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. Thu, 09 Feb 2012 10:12:51 +0100 http://www.medworm.com/index.php?rid=5556165&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F27%2F1%2F83%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556165 Fri, 30 Dec 2011 05:00:00 +0100 5556165 http://www.medworm.com/index.php?rid=5556164&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F27%2F1%2F80%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556164 Fri, 30 Dec 2011 05:00:00 +0100 5556164 http://www.medworm.com/index.php?rid=5556163&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F74%3Frss%3D1 The authors question whether the d-dimer assay and pulmonary computed tomography angiography (CTA) are being used appropriately to evaluate suspected acute pulmonary embolism (PE) at their hospital. To answer this question, a retrospective review was performed on all emergency department (ED) patients who underwent d-dimer assay and/or CTA from August 15, 2008, to August 14, 2009. The authors’ algorithm for diagnosing PE requires that patients with low or intermediate probability of acute PE undergo a d-dimer assay, followed by CTA if the d-dimer is positive. Patients with high probability of PE should have CTA performed without a d-dimer assay. This result suggests that d-dimer assay and CTA are used inappropriately to evaluate patients with suspected acute PE in our ED. The low thr... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556163 Fri, 30 Dec 2011 05:00:00 +0100 5556163 http://www.medworm.com/index.php?rid=5556162&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F66%3Frss%3D1 Health care–associated infections (HAIs) increase morbidity, mortality, and hospital costs. Multiple organizations have worked independently to reduce HAIs. Regional collaborative efforts to reduce HAIs have been less common but may be particularly effective. The authors describe a statewide multicomponent approach implemented by the Iowa Healthcare Collaborative (IHC) to reduce HAIs. IHC’s initiatives helped providers improve patient care by becoming engaged in specific projects, improving communication, sharing data, and implementing best practices. Other states could use this approach as a model to engage clinicians in patient safety initiatives and thereby accelerate the rate at which clinical care and health care outcomes are improved. (Source: American Journal of Medical ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556162 Fri, 30 Dec 2011 05:00:00 +0100 5556162 http://www.medworm.com/index.php?rid=5556161&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F58%3Frss%3D1 The authors present Mayo Clinic’s Value Creation System, a coherent systems engineering approach to delivering a single high-value practice. There are 4 tightly linked, interdependent phases of the system: alignment, discovery, managed diffusion, and measurement. The methodology is described and examples of the results to date are presented. The Value Creation System has been demonstrated to improve the quality of patient care while reducing costs and increasing productivity. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556161 Fri, 30 Dec 2011 05:00:00 +0100 5556161 http://www.medworm.com/index.php?rid=5556160&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F48%3Frss%3D1 The objective was to investigate the effect of admission health status on hospital adverse events and added costs. Secondary data were from merged administrative and clinical sources for Mayo Clinic Rochester, Minnesota hospital discharges in 2005 (N = 60 599). This was a retrospective cross-sectional study of the effect of demographics, diagnosis group, comorbidity, and admission illness severity on adverse events, incremental costs, and length of stay (LOS) using the Agency for Healthcare Research and Quality Patient Safety Indicators and provider-reported events with harm. Estimates are derived from generalized linear models. Admission severity increased the likelihood of all types of adverse events (7.2% per unit acute physiology score for any event); 7 specific comorbidities were asso... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556160 Fri, 30 Dec 2011 05:00:00 +0100 5556160 http://www.medworm.com/index.php?rid=5556159&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F39%3Frss%3D1 Internal medicine residents were surveyed regarding patient sign-outs at shift change. Data were used to design and implement interventions aimed at improving sign-out quality. This quasi-experimental project incorporated the Plan, Do, Study, Act methodology. Residents completed an anonymous electronic survey regarding experiences during sign-outs. Survey questions assessed structure, process, and outcome of sign-outs. Analysis of qualitative and quantitative data was performed; interventions were implemented based on survey findings. A total of 120 surveys (89% response) and 115 surveys (83% response) were completed by residents of 4 postgraduate years in response to the first (2008) and second (2009) survey requests, respectively. Approximately 79% of the respondents to the second survey... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556159 Fri, 30 Dec 2011 05:00:00 +0100 5556159 http://www.medworm.com/index.php?rid=5556158&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F30%3Frss%3D1 We report our experience using this framework, noting both how the framework helped anticipate needs and what challenges we encountered that were not anticipated based on the spread plan. Using our framework, we were able to spread the changes across more than 79 distinct hospital services, improving use of appropriate VTE prophylaxis to more than 95%. Use of an explicit, well-constructed spread plan allows for an orderly management of diffusion of best practices. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556158 Fri, 30 Dec 2011 05:00:00 +0100 5556158 http://www.medworm.com/index.php?rid=5556157&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F21%3Frss%3D1 The medical center experienced 8 wrong site/procedure/patient events between April 2008 and January 2010. A common cause analysis (CCA) was conducted on all 8 events to determine the causal factors of these events. After a sentinel event is identified, the medical center conducts a root cause analysis (RCA) within 45 days of the event. A CCA helps recognize trends and establish themes identified from each RCA. The CCA revealed that there were 22 occurrences of failure modes noted in the category of Rules, Policies, and Procedures and 17 failure modes present in the category of Human Factors: Scheduling and Fatigue. A multidisciplinary team was assembled to confirm the failure modes identified in the CCA and to develop processes to address these failure modes. No further wrong site, procedu... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556157 Fri, 30 Dec 2011 05:00:00 +0100 5556157 http://www.medworm.com/index.php?rid=5556156&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F16%3Frss%3D1 The purpose of this cross-sectional study was to identify key predictor variables with the most impact on door-to-balloon time for acute myocardial infarction patients. The authors examined arrival, process, and patient-related variables from retrospective data from calendar years 2006 and 2007 within a single community hospital (N = 273). The door-to-balloon time ranged from 28 to 167 minutes, with an average of 76.77 (standard deviation ±24.5) minutes. Key predictor variables identified through multivariate linear regression included portable chest X-ray, presentation from walk-in versus ambulance, responding cardiology group, emergency department (ED) time of arrival (day 8 am to 5 pm or night 5 pm to 8 am), ED day of arrival (weekday or weekend), if a code R was called prior to ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556156 Fri, 30 Dec 2011 05:00:00 +0100 5556156 http://www.medworm.com/index.php?rid=5556155&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F11%3Frss%3D1 It is widely believed that timely follow-up decreases hospital readmissions; however, the literature evaluating time to follow-up is limited. The authors conducted a retrospective analysis of patients discharged from a tertiary care academic medical center and evaluated the relationship between outpatient follow-up appointments made and 30-day unplanned readmissions. Of 1044 patients discharged home, 518 (49.6%) patients had scheduled follow-up ≤14 days after discharge, 52 (4.9%) patients were scheduled ≥15 days after discharge, and 474 (45.4%) had no scheduled follow-up. There was no statistical difference in 30-day readmissions between patients with follow-up within 14 days and those with follow-up 15 days or longer from discharge (P = .36) or between patients with follow-up within... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556155 Fri, 30 Dec 2011 05:00:00 +0100 5556155 http://www.medworm.com/index.php?rid=5556154&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F27%2F1%2F5%3Frss%3D1 Cardiac surgical outcomes improvement in a community hospital was driven by a physician champion working with a nurse clinical coordinator. Specific system improvements implemented were (1) nurse checklists of vital signs, cardiovascular function parameters, and life support appliance operation; (2) use of the EuroSCORE system of preoperative patient risk assessment; (3) monthly morbidity and mortality conferences; and (4) daily patient progress tracking. The hospital received 1 star (bottom 12% of hospitals for quality outcomes) from the Society of Thoracic Surgeons Adult Cardiac Database in 2006 prior to program inception, 2 stars (middle 76% of hospitals for quality outcomes) in 2007 and 2008, and 3 stars (top 12% of hospitals) in 2009. The physician and nurse together combined a strate... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5556154 Fri, 30 Dec 2011 05:00:00 +0100 5556154 http://www.medworm.com/index.php?rid=5394573&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F6%2F508%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394573 Fri, 04 Nov 2011 04:00:00 +0100 5394573 http://www.medworm.com/index.php?rid=5394572&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F6%2F505%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394572 Fri, 04 Nov 2011 04:00:00 +0100 5394572 http://www.medworm.com/index.php?rid=5394571&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F6%2F502%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394571 Fri, 04 Nov 2011 04:00:00 +0100 5394571 http://www.medworm.com/index.php?rid=5394570&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F491%3Frss%3D1 Reducing disparities in care requires that health care providers identify populations at risk for suboptimal quality of care. Stratified analyses are often used to examine disparities (eg, by race or sex). However, stratified analyses can be misleading if the variables are confounded. The authors examined disparities in quality within a large ambulatory care practice using both unadjusted and adjusted methods for 18 measures. In unadjusted analyses, differences in quality were identified for 9 measures by race. However, in analyses adjusted simultaneously for race, sex, age, socioeconomic status, and chronic medical conditions, racial differences were apparent for only 4 measures. Women received lower quality care for 4 measures in both unadjusted and adjusted analyses. The pattern of obse... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394570 Fri, 04 Nov 2011 04:00:00 +0100 5394570 http://www.medworm.com/index.php?rid=5394569&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F485%3Frss%3D1 As one of several initiatives to transform health care delivery across the United States, the National Priorities Partnership has identified "eliminating overuse while ensuring the delivery of appropriate care" as a top priority. Cardiac revascularization procedures, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), constitute one area of focus for reduction of overuse. Despite the multiyear development of clinical guidelines to define appropriate use of cardiac revascularization, substantial variability in the application of these procedures is observed. Concurrent data collection tools to support real-time clinical decision making regarding appropriateness are needed and can be used, along with financial incentives such as pay-for-performance ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394569 Fri, 04 Nov 2011 04:00:00 +0100 5394569 http://www.medworm.com/index.php?rid=5394568&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F480%3Frss%3D1 There are differences between nurse and physician perceptions of teamwork. The purpose of this study was to determine whether these differences would be reduced with medical team training (MTT). The Safety Attitudes Questionnaire was administered to nurses and physicians working in the operating rooms of 101 consecutive hospitals before and at the completion of an MTT program. Responses to the 6 teamwork climate items on the Safety Attitudes Questionnaire were analyzed using nonparametric testing. At baseline, physicians had more favorable perceptions on teamwork climate items than nurses. Physicians demonstrated improvement on all 6 teamwork climate items. Nurses demonstrated improvement in perceptions on all teamwork climate items except "Nurse input is well received." Physicians still h... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394568 Fri, 04 Nov 2011 04:00:00 +0100 5394568 http://www.medworm.com/index.php?rid=5394567&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F474%3Frss%3D1 The National Surgical Quality Improvement Program (NSQIP) is used by the American College of Surgeons to measure and report surgical quality and outcomes. Premier’s Quality Manager (QM) generates expected outcomes from patient charts. The authors compared observed NSQIP morbidity and mortality outcomes with those predicted by QM. NSQIP data for 1919 patients were entered into QM. The discriminatory accuracy of the QM model was assessed using the C statistic (1.0 implies perfect discrimination, and 0.5 implies no discrimination). NSQIP and QM both identified 51 deaths (C statistic, 0.91). NSQIP identified 478 postoperative occurrences, whereas QM predicted 714 patients with at least 1 complication; 223 of these were subclassified as patients with at least 1 morbid complication (C stat... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394567 Fri, 04 Nov 2011 04:00:00 +0100 5394567 http://www.medworm.com/index.php?rid=5394566&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F468%3Frss%3D1 Hospitals have experienced increasing requirements for public reporting of various infection rates using clinical and administrative data. Until recently, such reports have not included analysis of "present on admission" (POA), an indicator designed to assess whether such infections are hospital acquired. The authors evaluated the frequency of the POA coding designation for 167 University HealthSystem Consortium hospitals for sepsis/septicemia (S-S), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile infection (CDI). The authors found that 70% of hospitalizations of patients with S-S, 86% of patients with MRSA, and 67% of patients with CDI had these conditions coded POA. The authors recommend that public reporting of hospital infection rates include POA status an... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394566 Fri, 04 Nov 2011 04:00:00 +0100 5394566 http://www.medworm.com/index.php?rid=5394565&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F461%3Frss%3D1 This study is a retrospective chart review to determine the association of Charlson Comorbidity Index (CCI), age, body mass index (BMI), and admission glucose with the incidence of postoperative 30-day mortality in older patients undergoing hip fracture surgery from January 1, 2000, to June 30, 2002. A total of 40 (8%) of 485 eligible patients died within 30 days after hip fracture surgery. The factors associated with 30-day mortality were age > 90 years (odds ratio [OR] = 2.74; confidence interval [CI] = 1.27-5.95; P = .012), BMI < 18.5 (OR = 3.98; CI 1.48-10.65; P = .006), and CCI ≥ 6 (OR = 2.6; CI = 1.20-5.65; P = .015). There was no relationship between admission glucose concentration and 30-day mortality. Advanced age, low BMI, and high CCI can be identified prospectively and... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394565 Fri, 04 Nov 2011 04:00:00 +0100 5394565 http://www.medworm.com/index.php?rid=5394564&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F452%3Frss%3D1 The purpose of this study was to collect information on the utilization of physician assistants (PAs) and nurse practitioners (NPs) in academic health centers. Data were gathered from a national sample of University HealthSystem Consortium member academic medical centers (AMCs). PAs and NPs have been integrated into most services of respondent AMCs, where they are positively rated for the value they bring to these organizations. The primary reason cited by most AMCs for employing PAs and NPs was Accreditation Council for Graduate Medical Education resident duty hour restrictions (26.9%). Secondary reasons for employing PAs and NPs include increasing patient throughput (88%), increasing patient access (77%), improving patient safety/quality (77%), reducing length of stay (73%), and improvin... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394564 Fri, 04 Nov 2011 04:00:00 +0100 5394564 http://www.medworm.com/index.php?rid=5394563&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F441%3Frss%3D1 This study provides and evaluates a use case for a generally applicable approach to validating quality metrics measured electronically from EHR-based data. The authors iteratively refined and validated 4 outpatient quality metrics and classified errors in measurement. Multiple iterations of validation and measurement resulted in high levels of sensitivity and agreement versus the "gold standard" of manual review. In contrast, substantial differences remained for measurement based on coded billing data. Measuring quality metrics using an EHR-based electronic process requires validation to ensure accuracy; approaches to validation such as those described in this study should be used by organizations measuring quality from EHR-based information. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394563 Fri, 04 Nov 2011 04:00:00 +0100 5394563 http://www.medworm.com/index.php?rid=5394562&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F433%3Frss%3D1 This study investigates how the information search process may contribute to explaining this result. The analysis reveals that the Web sites most likely to be found by consumers are owned by private companies and provide information based on anecdotal patient experiences. Web sites less likely to be found have government or community-based ownership, are based on administrative data, and contain a mixture of quality, cost, and patient experience information. Searches for information on hospitals reveal more cost and quality information based on administrative data, whereas searches that focus on clinics or physicians are more likely to produce information based on patient narratives. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394562 Fri, 04 Nov 2011 04:00:00 +0100 5394562 http://www.medworm.com/index.php?rid=5394561&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F6%2F423%3Frss%3D1 Despite the availability of safe and effective prophylaxis, appropriate use of venous thromboembolism (VTE) prophylaxis in surgical patients remains suboptimal. Multifaceted quality improvement (QI) activities are needed for sustained improvement at the individual institution level. This work describes a QI initiative for VTE prophylaxis in surgery that combined clinical education with Crew Resource Management (CRM)—a set of principles and techniques for communication, teamwork, and error avoidance used in the aviation industry. Surveys of clinicians participating in the initiative demonstrated immediate and retained confidence and increased knowledge in identifying process-related factors leading to errors, applying CRM to patient care, and identifying VTE prophylaxis candidates and... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394561 Fri, 04 Nov 2011 04:00:00 +0100 5394561 http://www.medworm.com/index.php?rid=5394560&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F6%2F422%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5394560 Fri, 04 Nov 2011 04:00:00 +0100 5394560 http://www.medworm.com/index.php?rid=5153504&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F5%2F413%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153504 Thu, 18 Aug 2011 23:00:00 +0100 5153504 http://www.medworm.com/index.php?rid=5153503&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F5%2F411%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153503 Thu, 18 Aug 2011 23:00:00 +0100 5153503 http://www.medworm.com/index.php?rid=5153502&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F5%2F408%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153502 Thu, 18 Aug 2011 23:00:00 +0100 5153502 http://www.medworm.com/index.php?rid=5153501&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F5%2F405%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153501 Thu, 18 Aug 2011 23:00:00 +0100 5153501 http://www.medworm.com/index.php?rid=5153500&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F396%3Frss%3D1 The aims of this preintervention and postintervention study were to monitor and evaluate the clinical pathway (CP) for colorectal cancer (CRC) over a 5-year period and to compare 2 groups of patients (before and after the intervention) with regard to different variables of effectiveness. Group I comprised 68 patients who underwent planned surgery between January 2002 and January 2003. Group II comprised a sample of 202 patients who underwent surgery between January 2004 and December 2008. No significant differences were found in the majority of the parameters measured: postoperative stay, compliance with antibiotic prophylaxis, compliance with the staging study, mortality, rate of infection, and reoperations. The mean length of stay (±standard deviation) for patients without complic... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153500 Thu, 18 Aug 2011 23:00:00 +0100 5153500 http://www.medworm.com/index.php?rid=5153499&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F387%3Frss%3D1 Central line–associated bloodstream infections (CLABSIs) are common, costly, and largely preventable. Consumers who want high-quality care should have access to CLABSI rates to make health care decisions. The authors searched state health department Web sites for publicly available CLABSI data. Fourteen states, all with mandatory CLABSI monitoring laws, had publicly available data. The authors identified significant variation in the presentation of infection rates, methods of risk adjustment, locations and care settings reported, time span of data collection, and time lag to reporting. The wide variation in availability and content of information illustrates the need for standardized CLABSI monitoring and reporting mechanisms. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153499 Thu, 18 Aug 2011 23:00:00 +0100 5153499 http://www.medworm.com/index.php?rid=5153498&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F380%3Frss%3D1 Handoff communication is a point of vulnerability when valuable patient information can be inaccurate or omitted. An institutional protocol was implemented in 2005 to improve the handoff from the operating room to the intensive care unit after pediatric cardiac surgery. A cross-sectional study of the present process was performed to understand how users adapt a communication intervention over time. Twenty-nine handoff events were observed. Individuals required for the handoff were present at 97% of the events. Content items averaged a 53% reporting rate. Some clinical information not specified in the protocol demonstrated a higher reporting rate, such as echocardiogram results (68%) and vascular access (79%). A mean of 2.3 environmental distractions per minute of communication were noted. ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153498 Thu, 18 Aug 2011 23:00:00 +0100 5153498 http://www.medworm.com/index.php?rid=5153497&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F372%3Frss%3D1 Disruptive behaviors have been shown to have a negative impact on work relationships, team collaboration, communication efficiency, and process flow, all of which can adversely affect patient safety and quality of care. Despite the growing recognition of the damage that can be done, there are still pockets of resistance to taking action to address the issue head-on. Given the new call to action from the Joint Commission accreditation standard and the growing public accountability for patient safety, organizations need to recognize the full impact of disruptive behaviors and implement appropriate policies, procedures, and educational programs to raise levels of awareness regarding the seriousness of the issue, hold individuals accountable for their behavior, and provide training and support... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153497 Thu, 18 Aug 2011 23:00:00 +0100 5153497 http://www.medworm.com/index.php?rid=5153496&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F364%3Frss%3D1 Despite guidelines recommending that women aged 40 years and older undergo screening mammography at least biennially, reports find that many women do not adhere to these recommendations. The authors’ objective was to investigate the factors associated with undergoing a screening mammography. Eligible women were enrolled in Medicare during 2004 and 2005 and resided in North or South Carolina. Information on morbidities, demographics, and physician visits were assessed as predictors for whether a woman underwent a screening mammography. Approximately 50% of the women included in the study had undergone a screening mammography during the study period. An increasing number of physician visits was positively associated with having a screening mammography. Women making at least 1 visit to ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153496 Thu, 18 Aug 2011 23:00:00 +0100 5153496 http://www.medworm.com/index.php?rid=5153495&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F357%3Frss%3D1 The objectives of this study were the following: (1) describe one organization’s experience with recruiting minority-serving private practice primary care physicians to an ambulatory quality improvement (QI) project; (2) compare and contrast physicians who agreed to participate with those who declined; and (3) list incentives and barriers to participation. The authors identified eligible physicians by analyzing Medicare Part B claims data, a publicly available physician database, and office staff responses to telephone inquiries. The recruitment team had difficulty identifying, contacting, and recruiting eligible physicians. Solo practitioners and physicians who had lower scores on certain quality measures were more likely to participate. Barriers to participation were similar in all... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153495 Thu, 18 Aug 2011 23:00:00 +0100 5153495 http://www.medworm.com/index.php?rid=5153494&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F349%3Frss%3D1 Blood management strategies are crucial in light of transfusion-related health risks to patients and the relative scarcity and cost of blood products. The authors describe a collaborative quality initiative to reduce blood use in their coronary artery bypass graft (CABG) population and other cardiovascular intensive care unit (CVICU) patients. A multidisciplinary team was engaged at all levels of patient care. The 2-part initiative involved a direct educational component emphasizing transfusion risk awareness and patient-centered blood management strategies accompanied by a data-based component that included monthly dissemination of blood product use to the relevant service lines. The authors observed a reduction in postoperative blood product use among CABG patients (14.3% decrease in the... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153494 Thu, 18 Aug 2011 23:00:00 +0100 5153494 http://www.medworm.com/index.php?rid=5153493&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F340%3Frss%3D1 The objective was to investigate the impact of a pay-for-performance program (P4P) on quality care and outcomes among cardiovascular disease (CVD) patients. Claims data were used to identify CVD patients in a commercial plan in 1999-2006. Multivariate analyses were employed to examine the impact of P4P on quality care (lipid monitoring and treatment) and quality care on outcomes (new coronary events, hospitalizations, and lipid control). Patients who were treated by physicians participating in P4P were more likely to receive quality care than patients who were not. Patients who received quality care were less likely to have new coronary events (odds ratio [OR] = 0.80; 95% confidence interval [CI] = 0.69-0.92), be hospitalized (OR = 0.76; 95% CI = 0.69-0.83), or have uncontrolled lipids (OR... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153493 Thu, 18 Aug 2011 23:00:00 +0100 5153493 http://www.medworm.com/index.php?rid=5153492&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F5%2F333%3Frss%3D1 This study calculates the costs and benefits of a patient safety program in intensive care units in 6 hospitals that were part of the Michigan Keystone ICU Patient Safety Program. On average, 29.9 catheter-related bloodstream infections and 18.0 cases of ventilator-associated pneumonia were averted per hospital on an annual basis. The average cost of the intervention is $3375 per infection averted, measured in 2007 dollars. The cost of the intervention is substantially less than estimates of the additional health care costs associated with these infections, which range from $12 208 to $56 167 per infection episode. These results do not take into account the additional effect of the Michigan Keystone program in terms of reducing cases of sepsis or its effects in terms of preventing mortalit... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5153492 Thu, 18 Aug 2011 23:00:00 +0100 5153492 http://www.medworm.com/index.php?rid=5034623&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F4%2F324%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034623 Wed, 13 Jul 2011 23:00:00 +0100 5034623 http://www.medworm.com/index.php?rid=5034622&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F4%2F323%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034622 Wed, 13 Jul 2011 23:00:00 +0100 5034622 http://www.medworm.com/index.php?rid=5034621&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F315%3Frss%3D1 Instruction on quality improvement (QI) methods is required as part of residency education; however, there is limited evidence regarding whether internal medicine residents can improve patient care using these methods. Because obesity screening is not done routinely in clinical practice, residents aimed to improve screening using QI techniques. Residents streamlined body mass index (BMI) documentation, created educational materials about obesity, and launched an obesity screening QI initiative in a residency clinic. Residents designed plan-do-study-act cycles focused on increasing awareness and maintaining improvements in screening over a 1-year period. Documentation rates were collected at baseline, 2 weeks, 6 months, and 1 year post-intervention. At 1 year, obesity treatment rates also w... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034621 Wed, 13 Jul 2011 23:00:00 +0100 5034621 http://www.medworm.com/index.php?rid=5034620&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F308%3Frss%3D1 Follow-up of abnormal ambulatory laboratory results is often suboptimal. The impact of an ambulatory electronic health record (EHR) on follow-up of markedly elevated blood potassium (K +) results was investigated via a retrospective medical record review—before and after EHR implementation—of patients at an adult primary care practice who had a nonhemolyzed K+ ≥ 6.0 mEq/L. In all, 188 patients in the pre-EHR group and 30 in the EHR group satisfied inclusion criteria. The mean K+ for the 2 groups was 6.3 mEq/L. The EHR group had 4.5 times the odds (95% confidence interval = 1.3-15.8) of having their episodes of hyperkalemia followed up within 4 days. Patients in the EHR group were also more likely to have their blood K+ rechecked within 4 days (63.3% vs 43.6%; P = .044). An a... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034620 Wed, 13 Jul 2011 23:00:00 +0100 5034620 http://www.medworm.com/index.php?rid=5034619&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F300%3Frss%3D1 This study indicates that educational interventions are warranted to improve physicians’ awareness of the importance of documenting correct tube placement. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034619 Wed, 13 Jul 2011 23:00:00 +0100 5034619 http://www.medworm.com/index.php?rid=5034618&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F291%3Frss%3D1 This article reports on the extent and type of nursing care missed and the reasons for missed care. The MISSCARE Survey was administered to nursing staff (n = 4086) who provide direct patient care in 10 acute care hospitals. Missed nursing care patterns as well as reasons for missing care (labor resources, material resources, and communication) were common across all hospitals. Job title (ie, registered nurse vs nursing assistant), shift worked, absenteeism, perceived staffing adequacy, and patient work loads were significantly associated with missed care. The data from this study can inform quality improvement efforts to reduce missed nursing care and promote favorable patient outcomes. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034618 Wed, 13 Jul 2011 23:00:00 +0100 5034618 http://www.medworm.com/index.php?rid=5034617&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F284%3Frss%3D1 This article presents a qualitative analysis of systemic barriers to primary care diabetes management in the small office setting in Delaware. Grounded theory was used to identify key themes of focus group discussions with 25 Delaware physicians. A total of 6 systemic barriers were identified: (1) a persistent orientation toward acute care; (2) an inability to provide proactive, population-based patient management; (3) an inability to provide adequate self-management education; (4) poor integration of payer-driven disease management activities; (5) lack of universally available clinical information; and (6) lack of public health support. The results suggest that significant systemic barriers limit the ability of primary care providers, particularly those in small practices, to effectively ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034617 Wed, 13 Jul 2011 23:00:00 +0100 5034617 http://www.medworm.com/index.php?rid=5034616&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F278%3Frss%3D1 This article reviews these emerging trends and posits that these developments are a necessary prerequisite not only for accountability and better governance but also for quality care. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034616 Wed, 13 Jul 2011 23:00:00 +0100 5034616 http://www.medworm.com/index.php?rid=5034615&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F272%3Frss%3D1 This study compares EMR versus paper medical record documentation of basic health history and preventive service indicators in 47 community-based practices. Differences in practice-level documentation rates between practices that did and did not use an EMR were examined using the Kruskal—Wallis nonparametric test and robust regression, adjusting for practice-level covariates. Frequency of documentation of health history and preventive service indicator items were similar in the 2 groups of practices. Although EMRs provide the capacity for more robust record keeping, the community-based practices here do not use EMRs to their full capacity. EMR usage does not guarantee more systematic record keeping and thus may not lead to improved quality in the community practice setting. (Source: ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034615 Wed, 13 Jul 2011 23:00:00 +0100 5034615 http://www.medworm.com/index.php?rid=5034614&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F261%3Frss%3D1 The number of Americans who report delaying or forgoing necessary medical care because of cost concerns has increased markedly in recent years. Delaying or forgoing treatment may result in negative health effects, but empirical evidence is scarce. Using the merged data set of the Medical Expenditure Panel Survey and the National Health Interview Survey 2002-2006, the effect of delaying or forgoing medical care on ex post health status was estimated. Results indicate that people who delayed or forwent medical treatment were significantly less likely to report having excellent or very good ex post health status and had significantly lower quality-of-life scores compared with people who never delayed or forwent necessary medical care, controlling for socioeconomic and demographic factors, chr... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034614 Wed, 13 Jul 2011 23:00:00 +0100 5034614 http://www.medworm.com/index.php?rid=5034613&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F4%2F254%3Frss%3D1 This article identifies some important policy implications regarding boards’ oversight of quality and acknowledges existing limits to how we can measure quality and safety progress on the national or hospital level. If boards and their hospitals are to monitor progress in improving quality, they need more valid outcome measures. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=5034613 Wed, 13 Jul 2011 23:00:00 +0100 5034613 http://www.medworm.com/index.php?rid=4801151&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F3%2F247%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801151 Sun, 08 May 2011 23:00:00 +0100 4801151 http://www.medworm.com/index.php?rid=4801150&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F3%2F246%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801150 Sun, 08 May 2011 23:00:00 +0100 4801150 http://www.medworm.com/index.php?rid=4801149&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F3%2F243%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801149 Sun, 08 May 2011 23:00:00 +0100 4801149 http://www.medworm.com/index.php?rid=4801148&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F3%2F241%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801148 Sun, 08 May 2011 23:00:00 +0100 4801148 http://www.medworm.com/index.php?rid=4801147&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F3%2F239%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801147 Sun, 08 May 2011 23:00:00 +0100 4801147 http://www.medworm.com/index.php?rid=4801146&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F3%2F229%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801146 Sun, 08 May 2011 23:00:00 +0100 4801146 http://www.medworm.com/index.php?rid=4801145&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F220%3Frss%3D1 This study examined whether health confidence is associated with consumers’ ratings and reports of care and whether adjusting for health confidence and other factors attenuates ethnic or racial disparities. Data are from the 2005 Medical Expenditure Panel Survey. Persons with greater health confidence had lower adjusted odds of high overall care ratings (OCRs) and high reports of getting needed care and provider communication. Adjusting for health confidence and other factors, there were no Hispanic/non-Hispanic differences. Compared with whites, African Americans had lower OCRs and reports of getting needed care; Asians had lower OCRs and reports of getting needed care, getting care quickly, and provider communication. Health care organizations and providers should consider targetin... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801145 Sun, 08 May 2011 23:00:00 +0100 4801145 http://www.medworm.com/index.php?rid=4801144&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F212%3Frss%3D1 The purpose of this pilot study was to (1) understand the attitudes, knowledge, and beliefs of internists who manage patients with chronic obstructive pulmonary disease (COPD) and (2) evaluate the impact of a multifaceted approach to quality improvement (QI) work involving the management of COPD patients. This pilot study used a pre-post intervention design. The intervention included an online educational toolkit, QI coaching calls led by faculty, and the use of individual physician feedback reports to act as motivators for change. Data were collected using a practice pattern survey and a chart abstraction tool to identify discrepancies between perceived and actual care. Results from the pilot study showed a statistically significant improvement in quality indicators postintervention, sugg... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801144 Sun, 08 May 2011 23:00:00 +0100 4801144 http://www.medworm.com/index.php?rid=4801143&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F206%3Frss%3D1 The EMPOWER project was a collaborative effort to promote a culture of patient safety at Danbury Hospital through an interdisciplinary leadership-driven communication program. The "EMPOWER" component includes Educating and Mentoring Paraprofessionals On Ways to Enhance Reporting of changes in patient status. Specifically, the EMPOWER program was designed to prepare paraprofessional staff (PPS) to communicate changes in patient status using SBAR (situation, background, assessment, recommendations) structured communication. The specific project goals included (a) translation of SBAR structured communication methods for use with PPS, (b) reduction of cultural and educational barriers to interdisciplinary communication, and (c) examination of the effect of the EMPOWER intervention on the PPS c... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801143 Sun, 08 May 2011 23:00:00 +0100 4801143 http://www.medworm.com/index.php?rid=4801142&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F200%3Frss%3D1 This study evaluates the long-term impact of a chronic kidney disease (CKD) quality improvement (QI) project. A retrospective chart review was performed at a family practice that completed a QI project 2 years previously. In a study population of 195 patients, CKD recognition decreased during the maintenance period from 70% to 60.8% (P = 1.98), from a baseline of 38.1%, and anemia recognition declined from 70% to 50% (P =.132), from a baseline of 35%. Evaluation for parathyroid hormone, vitamin D, and phosphate decreased from 44% to 33% (P =.216), from a baseline of 4.8%. Referrals to nephrologists decreased from 77% to 61% (P = .369), from a baseline of 14%. The decrement in KDOQI guideline compliance during the maintenance period was not statistically significant, nor was there a return ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801142 Sun, 08 May 2011 23:00:00 +0100 4801142 http://www.medworm.com/index.php?rid=4801141&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F193%3Frss%3D1 Microvascular complications of diabetes can result in peripheral neuropathy and impaired sensation in the feet. These issues can significantly affect morbidity and quality of life. Regular foot exams play a major role in early detection of foot problems and may help prevent amputations. An initial review found that a comprehensive diabetic foot exam (CDFE) was documented 13.5% of the time. A quality improvement effort combined provider and staff education, a standardized documentation form, an electronic reminder, and a well-defined process to improve the frequency and completeness of diabetic foot exams. After the intervention, 44.5% of CDFEs found in dictated notes lacked at least 1 component of the exam, whereas less than 4% of charts using a standardized form lacked documentation of an... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801141 Sun, 08 May 2011 23:00:00 +0100 4801141 http://www.medworm.com/index.php?rid=4801140&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F185%3Frss%3D1 This article reports the effect of a unique prophylactic antibiotic use program on compliance rates and costs. The Departments of Surgery, Infection Control, and Anesthesiology collaborated on a prophylactic preoperative antibiotic protocol, whereby Anesthesiology assumed responsibility for timely antibiotic prophylaxis (TAP) before surgical incision. Data from January 1, 2008, to December 31, 2008, were compared (z test) with the 12-month period before this change. 2 Analysis identified factors associated with TAP. Return on investment (ROI) was calculated. TAP compliance rates increased from 75.1% to 89.3% (P < .001) following program implementation. Factors associated with TAP failure included >60 minutes from anesthesia induction to surgical incision (P < .001), surgical proce... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801140 Sun, 08 May 2011 23:00:00 +0100 4801140 http://www.medworm.com/index.php?rid=4801139&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F181%3Frss%3D1 Perceptions of organizational commitment to safety differ between the operating rooms in high- and medium-complexity facilities of the Veterans Health Administration (VHA). The purpose of this study was to see whether medical team training (MTT) reduced this difference. The Safety Attitudes Questionnaire was administered before and at the completion of a MTT program. The study population consisted of respondents working in the operating room. Responses to the 7 safety climate items were analyzed using nonparametric tests. Before MTT, respondents working at medium-complexity facilities had more favorable perceptions of knowledge of proper channels and encouragement by colleagues to report safety concerns than respondents who work at high-complexity facilities. At completion, there was no di... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801139 Sun, 08 May 2011 23:00:00 +0100 4801139 http://www.medworm.com/index.php?rid=4801138&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F3%2F174%3Frss%3D1 This study’s purpose was to describe compliance with established venous thromboembolism (VTE) prophylaxis guidelines in medical and surgical inpatients at US academic medical centers (AMCs). Data were collected for a 2007 University HealthSystem Consortium Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE) Benchmarking Project that explored VTE in AMCs. Prophylaxis was considered appropriate based on 2004 American College of Chest Physicians guidelines. A total of 33 AMCs from 30 states participated. In all, 48% of patients received guideline-directed prophylaxis—59% were medical and 41% were surgical patients. VTE history was more common among medical patients with guideline-directed prophylaxis. Surgical patients admitted from the emergency department and with higher illness se... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4801138 Sun, 08 May 2011 23:00:00 +0100 4801138 http://www.medworm.com/index.php?rid=4657328&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F2_suppl%2F4S%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4657328 Fri, 18 Mar 2011 00:00:00 +0100 4657328 http://www.medworm.com/index.php?rid=4589228&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F2%2F165%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589228 Mon, 14 Mar 2011 00:00:00 +0100 4589228 http://www.medworm.com/index.php?rid=4589227&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F2%2F163%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589227 Mon, 14 Mar 2011 00:00:00 +0100 4589227 http://www.medworm.com/index.php?rid=4589226&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F2%2F160%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589226 Mon, 14 Mar 2011 00:00:00 +0100 4589226 http://www.medworm.com/index.php?rid=4589225&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F2%2F157%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589225 Mon, 14 Mar 2011 00:00:00 +0100 4589225 http://www.medworm.com/index.php?rid=4589224&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F2%2F154%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589224 Mon, 14 Mar 2011 00:00:00 +0100 4589224 http://www.medworm.com/index.php?rid=4589223&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F145%3Frss%3D1 The authors tested the effectiveness and estimated the cost of several interventions aimed at reducing drug interactions in primary care by designing a 15-month cluster-controlled trial. The trial involved 265 family physicians and their patients who were randomized into 4 groups: control, report (received feedback reports), session (group sessions), and face-to-face (personal interviews). The outcome was the mean of relevant interactions detected on electronic medical records. Cost-effectiveness was defined as the incremental cost to reduce drug interactions by 1%. The authors detected a baseline mean of 6.7 interactions per 100 patients, which was reduced to 5.3 interactions after follow-up. No improvement was seen in the report group when compared with the control group, whereas progres... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589223 Mon, 14 Mar 2011 00:00:00 +0100 4589223 http://www.medworm.com/index.php?rid=4589222&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F138%3Frss%3D1 Door-to-physician time in the emergency department (ED) correlates with patient satisfaction and clinical quality and outcomes. Delays in seeing a provider result in a 3% nationwide rate of patients leaving without being seen(LWBS) after presenting for ED care. Two community hospitals had door-to-physician times of 51 and 47 minutes. The LWBS rates were 3% and 2%. A quality improvement project was initiated with a change package, including prompts, training, and feedback. Door-to-physician times decreased to 31 and 27 minutes. The change occurred in less than a month and was sustained for 6 months after the study. In addition, the LWBS rates at each facility fell by one third. Basic process improvement strategies borrowed from service industries were used in 2 EDs to improve the door-to-ph... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589222 Mon, 14 Mar 2011 00:00:00 +0100 4589222 http://www.medworm.com/index.php?rid=4589221&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F132%3Frss%3D1 The objective of this study was to identify any residual challenges in a unit with a track record of good clinical performance. A cross-sectional survey of frontline caregiver attitudes was conducted using a validated psychometric instrument. A total of 69% (91 of 132) of eligible participants completed questionnaires. The results indicated positive safety culture, teamwork climate, and job satisfaction. Perceptions of high workload and insufficient staffing levels were the most prominent negative observations but not to the detriment of job satisfaction or perception of work conditions. Male staff had consistently better safety attitudes in multivariate analyses. The authors identified 24-hour consultant (attending) presence and better support by management as prerequisites for further im... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589221 Mon, 14 Mar 2011 00:00:00 +0100 4589221 http://www.medworm.com/index.php?rid=4589220&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F127%3Frss%3D1 Although keeping patients informed is a part of quality hospital care, inpatients often report they are not well informed. The authors placed whiteboards in each patient room on medicine wards in their hospital and asked nurses and physicians to use them to improve communication with inpatients. The authors then examined the effect of these whiteboards by comparing satisfaction with communication of patients discharged from medical wards before and after whiteboards were placed to satisfaction with communication of patients from surgical wards that did not have whiteboards. Patient satisfaction scores (0-100 scale) with communication improved significantly on medicine wards: nurse communication (+6.4, P < .001), physician communication (+4.0, P = .04), and involvement in decision making... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589220 Mon, 14 Mar 2011 00:00:00 +0100 4589220 http://www.medworm.com/index.php?rid=4589219&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F120%3Frss%3D1 This study revealed disparate approaches to reducing unwarranted clinical practice variations and also highlighted barriers to reducing variation. The case studies identified some models that could be emulated, but questions remain about whether there is a single best way forward. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589219 Mon, 14 Mar 2011 00:00:00 +0100 4589219 http://www.medworm.com/index.php?rid=4589218&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F110%3Frss%3D1 Despite its importance, the objective impact of clinical peer review on the quality and safety of care has not been studied. Data from 296 acute care hospitals show that peer review program and related organizational factors can explain up to 18% of the variation in standardized measures of quality and patient safety. The majority of programs rely on an outmoded and dysfunctional process model. Adoption of best practices informed by the continuing study of peer review program effectiveness has the potential to significantly improve patient outcomes. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589218 Mon, 14 Mar 2011 00:00:00 +0100 4589218 http://www.medworm.com/index.php?rid=4589217&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F103%3Frss%3D1 This study identified and described the barriers and facilitators to QI implementation in hospice. Using semistructured interviews with a national sample of key informants (n = 52) concerning facilitators and barriers to QI in hospice, 4 major themes emerged from the data regarding participants’ experiences and perceptions: (1) external factors constrain QI implementation; (2) internal factors limit capacity for QI; (3) research on best practices is limited; and (4) traditional QI may not be a good fit for hospice. Though challenging, participants provided recommendations that they believed would facilitate QI in hospice. Categorizing barriers and facilitators as within or outside an organization’s control may help organizations assess their capabilities and locate resources to... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589217 Mon, 14 Mar 2011 00:00:00 +0100 4589217 http://www.medworm.com/index.php?rid=4589216&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F95%3Frss%3D1 This study examined hospitalists’ impact on patient satisfaction, considering a host of characteristics. Cross-sectional data received in calendar year 2008, aggregated to the facility level, represent 1777 hospitals (41% of which employed hospitalists) and 2 648 275 patients. Press Ganey’s psychometrically sound inpatient satisfaction survey consists of 38 items (10 sections) rated on a 5-point Likert-type scale. Findings suggest that facilities with hospitalists may have an advantage regarding satisfaction with nursing and personal issues (eg, privacy, emotional needs, response to complaints), both of which may be related to broader communication issues. Moreover, teaching (overall satisfaction) and large facilities (satisfaction with admissions, nursing, and tests/treatments... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589216 Mon, 14 Mar 2011 00:00:00 +0100 4589216 http://www.medworm.com/index.php?rid=4589215&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F2%2F89%3Frss%3D1 Ten years after the 1999 Institute of Medicine report, it is clear that despite significant progress, much remains to be done to improve quality and patient safety (QPS). Recognizing the critical role of postgraduate trainees, an innovative approach was developed at New York-Presbyterian Hospital, Weill Cornell Medical Center to engage residents in QPS by creating a Housestaff Quality Council (HQC). HQC leaders and representatives from each clinical department communicate and partner regularly with hospital administration and other key departments to address interdisciplinary quality improvement (QI). In support of the mission to improve patient care and safety, QI initiatives included attaining greater than 90% compliance with medication reconciliation and reduction in the use of paper la... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589215 Mon, 14 Mar 2011 00:00:00 +0100 4589215 http://www.medworm.com/index.php?rid=4336156&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F1%2F77%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336156 Tue, 11 Jan 2011 00:00:00 +0100 4336156 http://www.medworm.com/index.php?rid=4336155&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F1%2F75%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336155 Tue, 11 Jan 2011 00:00:00 +0100 4336155 http://www.medworm.com/index.php?rid=4336154&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F1%2F73%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336154 Tue, 11 Jan 2011 00:00:00 +0100 4336154 http://www.medworm.com/index.php?rid=4336153&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F59%3Frss%3D1 The American College of Medical Quality is a national organization of health care professionals who are interested in the advancement of medical quality as a field. Composed primarily of doctorate-level individuals in medicine, dentistry, and podiatry, it also includes affiliate members in preprofessional training as well as nursing. Origins of the organization date to 1973, when it was first called the American College of Utilization Review Physicians. It is formally recognized by the American Medical Association and holds a seat in its House of Delegates. The College views the advancement of medical quality as a field of study within itself and offers multiple venues for self-education, testing, and professional networking for its members. Recently, rising national awareness of quality i... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336153 Tue, 11 Jan 2011 00:00:00 +0100 4336153 http://www.medworm.com/index.php?rid=4336152&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F53%3Frss%3D1 Rates of adherence to 2 quality measures, modeled after Heathcare Effectiveness Data and Information Set (HEDIS) measures, were evaluated in a pediatric population in a convenient care (retail medicine) clinic setting. The measures were appropriate testing for children with pharyngitis and appropriate treatment for children with upper-respiratory infection (URI). The convenient care clinic (CCC) achieved a ranking above the HEDIS 90th percentile for the pharyngitis measure and approximately midway between the 50th and 90th percentiles for the URI measure for the 2007 reporting period. This represents the third major study reporting quality of care for pharyngitis in a CCC setting and the first study for URIs. Other aspects of quality—namely access, follow-up, and equity—are als... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336152 Tue, 11 Jan 2011 00:00:00 +0100 4336152 http://www.medworm.com/index.php?rid=4336151&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F43%3Frss%3D1 The patient safety vision at Baylor Health Care System (BHCS) has 3 components: (1) achieving no preventable deaths, (2) ensuring no preventable injuries, and (3) seeking no preventable risk. These goals require strategic efforts in the categories of culture, processes, and technology. Culture focuses on tactics such as teamwork training and quality improvement education. Processes are measured using the percentage adoption of a variety of target clinical processes such as order set use and adherence to National Patient Safety Goals. Technology includes focus areas such as clinical decision support and reliability of the electronic health record. BHCS has also achieved significant systemwide standardization of safety processes and development of the systemwide Office of Patient Safety to f... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336151 Tue, 11 Jan 2011 00:00:00 +0100 4336151 http://www.medworm.com/index.php?rid=4336150&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F39%3Frss%3D1 This article describes a housestaff-championed intervention of a "hard stop" for on-admission MR orders that led to a statistically significant increase in compliance that was sustained at 6 months after intervention. Academic medical centers, which comprise large numbers of housestaff, can improve compliance with on-admission MR by engaging housestaff in the development of solutions and in communication to their peers, leading to sustained results. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336150 Tue, 11 Jan 2011 00:00:00 +0100 4336150 http://www.medworm.com/index.php?rid=4336149&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F34%3Frss%3D1 A growing public health concern over the increasing prevalence of adolescent overweight and obesity and 2007 Expert Committee recommendations on child and adolescent overweight and obesity prompted a performance improvement project at 9 school-based health centers (SBHCs) in Delaware. Body mass index (BMI) and blood pressure measurements were assessed for 1548 students during the 2008-2009 school year. Students identified as having BMI or blood pressure readings out of the normal range were offered nutritional and/or medical services at the center and referred to their primary care physicians, when necessary, for further medical follow-up. Four of the centers additionally assessed their students for needed immunizations, availability of medical insurance, access to a medical home, and psyc... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336149 Tue, 11 Jan 2011 00:00:00 +0100 4336149 http://www.medworm.com/index.php?rid=4336148&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F26%3Frss%3D1 Identifying, understanding, and addressing clinical variation is a useful tool to promote appropriate care while helping control health care costs. Although accurate, relevant, and useful data are important in the process, successfully engaging physicians to change behavior is often the most significant challenge. Using a commercially available variation analysis process, a California Medicaid managed care plan identified significant network practice pattern variation. A team of panel practitioners then developed a strategy to reduce overuse of 5 identified behaviors. The intervention was evaluated using a pre—post comparison of the panel’s use of the 5 behaviors. During the preintervention period, narcotics, muscle relaxants, magnetic resonance imaging (MRI), and spinal inject... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336148 Tue, 11 Jan 2011 00:00:00 +0100 4336148 http://www.medworm.com/index.php?rid=4336147&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F18%3Frss%3D1 In recent years, hospitals and payers have increased their efforts to improve the quality of patient care by encouraging provider adherence to evidence-based practices. Although the individual provider is certainly essential in the delivery of appropriate care, a team perspective is important when examining variation in quality. In the present study, the authors modeled the relationship between a measure of aggregate job satisfaction for members of primary care teams and objective measures of quality based on process indicators and intermediate outcomes. Multilevel analyses indicated that aggregate job satisfaction ratings were associated with higher values on both types of quality measures. Team-level job satisfaction ratings are a potentially important marker for the effectiveness of pri... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336147 Tue, 11 Jan 2011 00:00:00 +0100 4336147 http://www.medworm.com/index.php?rid=4336146&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F26%2F1%2F10%3Frss%3D1 Patient empowerment is a new concept in health care that has now been extended to the domain of patient safety. Within the framework of the development of the new World Health Organization (WHO) Guidelines on Hand Hygiene in Health Care, the authors conducted a review of the literature from 1997 to 2008 to identify the evidence supporting programs aimed at encouraging patients to take an active role in their care. Patient empowerment is an integral part of the WHO hand hygiene multimodal strategy. Hand hygiene promotion strategies that have demonstrated evidence of successfully empowering patients include one or all of the following components: educational tools, motivation and reminder tools, and role modeling. What is important is that programs and models to empower patients must be deve... