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

Despite widespread attention to addressing healthcare quality problems, few academic medical centers provide an academic pathway for faculty engaged in such work. This qualitative case study examined physicians and department leaders' perceptions and experiences of a novel "Clinician in Quality and Innovation" (CQI) academic pathway created in 2012. Interviews were conducted with 23 CQI faculty and 7 department leaders. Of the department's 20 divisions, 15 included at least one CQI with a median of 5 per division. Findings demonstrated how the academic track aligned with, and legitimized, CQIs' interests, and allowed for a wide range of "quality and innovation" activities (eg, improving healthcare processes, developing models of care, clinical informatics). Contextual factors such as synergies with hospital-based initiatives for healthcare improvement and changes to academic promotion criteria were instrumental in CQI's performance of the academic role. Despite promotion successes, CQIs described some tensions between academic and clinical role expectations.

Using data from the National Surgical Quality Improvement Project (NSQIP), we aimed to reduce the incidence of postoperative sepsis, focusing on patients receiving red blood cell (RBC) transfusions and with open wounds. We postulated that diverse countermeasures would reduce postoperative sepsis. Workgroups were created around 4 problems with root causes identified using standardized processes: excessive RBC transfusions, owing to transfusing for Hb > 7 or > 1 unit at a time; infrequent use of cell salvage due to knowledge deficit or cell salvage machine not available; incorrect antibiotics owing to penicillin-allergic patients not getting cephalosporins or patients getting empiric antibiotics to which organisms are resistant; suboptimal postoperative wound management owing to poor communication regarding care plans and care transitions. Thirteen countermeasures were implemented. With improvement in 7 of 8 process metrics, the rate of postoperative sepsis declined from 1.56% (tenth decile performance in the NSQIP database) to 0.59% (first decile), P = 0.0065.

The impact of providing comparative individual surgeon performance feedback on outcomes has received little attention. The objective was to determine whether repeated distribution and discussion among orthopedic surgeons of their own customized comparative surgeon performance feedback concerning Patient-Reported Outcome Measures, implant costs, and procedure time had an impact on these same outcomes, surgeon rating, and procedure time. This quality improvement initiative utilized a single-group interrupted time series design evaluating pre- to postexposure to surgeon feedback reports for surgeries in 2236 total knee arthroplasty and 1582 total hip arthroplasty patients to assess differences in implant costs, procedure time, change in patient-reported Oxford Knee/Hip Scores, surgeon rating after surgery, and shared decision after surgery. There was no consistent evidence that the receipt and discussion of comparative surgeon performance feedback by surgeons resulted in improvement in the outcomes considered.

This study explored the independent risk factors for patients giving a less than "top box" score on their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys in the "doctor communication" domain (DCD). After adjusting for age, gender, length of stay, receiving a postdischarge phone call (PC), new medication during hospitalization, highest education level, language spoken at home, and zip code, results from 803 HCAHPS surveys (from January 1 to December 31, 2023) revealed that not receiving a PC was associated with a more than doubling of the odds that a patient would give less than a "top box" score for the DCD (overall adjusted odds ratio of 2.22; 95% confidence interval: 1.77-2.78) and a nearly doubling the actual probability of doing so (34.3% less than "top box" score if no PC, 17.9% less than "top box" score if PC). These findings support the potential value of a post-discharge patient PC.

Exposure keratopathy (EK) is corneal damage from prolonged environmental exposure. If untreated, EK can lead to corneal scarring and/or blindness. Critically ill patients are at high risk. A case of EK in our intensive care unit led us to investigate the incidence of EK in our critical care units and understand the interventions needed to reduce its impact. We found 44 cases of EK over 3 years. 95% received mechanical ventilation and 32% received paralytic agents. Average time to diagnosis was 15.8 days from intensive care unit admission. More than a quarter (27%) of patients had severe EK at diagnosis, and 52% of patients had received prior eye care. EK occurred frequently in our critical care units. Many subjects did not receive prophylaxis and disease was diagnosed at a late stage. To address this, we plan a 3-pronged approach focusing on prevention, early recognition, and timely initiation of treatment.