Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.05.009
An interdisciplinary team developed, implemented, and evaluated a standardized structure and process for an electronic apparent cause analysis (eACA) tool that includes principles of high reliability, human factors engineering, and Just Culture. Steps include assembling a team, describing what happened, determining why the event happened, determining how defects might be fixed, and deciding which defects will be fixed. The eACA is an intuitive tool for identifying defects, apparent causes of those defects, and the strongest corrective actions. Moreover, the eACA facilitates system learning by aggregating apparent causes and corrective action trends to prioritize and implement system change(s).
{"title":"Developing, Implementing, Evaluating Electronic Apparent Cause Analysis Across a Health Care System","authors":"","doi":"10.1016/j.jcjq.2024.05.009","DOIUrl":"10.1016/j.jcjq.2024.05.009","url":null,"abstract":"<div><div><span>An interdisciplinary team developed, implemented, and evaluated a standardized structure and process for an electronic apparent cause analysis (eACA) tool that includes principles of high reliability, </span>human factors<span><span> engineering, and Just Culture. Steps include assembling a team, describing what happened, determining why the event happened, determining how defects might be fixed, and deciding which defects will be fixed. The eACA is an intuitive tool for identifying defects, apparent causes of those defects, and the strongest corrective actions. Moreover, the eACA facilitates </span>system learning by aggregating apparent causes and corrective action trends to prioritize and implement system change(s).</span></div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 10","pages":"Pages 724-736"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141274609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.01.001
Brittany N. Burton MD, MAS, MHS (is Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles (UCLA).), Janet O. Adeola MD (is Anesthesiologist, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School/Brigham & Women's Hospital, Boston.), Veena M. Do (is Medical Student, School of Medicine, University of California, San Diego.), Adam J. Milam MD, PhD (is Senior Associate Consultant and Associate Professor of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix.), Maxime Cannesson MD, PhD (is Chair, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA.), Keith C. Norris MD, PhD (is Professor, Department of Medicine, David Geffen School of Medicine, UCLA.), Nicole E. Lopez MD (is Associate Professor, Division of Colorectal Surgery, Department of Surgery, University of California, San Diego.), Rodney A. Gabriel MD, MAS (is Associate Professor, Division of Regional Anesthesia, and Director, Division of Perioperative Informatics, University of California, San Diego. Please address correspondence to Brittany N. Burton)
Background
Health equity in pain management during the perioperative period continues to be a topic of interest. The authors evaluated the association of race and ethnicity with regional anesthesia in patients who underwent colorectal surgery and characterized trends in regional anesthesia.
Methods
Using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020, the research team identified patients who underwent open or laparoscopic colorectal surgery. Associations between race and ethnicity and use of regional anesthesia were estimated using logistic regression models.
Results
The final sample size was 292,797, of which 15.6% (n = 45,784) received regional anesthesia. The unadjusted rates of regional anesthesia for race and ethnicity were 15.7% white, 15.1% Black, 12.8% Asian, 29.6% American Indian or Alaska Native, 16.3% Native Hawaiian or Pacific Islander, and 12.4% Hispanic. Black (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90–0.96, p < 0.001) and Asian (OR 0.76, 95% CI 0.71–0.80, p < 0.001) patients had lower odds of regional anesthesia compared to white patients. Hispanic patients had lower odds of regional anesthesia compared to non-Hispanic patients (OR 0.72, 95% CI 0.68–0.75, p < 0.001). There was a significant annual increase in regional anesthesia from 2015 to 2020 for all racial and ethnic cohorts (p < 0.05).
Conclusion
There was an annual increase in the use of regional anesthesia, yet Black and Asian patients (compared to whites) and Hispanics (compared to non-Hispanics) were less likely to receive regional anesthesia for colorectal surgery. These differences suggest that there are racial and ethnic differences in regional anesthesia use for colorectal surgery.
