Ernest Hawk
Texas's size and unique population demographics present challenges to addressing the state's cancer burden. The University of Texas MD Anderson Cancer Center is one of 69 National Cancer Institute-designated cancer centers across the United States. While these centers traditionally have focused on research, education and training, and providing research-driven patient care, they are in a unique position to collaboratively advance population health through cancer control. Unlike the traditional academic model of a three-legged stool representing research, education, and patient care, MD Anderson's mission includes a fourth leg that incorporates population health approaches...
February 1, 2018: Texas Medicine
Kerstin de Wit, Janet Curran, Brent Thoma, Shawn Dowling, Eddy Lang, Nebojsa Kuljic, Jeffrey J Perry, Laurie Morrison
OBJECTIVES: Advances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments. METHODS: A systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience...
May 2018: CJEM
Lindsay A Edwards, Christine Bui, Antonio G Cabrera, Jill Ann Jarrell
OBJECTIVE: To improve outpatient advanced care planning (ACP) for adults with congenital/pediatric heart disease followed in a pediatric heart failure (HF) and transplant clinic through quality improvement (QI) methodology. DESIGN: A one-year QI project was completed. We conducted quarterly chart reviews and incorporated feedback from the providers to direct subsequent interventions. PATIENTS AND SETTING: Patients ≥18 years of age seen in the HF and Transplant Clinic for follow-up visit were included in analysis...
May 2018: Congenital Heart Disease
Jennifer M Baker, Richard W Grant, Anjali Gopalan
BACKGROUND: Evidence supporting the effectiveness of care management programs for complex patients has been inconclusive. However, past reviews have not focused on complexity primarily defined by multimorbidity and healthcare utilization. We conducted a systematic review of care management interventions targeting the following three patient groups: adults with two or more chronic medical conditions, adults with at least one chronic medical condition and concurrent depression, and adults identified based solely on high past or predicted healthcare utilization...
January 30, 2018: BMC Health Services Research
Esra Alagoz, Ming-Yuan Chih, Mary Hitchcock, Randall Brown, Andrew Quanbeck
BACKGROUND: External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings. METHODS: We searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies...
January 25, 2018: BMC Health Services Research
Andrew Quanbeck, Randall T Brown, Aleksandra E Zgierska, Nora Jacobson, James M Robinson, Roberta A Johnson, Brienna M Deyo, Lynn Madden, Wen-Jan Tuan, Esra Alagoz
BACKGROUND: This paper reports on the feasibility, acceptability, and effectiveness of an innovative implementation strategy named "systems consultation" aimed at improving adherence to clinical guidelines for opioid prescribing in primary care. While clinical guidelines for opioid prescribing have been developed, they have not been widely implemented, even as opioid abuse reaches epidemic levels. METHODS: We tested a blended implementation strategy consisting of several discrete implementation strategies, including audit and feedback, academic detailing, and external facilitation...
January 25, 2018: Implementation Science: IS
Harriet Hiscock, Rachel Jane Neely, Hayley Warren, Jason Soon, Andrew Georgiou
CONTEXT: Unnecessary imaging and pathology procedures represent low-value care and can harm children and the health care system. OBJECTIVE: To perform a systematic review of interventions designed to reduce unnecessary pediatric imaging and pathology testing. DATA SOURCES: We searched Medline, Embase, Cinahl, PubMed, Cochrane Library, and gray literature. STUDY SELECTION: Studies we included were: reports of interventions to reduce unnecessary imaging and pathology testing in pediatric populations; from developed countries; written in the English language; and published between January 1, 1996, and April 29, 2017...
February 2018: Pediatrics
Pei-Ni Jone, Ruthanne Gould, Cindy Barrett, Adel K Younoszai, Brian Fonseca
Echocardiography is the primary diagnostic modality for congenital heart disease patients. The written report is used to communicate with the care team and organization is often divided into the body with detailed findings and the conclusions with important findings summarized. Strategies to increase workflow efficiency include batch writing of reports after performance of multiple echocardiograms and the use of report templates which may contribute to discrepancies within report leading to potential downstream medical errors...
April 2018: Pediatric Cardiology
2018-02-03 12:59:55
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