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

Physicians encounter several challenges with current billing processes. The current Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic review identifies and characterizes quality improvement (QI) strategies to enhance physician billing. MEDLINE, EMBASE, HealthStar, and Web of Science were searched for studies that described QI interventions targeting practicing or trainee physicians and outcomes including improved efficacy, enhanced efficiency, accurate billing code selection, or increased satisfaction. Fifty-six of 11,621 studies met the inclusion criteria. More than 40% of studies utilized more than 1 intervention and over 60% of studies included an educational intervention. Revenue-related outcomes were commonly reported among included studies (n = 30, 54%), followed by accuracy or error rates (n = 22, 43%), and billing completion rates (n = 14, 25%). QI interventions to enhance physician billing tend to be lower on the hierarchy of intervention effectiveness. Future work should explore the durability and generalizability of interventions and their impact on physician and patient outcomes.

Efforts to improve patient engagement in pain management are often hindered by inconsistent definitions and measurements. To address this gap, we developed and pilot-tested the 15-item Patient Engagement in Pain Management survey. A systematic review of 77 survey instruments identified 6 key constructs of patient engagement, and semi-structured interviews with 36 patients and 3 providers from the Johns Hopkins Personalized Pain Program informed its development. The initial 33-item survey was refined to 15 items, and usability and test-retest reliability were evaluated with 60 Personalized Pain Program patients. The median completion time was 3.5 minutes, with minimal missing data (<0.5%). Most respondents (96-100%) found the questions relevant, with higher average scores for patient-provider communication (3.6-4.5 on a 5-point scale) and lower scores for adherence challenges. Although the Patient Engagement in Pain Management survey demonstrated good usability and applicability, further studies are needed to enhance its test-retest reliability and psychometric validation.

This paper explores the concept of high reliability within clinical laboratories and its critical role in ensuring accurate and trustworthy diagnostic results. It examines the intrinsic connection between quality and reliability in patient care, emphasizing the importance of robust quality management systems and the expertise of laboratory professionals. The paper outlines the 5 pillars of a high-reliability organization and discusses the significance of eliminating preventable harm through standardized protocols. Furthermore, it addresses the complexities of change management, utilizing the Kübler-Ross Change Curve and McKinsey's 7S model to facilitate staff engagement and resilience during transitions. By integrating systematic approaches to quality control and human performance, the paper advocates for a culture of continuous improvement aimed at achieving high reliability and a zero-harm environment in clinical laboratories. Ultimately, the journey toward high reliability is presented as an ongoing commitment to excellence in patient care, highlighting the need for effective leadership and employee collaboration.

There are significant gaps in care for patients with atrial fibrillation (AF) and is a need to focus on improving guideline-concordant care. Recognizing challenges encountered in pursuing sustainable quality improvement (QI) in AF care, the Heart Rhythm Society spearheaded a multifaceted collaboration grounded in the principles of Improvement Science to develop a robust platform aimed specifically at demystifying QI for clinicians and health care systems interested in closing care gaps for patients with AF. Solution development included an innovative discovery process, a design phase, piloting, and refinement, and finished with transformation into a comprehensive digital platform. End-users were engaged throughout the 4-phase process to help ensure the final platform would meet the needs of clinicians and health care systems. The result was the launch of www.CardiQ.org featuring the Atrial Fibrillation QI Framework and an extensive, curated Resource Library that has been accessed by more than 10 000 users spanning over 100 countries.