{"title":"Differences in the Receipt of Regional Anesthesia Based on Race and Ethnicity in Colorectal Surgery","authors":"Brittany N. Burton MD, MAS, MHS (is Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles (UCLA).), Janet O. Adeola MD (is Anesthesiologist, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School/Brigham & Women's Hospital, Boston.), Veena M. Do (is Medical Student, School of Medicine, University of California, San Diego.), Adam J. Milam MD, PhD (is Senior Associate Consultant and Associate Professor of Anesthesiology, Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix.), Maxime Cannesson MD, PhD (is Chair, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, UCLA.), Keith C. Norris MD, PhD (is Professor, Department of Medicine, David Geffen School of Medicine, UCLA.), Nicole E. Lopez MD (is Associate Professor, Division of Colorectal Surgery, Department of Surgery, University of California, San Diego.), Rodney A. Gabriel MD, MAS (is Associate Professor, Division of Regional Anesthesia, and Director, Division of Perioperative Informatics, University of California, San Diego. Please address correspondence to Brittany N. Burton)","doi":"10.1016/j.jcjq.2024.01.001","DOIUrl":"10.1016/j.jcjq.2024.01.001","url":null,"abstract":"<div><h3>Background</h3><p>Health equity in pain management during the perioperative period continues to be a topic of interest. The authors evaluated the association of race and ethnicity with regional anesthesia in patients who underwent colorectal surgery and characterized trends in regional anesthesia.</p></div><div><h3>Methods</h3><p>Using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020, the research team identified patients who underwent open or laparoscopic colorectal surgery. Associations between race and ethnicity and use of regional anesthesia were estimated using logistic regression models.</p></div><div><h3>Results</h3><p>The final sample size was 292,797, of which 15.6% (<em>n</em> = 45,784) received regional anesthesia. The unadjusted rates of regional anesthesia for race and ethnicity were 15.7% white, 15.1% Black, 12.8% Asian, 29.6% American Indian or Alaska Native, 16.3% Native Hawaiian or Pacific Islander, and 12.4% Hispanic. Black (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90–0.96, <em>p</em> < 0.001) and Asian (OR 0.76, 95% CI 0.71–0.80, <em>p</em> < 0.001) patients had lower odds of regional anesthesia compared to white patients. Hispanic patients had lower odds of regional anesthesia compared to non-Hispanic patients (OR 0.72, 95% CI 0.68–0.75, <em>p</em> < 0.001). There was a significant annual increase in regional anesthesia from 2015 to 2020 for all racial and ethnic cohorts (<em>p</em> < 0.05).</p></div><div><h3>Conclusion</h3><p>There was an annual increase in the use of regional anesthesia, yet Black and Asian patients (compared to whites) and Hispanics (compared to non-Hispanics) were less likely to receive regional anesthesia for colorectal surgery. These differences suggest that there are racial and ethnic differences in regional anesthesia use for colorectal surgery.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 416-424"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139540189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.04.007
Celine Larkin PhD (is Assistant Professor, Department of Emergency Medicine and Center for Accelerating Practices to End Suicide (CAPES), UMass Chan Medical School, Worcester, Massachusetts. Please address correspondence to Celine Larkin)
{"title":"Implementation of Suicide Prevention Activities at Acute Care Discharge: Time for Change?","authors":"Celine Larkin PhD (is Assistant Professor, Department of Emergency Medicine and Center for Accelerating Practices to End Suicide (CAPES), UMass Chan Medical School, Worcester, Massachusetts. Please address correspondence to Celine Larkin)","doi":"10.1016/j.jcjq.2024.04.007","DOIUrl":"10.1016/j.jcjq.2024.04.007","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 391-392"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140788428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.03.007
Lisa Rotenstein MD, MBA, MSc (is Assistant Professor and Primary Care Physician, Division of General Internal Medicine and Division of Clinical Informatics, University of California at San Francisco.), Hanhan Wang MPS (is Biostatistician, WellMD Center, Stanford University School of Medicine.), Colin P. West MD, PhD (is Professor and Quantitative Health Sciences Researcher, Departments of Medicine and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.), Liselotte N. Dyrbye MD (is Professor, Department of Medicine and Chief Well-Being Officer, University of Colorado School of Medicine.), Mickey Trockel MD (is Professor, Department of Psychiatry, Stanford University School of Medicine.), Christine Sinsky MD (is Vice President, Professional Satisfaction, American Medical Association, Chicago.), Tait Shanafelt MD (is Professor, Department of Medicine, Stanford University School of Medicine, and Chief Wellness Officer, Stanford Medicine. Please address correspondence to Lisa Rotenstein)
