American Journal of Medical Quality最新文献

Quality Improvement and Patient Safety (QIPS) has become an increasingly important area of focus within undergraduate and graduate medical education. A variety of different QIPS curriculums have been developed, but standardization and effectiveness of these curriculums is largely unknown. The authors conducted a scoping review to explore the status of undergraduate and graduate nondegree QIPS curriculum in the United States. A scoping review was performed using The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model as a guide. Two databases were screened from January 2019 to March 2022 to identify relevant articles. Forty-seven articles met eligibility criteria, with most articles (n = 38) focused on graduate medical education. Of those 38, 86.8% (33/38) were developed as curriculum specific to a particular specialty. The article highlights similarities and differences in structure, evaluation metrics, and outcomes, and subsequently offers insight into curriculum components that should help guide standardization of successful curriculum development moving forward.

Patient-reported outcome measures (PROMs), increasingly used for research and quality measurement, are lauded for their potential to improve patient-centered care, both through aggregate reporting and when integrated into clinical practice. However, there are few published studies of the resultant use of PROMs in clinical practice. This case study describes the implementation and use of PROMS in a Midwestern multispecialty medical group orthopedic practice among patients undergoing total knee and hip surgery. Specifically, rates of PROMs use by care teams are tracked over time once made available in the electronic health record. During this time, the orthopedics department achieved a patient PROMS survey response rate of 68% at baseline, 58% 3 months post-surgery, and 55% 12 months post-surgery. However, these data were only accessed by the care teams for fewer than 1% of associated clinical encounters. This suggests that making PROMs available for care team review in the electronic health record, even when coupled with relatively high response rates from patients and departmental leadership support is not enough to encourage integration of PROMs into clinical care for patients. Additional effort is required to identify barriers to PROMs use in clinical care and to test methods to enhance use.

Computerized clinical decision support tools are increasingly necessary and widespread in primary care due to rapidly evolving evidence and shifting clinical guidelines. Clinical pathways are a subtype of clinical decision support tool which aim to link evidence to practice and which require evaluation of benefits and barriers to use to inform user-centered design. The objective was to describe the use and perceived benefits and barriers to evidence-based, disease-specific electronic health record pathways for clinical decision support. Primary care providers at a large integrated health system were surveyed about their use of clinical pathways using an online questionnaire distributed via email in November 2021. Descriptive statistics were estimated and differences in the characteristics and responses by pathway use were assessed using chi-square or Fisher exact tests. The survey response rate was 26% (153/593). There were differences in the response rates between providers by practice type (42% academic versus 54% community; P < 0.001). No difference was found in the demographics of those that used the pathways versus those that did not according to role, age, or length of time in practice. Providers in the academic practice were more likely than those in community practices to have used the pathways. Among providers who used the pathways, 98% agree they have evidence-based information, 98% agree they allow them to take better care of patients, 88% agree they guide clinical-decisions, and 85% agree they save time. The main barrier for those who had used pathways was that they forget about them. Among those who had not used pathways, 35% were unaware that pathways existed. This analysis demonstrates that primary care providers who adopt clinical pathways perceive benefits in several domains. The largest barriers to adoption were that users forgot about pathways or were unaware of them. Future work should focus on dissemination and education, improving tool accessibility, and content optimization to balance complexity with efficiency.

In 2020, the US Department of Veterans Affairs Connecticut Healthcare System began its journey to becoming a high-reliability organization as part of Veterans Affairs efforts to become an enterprise-wide high-reliability organization through the Veterans Health Administration. The initiative was launched to create safe enterprise-wide health care systems and environments with robust continuous process improvements as a method for providing patients with safer and higher quality care. In this article, the authors describe a continuous process improvement initiative aimed at implementing system-wide initiatives along the journey to becoming a high-reliability organization. The initiatives are described from the perspectives of individuals representing staff from the frontline to executive leadership. The authors believe that the processes, strategies, and example initiatives described can be readily adopted and implemented in other health care organizations along the journey to high reliability.

The COVID-19 pandemic exposed the need to more effectively harness and leverage digital tools and technology for remote patient monitoring (RPM). RPM gained great popularity given the need to provide effective, safe, efficient, and remote patient care. RPM is based on noninvasive digital technologies aimed at improving the safety and efficiency of health care delivery. We report on an RPM program in which 200 COVID-19 patients were followed remotely to evaluate the effectiveness in treating and monitoring patients in home settings. We analyzed the inherent risks using mixed methods, including failure mode and effect analysis, a prospective, team-based risk management methodology structured to identify high-risk process system failures before they occur in telemonitoring of remote patients. The RPM saved lives and improved decision-making during the pandemic and helped prevent the health system's collapse. The failure mode and effect analysis-based assessment offers important insights and considerations for evaluating future RPM implementation and direction. RPM solutions are technically feasible, staff friendly, and can achieve high adherence rates. Rigorous and ongoing evaluation of devices and platforms is essential to clarifying their value and guiding national health and insurance health coverage decisions and adoption programs.

Leadership of a multispecialty group practice within a health system recognized in 2015 that population health management requires quality performance improvement and organizational culture change. While blueprints for building successful Accountable Care Organizations (ACOs) exist in the literature, few describe the journey to achieving both shared savings and high quality outcomes achieved by a medical group within an academic health system. Clinician education and engagement, prioritizing prevention and achieving benchmarks, developing supportive roles, more precise documentation of accurate diagnostic coding, and risk stratification constituted the approach. When first participating as an ACO, the medical group built programs and teams to improve quality, while CMS simultaneously changed quality measurements from pay-for-reporting to pay-for-performance. Quality scores initially dipped, though scores have since risen to 98.44% in 2020. Between 2015 and 2017, financial results were more than $10 million below the threshold, while in performance years 2018 to 2020, Northeast Medical Group achieved $24 million in aggregate in shared savings.

The UW Medicine Telehealth Services team developed a comprehensive telehealth Quality Improvement (QI) program founded upon 5 QI pillars: incident reporting, patient experience surveys, patient complaints, peer review, and targeted QI projects. The authors outline the foundation of this QI program, early trends from peer review, patient experience surveys, and telehealth utilization by demographic group. Telehealth quality should be scrutinized with the same rigor applied to in-person care. All health systems should establish a telehealth QI program.

US hospital quality rankings and ratings use disparate methodologies and are weakly correlated. This causes confusion for patients and hospital quality staff. At the authors' institution, a Composite Hospital Quality Index (CHQI) was developed to combine hospital quality ratings. This approach is described and a calculator is shared here for other health systems to explore their performance. Among the US News and World Report Top 50 Hospitals, hospital-specific numeric summary scores were aggregated from the 2021 Centers for Medicare and Medicaid Services (CMS) Hospital Overall Star Rating, the Spring 2021 Leapfrog Safety Grade, and the April 2021 Hospital Consumer Assessment of Healthcare Providers and Systems Star Rating. The CHQI is the hospital-specific sum of the national percentile-rankings across these 3 ratings. In this example, mean (SD) percentiles were as follows: CMS Stars 74 (19), Hospital Consumer Assessment of Healthcare Providers and Systems 63 (19), Leapfrog 65 (24), with mean (SD) CHQI of 202 (49). The CHQI is used at the authors' institution to identify improvement opportunities and ensure that high-quality care is delivered across the health system.