Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Qual Manag Health Care [journal]
- Frictions as Barriers to Perioperative Alignment: Results From a Latent Class Analysis. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 July/September; 23(3):188-200.
The quality of the relationship between the sterile processing department (SPD) and the operating room (OR) is an important determinant of OR safety and performance. In this article, the concept of "friction" refers to the SPD behaviors and attributes that can negatively affect OR performance. Panels of SPD professionals initially were asked to identify and operationally define different ways in which behaviors of a hospital's SPD could compromise OR performance. A national convenience sample of OR nurses (N = 291) rated 14 frictions in terms of their agreement or disagreement that each had a negative effect on OR performance in their hospital. Overall, more than 50% of the entire sample agreed that 2 frictions, "SPD does not communicate effectively with the OR" (55%) and "SPD inventories are insufficient for surgical volume" (52%), had negative effect on OR performance. However, a latent class analysis revealed 3 distinct classes of nurses who varied with respect to their level of agreement that SPD-OR frictions negatively affected OR performance. The observed heterogeneity in how different groups of nurses viewed different frictions suggests that effective efforts aimed at reducing performance-limiting frictions should be customized so that resources can be used where they are most needed.
- Assessing and Addressing Patient Satisfaction in a Longer-term Inpatient Psychiatric Hospital: Preliminary Findings on the Menninger Quality of Care Measure and Methodology. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 July/September; 23(3):178-187.
Patient satisfaction is increasingly used as an indicator of health care quality. Few measures are available to assess characteristics unique to inpatient psychiatric hospitals, especially those that provide longer-term care. Furthermore, there is limited guidance on how to utilize patient satisfaction data to guide quality improvement initiatives. The authors developed the 20-item, Menninger Quality of Care measure at The Menninger Clinic in Houston, Texas. Psychometric analyses were based on responses from 337 adult inpatients. The measure has excellent internal reliability (Cronbach α = 0.92) with adequate concurrent and construct validity. We present a methodology to identify targeted quality improvement efforts by (1) highlighting the perspective of patients who are generally satisfied but had at least some reservations regarding the care they received and (2) highlighting areas of concern that are most associated with overall quality of care. We discuss our findings in light of national health care quality trends.
- Implementation of the Re-Engineered Discharge (RED) Toolkit to Decrease All-Cause Readmission Rates at a Rural Community Hospital. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 July/September; 23(3):169-177.
National hospital readmission rates average 19%. One in 5 Medicare patients are readmitted within 30 days of discharge each year, resulting in $17.5 billion in additional costs.The aim of this quality improvement project was to use the methodology outlined by Joint Commission Resources-Hospital Engagement Network and Project Re-Engineered Discharge (Project RED) to redesign the discharge process, reduce hospital 30-day all-cause readmission rates, and improve patient/family involvement in the discharge process.The methodology of the Joint Commission Resources-Hospital Engagement Network and the Agency for Healthcare Research and Quality Project RED toolkit, the After Hospital Care Plan, and a patient discharge questionnaire were used to incorporate best discharge practices into patient care and evaluate the outcomes of the project. Monthly readmission rates and patient/family involvement in the discharge process were examined for 336 patients discharged from a dedicated 30-bed medical-surgical unit in a rural community hospital over a 4-month period.During the 4-month project, readmissions were reduced by 32% (rate 7.12); the overall monthly reduction from baseline was 27%, with a 44% reduction from baseline during the previous 6 months. The patient and family perception of their discharge process was positive.
- Simulated application of US cardiology guidelines for statin use to hospital patients in Turkey. [Journal Article]
- Qual Manag Health Care 2014 Jul-Sep; 23(3):163-8.