{"title":"Teamwork Climate, Safety Climate, and Physician Burnout: A National, Cross-Sectional Study","authors":"Lisa Rotenstein MD, MBA, MSc (is Assistant Professor and Primary Care Physician, Division of General Internal Medicine and Division of Clinical Informatics, University of California at San Francisco.), Hanhan Wang MPS (is Biostatistician, WellMD Center, Stanford University School of Medicine.), Colin P. West MD, PhD (is Professor and Quantitative Health Sciences Researcher, Departments of Medicine and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.), Liselotte N. Dyrbye MD (is Professor, Department of Medicine and Chief Well-Being Officer, University of Colorado School of Medicine.), Mickey Trockel MD (is Professor, Department of Psychiatry, Stanford University School of Medicine.), Christine Sinsky MD (is Vice President, Professional Satisfaction, American Medical Association, Chicago.), Tait Shanafelt MD (is Professor, Department of Medicine, Stanford University School of Medicine, and Chief Wellness Officer, Stanford Medicine. Please address correspondence to Lisa Rotenstein)","doi":"10.1016/j.jcjq.2024.03.007","DOIUrl":"10.1016/j.jcjq.2024.03.007","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 458-462"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S155372502400076X/pdfft?md5=c3c52f641c9ff024820934eeb33be178&pid=1-s2.0-S155372502400076X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140276748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.01.011
Heather A. Prentice PhD (is Epidemiologist, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Jessica E. Harris MS (is Senior Manager, Clinical Consulting Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Kenneth Sucher MS (is Manager, Administrative Team, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Brian H. Fasig PhD (is Managerial Senior Consultant, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Ronald A. Navarro MD (is Professor and Director of Clinical Affairs, Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, California.), Kanu M. Okike MD (is Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hawaii Permanente Medical Group, Honolulu.), Gregory B. Maletis MD (is Chief, Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Baldwin Park, California.), Kern H. Guppy MD, PhD (is Director, Neurosurgery Spine Program, Department of Neurosurgery, Permanente Medical Group, Sacramento, California.), Robert W. Chang MD (is Assistant Chair, Department of Vascular Surgery, Permanente Medical Group, South San Francisco, California, and Adjunct Investigator, Division of Research, Kaiser Permanente Northern California, Oakland.), Matthew P. Kelly MD (is Orthopaedic Surgeon, Southern California Permanente Medical Group, Harbor City, California.), Adrian D. Hinman MD (is Orthopaedic Surgeon Department of Orthopaedic Surgery, Permanente Medical Group, San Leandro, California.), Elizabeth W. Paxton PhD (is Director, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego. Please address correspondence to Heather A. Prentice)
Background
Clinical quality registries (CQRs) are intended to enhance quality, safety, and cost reduction using real-world data for a self-improving health system. Starting in 2001, Kaiser Permanente established several medical device CQRs as a quality improvement initiative. This report examines the contributions of these CQRs on improvement in health outcomes, changes in clinical practice, and cost-effectiveness over the past 20 years.
Methods
Eight implant registries were instituted with standardized collection from the electronic health record and other institutional data sources of patient characteristics, medical comorbidities, implant attributes, procedure details, surgical techniques, and outcomes (including complications, revisions, reoperations, hospital readmissions, and other utilization measures). A rigorous quality control system is in place to improve and maintain the quality of data. Data from the Implant Registries form the basis for multiple quality improvement and patient safety initiatives to minimize variation in care, promote clinical best practices, facilitate recalls, perform benchmarking, identify patients at risk, and construct reports about individual surgeons.
