MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'American Journal of Medical Quality' source. Sun, 21 Mar 2010 16:47:33 +0100 http://www.medworm.com/index.php?rid=3353275&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F2%2F159%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353275 Wed, 10 Mar 2010 23:43:26 +0100 3353275 http://www.medworm.com/index.php?rid=3353274&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F2%2F157%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353274 Wed, 10 Mar 2010 23:43:26 +0100 3353274 http://www.medworm.com/index.php?rid=3353273&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F2%2F154%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353273 Wed, 10 Mar 2010 23:43:26 +0100 3353273 http://www.medworm.com/index.php?rid=3353272&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F149%3Frss%3D1 Mechanisms are needed to assess learning in the context of graduate medical education. In general, research in this regard is focused on the individual learner. At the level of the group, learning assessment can also inform practice-based learning and may provide the foundation for whole systems improvement. The authors present the results of a random forests classification analysis of the diagnostic skill of rheumatology trainees as compared with rheumatology attendings. A random forests classification analysis is a novel statistical approach that captures the strength of alignment of thinking between student and teacher. It accomplishes this by providing information about the strength and correlation of multiple variables. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353272 Wed, 10 Mar 2010 23:43:26 +0100 3353272 http://www.medworm.com/index.php?rid=3353271&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F143%3Frss%3D1 The authors examine the rates of cataract surgery as a crude measure of appropriateness of care among veterans 65 years of age and older who use Veterans Health Administration (VHA). Data were obtained from the national VHA data sets for fiscal years 2000 through 2007, using International Classification of Diseases codes and the American Medical Association’s Current Procedural Terminology codes. Cataract surgery was expressed as procedures per 10 000 veteran beneficiaries per fiscal year. The annual incidence of cataract surgery increased marginally over the study period with an average annual incidence of 105.8 surgeries per 10 000 beneficiaries. Institutional rates of VHA surgery differ substantially from those of Medicare beneficiaries, which are approximately 5.5-fold greater. A... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353271 Wed, 10 Mar 2010 23:43:26 +0100 3353271 http://www.medworm.com/index.php?rid=3353270&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F135%3Frss%3D1 Medical errors training is an important yet often overlooked aspect of medical education. A medical errors educational session was developed for rotating medical students (MSs) with prospective analysis of the educational tool. Students completed the same 12-question test before and after the educational session and a long-term posttest 1 to 12 months later. Control students who did not take part in the session completed the test twice with a 6-month interval. In all, 51 students completed a pretest and a short-term posttest, and 35 students completed a long-term posttest. Test scores for the study group increased significantly from a pretest mean of 29.3% to a short-term posttest mean of 73.7% ( P < .001) and a long-term posttest mean of 49.1% (P < .001). Long-term test scores for 2... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353270 Wed, 10 Mar 2010 23:43:26 +0100 3353270 http://www.medworm.com/index.php?rid=3353269&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F128%3Frss%3D1 Retail clinics are an increasingly popular new model of ambulatory care. To understand why patients seek care at these clinics and what their experiences were like, the authors interviewed 61 patients at 6 retail clinics. Patients were satisfied with the overall experience and were attracted to retail clinics because of their convenient locations and fixed, transparent pricing. Patients who had a primary care physician (PCP) sought care at these clinics primarily because their PCPs were not available in a timely manner. If retail clinics had not been available, a quarter of patients report they would have gone to the emergency department. Retail clinics appear to be responding to the need for convenient, affordable, and consumer-centered care. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353269 Wed, 10 Mar 2010 23:43:26 +0100 3353269 http://www.medworm.com/index.php?rid=3353268&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F116%3Frss%3D1 This study employed a national survey of US nursing home administrators (N = 2397) regarding the use of 12 advanced IT features in commercial MDS software. Overall, the effects of using advanced IT features in commercial MDS software on quality were highly significant (P < .01) when controlling for the prior years quality as well as facility characteristics. Although nursing homes have been slow to adopt IT, the use of the identified IT in MDS software packages appears to offer the promise to improve quality of care. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353268 Wed, 10 Mar 2010 23:43:26 +0100 3353268 http://www.medworm.com/index.php?rid=3353267&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F109%3Frss%3D1 To characterize safety culture in emergency medical services (EMS), the authors modified a validated safety culture instrument, the Safety Attitudes Questionnaire (SAQ). The pilot instrument was administered to 3 EMS agencies in a large metropolitan area. The authors characterized safety culture across 6 domains: safety climate, teamwork climate, perceptions of management, job satisfaction, working conditions, and stress recognition. The feasibility of characterizing safety culture in EMS was evaluated by examining response rate, item missingness, EMS chief administrators’ perceptions of the EMS-SAQ, as well as psychometric properties.The results confirm feasibility with a high response rate, acceptable internal consistency, and model fit validity. However, some agencies voiced conce... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353267 Wed, 10 Mar 2010 23:43:26 +0100 3353267 http://www.medworm.com/index.php?rid=3353266&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F102%3Frss%3D1 Patient safety and quality of care are public concerns that demand personal responsibility at all levels of the health care organization. Senior residents in our graduate medical education program took responsibility for a capstone quality improvement project designed to transform them into champions for health care quality. Residents (n = 26) participated alone or in pairs in a 1-month faculty-mentored rotation at the Veterans Administration Hospital during the 2007-2008 academic year. They completed a Web-based curriculum, identified a quality-of-care issue, applied Plan—Do—Study—Act cycles, authored a report, and engaged colleagues in their innovations during a department-wide presentation. Results indicated that residents demonstrated significantly enhanced knowledge ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353266 Wed, 10 Mar 2010 23:43:26 +0100 3353266 http://www.medworm.com/index.php?rid=3353265&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F95%3Frss%3D1 Data from the British Columbia Linked Health Database were analyzed to determine if size of hospital is associated with in-hospital death of critically ill adults whose admitting diagnosis is congestive heart failure (CHF). Patients who were <19 years of age, transferred from or to other hospitals, or who developed CHF as a complication were excluded. In unadjusted logistic regression analysis of 2616 patients, the odds ratio (OR) for in-hospital death associated with a doubling of the number of hospital beds was 1.12 (95% confidence interval [CI] = 1.03-1.23; P = .01). After adjustment for age, sex, CHF-specific comorbidity index, number of cardiac and noncardiac procedures, number of hospital admissions for CHF in the preceding year, and socioeconomic variables, the OR was 1.08 (95% C... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353265 Wed, 10 Mar 2010 23:43:26 +0100 3353265 http://www.medworm.com/index.php?rid=3353264&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F2%2F87%3Frss%3D1 Intimidation in health care settings can negatively affect patient safety. Following an adverse event in 2006 at Spectrum Health, a 7-hospital health care system in Grand Rapids, Michigan, leadership of the Grand Rapids perioperative services department led an initiative to evaluate and reduce the incidence of intimidation in the department. Physicians were surveyed to ascertain their beliefs about behaviors that constitute intimidation and to correlate those findings with definitions of intimidation identified by several national professional organizations. Our findings suggest that a majority of physicians in perioperative services agree that behaviors identified as intimidating by national organizations actually constitute intimidation in only 4 of 9 instances and that, for even the mos... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353264 Wed, 10 Mar 2010 23:43:26 +0100 3353264 http://www.medworm.com/index.php?rid=3353263&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F2%2F86%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3353263 Wed, 10 Mar 2010 23:43:26 +0100 3353263 http://www.medworm.com/index.php?rid=3132884&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F1%2F79%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132884 Wed, 30 Dec 2009 22:00:25 +0100 3132884 http://www.medworm.com/index.php?rid=3132883&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F1%2F78%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132883 Wed, 30 Dec 2009 22:00:25 +0100 3132883 http://www.medworm.com/index.php?rid=3132882&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F1%2F76%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132882 Wed, 30 Dec 2009 22:00:25 +0100 3132882 http://www.medworm.com/index.php?rid=3132881&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F1%2F73%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132881 Wed, 30 Dec 2009 22:00:25 +0100 3132881 http://www.medworm.com/index.php?rid=3132880&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F64%3Frss%3D1 This clinical review article examines the patient satisfaction literature for the past 20 years. This literature is summarized for qualitative themes and general trends. Intended for the practicing clinician, these themes are then applied to the emergency department (ED) milieu. According to the Agency for Healthcare Research and Quality, the ED is the point of entry for more than half of all patients admitted to the hospital in the United States. Indeed, the ED is the "front door" to the hospital. According to Press Ganey, satisfaction with ED care is at an all-time low. A review of the literature revealed 5 major elements of the ED experience that correlate with patient satisfaction: timeliness of care, empathy, technical competence, information dispensation, and pain management. The lit... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132880 Wed, 30 Dec 2009 22:00:25 +0100 3132880 http://www.medworm.com/index.php?rid=3132879&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F60%3Frss%3D1 To improve safety in the operating theater, a company of aviation pilots was employed to guide implementation of preprocedural briefings. A 5-point Likert scale survey that assessed the attitudes of operating room personnel toward patient safety was distributed before and 6 months following implementation of the briefings. Using Mann-Whitney analysis, the survey showed a significant (P < .05) improvement in 2 questions (of 13) involving reporting error and 2 questions (of 11) involving patient safety climate. When analyzed by occupation, there were no significant changes for faculty physicians; for resident physicians, there was a significant improvement in 1 question (of 13) regarding error reporting. For nurses, there were significant improvements in 3 questions (of 4) involving teamw... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132879 Wed, 30 Dec 2009 22:00:25 +0100 3132879 http://www.medworm.com/index.php?rid=3132878&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F51%3Frss%3D1 Provision of language services is central to the delivery of equitable, safe, high-quality health care for patients with limited English proficiency. However, there are many barriers to ensuring access to such services. We analyzed the experience of a model language service program at a public hospital to develop recommendations applicable to all hospitals that wish to create an effective language service program. Our case study demonstrates that with organizational commitment, early information technology involvement, attention to clinical needs, active engagement of stakeholders, and coordinated project management, it is possible to provide high-quality language services in a setting of financial constraints. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132878 Wed, 30 Dec 2009 22:00:25 +0100 3132878 http://www.medworm.com/index.php?rid=3132877&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F42%3Frss%3D1 The authors estimated the validity of algorithms for identification of mental health conditions (MHCs) in administrative data for the 133 068 diabetic patients who used Veterans Health Administration (VHA) nationally in 1998 and responded to the 1999 Large Health Survey of Veteran Enrollees. They compared various algorithms for identification of MHCs from International Classification of Diseases, 9th Revision (ICD-9) codes with self-reported depression, posttraumatic stress disorder, or schizophrenia from the survey. Positive predictive value (PPV) and negative predictive value (NPV) for identification of MHC varied by algorithm (0.65-0.86, 0.68-0.77, respectively). PPV was optimized by requiring ≥2 instances of MHC ICD-9 codes or by only accepting codes from mental health visits. NPV w... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132877 Wed, 30 Dec 2009 22:00:25 +0100 3132877 http://www.medworm.com/index.php?rid=3132876&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F34%3Frss%3D1 In hospitals and health systems, ensuring that standards for the quality of patient care are established and continuous improvement processes are in place are among the board’s most fundamental responsibilities. A recent survey has examined governance oversight of patient care quality at 123 nonprofit community health systems and compared their practices with current benchmarks of good governance. The findings show that 88% of the boards have established standing committees on patient quality and safety, nearly all chief executive officers’ performance expectations now include targets related to patient quality and safety, and 96% of the boards regularly receive formal written reports regarding their organizations’ performance in relation to quality measures and standards... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132876 Wed, 30 Dec 2009 22:00:25 +0100 3132876 http://www.medworm.com/index.php?rid=3132875&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F24%3Frss%3D1 This study evaluates the benefits and caveats of incorporating care-limiting orders, such as do not resuscitate (DNR) and palliative care (PC) information, in a general multivariate model of mortality risk, wherein the unit of observation is the patient hospital encounter. In a model of the mortality gap (observed - expected from the baseline model), DNR explains 8% to 24% of the gap variation. PC provides additional explanatory power to some disease groupings, especially heart and digestive diseases. One caveat is that DNR information, especially if associated with the later stages of hospital care, may mask opportunities to improve care for certain types of patients. But that is not a danger for PC, which is unequivocally valuable in accounting for patient risk, especially for certain su... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132875 Wed, 30 Dec 2009 22:00:25 +0100 3132875 http://www.medworm.com/index.php?rid=3132874&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F13%3Frss%3D1 The objectives of this study were to report on the body of empirical data about CRM training in clinical settings and to provide a conceptual framework for evaluating its effectiveness in medicine. Using the proposed conceptual framework, the authors further examine currently published methods of measuring effectiveness and identify future directions for the use of teamwork training in medicine. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132874 Wed, 30 Dec 2009 22:00:25 +0100 3132874 http://www.medworm.com/index.php?rid=3132873&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F1%2F6%3Frss%3D1 Morbidity and mortality associated with diabetes make it a prime target for quality improvement research. Quality gaps and racial/gender disparities persist throughout this population of patients necessitating a sustainable improvement in the clinical management of diabetes. The authors of this study sought (1) to provide a population perspective on diabetes management, and (2) to reinforce evidence-based clinical guidelines through a Web-based educational module.The project also aimed to gain insight into working remotely with a community of rural physicians. This longitudinal pre-post intervention study involved 18 internal medicine physicians and included 3 points of medical record data abstraction over 24 months. A Web-based educational module was introduced after the baseline data abs... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132873 Wed, 30 Dec 2009 22:00:25 +0100 3132873 http://www.medworm.com/index.php?rid=3132872&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F1%2F5%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132872 Wed, 30 Dec 2009 22:00:25 +0100 3132872 http://www.medworm.com/index.php?rid=3132886&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F1_suppl%2F4S%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132886 Tue, 29 Dec 2009 18:26:38 +0100 3132886 http://www.medworm.com/index.php?rid=3132885&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F1_suppl%2F3S%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132885 Tue, 29 Dec 2009 18:26:38 +0100 3132885 http://www.medworm.com/index.php?rid=2962267&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F6%2F534%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962267 Wed, 04 Nov 2009 23:55:40 +0100 2962267 http://www.medworm.com/index.php?rid=2962266&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F6%2F532%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962266 Wed, 04 Nov 2009 23:55:40 +0100 2962266 http://www.medworm.com/index.php?rid=2962265&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F6%2F529%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962265 Wed, 04 Nov 2009 23:55:40 +0100 2962265 http://www.medworm.com/index.php?rid=2962264&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F6%2F525%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962264 Wed, 04 Nov 2009 23:55:40 +0100 2962264 http://www.medworm.com/index.php?rid=2962263&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F520%3Frss%3D1 The authors retrospectively evaluated anonymously submitted inpatient medical error reports from 8 institutions participating in the University HealthSystem Consortium Patient Safety Net (PSN) in 2004 in an attempt to focus patient safety efforts on problems that were most commonly associated with harm. Of the 25 300 incidents reported, 3381 (13.3%) were associated with adverse events (AEs), and 109 (0.4%) were associated with death. Although the most commonly reported categories of incidents associated with AEs were complications of procedure/treatment/test (29%), falls (17%), and medication errors (10%), the taxonomy of the PSN limited efforts to find specific errors in care that might be addressed by attempts to improve patient safety. Skin breakdown and falls were confirmed as presenti... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962263 Wed, 04 Nov 2009 23:55:40 +0100 2962263 http://www.medworm.com/index.php?rid=2962262&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F512%3Frss%3D1 Although randomized controlled trials show that long-term β-blocker use post acute myocardial infarction (AMI) reduces mortality and subsequent cardiovascular events, and that increased compliance lowers mortality, there is limited published research on the effects of long-term β-blocker compliance in observational community settings. The authors retrospectively study the effect of β -blocker compliance on mortality and repeat reinfarction using claims records from a major health insurer of all patients who were discharged alive after AMI between January 2003 and June 2004, covered by that health insurer’s prescription drug coverage, and prescribed β-blockers (n = 3923). Using Cox proportional hazards regressions, they estimate both survival and AMI-free survival ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962262 Wed, 04 Nov 2009 23:55:40 +0100 2962262 http://www.medworm.com/index.php?rid=2962261&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F505%3Frss%3D1 The objective was to increase the annual rate of recommended tests and examinations for patients with diabetes and to reduce levels of glycosylated hemoglobin, blood pressure, and low-density lipoprotein cholesterol. A process change for type 2 diabetes mellitus was implemented that included changes in office visit structure, protocol-driven electronic prompts for nursing and physician staffs, clinical decision support built into a new electronic medical record form, and audit with feedback. Twelve primary care physicians treated a total of 1592 patients with diabetes between January 2007 and January 2008. There were prompt and statistically significant improvements in 5 process measures and 2 outcome measures; a quality summary measure showed 8% overall improvement. Statistically signific... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962261 Wed, 04 Nov 2009 23:55:40 +0100 2962261 http://www.medworm.com/index.php?rid=2962260&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F498%3Frss%3D1 Motivating physicians to increase productivity and maximize patient satisfaction may result in conflicted behavior, raising questions about whether one must be sacrificed for the other. To determine if high satisfaction (measured by Press Ganey patient satisfaction survey) can be achieved while maintaining high productivity (measured in McGladrey relative value units, MRVU), longitudinal data collected from January 2002 to July 2004 were modeled using repeated measures regression. A total of 136 000 patient-completed satisfaction questionnaires evaluating 417 physicians were collected for analysis. Patient confidence (positively correlated; P = .001) and physician/patient time (inversely correlated; P = .001) were associated with higher physician productivity. Increases in MRVU were associ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962260 Wed, 04 Nov 2009 23:55:40 +0100 2962260 http://www.medworm.com/index.php?rid=2962259&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F489%3Frss%3D1 The aim of this work was to evaluate our Glycemic Control Initiative that was put in place to improve blood glucose control in hyperglycemic intensive care patients and improve insulin safety by minimizing the risk of hypoglycemia. A computerized decision-support tool was developed for intravenous insulin dosing that provided an automated and standardized approach across the organization’s intensive care units (ICUs). As a result of this, at 3 years post implementation, ICU patients are 2.28 times more likely to have blood glucose levels <150 mg/dL (odds ratio = 2.28; 95% confidence interval = 2.25-2.30; P < .001) compared with the baseline period. Although glycemic control was significantly improved, the patient safety risk from hypoglycemia did not increase, as rates of blood... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962259 Wed, 04 Nov 2009 23:55:40 +0100 2962259 http://www.medworm.com/index.php?rid=2962258&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F480%3Frss%3D1 This article argues that incentives can be created for increasing coordination by specifying accountability for the 4 basic types of health care encounter defined in this article. Payment design can be used to identify units of service that are sufficiently narrow to give a transparent understanding of the type of care rendered but with the capacity for aggregation to describe the process as a whole. Transparency is defined as the use of categorical or rules-based models such as Diagnosis Related Groups. Payment systems can use a building block approach for each of the 4 types of health care encounter so as to encourage improved coordination of health care services. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962258 Wed, 04 Nov 2009 23:55:40 +0100 2962258 http://www.medworm.com/index.php?rid=2962257&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F474%3Frss%3D1 The National Surgical Quality Improvement Program (NSQIP), as administered by the American College of Surgeons, became available to private sector hospitals across the United States in 2004. The program works to improve surgical outcomes by providing high-quality, risk-adjusted data to surgeons at a given hospital to stimulate discussion and define target areas for improvement. Although the NSQIP began in the early 1990s with Veterans Administration hospitals and expanded to private sector hospitals nearly 5 years ago, the "how to" process for NSQIP implementation has been left to individual institutions to manage on their own. The NSQIP was instituted at a large tertiary hospital in 2005, identifying through experience 12 critical steps to help surgeons and hospitals implement the NSQIP. ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962257 Wed, 04 Nov 2009 23:55:40 +0100 2962257 http://www.medworm.com/index.php?rid=2962256&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6%2F465%3Frss%3D1 This study aims to identify 1 or more measures among the PSIs best suited for a quick index of general patient safety status. The 1997-2002 Nationwide Inpatient Sample was used to calculate the hospital-level risk-adjusted rates of the PSIs. Both pairwise correlation analyses and multivariate analyses showed that PSI #7 (Selected infections due to medical care) is significantly correlated with most of the other PSIs. The results are robust even when (1) the pairwise and multivariate analyses are rerun on a reduced data set that excludes admissions with multiple patient safety events, and (2) Bonferroni-adjusted P values are calculated. The study concludes that PSI #7 appears to be a candidate for a quick index of patient safety status. (Am J Med Qual 2009;24:465-473) (Source: American Jour... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962256 Wed, 04 Nov 2009 23:55:40 +0100 2962256 http://www.medworm.com/index.php?rid=2962255&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F6%2F462%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2962255 Wed, 04 Nov 2009 23:55:40 +0100 2962255 http://www.medworm.com/index.php?rid=3132890&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6_suppl%2F25S%3Frss%3D1 Over the last decade a number of new technologies have been introduced to the area of spine care. Although this recent explosion of innovation has brought advances to patient care, it has also brought concerns regarding overuse, increasing costs, and safety. A value-based approach to assessing and purchasing new technology depends on a shift toward comparative effectiveness analysis, transparency in pricing and potential conflicts of interest, and an alignment of incentives and goals among purchasers, consumers, and payers. How to assess the effectiveness of new technology in patient care is an unresolved issue for any cost-effectiveness analysis, as models traditionally used to assess medical therapies (ie, quality-adjusted life years) may not be directly applicable to analysis of surgica... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132890 Wed, 04 Nov 2009 23:14:43 +0100 3132890 http://www.medworm.com/index.php?rid=3132889&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6_suppl%2F15S%3Frss%3D1 Health care reform will emphasize evidence-based medicine to provide the highest quality care. Recent literature has emerged in spinal surgery that has profoundly increased the evidence base for several spinal procedures. There is now good evidence from randomized controlled trials that surgical treatment of symptomatic lumbar disc herniation, decompression for spinal stenosis, and decompression and fusion for degenerative spondylolisthesis all offer significant clinical benefit in the face of serious back and radicular pain when compared with nonsurgical care. Studies of nonsurgical and surgical treatments for chronic low back pain are inconclusive, limited by study design/methodology. Continuing to increase study quality in the field of spine surgery is more important now than ever befor... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132889 Wed, 04 Nov 2009 23:14:43 +0100 3132889 http://www.medworm.com/index.php?rid=3132888&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F6_suppl%2F4S%3Frss%3D1 Spinal disorders are extremely common, debilitating, and costly to the payer and to society as a whole. The rate and cost of various spinal treatments are increasing at an astonishing rate, but it is unclear whether the resulting quality of spinal care is improving. Rather than focusing solely on quality improvement measures or cost-saving measures, there is a recent emphasis on the value of health care. Defining the value of spine care depends on a standardized, accurate method of measuring outcomes and costs. It is important that the outcomes measured are patient centered and that both the outcomes and costs are measured over time with long-term follow-up. The purpose of this article is to review current methods for measuring outcomes and propose a means by which the value of spine care ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132888 Wed, 04 Nov 2009 23:14:43 +0100 3132888 http://www.medworm.com/index.php?rid=3132887&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F6_suppl%2F3S%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3132887 Wed, 04 Nov 2009 23:14:43 +0100 3132887 http://www.medworm.com/index.php?rid=2781042&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F5%2F449%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781042 Tue, 08 Sep 2009 23:00:00 +0100 2781042 http://www.medworm.com/index.php?rid=2781041&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F5%2F447%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781041 Tue, 08 Sep 2009 23:00:00 +0100 2781041 http://www.medworm.com/index.php?rid=2781040&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F5%2F444%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781040 Tue, 08 Sep 2009 23:00:00 +0100 2781040 http://www.medworm.com/index.php?rid=2781039&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F5%2F441%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781039 Tue, 08 Sep 2009 23:00:00 +0100 2781039 http://www.medworm.com/index.php?rid=2781038&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F428%3Frss%3D1 Developing highly reliable care for patients requires changes in some traditional beliefs of medical practice, an evolution toward a "system" of health care, the disciplined application of scientific principles, modifications in the way all future providers are trained, and a fundamental understanding by leadership that quality must become a business strategy and core work, not an expense or regulatory requirement. Quality at Mayo is defined as a composite of outcomes, safety, and service. A 4-part strategic construct focusing on Culture, Infrastructure, Engineering, and Execution has been developed to guide improvement activities and to ensure a comprehensive approach to better patient care. The Mayo Clinic experience has led to a greater understanding of the leadership commitment, organi... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781038 Tue, 08 Sep 2009 23:00:00 +0100 2781038 http://www.medworm.com/index.php?rid=2781037&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F419%3Frss%3D1 To assess applicability of adult quality indicators in the management of pediatric community-acquired pneumonia (CAP), a retrospective cohort study of children admitted with CAP was conducted. The primary outcome was achievement of recommended adult quality indicators. Associations between quality indicators and clinical outcomes were assessed. Most children had rapid oxygenation assessment (97%) and blood culture before antibiotics (98%). Antibiotic timing and selection indicators were met less frequently. The only quality indicator associated with time to stability or length of stay was antibiotic timing; each additional hour until antibiotic administration was associated with a 3% increase in time to clinical stability (P = .001) and a 3% increase in length of stay (P = .002). Recommend... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781037 Tue, 08 Sep 2009 23:00:00 +0100 2781037 http://www.medworm.com/index.php?rid=2781036&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F412%3Frss%3D1 Recent interest in publicly reporting health care–associated infections (HAIs) makes it important to develop reports that consumers can understand and evaluate. In-depth qualitative interviews were conducted with 59 consumers. Interviews focused on responses to existing and prototypical reports and on recommendations for improvements. Many interviewees were unfamiliar with HAIs and were distressed to learn HAIs occur and can result in death. Public reporting was seen as unlikely to affect hospital choice; other factors were considered more influential. Interviewees recommended that reports be brief and include information on prevention as well as performance data. Additional recommendations on format and content were identified. For public reporting of HAIs to be successful, attentio... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781036 Tue, 08 Sep 2009 23:00:00 +0100 2781036 http://www.medworm.com/index.php?rid=2781035&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F403%3Frss%3D1 The variability in frequency of allogeneic blood transfusion during coronary artery bypass surgery (CABG) is a concern. Evidence-based guidelines support minimizing the use of blood during open heart surgery. The Hospital Clinical Services Group quality indicator database was queried for intraoperative red blood cell (RBC) transfusions in 17 252 isolated CABG surgery cases during 2007. Institutional variability was observed in the frequency of intraoperative RBC transfusion rates, which ranged from 0% to 85.7%. The institution mean RBC transfusion rate was 40.8%. Regional geographic and cardiac program size variations were observed in RBC transfusion rates and volume with significant variation. Notable institutional variability persists with respect to intraoperative RBC transfusion in iso... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781035 Tue, 08 Sep 2009 23:00:00 +0100 2781035 http://www.medworm.com/index.php?rid=2781034&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F395%3Frss%3D1 This study directly compares the University HealthSystem Consortium Clinical Database (UHC CDB) and the National Surgical Quality Improvement Program (NSQIP) in terms of their assessment of complications and death for 26 322 surgery patients using analyses of variance, correlation, and multivariable logistic regression. The NSQIP had more variables with significant correlation with outcomes. The NSQIP was better at predicting death (c-index 0.94 vs 0.90, P < .05) and complications (c-index 0.78 vs 0.76, P = .07), especially for higher risk patients. The UHC CDB missed and misclassified several major complications. The data sets are similar in their explanatory power relative to outcomes, but the clinical data set is better, particularly at identifying higher risk patients and specific c... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781034 Tue, 08 Sep 2009 23:00:00 +0100 2781034 http://www.medworm.com/index.php?rid=2781033&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F385%3Frss%3D1 The electronic health record (EHR) is seen by many as an ideal vehicle for measuring quality of health care and monitoring ongoing provider performance. It is anticipated that the availability of EHR-extracted data will allow quality assessment without the expensive and time-consuming process of medical record abstraction. A review of the data requirements for the indicators in the Quality Assessment Tools system suggests that only about a third of the indicators would be readily accessible from EHR data. Other factors involving complexity of required data elements, provider documentation habits, and EHR variability make the task of quality measurement more difficult than may be appreciated. Accurately identifying eligible cases for quality assessment and validly scoring those cases with E... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781033 Tue, 08 Sep 2009 23:00:00 +0100 2781033 http://www.medworm.com/index.php?rid=2781032&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F5%2F374%3Frss%3D1 The objective of this study was to investigate safety climates within a cohort of regional hospitals to assess health care workers’ perceptions of their hospitals’ safety reporting, feedback, and problem-solving systems, and to examine how regional initiatives and health care organizations use safety climate information to improve patient safety outcomes. A purposive sample of staff at 25 western Pennsylvania hospitals was surveyed using Likert scale questions. The instrument studied provided foci on which regional efforts and hospitals could base interventions to improve patient safety culture. Significant differences in perceived patient safety climate existed between hospitals, respondents, and departments. The differences in responses suggest that such instruments may be us... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2781032 Tue, 08 Sep 2009 23:00:00 +0100 2781032 http://www.medworm.com/index.php?rid=2579280&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F4%2F360%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579280 Mon, 06 Jul 2009 23:00:00 +0100 2579280 http://www.medworm.com/index.php?rid=2579279&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F4%2F357%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579279 Mon, 06 Jul 2009 23:00:00 +0100 2579279 http://www.medworm.com/index.php?rid=2579278&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F4%2F352%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579278 Mon, 06 Jul 2009 23:00:00 +0100 2579278 http://www.medworm.com/index.php?rid=2579277&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F4%2F347%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579277 Mon, 06 Jul 2009 23:00:00 +0100 2579277 http://www.medworm.com/index.php?rid=2579276&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F4%2F344%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579276 Mon, 06 Jul 2009 23:00:00 +0100 2579276 http://www.medworm.com/index.php?rid=2579275&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F4%2F333%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579275 Mon, 06 Jul 2009 23:00:00 +0100 2579275 http://www.medworm.com/index.php?rid=2579274&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F321%3Frss%3D1 The objective of this study was to analyze the variables related to inappropriate admissions and hospital stays and their financial repercussions. This was a descriptive retrospective study in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative sample of 725 hospital admissions and 1350 hospital stays. The cost of inappropriate stays was calculated by cost accounting. The study found that 7.4% of admissions and 24.6% of stays were inappropriate. Inappropriate admissions were significantly related to medical specialties and younger patient age. Inappropriate stays were related to these factors, plus patients being outside their corresponding areas, nonurgent admissions, and low occupancy rate. The cost of the inappropriate admissions and stays was 147 044 eur... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579274 Mon, 06 Jul 2009 23:00:00 +0100 2579274 http://www.medworm.com/index.php?rid=2579273&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F310%3Frss%3D1 Glycemic control is an important quality indicator in the management of intensive care unit patients. Tight glycemic control and/or insulin infusion protocols may reduce complications and improve outcomes in certain intensive care unit patients. Unfortunately, a consistent method of describing glycemic control has not been used for this population. A standardized metric is needed to adequately evaluate quality performance as well as interpret and apply the literature. The current glycemic control metrics such as mean, median, mean morning, hyperglycemic index, and time-weighted averages will be analyzed. The complexities associated with reporting glycemic control data for national quality performance will also be reviewed. The goal is to facilitate and propose the selection of a glycemic c... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579273 Mon, 06 Jul 2009 23:00:00 +0100 2579273 http://www.medworm.com/index.php?rid=2579272&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F302%3Frss%3D1 This study implemented and evaluated the pilot phase of a pediatric practice-directed medical home quality improvement (QI) project focused on improving primary care for children and youth with special health care needs (CYSHCN). Six practices received training, QI team development and facilitation, and receipt of mini-grants for QI projects. Practice-level and parent-level evaluations were obtained at pre-intervention and post-intervention. The intervention was well-received. Many areas of improvement were found on practice-level evaluations, especially family-centered care and QI activities. Poor response rates limited the interpretation of family-level outcomes; 26% completed baseline outcome evaluations, and 64% of initial respondents completed them post-intervention. Practice educatio... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579272 Mon, 06 Jul 2009 23:00:00 +0100 2579272 http://www.medworm.com/index.php?rid=2579271&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F295%3Frss%3D1 The slow progress in health care quality improvement and patient safety in America can be attributed, in part, to the challenge of physician engagement. As multidisciplinary patient-centered care becomes the standard, it is essential to integrate physicians into this process. To this end, the UMass Memorial Medical Center redesigned its Physician Quality Officer (PQO) program in 2007. The PQOs of the UMass Memorial Medical Center, who are all practicing clinicians, are fully compensated for their time and effort, trained in safety science, and teamed with other members of the department of quality and patient safety. Over the first year of the new program, the PQOs have successfully led major hospital initiatives in areas such as surgical care improvement, critical values reporting, and me... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579271 Mon, 06 Jul 2009 23:00:00 +0100 2579271 http://www.medworm.com/index.php?rid=2579270&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F287%3Frss%3D1 Efforts to improve the quality of ambulatory care have received tremendous attention as bold new initiatives aimed at influencing the environment of care through financial incentives, public transparency, and information technology rapidly spread. Academic medical centers, which represent a long tradition of excellence and innovation in medical care, might be expected to lead the charge in these new arenas, but motivation for change may be mitigated by the unique complexity and multiple goals of these institutions. A survey conducted in the fall of 2006 examined the early impact of these major new influences on faculty practice plans. Respondents reported that many institutions have begun to develop key components of a quality infrastructure, but much work remains before a robust model eme... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579270 Mon, 06 Jul 2009 23:00:00 +0100 2579270 http://www.medworm.com/index.php?rid=2579269&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F4%2F278%3Frss%3D1 This study compares quality of care measures for hospitals with fully implemented computerized physician order entry (CPOE) systems with hospitals that have not fully implemented such a system. Using a cross-sectional design, this study linked hospital quality data from the Centers for Medicare and Medicaid Services to the Health Information Management Systems Society Analytics database, which contains hospital CPOE adoption information. Performance on quality measures was assessed using univariate and multivariate methods. In all, 8% of hospitals have fully implemented CPOE systems; CPOE hospitals were more frequently larger, not-for-profit, and teaching hospitals. After controlling for confounders, CPOE hospitals outperformed comparison hospitals on 5 of 11 measures related to ordering m... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2579269 Mon, 06 Jul 2009 23:00:00 +0100 2579269 http://www.medworm.com/index.php?rid=2426547&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F3%2F264%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426547 Wed, 20 May 2009 04:00:00 +0100 2426547 http://www.medworm.com/index.php?rid=2426546&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F3%2F262%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426546 Wed, 20 May 2009 04:00:00 +0100 2426546 http://www.medworm.com/index.php?rid=2426545&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F3%2F259%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426545 Wed, 20 May 2009 04:00:00 +0100 2426545 http://www.medworm.com/index.php?rid=2426544&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F250%3Frss%3D1 Medicare has introduced a number of new payment initiatives that will have a profound effect on hospital reimbursement and quality and safety ratings. The new medical severity diagnosis—related group (MS-DRG) payment system adds a number of new DRG categories to more adequately account for patient severity. The new present-on-admission (POA) initiative is designed to withhold additional reimbursement for selected complications that were not recorded as being POA but that occurred during the course of the hospitalization. The recovery audit contract requires hospitals to repay Medicare for services deemed not clinically necessary based on retrospective chart review. Reimbursement and quality rankings for each of these initiatives are based on the extent and thoroughness of physician c... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426544 Wed, 20 May 2009 04:00:00 +0100 2426544 http://www.medworm.com/index.php?rid=2426543&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F241%3Frss%3D1 This article analyzes the effects of offering smoking cessation advice in the US population. The Archimedes model is used to simulate several clinical trials in which basic advice and medication advice are offered and to calculate the rates of myocardial infarctions, congestive heart disease deaths, strokes, life years, quality-adjusted life years (QALYs), costs, and cost/ QALY. The simulated population is a representative sample of the US population drawn from the Third National Health and Nutrition Survey conducted just before the performance measures and guidelines were introduced. The results show that offering basic advice and medication advice can prevent about 13% and 19% of myocardial infarctions and strokes, respectively. The 30-year cost/QALY is approximately $3000 less than the ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426543 Wed, 20 May 2009 04:00:00 +0100 2426543 http://www.medworm.com/index.php?rid=2426542&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F229%3Frss%3D1 Nursing home quality measures impact policy decisions such as reimbursement or consumer choice. Quality indicators in the United States are collected through the federally mandated Minimum Data Set (MDS). Bias in MDS data collection or coding can thus have a negative impact on policy applications. To understand whether bias was present in coding, the authors studied 5174 pairs of MDS assessments that were independently collected by nursing home staff and study nurses from 206 nursing homes. The authors developed multivariate multilevel models to identify nursing home and resident characteristics that were significantly associated with the data quality of multiple MDS measures of nursing home quality. The outcomes were coding differences between nursing home staff and study nurses. Resident... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426542 Wed, 20 May 2009 04:00:00 +0100 2426542 http://www.medworm.com/index.php?rid=2426541&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F222%3Frss%3D1 End-of-life decision making, including consideration of advance directives and code status, is taking place more frequently in critical care units. There is a need to identify how nurses and physicians perceive end-of-life care so that nurse-physician understanding and communication can be improved. A total of 96 physicians and nurses completed a survey about their general beliefs and practices related to end-of-life care in the intensive care unit. Nurses were more likely to ask if there was a living will and to read it. Only 53% of physicians read living wills; however 90% of physicians consider the wishes in the living will when making recommendations to the family. Physicians were more likely to discuss do-not-resuscitate (DNR) orders only when a prognosis was poor. Family dynamics and... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426541 Wed, 20 May 2009 04:00:00 +0100 2426541 http://www.medworm.com/index.php?rid=2426540&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F214%3Frss%3D1 Graduate medical education (GME) has traditionally focused on the diagnosis and management of disease with little attention devoted to patient safety and systems thinking. In this article, we describe the results of a needs assessment conducted to develop a patient safety curriculum for GME. Eight program directors, 10 patient safety experts, and 9 experts in education technology were interviewed for this project. A total of 21 patient safety topics were identified in the categories of cultural, cognitive, and technical content and included communications and handoffs, sentinel event reporting and management, calling for help when in doubt, hand hygiene, universal protocol, fatigue, and the culture of safety and transparency. Objective structured clinical examinations and experiential lear... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426540 Wed, 20 May 2009 04:00:00 +0100 2426540 http://www.medworm.com/index.php?rid=2426539&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F205%3Frss%3D1 This article presents the results of a 12-month multicenter collaboration assessing HH compliance rates at US health care facilities by measuring product usage and providing feedback about HH compliance. Our results show that HH compliance at baseline was 26% for intensive care units (ICUs) and 36% for non-ICUs. After 12 months of measuring product usage and providing feedback, compliance increased to 37% for ICUs and 51% for non-ICUs. (ICU, P = .0119; non-ICU, P < .001). HH compliance in the United States can increase when monitoring is combined with feedback. However, HH still occurs at or below 50% compli- ance for both ICUs and non-ICUs. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426539 Wed, 20 May 2009 04:00:00 +0100 2426539 http://www.medworm.com/index.php?rid=2426538&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F196%3Frss%3D1 A systematic review of published English-language articles on handoffs is conducted (1987 to June 4, 2008). Forty-six articles describing 24 handoff mnemonics are identified by trained reviewers. The majority (82.6%) have been published in the last 3 years (2006-2008), and SBAR (Situation, Background, Assessment, Recommendation) is the most frequently cited mnemonic (69.6%). Of 7 handoff research articles, only 4 study mnemonics. All 4 of these studies have relatively small sample sizes (10-100) and lack validated instruments. Only 1 study has obtained IRB approval. Scientifically rigorous research studies are needed to assess the effectiveness of handoff mnemonics. These should be published in the peer-reviewed literature using the Standards for QUality Improvement Reporting Excellence (S... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426538 Wed, 20 May 2009 04:00:00 +0100 2426538 http://www.medworm.com/index.php?rid=2426537&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F192%3Frss%3D1 While required by the Accreditation Council for Graduate Medical Education (ACGME) and recommended by the Institute of Medicine, there are few published studies demonstrating that morbidity and mortality conferences (MMCs) are an effective strategy to improve patient care. To learn from medical incidents and improve patient care, care-givers need to: (1) elicit input from all staff involved in the incident, (2) use a structured framework to investigate all underlying contributing factors, and (3) assign responsibility for management and follow-up on recommendations. Many MMCs lack these key elements. The specific aims of this article are to describe the use of the learning from a defect tool as a strategy to meet ACGME requirements, advance medical education, and enhance traditional MMCs i... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426537 Wed, 20 May 2009 04:00:00 +0100 2426537 http://www.medworm.com/index.php?rid=2426536&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F3%2F185%3Frss%3D1 The objective was to develop and validate a method to link routinely captured electronic data for the measurement of emergency department (ED) quality indicators. Electronic ED data were linked to calculate time to antibiotics and time to electrocardiogram (ECG) for pneumonia and chest pain patients, respectively; validation was by comparison with chart data. Linked electronic data correctly identified 40/40 pneumonia and 65/65 chest pain patients. The median difference in time to antibiotics calculated from linked electronic data versus chart data was 6 minutes (standard deviation [SD] = 14.0); for time to ECG it was 0 minutes (SD = 70). The percentage of ED patients meeting target time to antibiotics was 47% with electronic data versus 44% with charts; for time to ECG, 8% met target time... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426536 Wed, 20 May 2009 04:00:00 +0100 2426536 http://www.medworm.com/index.php?rid=2426535&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F3%2F182%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426535 Wed, 20 May 2009 04:00:00 +0100 2426535 http://www.medworm.com/index.php?rid=2426548&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F2_suppl%2F5S%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2426548 Tue, 17 Mar 2009 04:00:00 +0100 2426548 http://www.medworm.com/index.php?rid=2272243&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F2%2F169%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2272243 Tue, 17 Mar 2009 04:00:00 +0100 2272243 http://www.medworm.com/index.php?rid=2272242&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F2%2F166%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2272242 Tue, 17 Mar 2009 04:00:00 +0100 2272242 http://www.medworm.com/index.php?rid=2272241&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F2%2F164%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2272241 Tue, 17 Mar 2009 04:00:00 +0100 2272241 http://www.medworm.com/index.php?rid=2272240&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F2%2F140%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2272240 Tue, 17 Mar 2009 04:00:00 +0100 2272240 http://www.medworm.com/index.php?rid=2272239&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F132%3Frss%3D1 This study describes a comparative analysis of replacing medical residents with physician assistants and hospitalists on patient outcomes in a community hospital. Prospective data during the physician assistants—hospitalists service for 2 years was compared with 2 years of retrospective data of the medical residents model. Outcome measures included mortality, adverse events, readmissions, and patient satisfaction. For physician assistants— hospitalists versus medical residents models, all-cause and case mix index—adjusted mortality was 107/5508 (1.94%) and 0.019 versus 156/5458 (2.85%) and 0.029, respectively (P ≤ .001). The adverse event cases were 9 versus 5 ( P = .29), and the readmission rate within 30 days was 64 versus 69 (P = .34). Patient satisfaction was 95% v... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2272239 Tue, 17 Mar 2009 04:00:00 +0100 2272239 http://www.medworm.com/index.php?rid=2272238&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F123%3Frss%3D1 The Authors investigated the addition of novel quality indicators, patient risk adjustment, and simple statistics in an ongoing clinician feedback initiative that profiles diabetes care for 13 Veterans Affairs (VA) clinics. Data were extracted from a computerized database for calendar years 2004 to 2005. Performance was assessed with 4 monitoring measures, 3 intermediate outcomes, and 3 appropriate treatment measures. Attainment rates for each indicator were calculated by clinic. The effect of risk adjustment and the significance of clinic performance variation were determined with multivariate logistic models. Analysis of the 10 quality measures revealed lower attainment and greater clinic-level variation for the less familiar indicators. Statistically significant performance variations w... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2272238 Tue, 17 Mar 2009 04:00:00 +0100 2272238 http://www.medworm.com/index.php?rid=2272237&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F116%3Frss%3D1 Physician recommendation is a major determinant of colorectal cancer screening. The purpose of this study was to examine physician attitudes and self-reported colorectal cancer patient screening. In a physician survey, perceived patient barriers included preparation for the tests and patient dislike of the blood stool test. Physician semistructured interviews revealed that perception of patient barriers included cost, time off from work, and transportation. Most physicians reported low knowledge of insurance coverage for screening, and self-reported screening rates among physicians themselves were not optimal. Evidence-based interventions to increase physician recommendations for screening, such as reminder and tracking systems, may be of value. Interventions that target physician knowledg... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2272237 Tue, 17 Mar 2009 04:00:00 +0100 2272237 http://www.medworm.com/index.php?rid=2272236&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F108%3Frss%3D1 This study evaluated different approaches for reporting hospital-level comparative data on HAIs and the extent to which such data might influence hospital choice. Eight versions of a report were developed, varying whether data were consistent across indicators, whether data were presented in text or graphs, and whether confidence intervals were included. A report and a questionnaire were mailed to a randomly selected sample of local residents. Findings provide no evidence that consistency of indicators, data presentation, report format, or inclusion of confidence intervals significantly impacted consumers' understanding. More educated consumers reported greater understanding of the reports. Responses suggested that public reporting of comparative data on HAIs could influence hospital choic... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2272236 Tue, 17 Mar 2009 04:00:00 +0100 2272236 http://www.medworm.com/index.php?rid=2272235&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F99%3Frss%3D1 This study explored the impact of the Preventive Cardiology Practice Improvement Module (PC- PIM) on residency clinics. Results from 22 clinic interviews indicated merit in using the PC-PIM to teach QI during residency. Many residents reported increased knowledge and confidence, particularly regarding the value of QI. The majority recognized that QI often leads to improved patient care and outcomes, even in resource poor environments. Conducting aspects of the QI process themselves (eg, chart audit, decision making) led to greater awareness of the patient and systems perspectives. Barriers included a lack of resident buy-in, discontinuity of care, and a lack of institutional support. These findings shed light on how residency clinics engage in QI activities and may aid in the implementatio... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2272235 Tue, 17 Mar 2009 04:00:00 +0100 2272235 http://www.medworm.com/index.php?rid=2272234&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F2%2F90%3Frss%3D1 The objective of this study was to describe the experience of a Quality Improvement Organization (QIO) providing educational outreach to promote use of quality improvement (QI) tools in primary care private practice. Two QIO outreach workers conducted visits with physicians and targeted staff. Data were analyzed on physician demographics, visits, and use of QI tools using standard quantitative and qualitative methods. QIO staff frequently encountered difficulty in accessing physicians and administrative staff and reported many barriers to QI. Despite these challenges, outreach visits were associated with adoption of QI tools, and certain physician characteristics were associated with greater numbers of outreach visits and tools adopted. QIOs and other external parties who seek to improve q... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2272234 Tue, 17 Mar 2009 04:00:00 +0100 2272234 http://www.medworm.com/index.php?rid=2097358&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F1%2F84%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097358 Mon, 12 Jan 2009 05:00:00 +0100 2097358 http://www.medworm.com/index.php?rid=2097357&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F1%2F82%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097357 Mon, 12 Jan 2009 05:00:00 +0100 2097357 http://www.medworm.com/index.php?rid=2097356&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F1%2F79%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097356 Mon, 12 Jan 2009 05:00:00 +0100 2097356 http://www.medworm.com/index.php?rid=2097355&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F1%2F77%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097355 Mon, 12 Jan 2009 05:00:00 +0100 2097355 http://www.medworm.com/index.php?rid=2097354&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F1%2F74%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097354 Mon, 12 Jan 2009 05:00:00 +0100 2097354 http://www.medworm.com/index.php?rid=2097353&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F1%2F71%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097353 Mon, 12 Jan 2009 05:00:00 +0100 2097353 http://www.medworm.com/index.php?rid=2097352&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F1%2F67%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097352 Mon, 12 Jan 2009 05:00:00 +0100 2097352 http://www.medworm.com/index.php?rid=2097351&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F61%3Frss%3D1 This study evaluates spirometry use at the Community Medical Center—Sierra in hospitalized patients with COPD. A retrospective medical record review from January 1, 2000, to March 15, 2002, assesses 1507 inpatients with COPD. The effects are analyzed of age, sex, race/ ethnicity, diagnosis, insurance status, disposition, and admitting service on spirometry use by physicians are analyzed. A questionnaire is used to evaluate the knowledge, attitudes, and behaviors of residents toward spirometry ordering. Baseline characteristics are similar between study groups. Only 3% of 1476 study patients have spirometry performed within the recommended time frame, and only 12.2% have at least 1 spirometry performed. Patients having a primary diagnosis of COPD have a greater likelihood of having sp... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097351 Mon, 12 Jan 2009 05:00:00 +0100 2097351 http://www.medworm.com/index.php?rid=2097350&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F53%3Frss%3D1 This study estimates excess cost and length of stay associated with voluntary patient safety event reports at 3 hospitals. Voluntary patient safety event reporting has proliferated in hospitals in recent years, yet little is known about the cost of events captured by this type of system. Events captured in an electronic reporting system at 3 urban community hospitals in Portland, Oregon, are evaluated. Cost and length of stay are assessed by linking event reports to risk-adjusted administrative data. Hospital stays with an event report are 17% more costly and 22% longer than stays without events. Medication and treatment errors are the most expensive and most common events, representing 77% of all event types and 77% of added costs. Ninety percent of events result in no measurable harm. Pa... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097350 Mon, 12 Jan 2009 05:00:00 +0100 2097350 http://www.medworm.com/index.php?rid=2097349&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F45%3Frss%3D1 Surgical site infections cause significant morbidity and mortality in the postoperative period. Opening of the operating room door disrupts its filtered atmosphere, increasing contamination above the wound. We conducted a study of traffic in the operating room as a risk for infections. This is an observational study of recorded behaviors in the operating room. Data collected included number of people entering/exiting, the role of these individuals, and the cause for the event. A total of 3071 door openings were recorded in 28 cases. Traffic varied from 19 to 50 events per hour across specialties. The preincision period represented 30% to 50% of all events. Information requests accounted for the majority of events. Door openings increase in direct proportion to case length, but have an expo... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097349 Mon, 12 Jan 2009 05:00:00 +0100 2097349 http://www.medworm.com/index.php?rid=2097348&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F35%3Frss%3D1 This study assesses the reliability of patient-reported information about care received by individual specialist physicians. A patient questionnaire that included core composites from the Consumer Assessment of Healthcare Providers and Systems Clinician & Group survey was administered to random samples of patients visiting 1315 physicians from 14 specialties in California during 2005-2006 (n = 68 406 respondents). The quality of specialist-patient interaction and organizational access composites achieved adequate physician-level reliability (MD = 0.70) with 30 or fewer patients per specialist, but the care coordination and health promotion support composites were generally less reliable. Patients reporting consult-based relationships with specialists reported worse care experiences acr... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097348 Mon, 12 Jan 2009 05:00:00 +0100 2097348 http://www.medworm.com/index.php?rid=2097347&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F29%3Frss%3D1 Infections in the surgical and trauma intensive care unit (STICU) are responsible for significant patient morbidity and mortality. Research into these infectious complications often uses administrative databases or clinical information systems designed for documenting and billing daily patient care. Neither of these sources is intended for research, and many investigators have questioned their accuracy. The Surgical Intensive Care–Infection Registry (SIC-IR) was developed as a research data repository to use to monitor STICU infections. SIC-IR is a relational database application designed to collect quality data and to integrate with daily patient care. SIC-IR prospectively collects and archives more than 100 clinical variables daily on each STICU patient to ensure completeness and c... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097347 Mon, 12 Jan 2009 05:00:00 +0100 2097347 http://www.medworm.com/index.php?rid=2097346&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F19%3Frss%3D1 More than 40 private sector hospital pay-for-performance (P4P) programs now exist, and Congress is considering initiating a Medicare hospital P4P program. Given the growing interest in hospital P4P, this systematic review of the literature examines the current state of knowledge about the effect of P4P on clinical process measures, patient outcomes and experience, safety, and resource utilization. Little formal evaluation of hospital P4P has occurred, and most of the 8 published studies have methodological flaws. The most rigorous studies focus on clinical process measures and demonstrate that hospitals participating in the Centers for Medicare and Medicaid Services-Premier Hospital Quality Incentive Demonstration, a P4P program, had a 2- to 4-percentage point greater improvement than the ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097346 Mon, 12 Jan 2009 05:00:00 +0100 2097346 http://www.medworm.com/index.php?rid=2097345&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F12%3Frss%3D1 This study assesses the validity and reliability of the scales. The sample includes 11212 specialty care visits, comprised of 64% women, 82% established patients, and 24% routine visits. A confirmatory factor analysis is used to test factor structure. Convergent validity also is examined. The goodness-of-fit index is 0.99, and standardized factor loadings are uniformly high, exceeding 0.90 for all but 2 items. Cronbach is 0.99 for the physician scale and 0.94 for the office scale. Both scales discriminate other satisfaction indicators. Correlation between scales is high at 0.90. Both scales possess excellent psychometric properties but are not clearly differentiated. Results agree with the unidimensional view of patient satisfaction and confirm that online surveys can be reliable and valid... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097345 Mon, 12 Jan 2009 05:00:00 +0100 2097345 http://www.medworm.com/index.php?rid=2097344&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F24%2F1%2F6%3Frss%3D1 This study demonstrates the validity, feasibility, and acceptability of an objective structured clinical examination station designed to assess competency in teamwork at the completion of a QI curriculum taught in a graduate medical education program. Further research with multiple teams and during a longer period will be needed to better understand the psychometric properties and predictive validity of the teamwork objective structured clinical examination station. (Am J Med Qual 2009;24:6-11) (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097344 Mon, 12 Jan 2009 05:00:00 +0100 2097344 http://www.medworm.com/index.php?rid=2097343&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F24%2F1%2F5%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=2097343 Mon, 12 Jan 2009 05:00:00 +0100 2097343 http://www.medworm.com/index.php?rid=1950759&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F6%2F496%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950759 Mon, 10 Nov 2008 05:00:00 +0100 1950759 http://www.medworm.com/index.php?rid=1950758&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F6%2F492%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950758 Mon, 10 Nov 2008 05:00:00 +0100 1950758 http://www.medworm.com/index.php?rid=1950757&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F6%2F484%3Frss%3D1 This study assessed the quality of primary care services provided to HIV-infected clients in the Baltimore EMA. Medical charts of 384 randomly selected clients served in 2004 were reviewed. A survey instrument was designed to assess the minimum requirements satisfied for CD4 and viral load count, highly active antiretroviral treatment, pneumocystitis carinii pneumonia and mycobacterium avium complex prophylaxis, tuberculosis, syphilis, hepatitis B and C screening and safe sex education. A numeric index of quality was developed for each client in the form of a total score. The clients were categorized into high, medium and low quality groups depending on their total scores. Only 32% of clients were in the high-quality category. Number of primary care visits per year (P ≤ .0001) was found... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950757 Mon, 10 Nov 2008 05:00:00 +0100 1950757 http://www.medworm.com/index.php?rid=1950756&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F6%2F475%3Frss%3D1 The purpose of this study was to evaluate the potential for online continuing medical education (CME) seminars to improve quality of care. Primary care physicians (113) participated in a randomized controlled trial to evaluate an online CME series. Physicians were randomized to view either a seminar about type 2 diabetes or a seminar about systolic heart failure. Following the seminar, physicians were presented with 4 clinical vignettes and asked to describe what tests, treatments, counseling, or referrals they would recommend. Physicians who viewed the seminars were significantly more likely to recommend guideline-consistent care to patients in the vignettes. For example, physicians who viewed the diabetes seminar were significantly more likely to order an eye exam for diabetes patients (... