American journal of medical quality : the official journal of the American College of Medical Quality最新文献

Ambulatory procedures performed electively in hospital outpatient departments are of increasing complexity and constitute a growing share of total procedure volume. Despite their importance, little is known of the prevalence of complications from routine procedures once patients are discharged. This study utilizes a 100% Medicare Fee-for-Service claims data file for the years 2019-2022 to assess the relative frequency of hospital-based ambulatory procedures and 30-day patient postprocedure emergency room and hospitalization complication rates utilizing the Ambulatory Potentially Preventable Complication (AM-PPC) classification method. AM-PPC is a claims-based method designed to calculate comparative provider rates of complication exclusively for elective ambulatory procedures excluding procedures performed in hospital emergency departments. The authors calculated the mean rate of ambulatory complications by procedure across hospitals and then compared them for variation in hospital-specific procedure complication rates to the mean rate. About 2.1% of patients receiving a procedure performed in a hospital outpatient department had an emergency room or inpatient hospitalization visit within 30 days. Complication event rates varied widely across hospital outpatient departments and within specific procedures. Hip arthroplasty complication rates varied from 0.0% to 7.6% while those for upper genitourinary procedures varied from 1.7% to 14.2%. In conclusion, the complication rate for ambulatory procedures is seen to vary substantially across hospital outpatient departments for well-established, routine procedures. This study provides a baseline of complication rates for ambulatory procedures, which will be essential for future efforts to improve patient safety.

Research on dashboard adoption has focused on technical and design requirements. Evidence on social mechanisms for successful dashboard adoption is scarce. This study examined 2 quality dashboards in a similar organizational context with different outcomes. The research question was: How do social mechanisms influence the adoption of dashboards in practice? This embedded case study within one Dutch hospital in 2 phases: (1) interviews and observations to identify social mechanisms in the end-user's team and (2) expert focus groups to validate identified mechanisms. Data were transcribed verbatim and analyzed thematically, resulting in the identification of 3 social mechanisms within the team of end-users influencing dashboard adoption: cultivating a supportive team climate, trust, and leadership behavior in end-users' teams. These mechanisms stimulate a learning environment for discussing and improving care quality. They require action from individuals and teams, so dashboards can be used for collective understanding, learning, and improving. Without these social mechanisms, dashboards remain an unadopted "materiality."

Narrow therapeutic time windows and delays in assessing acute ischemic stroke patients limit the access to and effectiveness of reperfusion therapies. A 2-year quality improvement project codesigned and tested a checklist for quicker evaluation of suspected stroke cases in 2 emergency departments (EDs). Utility, feasibility, and implementation barriers were assessed through semistructured interviews. The impact on stroke quality metrics was analyzed using bivariate and multivariate regression models with data from the American Heart Association's Get With the Guidelines registry. Implementing the checklist was significantly associated with higher odds of receiving intravenous thrombolytics within 60 minutes of ED arrival (odds ratio: 6.4, 95% confidence interval: 1.1-68.7, P = 0.03). Users felt the checklist improved the standardization of stroke care and promoted teamwork, especially in a time of higher staff turnover. An ED-based stroke checklist resulted in timelier stroke care for acute ischemic stroke patients, meriting further testing in larger, more diverse settings.

Small-bore feeding tubes (SBFT) in vulnerable patients carry a risk of iatrogenic pneumothorax by misplacement into the lung. This institution noted a series of iatrogenic pneumothoraxes caused by the placement of these devices. A resident-led, multidisciplinary team developed a hospital guideline through a consensus-driven process. The guideline mandated SBFT placement by approved "super-users" via the CORTRAK Enteral Access System or via non-CORTRAK Methods, including the 2-step X-ray Method, fluoroscopy, or direct visualization techniques. A "super-user" Program for the CORTRAK Enteral Access System was developed to assure competency and consistency. With the development of the guideline and "super-user" program, the authors observed a decrease in the number of SBFT-related iatrogenic pneumothoraxes. Following a brief period of adoption, the three-hospital organization has had no SBFT-related iatrogenic pneumothoraxes. This project demonstrates the effectiveness of developing a resident-driven, evidence-based hospital guideline for the safe passage of SBFTs.

This retrospective study aimed to describe the characteristics of cancer patients undergoing depression and distress screening at the Sidney Kimmel Cancer Center and to assess factors associated with their screening results. Data were retrieved from electronic medical records of adult Sidney Kimmel Cancer Center patients with at least one oncology encounter between January 2021 and June 2022, who underwent both depression and distress screening using the Patient Health Questionnaire-2/9 for depression and the National Comprehensive Cancer Network distress thermometer for distress during the encounter. Demographics, clinical factors, and screening results were analyzed using descriptive statistics and binary logistic regression. A total of 1954 cancer patients were screened for psychological needs. Of these, 110 (5.6%) screened positive for depression and 830 (42.5%) screened positive for distress. About 69.1% of patients who screened positive for depression also screened positive for distress. Conversely, 9.2% of patients who screened positive for distress also screened positive for depression. Cancer patients >65 years old were found significantly less likely to screen positive for both distress and depression, while males were found significantly less likely to screen positive for distress. African American patients were found to be significantly more likely than White patients to screen positive for both distress and depression (odds ratio: 2.58; confidence interval: 1:53-4.34). In this study, a higher proportion of cancer patients were found to be distressed than depressed, suggesting that the National Comprehensive Cancer Network distress thermometer may be a more useful tool in identifying psychosocial concerns in this population. Differences in depression and distress scores were significantly associated with age, sex, and race. These findings highlight the need for the implementation of effective screening strategies to better address the psychosocial needs of cancer patients. Further research is warranted to validate these findings and assess the impact of distress screening on patient outcomes across various oncology settings.

Randomized clinical trials and clinical practice guidelines recommend the use of self-measured blood pressure (SMBP) to help improve the treatment of patients with hypertension. Many clinicians use SMBP in their practices, but there is significant variability in how SMBP is implemented in their day-to-day practice. This quality improvement study details the pragmatic and real-world approach clinicians and administrators used at 3 sites of the IHA Medical Group, a part of Trinity Healthcare, to implement the American Medical Association (AMA) 7-Step SMBP framework as part of the larger AMA hypertension quality improvement program AMA MAP BP. The SMBP program included distributing SMBP devices, training patients on SMBP use, capturing and recording SMBP values in the electronic health record, using SMBP readings in treatment decisions, and receiving reimbursement for patient training and education. Of 331 patients enrolled, 98% of patients had at least 1 return visit within a year. Average systolic blood pressure was reduced by 8 mm Hg between the first and last office visit, and blood pressure control rates increased from 33.5% to 63.5% in these patients. Among patients with one return visit, 46% had documented SMBP readings and 71% were treated with medications. Payors reimbursed 95% of claims submitted for patient training.