Results
Following the inception of the Implant Registries, there was an observed (1) reduction in opioid utilization following orthopedic procedures, (2) reduction in use of bone morphogenic protein during lumbar fusion allowing for cost savings, (3) reduction in allograft for anterior cruciate ligament reconstruction and subsequent decrease in organizationwide revision rates, (4) cost savings through expansion of same-day discharge programs for joint arthroplasty, (5) increase in the use of cement fixation in the hemiarthroplasty treatment of hip fracture, and (6) organizationwide discontinuation of an endograft device associated with a higher risk for adverse outcomes following endovascular aortic aneurysm repair.
Conclusion
The use of Implant Registries within our health system, along with clinical leadership and organizational commitment to a learning health system, was associated with improved quality and safety outcomes and reduced costs. The exact mechanisms by which such registries affect health outcomes and costs require further study.
{"title":"Improvements in Quality, Safety and Costs Associated with Use of Implant Registries Within a Health System","authors":"Heather A. Prentice PhD (is Epidemiologist, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Jessica E. Harris MS (is Senior Manager, Clinical Consulting Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Kenneth Sucher MS (is Manager, Administrative Team, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Brian H. Fasig PhD (is Managerial Senior Consultant, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego.), Ronald A. Navarro MD (is Professor and Director of Clinical Affairs, Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, California.), Kanu M. Okike MD (is Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hawaii Permanente Medical Group, Honolulu.), Gregory B. Maletis MD (is Chief, Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Baldwin Park, California.), Kern H. Guppy MD, PhD (is Director, Neurosurgery Spine Program, Department of Neurosurgery, Permanente Medical Group, Sacramento, California.), Robert W. Chang MD (is Assistant Chair, Department of Vascular Surgery, Permanente Medical Group, South San Francisco, California, and Adjunct Investigator, Division of Research, Kaiser Permanente Northern California, Oakland.), Matthew P. Kelly MD (is Orthopaedic Surgeon, Southern California Permanente Medical Group, Harbor City, California.), Adrian D. Hinman MD (is Orthopaedic Surgeon Department of Orthopaedic Surgery, Permanente Medical Group, San Leandro, California.), Elizabeth W. Paxton PhD (is Director, Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego. Please address correspondence to Heather A. Prentice)","doi":"10.1016/j.jcjq.2024.01.011","DOIUrl":"10.1016/j.jcjq.2024.01.011","url":null,"abstract":"<div><h3>Background</h3><p>Clinical quality registries (CQRs) are intended to enhance quality, safety, and cost reduction using real-world data for a self-improving health system. Starting in 2001, Kaiser Permanente established several medical device CQRs as a quality improvement initiative. This report examines the contributions of these CQRs on improvement in health outcomes, changes in clinical practice, and cost-effectiveness over the past 20 years.</p></div><div><h3>Methods</h3><p>Eight implant registries were instituted with standardized collection from the electronic health record and other institutional data sources of patient characteristics, medical comorbidities, implant attributes, procedure details, surgical techniques, and outcomes (including complications, revisions, reoperations, hospital readmissions, and other utilization measures). A rigorous quality control system is in place to improve and maintain the quality of data. Data from the Implant Registries form the basis for multiple quality improvement and patient safety initiatives to minimize variation in care, promote clinical best practices, facilitate recalls, perform benchmarking, identify patients at risk, and construct reports about individual surgeons.