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950756 Mon, 10 Nov 2008 05:00:00 +0100 1950756 http://www.medworm.com/index.php?rid=1950755&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F6%2F465%3Frss%3D1 Data on Medicare discharges (n = 4086) in the discharge sample of the National Nursing Home Survey were used to study the association of registered nurse (RN) and physical therapist (PT) staffing levels to the outcomes and length of Medicare nursing home stays. Marginal effects were calculated in multinomial logistic modeling of Medicare beneficiaries who recovered/stabilized, died, or were hospitalized. Linear regression models on length of stay (LOS) were constructed. Higher RN staffing was related to fewer hospitalizations whereas greater PT staffing was associated with more recovered/stabilized outcomes and fewer deaths. RN and PT staffing may play different, though complementary, clinical roles affecting outcomes. Higher RN and PT staffing levels also reduced LOS of recovered/stabiliz... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950755 Mon, 10 Nov 2008 05:00:00 +0100 1950755 http://www.medworm.com/index.php?rid=1950754&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F6%2F457%3Frss%3D1 Stroke patients appear to have lower morbidity and mortality rates and better outcomes when neurologists serve as the primary admitting physician. The effect of neurological consultations on coronary artery bypass graft (CABG) patients who have suffered a postoperative transient ischemic attack (TIA) has not yet been determined. The authors evaluated whether neurology consultations improved outcomes. A retrospective analysis was conducted of CABG patients from a high-volume tertiary care center. Primary end points included 30-day mortality, discharge disposition, length of stay, and 1-year incidence of stroke. Post-CABG TIA patients receiving a neurological consult (N = 127) were compared with propensity-matched controls. Thirty-day mortality was identical (3.1%), with nonsignificant diffe... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950754 Mon, 10 Nov 2008 05:00:00 +0100 1950754 http://www.medworm.com/index.php?rid=1950753&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F6%2F448%3Frss%3D1 This was a population-based observational study to assess the impact of managed care (MC) on several dimensions of quality of surgical care among Medicare beneficiaries undergoing carotid endarterectomies (CEAs) (N = 9308) in New York. Clinical data were abstracted from medical charts to assess appropriateness and deaths or strokes within 30 days of surgery. Differences in patients, appropriateness, and outcomes were compared using chi-square tests; risk-adjusted outcomes were compared using regression. Fee-For-Service (FFS, N = 8691) and MC (N = 897) CEA patients had similar indications for surgery, perioperative risk, and comorbidities. There were no differences in inappropriateness between FFS and MC (8.6% vs 8.4%). MC patients were less likely to use a high-volume surgeon (20.1% vs 13.... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950753 Mon, 10 Nov 2008 05:00:00 +0100 1950753 http://www.medworm.com/index.php?rid=1950752&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F6%2F440%3Frss%3D1 The study design for this hospital-randomized controlled trial of an educational quality improvement intervention in rural and small community hospitals, following the implementation of a Web-based quality benchmarking and case review tool, specified a control group and a rapid-cycle quality improvement education group of ≥ 30 hospitals each. Of the 64 hospitals initially interested in participating, 7 could not produce the required quality data and 10 refused consent to randomization. Of the 23 hospitals randomized to the educational intervention, 16 completed the educational program, 1 attended the didactic sessions but did not complete the required quality improvement project, 3 enrolled in "make-up" sessions, and 3 were unable to attend. Of the 42 individuals who attended educationa... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950752 Mon, 10 Nov 2008 05:00:00 +0100 1950752 http://www.medworm.com/index.php?rid=1950751&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F6%2F427%3Frss%3D1 This article reports the results of a survey of nonprimary care physicians' views on office-based quality incentive and improvement programs. Data were collected from surveys completed by nonprimary care physicians practicing cardiology, hematology, oncology, obstetrics and gynecology, orthopedic surgery, and urology. Findings indicate that nonprimary care physicians recognize some value in office-based quality incentive and improvement programs. Specialty societies played a significant role in influencing physicians' views on office-based quality improvements. Physicians indicated support for incentive designs that included infrastructure grants to implement improvements in their office such as an electronic medical record. (Am J Med Qual 2008;23:427-439) (Source: American Journal of Medi... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950751 Mon, 10 Nov 2008 05:00:00 +0100 1950751 http://www.medworm.com/index.php?rid=1950750&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F6%2F420%3Frss%3D1 A valid measure of practice systems for improving chronic disease care is needed as a guide for both improvement and public accountability. We tested whether a new survey measure of the presence of practice systems (the PPC-R) is associated with performance measure rates for depression among 40 medical groups in Minnesota. These PPC-R scores were compared with standardized medical group measures of antidepressant persistence. Only 54% of potentially important systems were present, and there was high variability. However, there was a positive correlation between systems and quality on the 90-day measure of antidepressant persistence, both overall (r = .33, P = .04) and for the Chronic Care Model domains of decision support (r = .38, P = .02) and delivery system redesign (r = .31, P = .05). ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950750 Mon, 10 Nov 2008 05:00:00 +0100 1950750 http://www.medworm.com/index.php?rid=1950749&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F6%2F418%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1950749 Mon, 10 Nov 2008 05:00:00 +0100 1950749 http://www.medworm.com/index.php?rid=1832185&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F5%2F405-a%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832185 Fri, 26 Sep 2008 04:00:00 +0100 1832185 http://www.medworm.com/index.php?rid=1832184&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F5%2F405%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832184 Fri, 26 Sep 2008 04:00:00 +0100 1832184 http://www.medworm.com/index.php?rid=1832183&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F5%2F404-a%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832183 Fri, 26 Sep 2008 04:00:00 +0100 1832183 http://www.medworm.com/index.php?rid=1832182&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F5%2F404%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832182 Fri, 26 Sep 2008 04:00:00 +0100 1832182 http://www.medworm.com/index.php?rid=1832181&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F5%2F402%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832181 Fri, 26 Sep 2008 04:00:00 +0100 1832181 http://www.medworm.com/index.php?rid=1832180&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F5%2F399%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832180 Fri, 26 Sep 2008 04:00:00 +0100 1832180 http://www.medworm.com/index.php?rid=1832179&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F5%2F396%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832179 Fri, 26 Sep 2008 04:00:00 +0100 1832179 http://www.medworm.com/index.php?rid=1832178&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F5%2F389%3Frss%3D1 In general, an appreciation of the standards of qualitative research and the types of qualitative data analyses available to researchers have not kept pace with the growing presence of qualitative studies in medical science. To help rectify this problem, the authors clarify qualitative research reliability, validity, sampling, and generalizability. They also provide 3 major theoretical frameworks for data collection and analysis that investigators may consider adopting. These 3 approaches are ethnography, existential phenomenology, and grounded theory. For each, the basic steps of data collection and analysis involved are presented, along with real-life examples of how they can contribute to improving medical care. (Am J Med Qual 2008;23:389-395) (Source: American Journal of Medical Qualit... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832178 Fri, 26 Sep 2008 04:00:00 +0100 1832178 http://www.medworm.com/index.php?rid=1832177&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F5%2F382%3Frss%3D1 This article provides a primer on innovation for quality improvement practitioners and physician leaders who play a key role in creating innovation and environments for innovations to flourish. (Am J Med Qual 2008;23:382-388) (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832177 Fri, 26 Sep 2008 04:00:00 +0100 1832177 http://www.medworm.com/index.php?rid=1832176&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F5%2F375%3Frss%3D1 To examine lipid management in a large national outpatient network, a cross-sectional study was conducted that included 1 385 242 active patients ages 20 to 79 years of age in a national network of over 5000 providers using electronic health records (EHRs). Adequate lipid testing, achievement of lipid goals, and appropriate use of lipid-lowering medication were defined according to National Cholesterol Education Program (NCEP) guidelines. Lipid testing was adequate for 62% of high-risk, 67% of moderate-risk, and 36% of low-risk patients. Lipid goals were achieved in 65%, 66%, and 90% of these 3 risk groups; 35%, 45%, and 32% achieved adequate testing and optimal goals. Medications were appropriately prescribed for 70%, 47%, and 48%. There is significant room for improvement in lipid manage... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832176 Fri, 26 Sep 2008 04:00:00 +0100 1832176 http://www.medworm.com/index.php?rid=1832175&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F5%2F365%3Frss%3D1 Conclusions: Quality and resource use for managed care populations with diabetes may vary considerably and be largely independent factors in health care delivery. Health plans may be able to favorably impact both factors. (Am J Med Qual 2008:23:365-374) (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832175 Fri, 26 Sep 2008 04:00:00 +0100 1832175 http://www.medworm.com/index.php?rid=1832174&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F5%2F356%3Frss%3D1 The Institute of Medicine's quality imperatives include the need to provide safe, effective, patient-centered, timely, efficient, and equitable care. Less attention has been paid to quality metrics as they relate to the assessment of clinical ethics consultation and its impact on care. A better understanding of how ethics consultation influences the quality of care might identify opportunities for improvement. A descriptive pilot study, involving 7 hospitals in the New York-Presbyterian Healthcare System, was conducted to identify key elements of the ethics consultative process that might impact clinical and psychosocial outcomes. A majority of consults involved medical or intensive care unit patients and end-of-life decision making; 75.5% had or received a do-not-resuscitate order, 90.6% ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832174 Fri, 26 Sep 2008 04:00:00 +0100 1832174 http://www.medworm.com/index.php?rid=1832173&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F5%2F350%3Frss%3D1 This study's purpose was to determine the psychometric properties of an Objective Structured Clinical Examination (OSCE) to assess negotiation skills. The OSCE uses an actor trained to respond to the learner in a standardized fashion. The negotiation station was part of an 8-station QI OSCE piloted in the Mayo Clinic Endocrinology and Preventive Medicine fellowship programs. External experts judged the content validity to be excellent. Interrater reliability was outstanding for the global competency assessment (0.80) and moderate for checklist scores (0.53). All participating faculty strongly agreed (33.3%) or agreed (66.7%) that the OSCE station was an authentic assessment tool. Further research is needed to study the predictive validity of such an OSCE and its application to assessing ot... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832173 Fri, 26 Sep 2008 04:00:00 +0100 1832173 http://www.medworm.com/index.php?rid=1832172&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F5%2F342%3Frss%3D1 Pressure ulcer healing is an important quality measure for nursing homes, but the factors that predict healing have not been well studied. Using the Minimum Data Set, the authors identified candidate variables for a logistic regression, risk-adjustment model to predict ulcer healing. The authors then assessed model discrimination and calibration. Finally, the authors compared unadjusted with risk-adjusted performance for the individual facilities within a nursing home chain. Significant predictors of healing included mobility in bed, presence of a stage 2 ulcer (compared with a stage 4 ulcer), absence of paraplegia and quadriplegia, and absence of end-stage illness. The model C statistic was 0.67, and the calibration was acceptable. Judgments about nursing performance varied in 2 cases dep... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832172 Fri, 26 Sep 2008 04:00:00 +0100 1832172 http://www.medworm.com/index.php?rid=1832171&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F5%2F336%3Frss%3D1 This study purports to show the relationship between volume and patient harm due to health care error. Using 5 measures of volume and incident reports weighted for patient harm over the course of 515 days, it is shown that increased volume is related to increased harm to patients. As the number of areas in the hospital experiencing high volume increased, the likelihood of patients sustaining serious harm because of health care error also increased. This is attributed to reaching system capacity causing support services (ie, lab, pharmacy, radiology, housekeeping and engineering) to be overwhelmed and unable to keep up with requests from caregivers. (Am J Med Qual 2008;23:336-341) (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832171 Fri, 26 Sep 2008 04:00:00 +0100 1832171 http://www.medworm.com/index.php?rid=1832170&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F5%2F334%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1832170 Fri, 26 Sep 2008 04:00:00 +0100 1832170 http://www.medworm.com/index.php?rid=1651642&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F4%2F322%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651642 Thu, 24 Jul 2008 04:00:00 +0100 1651642 http://www.medworm.com/index.php?rid=1651641&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F4%2F318%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651641 Thu, 24 Jul 2008 04:00:00 +0100 1651641 http://www.medworm.com/index.php?rid=1651640&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F4%2F311%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651640 Thu, 24 Jul 2008 04:00:00 +0100 1651640 http://www.medworm.com/index.php?rid=1651639&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F4%2F302%3Frss%3D1 It is widely believed that health care quality affects primary care outcomes, but the evidence is fragmented and incomplete. The authors searched MEDLINE for relevant articles published between 1950 and 2006 and reviewed the evidence to assess the relationship between the personal aspects of primary care quality and patients' health status and health services utilization. These personal aspects, which include patient-physician continuity and communication, are distinct from the technical aspects of primary care, which include ordering tests, treatments, and referrals. Fourteen articles met the inclusion criteria. Results showed that greater continuity of care is associated with less use of hospitals and emergency departments and lower health care costs; effective communication may be assoc... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651639 Thu, 24 Jul 2008 04:00:00 +0100 1651639 http://www.medworm.com/index.php?rid=1651638&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F4%2F296%3Frss%3D1 Systems failures and their impact on quality and cost have fueled the need for a paradigm shift in medical education. Despite a growing interest in health care quality improvement (QI), few physician educators possess the necessary expertise in either systems engineering or QI. In this article, we describe a novel teaching partnership between engineers and physicians in implementing a 3-week elective QI training curriculum on health care QI. Nine learners, 2 preventive medicine and 7 endocrinology fellows, participated in this rotation. Key concepts taught by the 4 engineering faculty include stake-holder analysis, root cause analysis, process mapping, failure mode and effects analysis, resource management, negotiation, and leadership. Learner scores on the QI knowledge application tool im... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651638 Thu, 24 Jul 2008 04:00:00 +0100 1651638 http://www.medworm.com/index.php?rid=1651637&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F4%2F287%3Frss%3D1 To assess the performance of its contracted hospitals, Highmark developed the Hospital Quality Performance Report, which used 4 databases (patient satisfaction, patient safety, quality indicators, and hospital compare data) to assess patient safety and quality of care. Our study found little pairwise correlation among any of the databases used in the Hospital Quality Performance Report, highlighting the importance of assessing performance across multiple measures. Regression analysis of a set of common characteristics used to describe hospitals revealed an association between hospital bed size and the composite score, patient satisfaction score, patient safety score, and hospital compare data score and an association between hospital accreditation with the composite score, patient safety s... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651637 Thu, 24 Jul 2008 04:00:00 +0100 1651637 http://www.medworm.com/index.php?rid=1651636&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F4%2F279%3Frss%3D1 It is unclear whether public reporting of hospital and physician performance has improved outcomes for the conditions being reported. We studied the effect of intensive public reporting on hospital mortality for 6 high-frequency, high-mortality medical conditions. Patients in Pennsylvania were matched to patients in other states with varying public reporting environments using propensity score methods. The effect of public reporting was estimated using a difference in differences approach. Patients treated at hospitals subjected to intensive public reporting had significantly lower odds of in-hospital mortality when compared with similar patients treated at hospitals in environments with no public reporting or only limited reporting. Overall, the 2000-2003 in-hospital mortality odds ratio ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651636 Thu, 24 Jul 2008 04:00:00 +0100 1651636 http://www.medworm.com/index.php?rid=1651635&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F4%2F271%3Frss%3D1 Using a successful 6-step approach to medical curriculum development, a multidisciplinary systems-based safety curriculum for first-year medical students was developed and implemented. A targeted needs assessment was completed based on students' perceptions of patient safety. Goals and objectives identified were the following: (1) provide a practical framework to identify defects, (2) identify patient hazards, (3) investigate an adverse event, (4) understand incident reporting, (5) understand the impact of teamwork and communication in safety, (6) acquire skills to improve teamwork and communication, and (7) learn to disclose medical mistakes. Students were able to identify many of the teamwork and communication problems entrenched in our current health care culture. Interactive learning w... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651635 Thu, 24 Jul 2008 04:00:00 +0100 1651635 http://www.medworm.com/index.php?rid=1651634&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F4%2F266%3Frss%3D1 This paper demonstrates that the staff of a community hospital can learn a system of quality improvement (QI) and subsequently apply it to new challenges within the organization. Team members from Meadville Medical Center (MMC), a rural hospital in Northwestern Pennsylvania, participated in the Accelerating Best Care in Pennsylvania project to learn rapid-cycle QI methodology. The team applied this method to 2 areas that were identified as opportunities for improvement. The projects included increasing compliance with deep vein thrombosis prophylaxis in a hospital unit, and the administration of pneumococcal vaccinations on another unit. Compliance was 100% by the end of the initial measurement period. Improvements made to protocols and processes during the course of the projects have been... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651634 Thu, 24 Jul 2008 04:00:00 +0100 1651634 http://www.medworm.com/index.php?rid=1651633&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F4%2F259%3Frss%3D1 Hazleton General Hospital (HGH) was 1 of 2 rural area community hospitals selected to participate in Accelerating Best Care in Pennsylvania, a demonstration project conducted by Baylor University and Jefferson Medical College. This paper describes how a project team from HGH succeeded in learning and applying a rapid-cycle QI methodology that was developed for a large, academic health care system. The 5 projects undertaken for the demonstration included: heart failure discharge instructions, surgical antibiotic prophylaxis, care of the stroke patient, pneumonia care—administering antibiotic within 4 hours, and pneumococcal vaccine administration. The project teams achieved 100% compliance by the end of the initial measurement period. The program boosted QI at HGH and has been instrum... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651633 Thu, 24 Jul 2008 04:00:00 +0100 1651633 http://www.medworm.com/index.php?rid=1651632&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F23%2F4%2F252%3Frss%3D1 Industrial quality improvement (QI) methods such as continuous quality improvement (CQI) may help bridge the gap between evidence-based "best care" and the quality of care provided. In 2006, Baylor Health Care System collaborated with Jefferson Medical College of Thomas Jefferson University to conduct a QI demonstration project in select Pennsylvania hospitals using CQI techniques developed by Baylor. The training was provided over a 6-month period and focused on methods for rapid-cycle improvement; data system design; data management; tools to improve patient outcomes, processes of care, and cost-effectiveness; use of clinical guidelines and protocols; leadership skills; and customer service skills. Participants successfully implemented a variety of QI projects. QI education programs deve... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651632 Thu, 24 Jul 2008 04:00:00 +0100 1651632 http://www.medworm.com/index.php?rid=1651631&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F4%2F250%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1651631 Thu, 24 Jul 2008 04:00:00 +0100 1651631 http://www.medworm.com/index.php?rid=1498878&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F3%2F239%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1498878 Fri, 06 Jun 2008 04:00:00 +0100 1498878 http://www.medworm.com/index.php?rid=1498877&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F3%2F238-a%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1498877 Fri, 06 Jun 2008 04:00:00 +0100 1498877 http://www.medworm.com/index.php?rid=1498876&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F23%2F3%2F238%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=1498876 Fri, 06 Jun 2008 04:00:00 +0100 1498876