Simulate the application of the new cardiology prevention guideline on statin use in an angiography clinic sample taken from a hospital in Turkey.Taking statins was used as a quality indicator. All cases (323) included in the sample met criteria for taking statins upon arrival in the angiography clinic. The study population was divided into 3 groups: critical coronary artery disease (CAD) (>50%), noncritical (<50%), or individuals with normal coronary arteries. Patient risk factors were tested for association with taking statins using multiple logistic regression analysis.Only 20.2% of patients were taking statins when they were accepted for coronary angiography. Patients with critical CAD and noncritical CAD had higher odds of receiving statins than persons with no CAD [odds ratio (OR)=12.9, P<.001 and OR=3.5, P=.025, respectively]. Patients receiving angiographic interventions for stent control were more likely to be on statins than patients with angina (OR=5.298, P=0.004). Compared to those not taking the treadmill test, both those with positive and those with negative results had reduced odds of receiving statins (OR=0.260, P=.002, and OR=0.130, P=.002, respectively). Both former and current smokers had lower odds of receiving statins than persons who had never smoked (OR=0.148, P<.001, and OR=0.161, P=.001). Patients taking aspirin were at risk of not being on statins (OR=0.238, P = .001).Most of the patients in this study were not taking statins comparing according to US guidelines. Patients who exhibited risk factors for a cardiovascular event but who had not been diagnosed with CAD were at risk for not being on statins.
- Increasing Capacity for Quality Improvement in Underresourced Primary Care Settings. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 July/September; 23(3):155-162.
While hospitals have widely adopted quality improvement (QI) initiatives, primary care practices continue to face unique challenges to QI implementation. The purpose of this article is to outline a strategy for promoting QI in primary care practices by introducing specially trained nurses. Two case examples are described, one with a QI nurse external to the practice and one with a nurse internal to the practice. Lessons learned and barriers and facilitators to QI in primary care are presented. Barriers and facilitators are identified in the following categories: practice infrastructure, practice leadership, and practice organizational culture. Implications for primary care practitioners and avenues for future work are discussed.
- Building the Case for Quality Improvement in the Health Care Industry: A Focus on Goals and Training. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 July/September; 23(3):138-154.
Health care organizations are under intense pressure to improve the efficiency and effectiveness of care delivery and, increasingly, they are using quality improvement teams to identify and target projects to improve performance outcomes. This raises the question of what factors actually drive the performance of these projects in a health care environment. Using data from a survey of health care professionals acting as informants for 244 patient care, clinical-administrative, and nonclinical administrative quality improvement project types in 93 health care organizations, we focus on 2 factors-goal setting and quality training-as potential drivers of quality improvement project performance. We find that project-level goals and quality training have positive associations with process quality, while organizational-level goals have no impact. In addition, the relationship between project-level goals and process quality is stronger for patient care projects than for administrative projects. This indicates that the motivational and cognitive effects of goal setting are greater for projects that involve interactions with clinicians than for ones that involve interactions with other staff. Although project-level goal setting is beneficial for improving process quality overall, our findings suggest the importance of being especially attentive to goal setting for projects that impact direct patient care.
- In ... and Out: Open Access Publishing in Scientific Journals. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 July/September; 23(3):133-137.
Open access (OA) journals are a growing phenomenon largely of the past decade wherein readers can access the content of scientific journals without paying for a subscription. The costs are borne by authors (or their institutions) who pay a fee to be published, thus allowing readers to access, search, print, and cite the journals without cost. Although the OA model, in and of itself, need not diminish scientific rigor, selectivity, or peer review, the "author pays" model creates an inherent conflict of interest: it operates with the incentive on the part of the journal to publish more and reject less. This is coupled with cost containment measures that affect the journals' ability to engage experienced editors and professional staff to scrutinize data, data analyses, and author conflicts of interest. While some OA journals appear to be comparable to their print competitors, others are "predatory" and have no legitimacy at all. Two recent "scams"-one recently published in Science-highlight the urgency of addressing the issues raised by OA publication so that OA does not lose its credibility just as it begins to gather substantial momentum. High-quality journals develop their reputations over time, and OA outlets will be no exception. For this to occur, however, the OA audience will need to be satisfied that OA can deliver high-quality publications utilizing rigorous peer review, editing, and conflict of interest scrutiny. Academic tenure and promotion committees that review scholarly credentials are understandably skeptical of publications in unrecognized journals, and the large number of new OA outlets contributes to this urgency from their perspective as well.