</p></div><div><h3>Results</h3><p>Following the inception of the Implant Registries, there was an observed (1) reduction in opioid utilization following orthopedic procedures, (2) reduction in use of bone morphogenic protein during lumbar fusion allowing for cost savings, (3) reduction in allograft for anterior cruciate ligament reconstruction and subsequent decrease in organizationwide revision rates, (4) cost savings through expansion of same-day discharge programs for joint arthroplasty, (5) increase in the use of cement fixation in the hemiarthroplasty treatment of hip fracture, and (6) organizationwide discontinuation of an endograft device associated with a higher risk for adverse outcomes following endovascular aortic aneurysm repair.</p></div><div><h3>Conclusion</h3><p>The use of Implant Registries within our health system, along with clinical leadership and organizational commitment to a learning health system, was associated with improved quality and safety outcomes and reduced costs. The exact mechanisms by which such registries affect health outcomes and costs require further study.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 404-415"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139636752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.02.003
Kedar S. Mate MD (is President and Chief Executive Officer, Institute for Healthcare Improvement, Boston.), Leslie Pelton MPA (is Vice President, Institute for Healthcare Improvement. Please address correspondence to Kedar S. Mate)
{"title":"The Urgent Need for the Age-Friendly Health Systems Movement","authors":"Kedar S. Mate MD (is President and Chief Executive Officer, Institute for Healthcare Improvement, Boston.), Leslie Pelton MPA (is Vice President, Institute for Healthcare Improvement. Please address correspondence to Kedar S. Mate)","doi":"10.1016/j.jcjq.2024.02.003","DOIUrl":"10.1016/j.jcjq.2024.02.003","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 463-466"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139829414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.02.005
Stephen P. Schmaltz PhD, MPH, MS (is Senior Biostatistician, Department of Research, The Joint Commission, Oakbrook Terrace, Illinois.), Beth A. Longo DrPH, MSN, RN (is Associate Director, Department of Research, The Joint Commission.), Scott C. Williams PsyD (is Director, Department of Research, The Joint Commission. Please address correspondence to Beth A. Longo)
Background
This study evaluated the relationship between Joint Commission accreditation and health care–associated infections (HAIs) in long-term care hospitals (LTCHs).
Methods
This observational study used Centers for Medicare & Medicaid Services (CMS) LTCH data for the period 2017 to June 2021. The standardized infection ratio (SIR) of three measures used by the Centers for Disease Control and Prevention's National Healthcare Safety Network were used as dependent variables in a random coefficient Poisson regression model (adjusting for CMS region, owner type, and bed size quartile): catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and central line–associated bloodstream infections (CLABSIs) for the periods 2017 to 2019 and July 1, 2020, to June 30, 2021. Data from January 1 to June 30, 2020, were excluded due to the COVID-19 pandemic.
Results
The data set included 244 (73.3%) Joint Commission–accredited and 89 (26.7%) non–Joint Commission–accredited LTCHs. Compared to non–Joint Commission–accredited LTCHs, accredited LTCHs had significantly better (lower) SIRs for CLABSI and CAUTI measures, although no differences were observed for CDI SIRs. There were no significant differences in year trends for any of the HAI measures. For each year of the study period, a greater proportion of Joint Commission–accredited LTCHs performed significantly better than the national benchmark for all three measures (p = 0.04 for CAUTI, p = 0.02 for CDI, p = 0.01 for CLABSI).
Conclusion
Although this study was not designed to establish causality, positive associations were observed between Joint Commission accreditation and CLABSI and CAUTI measures, and Joint Commission–accredited LTCHs attained more consistent high performance over the four-year study period for all three measures. Influencing factors may include the focus of Joint Commission standards on infection control and prevention (ICP), including the hierarchical approach to selecting ICP–related standards as inputs into LTCH policy.