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336146 Tue, 11 Jan 2011 00:00:00 +0100 4336146 http://www.medworm.com/index.php?rid=4336145&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F1%2F8%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336145 Tue, 11 Jan 2011 00:00:00 +0100 4336145 http://www.medworm.com/index.php?rid=4336144&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F1%2F6%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4336144 Tue, 11 Jan 2011 00:00:00 +0100 4336144 http://www.medworm.com/index.php?rid=4589232&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F1_suppl%2F24S%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589232 Fri, 07 Jan 2011 00:00:00 +0100 4589232 http://www.medworm.com/index.php?rid=4589231&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F1_suppl%2F22S%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589231 Fri, 07 Jan 2011 00:00:00 +0100 4589231 http://www.medworm.com/index.php?rid=4589230&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%2F1_suppl%2F5S%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4589230 Fri, 07 Jan 2011 00:00:00 +0100 4589230 http://www.medworm.com/index.php?rid=4589229&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F26%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=4589229 Fri, 07 Jan 2011 00:00:00 +0100 4589229 http://www.medworm.com/index.php?rid=4211896&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F6%2F490%3Frss%3D1 (No abstract is available for this citation) (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211896 Mon, 29 Nov 2010 00:00:00 +0100 4211896 http://www.medworm.com/index.php?rid=4211895&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F6%2F488%3Frss%3D1 (No abstract is available for this citation) (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211895 Mon, 29 Nov 2010 00:00:00 +0100 4211895 http://www.medworm.com/index.php?rid=4211894&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F6%2F486%3Frss%3D1 (No abstract is available for this citation) (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211894 Mon, 29 Nov 2010 00:00:00 +0100 4211894 http://www.medworm.com/index.php?rid=4211893&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F6%2F481%3Frss%3D1 (No abstract is available for this citation) (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211893 Mon, 29 Nov 2010 00:00:00 +0100 4211893 http://www.medworm.com/index.php?rid=4211892&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F474%3Frss%3D1 This study sought to validate the utility of a Peer Review Program Self-Evaluation Tool as a potential guide to physician and hospital leaders seeking greater program value. Data from 330 hospitals show that the total score from the self-evaluation tool is strongly associated with perceived quality impact. Organizational culture also plays a significant role. When controlling for these factors, there was no evidence of benefit from a multispecialty review process. Physicians do not generally use reliable methods to measure clinical performance. A high rate of change since 2007 has not produced much improvement. The Peer Review Program Self-Evaluation Tool reliably differentiates hospitals along a continuum of perceived program performance. The full potential of peer review as a process to ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211892 Mon, 29 Nov 2010 00:00:00 +0100 4211892 http://www.medworm.com/index.php?rid=4211891&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F468%3Frss%3D1 Clinical decision support (CDS) software requires regular maintenance and development. CDS software can be very complex and can have several different performance parameters that need to be considered in development and maintenance cycles. Stakeholders in management and software development need a shared and mutually agreed on framework to prioritize the development and maintenance of CDS software. The prioritization matrix, a quality improvement tool, was used to prioritize triage algorithms at Ask Mayo Clinic, a national triage call center. Key elements used in the priority matrix were the frequency of algorithm use, potential safety impact of the algorithm, algorithm length, overall agreement between software recommendation and triage nurse, and asymmetry of nurse overrides of the softw... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211891 Mon, 29 Nov 2010 00:00:00 +0100 4211891 http://www.medworm.com/index.php?rid=4211890&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F462%3Frss%3D1 An elective course exposing medical students to nonphysician hospital providers and staff was conceived and implemented. Goals and objectives identified were to (1) increase students’ understanding of the roles of nonphysician professionals in hospital care, (2) demonstrate how the services offered by these professionals complement those offered by physicians, (3) improve students’ skill in communicating with nonphysician professionals, (4) develop students’ comfort approaching these professionals about patient care issues, (5) show students "what it is like" to be each of these providers, and (6) demonstrate the common challenges they face. A 2-week elective rotation paired students with experienced preceptors in several nonphysician hospital care disciplines. Quantitati... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211890 Mon, 29 Nov 2010 00:00:00 +0100 4211890 http://www.medworm.com/index.php?rid=4211889&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F457%3Frss%3D1 This study explores the effect of facility complexity on operating room (OR) caregiver perceptions of safety climate in the Veterans Health Administration (VHA). Facility complexity is a standardized score based on volume, risk, teaching, research, and intensive care unit capability. The Safety Attitudes Questionnaire was administered at 34 VHA hospitals. The authors performed analysis of variance on safety climate item scores by facility complexity and Bonferroni post hoc probes. Caregivers at high-complexity facilities were significantly less likely to agree that "Medical errors are handled appropriately in this hospital" than caregivers at medium-complexity facilities. Caregivers at high-complexity facilities were significantly more likely to agree that "I know the proper channels to di... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211889 Mon, 29 Nov 2010 00:00:00 +0100 4211889 http://www.medworm.com/index.php?rid=4211888&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F449%3Frss%3D1 The objective was to determine if a standardized process of care—namely, standardized evidence-based medical orders (SEBMOs)—improves physician compliance with venous thromboembolism (VTE) prophylaxis. A total of 61 physicians received information about VTE prophylaxis after introduction of an admission SEBMO. Hospitalists received enhanced presentations about SEBMOs and their value in VTE prevention; specialists did not. Data were analyzed for 2 cohorts of 249 at-risk patients: one cohort was admitted with SEBMOs and the other with handwritten orders. VTE prophylaxis was ordered for 70% (173 of 249) of the SEBMO cohort compared with 22% (55 of 249) of patients whose physicians handwrote orders (relative risk ratio = 2.97; 95% confidence interval = 2.33-3.79; P < .0001). Spe... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211888 Mon, 29 Nov 2010 00:00:00 +0100 4211888 http://www.medworm.com/index.php?rid=4211887&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F444%3Frss%3D1 The authors acquired valid clinical data representative of patients who choose to undergo elective operations. Their results indicate that complementary data recorded by paid, trained abstractors and from the specialist surgeon and his/her office staff on hospital events add major evaluative components to those derived from administrative data sets. The cost of these extra reports is reasonable, and they provide a more complete review of the entire episode of care, extending to the return to normal activities. If "quality" is to be validly reported and used for assessment, punishment, or reward processes, then the value of these 2 sources is too great to ignore. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211887 Mon, 29 Nov 2010 00:00:00 +0100 4211887 http://www.medworm.com/index.php?rid=4211886&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F436%3Frss%3D1 Effective communication is critical to providing quality health care and can be affected by a number of modifiable organizational factors. The authors performed a prospective multisite validation study of an organizational communication climate assessment tool in 13 geographically and ethnically diverse health care organizations. Communication climate was measured across 9 discrete domains. Patient and staff surveys with matched items in each domain were developed using a national consensus process, which then underwent psychometric field testing and assessment of domain coherence. The authors found meaningful within-site and between-site performance score variability in all domains. In multivariable models, most communication domains were significant predictors of patient-reported quality... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211886 Mon, 29 Nov 2010 00:00:00 +0100 4211886 http://www.medworm.com/index.php?rid=4211885&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F429%3Frss%3D1 The objective of this study was to measure the relationship between emergency medicine (EM) specialty training and quality measures in the emergency department (ED). Data were gathered from the 2003-2004 National Hospital Ambulatory Medical Care Survey. The outcome was proportion of patients with acute myocardial infarction (AMI), pneumonia (PNA), and long-bone fracture (LBF) who received recommended therapy. These measures were analyzed with respect to EM residency completion. Compared with EDs with more than 80% EM-trained physicians, EDs with fewer than 80% EM-trained physicians had similar rates of aspirin (43% vs 42%) and β-blocker (26% vs 19%) use for AMI, appropriate antibiotics (78% vs 83%) and pulse oximetry (51% vs 55%) for PNA, and analgesia (85% vs 79%) for LBF. Additional... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211885 Mon, 29 Nov 2010 00:00:00 +0100 4211885 http://www.medworm.com/index.php?rid=4211884&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F6%2F416%3Frss%3D1 The End-Stage Renal Disease Network 5 sought to improve the influenza vaccination rate for the period September 1, 2008, to January 31, 2009, through an awareness campaign, coupled with primary data collection in the form of a tracking tool prepopulated with patient names. The latter served as a reminder to staff to determine the immunization status of patients and offer the influenza vaccination, as appropriate. Targets for the intervention were all facilities and their prevalent hemodialysis and peritoneal dialysis patients, with the exclusion of military treatment centers, Veterans Health Administration hospitals, and prisons. The majority of eligible network facilities (86.9%) participated in the project to achieve an overall adult influenza vaccination rate of 82.6% (95% confidence in... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211884 Mon, 29 Nov 2010 00:00:00 +0100 4211884 http://www.medworm.com/index.php?rid=4211883&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F6%2F414%3Frss%3D1 (No abstract is available for this citation) (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=4211883 Mon, 29 Nov 2010 00:00:00 +0100 4211883 http://www.medworm.com/index.php?rid=3956883&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F5%2F406%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956883 Fri, 10 Sep 2010 21:36:18 +0100 3956883 http://www.medworm.com/index.php?rid=3956882&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F5%2F404%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956882 Fri, 10 Sep 2010 21:36:18 +0100 3956882 http://www.medworm.com/index.php?rid=3956881&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F5%2F402%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956881 Fri, 10 Sep 2010 21:36:18 +0100 3956881 http://www.medworm.com/index.php?rid=3956880&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F5%2F398%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956880 Fri, 10 Sep 2010 21:36:18 +0100 3956880 http://www.medworm.com/index.php?rid=3956879&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F392%3Frss%3D1 Unnecessary variation and overuse in care are associated with increased length of stay. Efforts to improve efficiency without physician leadership and buy-in have been unsuccessful. Congestive heart failure (CHF) is the most frequent admitting diagnosis and is associated with increased hospital length of stay. This performance improvement initiative used Six Sigma methodology to reduce CHF length of stay at a community hospital. Daily rounding, prioritization of CHF patients for left-ventricular (LV) assessments, and standardization of orders accounted for improvements in delivery of care. Turnaround time for LV assessments was reduced from a mean of 2.2 days to a mean of 0.78 days. Use of standardized CHF order sets by physicians rose from 25% to 72.6%, and length of stay was reduced from... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956879 Fri, 10 Sep 2010 21:36:18 +0100 3956879 http://www.medworm.com/index.php?rid=3956878&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F384%3Frss%3D1 This pilot study investigated the perception of the quality of health care received by 55 HIV-positive African Americans. A survey instrument, "The Quality of Care Through the Patient’s Eyes"—HIV questionnaire (QUOTE-HIV), developed in the Netherlands, was used to collect quantitative data from the modified QUOTE-HIV. Qualitative data are from 2 focus groups’ perception discussions of the applicability of the QUOTE-HIV to HIV-positive African Americans. The study’s purpose was to assess the usefulness of the questionnaire to identify patients’ perceptions of quality health care. Results indicated that the QUOTE-HIV is a useful tool to assess HIV-positive African Americans’ satisfaction and adequately covered all areas of concern discussed by both focus g... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956878 Fri, 10 Sep 2010 21:36:18 +0100 3956878 http://www.medworm.com/index.php?rid=3956877&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F378%3Frss%3D1 Use of laparoscopy is an area of interest owing to a previous report of significant numbers of repeat laparoscopic surgery in some women in Alberta, Canada. It was hypothesized that analyzing individual-woman rates of annual repeat procedures documents potential overuse of laparoscopic surgery. Administrative data concerning yearly individual specific laparoscopy experiences were obtained from Alberta Health and Wellness for the years 1996 to 2007. Rates of repeat diagnostic and operative laparoscopic procedures were determined for each fiscal year and analyzed using statistical process control methods. The rate of reoperation for an individual woman for both procedures has "special causes" of variation. Rates of reoperation within the fiscal year varied significantly. The reasons could in... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956877 Fri, 10 Sep 2010 21:36:18 +0100 3956877 http://www.medworm.com/index.php?rid=3956876&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F370%3Frss%3D1 It has been well established that there are racial and ethnic disparities in cardiovascular care. Quality improvement initiatives have been recommended to proactively address these disparities. An initiative was implemented to improve timeliness of and access to primary percutaneous coronary intervention (PCI) procedures among myocardial infarction patients at an academic medical center serving a predominantly minority population. The effort was part of a national quality improvement collaborative focused on improving cardiovascular care for Hispanic/Latino and African American/ black populations. The proportion of primary PCI procedures performed within 90 minutes improved significantly from 17% in the first quarter of 2006 to 93% in the fourth quarter of 2008 (P < .001). There were no... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956876 Fri, 10 Sep 2010 21:36:18 +0100 3956876 http://www.medworm.com/index.php?rid=3956875&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F365%3Frss%3D1 Evidence-based guidelines recommend that heparin-induced thrombocytopenia (HIT) should be suspected whenever a patient develops thrombosis or thrombocytopenia 5 to 14 days after heparin initiation. The authors determined how frequently emergency department (ED) physicians document HIT risk assessment in patients presenting with thrombosis. Relevant data were extracted from the ED charts of 134 patients with venous or arterial thrombosis. Documentation (ie, notation of positive or negative findings) existed for recent heparin exposure in 7 (5.2%) of 134 charts, recent hospitalization in 33 (24.6%), history of thrombocytopenia in 0 (0%), and history of thrombosis in 62 (45.5%). Of 35 patients administered heparin in the ED, the preheparin platelet count was available for 19 (54.3%) and old r... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956875 Fri, 10 Sep 2010 21:36:18 +0100 3956875 http://www.medworm.com/index.php?rid=3956874&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F359%3Frss%3D1 Comprehensive measures to benchmark or track safety performance do not yet exist. The authors aimed to develop and validate a process to identify comprehensive, clinically meaningful sets of safety measures that would draw on the clinical experiences and perceptions of active practitioners. They pilot tested this process for safety measure development for 2 hospital departments (ie, intensive care units and general surgery services) by holding 7 brainstorming sessions with physicians and nurses in major academic and community teaching hospitals in Boston, Massachusetts, and Baltimore, Maryland. Participants identified lists of patient harms that they considered to be among the 20 most frequent and the 20 most severe in their respective units. The authors generated a master list of patient ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956874 Fri, 10 Sep 2010 21:36:18 +0100 3956874 http://www.medworm.com/index.php?rid=3956873&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F351%3Frss%3D1 Underuse of clinical preventive services (CPS) such as low-dose aspirin therapy leads to tens of thousands of preventable deaths per year. The authors examined the current literature related to delivery of CPS and then provided the results to a preventive medicine expert panel who identified best practices to improve aspirin counseling and use. An exploratory literature search was conducted in PubMed using keywords associated with preventive health interventions. The review included articles published between January 2000 and March 2009. More than 200 articles were identified for review, and 35 met inclusion criteria. Interventions that increased patient—provider contact and physician interactive educational programs were most likely to improve delivery of CPS. The expert panel recom... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956873 Fri, 10 Sep 2010 21:36:18 +0100 3956873 http://www.medworm.com/index.php?rid=3956872&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F346%3Frss%3D1 This study included all patients requiring invasive airway management during a 21-month period (July 1, 2005, through March 31, 2007). An audit form was developed and implemented to collect data on intubations. During the study period, 224 patients required invasive airway control. Of all airways managed by emergency medicine residents, the intubation success rate was 99% (200/203; 95% confidence interval [CI] = 96%-100%), with 3% of those (6/203; 95% CI = 1%-6%) requiring more than 3 attempts; 3 patients (1%; 95% CI = 0%-4%) could not be intubated and required a surgical airway. Use of an airway registry based on the NEAR registry as a benchmark of rates and types of successful intubation allows comparison of airway practices. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956872 Fri, 10 Sep 2010 21:36:18 +0100 3956872 http://www.medworm.com/index.php?rid=3956871&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F343%3Frss%3D1 Subspecialization of critical care units and overall increasing demand for critical care services has led to inefficiencies in allocation of critical care resources with potential impacts on hospital economics and patient outcomes. Centralized management of critical care resource allocation within an institution may improve use while simultaneously ensuring quality of patient care. The authors’ institution has implemented a Central Intensivist Physician (CIP) program to oversee resource allocation within the adult surgical intensive care units (ICUs). The result has been an improvement in patient flow throughout the surgical ICUs manifested by steady case cancellation rates despite increasing acuity and length of stay. Additionally, triage duties have been shifted from the individual... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956871 Fri, 10 Sep 2010 21:36:18 +0100 3956871 http://www.medworm.com/index.php?rid=3956870&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F5%2F336%3Frss%3D1 Policy maker efforts to evaluate the quality and costs of health care have stimulated a proliferation of disparate performance measures. This cacophony of performance measures creates confusion over which measures are applicable at which level of the health care system, limiting their effective application for accountability and improvements in patient care. The American College of Physicians (ACP) has created a clinical performance measurement framework to provide direction to policy makers and measure developers for future performance measure development and application. The ACP believes that this clinical performance measurement framework is one way to help promote transformational change in patient care through judicious application of performance measures. Recommendation. The ACP reco... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956870 Fri, 10 Sep 2010 21:36:18 +0100 3956870 http://www.medworm.com/index.php?rid=3956869&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F5%2F334%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3956869 Fri, 10 Sep 2010 21:36:18 +0100 3956869 http://www.medworm.com/index.php?rid=3728969&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F4%2F326%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728969 Tue, 06 Jul 2010 21:35:30 +0100 3728969 http://www.medworm.com/index.php?rid=3728968&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F4%2F325%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728968 Tue, 06 Jul 2010 21:35:30 +0100 3728968 http://www.medworm.com/index.php?rid=3728967&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F4%2F322%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728967 Tue, 06 Jul 2010 21:35:30 +0100 3728967 http://www.medworm.com/index.php?rid=3728966&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F4%2F319%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728966 Tue, 06 Jul 2010 21:35:29 +0100 3728966 http://www.medworm.com/index.php?rid=3728965&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F312%3Frss%3D1 This study was conducted to assess what independent influence, if any, weekend admission might have on inhospital mortality. The authors analyzed the clinical data of 429 880 adults >" xbd="1605" xhg="1582" ybd="1190" yhg="1154"/>14 years of age who were admitted to internal medicine wards in Spain after having presented to the hospitals’ emergency departments. Overall mortality and early mortality (occurring in the first 48 hours) were examined, taking into account whether a patient was admitted on a weekend or a weekday, in addition to other parameters. Weekend admissions were associated with a significantly higher inhospital mortality than weekday admissions among patients admitted to an internal medicine service (odds ratio [OR] = 1.1; 95% confidence interval [CI] = 1.14-1.... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728965 Tue, 06 Jul 2010 21:35:29 +0100 3728965 http://www.medworm.com/index.php?rid=3728964&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F305%3Frss%3D1 The authors recently discovered 2 quality and patient safety curricula for internal medicine and general surgery residents in major teaching hospitals: an infrequent formal curriculum developed by the university and a positive informal curriculum found in the teaching hospital. A hidden curriculum was postulated. These data were gathered through applied qualitative research methodology. In this article, curricular characteristics of the formal, informal, and hidden curricula are described and analyzed. Themes evaluated were planning, delivery, evaluation, drivers, responsible entity, and resources. The data show different curricular characteristics in each theme, especially for the formal and informal curricula. Understanding curricular characteristics represents the next step in understan... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728964 Tue, 06 Jul 2010 21:35:29 +0100 3728964 http://www.medworm.com/index.php?rid=3728963&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F297%3Frss%3D1 Airway management is germane to safe patient care. Keys to management of difficult airways (DAs) are the "Right People, Right Parts, and Right Place" (R3P3). Successful management of DA requires clinicians who have adequate training, experience, and equipment. Policies were implemented to optimize the management of DAs. One identified inpatients with potential DAs, whereas the other addressed creation and deployment of "Alpha Teams" (ATs). In the event of impending respiratory compromise, an AT was called in the same manner as a code blue. Health care providers were educated about these process changes, and ATs were tested using computerized patient simulators and self-paced observations. Testing assessed performance before, immediately after, and 30 days after the seminar. Changes in, and... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728963 Tue, 06 Jul 2010 21:35:29 +0100 3728963 http://www.medworm.com/index.php?rid=3728962&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F289%3Frss%3D1 The objective of this retrospective cohort study was to assess frequency and outcomes associated with blood products transfusion. Data from the 2004 Nationwide Inpatient Sample database were used. Length of stay (LOS), postoperative infections, noninfectious transfusion-related complications, in-hospital mortality, and total charges were evaluated for transfused and nontransfused cohorts. Of the estimated 38.66 million discharges in the United States in 2004, 5.8% (2.33 million) were associated with blood products transfusion. Average LOS was 2.5 days longer, and charges were $17 194 higher for the transfused cohort (P < .0001). Odds of death were 1.7 times higher (P < .0001) and odds of infection 1.9 times higher (P < .0001) for the transfused cohort. Increased provider awareness... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728962 Tue, 06 Jul 2010 21:35:29 +0100 3728962 http://www.medworm.com/index.php?rid=3728961&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F285%3Frss%3D1 Increased emphasis on patient safety in hospitals worldwide has become a critical goal for health care facilities and providers over the past decade. Resident work hour restrictions, handwashing efforts, medication reconciliation, procedural pauses, and a variety of improved communication mechanisms among all providers have been instituted. In an effort to improve patient safety and quality in the operating room and to reduce any potential errors in care, the Department of Neurological Surgery at Mayo Clinic in Arizona initiated an intraoperative checklist program 8 years ago. The concept was to develop a tool to maintain and improve patient safety in the operating rooms that would be both effective and practical. The authors report on their 8-year experience with this tool and review the ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728961 Tue, 06 Jul 2010 21:35:29 +0100 3728961 http://www.medworm.com/index.php?rid=3728960&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F274%3Frss%3D1 This study’s goal was to identify the strongest predictors of satisfaction with a health plan offered to employees at a large university in the Midwestern United States. Survey responses from 1533 employees were analyzed (response rate of 51.2%). Unadjusted odds ratios (ORs) were calculated to identify factors that were statistically associated with plan satisfaction. Multivariate logistic regression analyses followed by likelihood ratio testing were conducted to assess the predictive value of particular variables. The strongest predictors of satisfaction with the health plan were the perceived quality of the plan’s wellness and prevention services (OR = 3.69), having a personal doctor or nurse (OR = 2.70), being satisfied with the cost of the health plan (OR = 2.18), and havin... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728960 Tue, 06 Jul 2010 21:35:29 +0100 3728960 http://www.medworm.com/index.php?rid=3728959&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F268%3Frss%3D1 Technological and medical advancements have dramatically accelerated the speed of change in the realm of health care. New technology, the changing needs of patients, and economic pressures all contribute to the need for health organizations to modify practices continually. Quality improvement (QI) of current processes is central to these efforts. To best manage the introduction of change through QI in a health organization, a focus on the people side of change is necessary. Change management is any action or process taken to smoothly transition an individual or group from the current state to a future desired state of being. The authors provide an overview of the steps to design and execute QI projects that require change management. Key steps for successful change management include asses... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728959 Tue, 06 Jul 2010 21:35:29 +0100 3728959 http://www.medworm.com/index.php?rid=3728958&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F261%3Frss%3D1 The objective was to study the impact of a practice-based quality improvement program on practice teams’ care for patients who have increased risk of cardiovascular disease. A total of 54 team members from 18 internal medicine practices participated in an educational program that used a pre-post intervention study design and focused on measures related to cardiovascular risk factors. The program involved live instruction, faculty-led conference calls, practice data collection, and progress reports detailing practices’ improvement strategies. Data on 817 patients were reported. Practices showed significant improvement in counseling for diet (70% to 78%), exercise (67% to 74%), and weight loss (64% to 72%). Use of aspirin (53% to 64%) and statins (83% to 89%) also showed signific... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728958 Tue, 06 Jul 2010 21:35:29 +0100 3728958 http://www.medworm.com/index.php?rid=3728957&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F255%3Frss%3D1 Central line–associated bloodstream infections (CLABSIs) acquired in health care institutions are common and costly. A novel monitoring and prevention program dramatically reduced CLABSIs across one state. The extent to which other states have adopted similar efforts is unknown. State hospital associations were surveyed regarding their efforts to address these infections. All 50 responding associations endorsed the importance of improving patient safety, health care quality, or health care–associated infections. Although 42 (84%) cited CLABSIs as a priority, only 11 (22%) provided statewide CLABSI rates. CLABSI programs were active in 6 (12%) states, and an additional 7 (14%) states were planning programs. Barriers identified included a lack of coordinated priorities, limited i... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728957 Tue, 06 Jul 2010 21:35:29 +0100 3728957 http://www.medworm.com/index.php?rid=3728956&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F4%2F249%3Frss%3D1 Performance measurement and reporting has become widespread. The authors provide a status snapshot of regional (n = 20) and nonregional (n = 24) initiatives that have issued at least 1 performance report since 2005. Most regional initiatives around the United States are in the very early stages of acquiring data and devising data collection strategies. The authors recommend that a framework and approach for generating nationally consistent and locally adaptable performance information for communities across the United States should be formulated. This would allow better coordination of promising regional initiatives to improve their impact and reduce operating costs/burden. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728956 Tue, 06 Jul 2010 21:35:29 +0100 3728956 http://www.medworm.com/index.php?rid=3728955&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F4%2F246%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3728955 Tue, 06 Jul 2010 21:35:29 +0100 3728955 http://www.medworm.com/index.php?rid=3555013&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F3%2F236%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3555013 Tue, 11 May 2010 17:23:46 +0100 3555013 http://www.medworm.com/index.php?rid=3555012&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F3%2F234%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3555012 Tue, 11 May 2010 17:23:46 +0100 3555012 http://www.medworm.com/index.php?rid=3555011&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Freprint%2F25%2F3%2F232%3Frss%3D1 (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3555011 Tue, 11 May 2010 17:23:46 +0100 3555011 http://www.medworm.com/index.php?rid=3555010&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F225%3Frss%3D1 The authors report on a preliminary analysis of an electronic database that includes more than 32 000 pediatric hospitalizations during 2000-2003. They analyzed pediatric inpatient medication use in a defined geographic area, the catchment area for the Alfred I. duPont Hospital for Children, serving Delaware, Maryland, New Jersey, and Pennsylvania. The study population included 18 108 female and 14 375 male children. The authors calculated the percentages of children receiving at least 1 administration of each drug. More than 700 drugs were received by children in the study population; 9 were received by at least 10% of all patients. The probability of receiving specific medications varied with patient age, sex, and race, but much further work is needed to quantify the variations. The data... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3555010 Tue, 11 May 2010 17:23:46 +0100 3555010 http://www.medworm.com/index.php?rid=3555009&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F218%3Frss%3D1 Hospital administrative data are being used to identify hospitals with hospital-acquired complications such as iatrogenic pneumothorax. This was a retrospective cross-sectional study of hospitalization records to estimate the positive predictive value (PPV) of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for iatrogenic pneumothorax. A probability sample of inpatient medical records from 2006 to 2007 was reviewed in a national sample of 28 volunteer hospitals. Among the 200 flagged cases, the PPV was 78% (95% confidence interval = 73%-82%). False positive cases were mostly a result of exclusionary conditions (11%) and pneumothoraxes that were present on admission (7%). About 44% of events followed attempted central venous catheter (CVC) placement. Of the 69... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3555009 Tue, 11 May 2010 17:23:46 +0100 3555009 http://www.medworm.com/index.php?rid=3555008&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F211%3Frss%3D1 Patient safety (PS) and quality improvement (QI) are among the highest priorities for all health systems. Resident physicians are often at the front lines of providing care for patients. In many instances, however, QI and PS initiatives exclude trainees. By aligning the goals of the health system with those of the residency program to engage residents in QI and PS projects, there is a unique opportunity to fulfill both a corporate and educational mission to improve patient care. Here, the authors briefly describe one residency program’s educational curriculum to provide foundational knowledge in QI and PS to all its trainees and highlight a resident team—based project that applied principles of lean thinking to evaluate the process of responding to an in-hospital cardiopulmonar... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3555008 Tue, 11 May 2010 17:23:46 +0100 3555008 http://www.medworm.com/index.php?rid=3555007&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F202%3Frss%3D1 This retrospective follow-up study aimed to evaluate the effect of following glycated hemoglobin (HbA1c) testing practice guidelines on Medicare expenditures. The authors identified 12 635 incident diabetes patients from 1998 and 1999 Medicare 5% claims data and calculated Medicare payments from 2000 to 2003. They applied a 2-stage least-squares model with instrumental variable (IV) methodology to estimate the effect of receiving ≥2 HbA1c tests annually on Medicare expenditures. Only 27.7% (3503/12 635) of the sample received ≥2 HbA1c tests annually. IV estimation results showed that receiving the tests was associated with a $953 decrease in Medicare payments per patient-year. Improved HbA1c test rates could save Medicare costs. For each year, 2000 to 2003, the authors estimate that ... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3555007 Tue, 11 May 2010 17:23:46 +0100 3555007 http://www.medworm.com/index.php?rid=3555006&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F197%3Frss%3D1 The objective of this study was to demonstrate the impact of a single ICD-9 (International Statistical Classification of Diseases and Related Health Problems, Version 9) code on the observed-to-expected mortality ratios for acute care hospitals, calculated using administrative data. The study was a retrospective analysis of mortality data and prospective measurement of the impact of a change in coding on expected mortality rates. Measurement included overall mortality observed-to-expected mortality index for 2 hospitals and rate of use of the palliative care ICD-9 code. The main result was that both retrospective and prospective applications of this single ICD-9 code significantly reduced observed-to-expected mortality ratios. Both regulators and hospitals need to be aware of the impact of... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3555006 Tue, 11 May 2010 17:23:46 +0100 3555006 http://www.medworm.com/index.php?rid=3555005&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F192%3Frss%3D1 This article provides a description of the theories supporting patient partnership and community engagement, reviews critical elements of successful community-based programs, and identifies the potential for empowering communities to improve patient safety. (Source: American Journal of Medical Quality) American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3555005 Tue, 11 May 2010 17:23:46 +0100 3555005 http://www.medworm.com/index.php?rid=3555004&cid=s_31273_51_f&fid=31273&url=http%3A%2F%2Fajm.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F25%2F3%2F186%3Frss%3D1 The root cause analysis (RCA) process is used to investigate adverse events. However, it may not reduce the risk of recurrence as effectively as intended. The authors propose adapting a risk prioritization and reduction process modeled after the Commercial Aviation Safety Team (CAST). The process involves the following: (a) increasing effectiveness of selected interventions by prioritizing each cause/contributing factor based on its role in the current sentinel event as well as in future events; interventions are then selected based on their ability to remediate the root causes/contributing factors and the likelihood of successful implementation; (b) measuring effectiveness of intervention implementation; and ( c) evaluating effectiveness of the interventions by measuring the rates of even... American Journal of Medical Quality journals http://www.medworm.com/rss/comments.php?id=3555004 Tue, 11 May 2010 17:23:46 +0100 3555004