- Making quality registers supporting improvements: a systematic review of the data visualization in 5 quality registries. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):119-28.
Traditionally, quality registries have been initiated, developed, and used by physicians essentially for research purposes. There is an unrealized opportunity to expand and strengthen the contribution of quality registries in health care quality improvement. This article aims to characterize quality registry annual reports regarding factors deemed important to process improvement. The 2012 annual reports of the 5 most highly developed Swedish quality registries were examined. Each of the 636 charts included was coded according to an abstraction form. Results show that league tables are highly prevalent, whereas funnel plots and control charts are rare. Health care quality is monitored over time on the basis of few and highly aggregated measurements, and it is usually measured using percentages. In conclusion, quality registry annual reports lack both the level of detail and the consideration of random variation necessary to being able to be systematically used in process improvement. Users of annual reports are recommended caution when discussing differences in quality, both over time and across health care providers, as they can be due to chance and insufficient guidance is provided on the reports in this regard. To better support process improvement, annual reports should thus be more detailed and give more consideration to random variation.
- Analysis and Improvement of Organizational Models for the Management of Patients With Type 2 Diabetes Mellitus: A Case Study in North-east Italy. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):99-118.
The study aimed to establish whether the organization for the management of type 2 diabetes mellitus at 9 diabetic units (DUs), in 5 neighboring local health authorities (LHAs), was able to (a) comply with the organizational model prescribed by specific regional standards; (b) ensure adequate clinical management of diabetic patients; (c) assess whether the relationship between primary care physicians (PCPs) and diabetologists (SDs) was instrumental to the needs of patients; (d) optimize specialist treatment at the DUs; (e) optimize drug management; and (f) check whether organizational changes led to variations in clinical results.This 6-stage study analyzed procedures, precoded actions, and recordable processes. Stage (1) Defining clinical and organizational endpoints; (2) Drafting flowcharts to describe the actions and work procedures implemented within each LHA; (3) Comparing the flowcharts with the data obtained from related literature; (4) Establishing a protocol shared with PCPs for the management and treatment of patients with type 2 diabetes; (5) Changing the procedures at the DUs; and (6) Evaluating the results. The data were assessed before and after establishing a shared protocol for SDs and PCPs (year 2009 vs 2011).The study shows inconsistencies in the organization of work in the 5 LHAs; however, collaboration with PCPs has guaranteed: (a) unchanged hemoglobin A1C values before and after applying the protocol; (b) a percentage increase in the number of patients with type 2 diabetes who were identified thanks to these protocols; (c) an increase in the use of biguanides compared to the preprotocol period; and (d) no change in the number of patients hospitalized because of acute complications from type 2 diabetes mellitus.This study confirms how adequate collaboration between SDs and PCPs keeps the risk of complications stable. Nevertheless, shared protocols and clearly defined roles are required.
- Implementing incentivized practice to improve patient care in developing countries. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):94-8.
Faculty awards provide an incentive to encourage higher standards of personal performance, which closely reflects the quality of health care. We report the development and implementation of the first medical faculty award program in the region.Anonymous preaward survey evaluated responses to understand the overall state of our institution. Five awards were celebrated. An anonymous postaward survey gathered responses to evaluate the effectiveness of the program.A total of 60% (307/509) of preaward survey responses were collected. Among those, 92% (283/307) felt that employee recognition was important and 78% (240/307) felt that performance should be the deciding criteria for employee recognition. A 24% (20/85) of the faculty received the decade of excellence award and 13% (11/85) received the compassionate physician award. Best service award was granted to 7% (6/85) of the nominees. Postaward survey showed 68% (170/250) agreed that the award ceremony incentivized them to increase quality of personal performance.In summary, we feel that this transparent, objective, and peer-nominated awards program could serve as an incentivized model for health care providers to elevate the standards of personal performance, which in turn will benefit the advancement of patient care.