{"title":"Infection Control Measure Performance in Long-Term Care Hospitals and Their Relationship to Joint Commission Accreditation","authors":"Stephen P. Schmaltz PhD, MPH, MS (is Senior Biostatistician, Department of Research, The Joint Commission, Oakbrook Terrace, Illinois.), Beth A. Longo DrPH, MSN, RN (is Associate Director, Department of Research, The Joint Commission.), Scott C. Williams PsyD (is Director, Department of Research, The Joint Commission. Please address correspondence to Beth A. Longo)","doi":"10.1016/j.jcjq.2024.02.005","DOIUrl":"10.1016/j.jcjq.2024.02.005","url":null,"abstract":"<div><h3>Background</h3><p>This study evaluated the relationship between Joint Commission accreditation and health care–associated infections (HAIs) in long-term care hospitals (LTCHs).</p></div><div><h3>Methods</h3><p>This observational study used Centers for Medicare & Medicaid Services (CMS) LTCH data for the period 2017 to June 2021. The standardized infection ratio (SIR) of three measures used by the Centers for Disease Control and Prevention's National Healthcare Safety Network were used as dependent variables in a random coefficient Poisson regression model (adjusting for CMS region, owner type, and bed size quartile): catheter-associated urinary tract infections (CAUTIs), <em>Clostridioides difficile</em> infections (CDIs), and central line–associated bloodstream infections (CLABSIs) for the periods 2017 to 2019 and July 1, 2020, to June 30, 2021. Data from January 1 to June 30, 2020, were excluded due to the COVID-19 pandemic.</p></div><div><h3>Results</h3><p>The data set included 244 (73.3%) Joint Commission–accredited and 89 (26.7%) non–Joint Commission–accredited LTCHs. Compared to non–Joint Commission–accredited LTCHs, accredited LTCHs had significantly better (lower) SIRs for CLABSI and CAUTI measures, although no differences were observed for CDI SIRs. There were no significant differences in year trends for any of the HAI measures. For each year of the study period, a greater proportion of Joint Commission–accredited LTCHs performed significantly better than the national benchmark for all three measures (<em>p</em> = 0.04 for CAUTI, <em>p</em> = 0.02 for CDI, <em>p</em> = 0.01 for CLABSI).</p></div><div><h3>Conclusion</h3><p>Although this study was not designed to establish causality, positive associations were observed between Joint Commission accreditation and CLABSI and CAUTI measures, and Joint Commission–accredited LTCHs attained more consistent high performance over the four-year study period for all three measures. Influencing factors may include the focus of Joint Commission standards on infection control and prevention (ICP), including the hierarchical approach to selecting ICP–related standards as inputs into LTCH policy.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 425-434"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139965528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.01.012
Imane Hammana MSc, PhD (is Researcher, Health Technology Assessment Unit, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal.), Marie-Claude Bernier (is Senior Advisor, Respiratory Therapy and Anesthesiology, CHUM.), Sabrine Sahmi (is Senior Advisor, Material Resources Management, CHUM.), Alfons Pomp MD, FRCSC, FACS. (is Professor of Surgery and Director, Health Technology Assessment Unit, CHUM. Please address correspondence to Alfons Pomp)
{"title":"Reusing Single-Use Intermittent Pneumatic Compression Devices to Promote Greenhouse Gas Reduction in Hospitals: A Pilot Study","authors":"Imane Hammana MSc, PhD (is Researcher, Health Technology Assessment Unit, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal.), Marie-Claude Bernier (is Senior Advisor, Respiratory Therapy and Anesthesiology, CHUM.), Sabrine Sahmi (is Senior Advisor, Material Resources Management, CHUM.), Alfons Pomp MD, FRCSC, FACS. (is Professor of Surgery and Director, Health Technology Assessment Unit, CHUM. Please address correspondence to Alfons Pomp)","doi":"10.1016/j.jcjq.2024.01.012","DOIUrl":"10.1016/j.jcjq.2024.01.012","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 456-457"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjq.2024.04.005
David W. Baker MD, MPH, FACP (at the time of this interview recording, was Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety, Oakbrook Terrace, Illinois. Please address correspondence to Scott Williams)
{"title":"Clinician Well-Being and Burnout: Panel Interview with Tait Shanafelt, Lisa Rotenstein, and Christine Sinsky","authors":"David W. Baker MD, MPH, FACP (at the time of this interview recording, was Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety, Oakbrook Terrace, Illinois. Please address correspondence to Scott Williams)","doi":"10.1016/j.jcjq.2024.04.005","DOIUrl":"10.1016/j.jcjq.2024.04.005","url":null,"abstract":"","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 6","pages":"Pages 467-471"},"PeriodicalIF":2.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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