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Quality Improvement Initiatives (quality + improvement_initiative)
Selected AbstractsEffectiveness of a Multidisciplinary Quality Improvement Initiative in Reducing Door-to-Balloon Times in Primary AngioplastyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2004F.A.C.C., STUART W. ZARICH M.D. Primary angioplasty (PA) for acute myocardial infarction (AMI) has emerged as the standard of care in hospitals with cardiac interventional facilities. The benefits from the PA are time dependent, but recent data raise concerns regarding the timeliness of delivery of care in AMI and the level of benefit achieved by current standards. We assessed the effectiveness of an extensive multidisciplinary quality improvement initiative in reducing door-to-balloon (DTB) times in PA. The PA process was divided into six separate time periods, which were assessed individually. Subsequent quality initiatives resulted in a dramatic reduction in the mean DTB time (141.3 minutes preintervention compared to 95.1 minutes postintervention; P < 0.001). [source] Guideline Implementation Research: Exploring the Gap between Evidence and Practice in the CRUSADE Quality Improvement InitiativeACADEMIC EMERGENCY MEDICINE, Issue 11 2007Andra L. Blomkalns MD Translating research results into routine clinical practice remains difficult. Guidelines, such as the 2002 American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Unstable Angina and non-ST-segment elevation myocardial infarction, have been developed to provide a streamlined, evidence-based approach to patient care that is of high quality and is reproducible. The Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation (CRUSADE) Quality Improvement Initiative was developed as a registry for non,ST-segment elevation acute coronary syndromes to track the use of guideline-based acute and discharge treatments for hospitalized patients, as well as outcomes associated with the use of these treatments. Care for more than 200,000 patients at more than 400 high-volume acute care hospitals in the United States was tracked in CRUSADE, with feedback provided to participating physicians and hospitals regarding their performance over time and compared with similar institutions. Such access to data has proved important in stimulating improvements in non,ST-segment elevation acute coronary syndromes care at participating hospitals for delivery of acute and discharge guideline-based therapy, as well as improving outcomes for patients. Providing quality improvement methods such as protocol order sets, continuing education programs, and a CRUSADE Quality Improvement Initiative toolbox serve to actively stimulate physician providers and institutions to improve care. The CRUSADE Initiative has also proven to be a fertile source of research in translation of treatment guidelines into routine care, resulting in more than 52 published articles and 86 abstracts presented at major emergency medicine and cardiology meetings. The cycle for research of guideline implementation demonstrated by CRUSADE includes four major steps,observation, intervention, investigation, and publication,that serve as the basis for evaluating the impact of any evidence-based guideline on patient care. Due to the success of CRUSADE, the American College of Cardiology combined the CRUSADE Initiative with the National Registry for Myocardial Infarction ST-segment elevation myocardial infarction program to form the National Cardiovascular Data Registry,Acute Coronary Treatment & Intervention Outcomes Network Registry beginning in January 2007. [source] Effectiveness of a Multidisciplinary Quality Improvement Initiative in Reducing Door-to-Balloon Times in Primary AngioplastyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2004F.A.C.C., STUART W. ZARICH M.D. Primary angioplasty (PA) for acute myocardial infarction (AMI) has emerged as the standard of care in hospitals with cardiac interventional facilities. The benefits from the PA are time dependent, but recent data raise concerns regarding the timeliness of delivery of care in AMI and the level of benefit achieved by current standards. We assessed the effectiveness of an extensive multidisciplinary quality improvement initiative in reducing door-to-balloon (DTB) times in PA. The PA process was divided into six separate time periods, which were assessed individually. Subsequent quality initiatives resulted in a dramatic reduction in the mean DTB time (141.3 minutes preintervention compared to 95.1 minutes postintervention; P < 0.001). [source] Invest now to save later: The need for a national quality improvement initiative to reduce the costs of liver transplantation in childrenPEDIATRIC TRANSPLANTATION, Issue 2 2008P. R. Salvalaggio No abstract is available for this article. [source] Improving the Quality of Workers' Compensation Health Care Delivery: The Washington State Occupational Health Services ProjectTHE MILBANK QUARTERLY, Issue 1 2001Thomas M. Wickizer Researchers and health policy analysts in Washington State set out to determine the extent to which administrative process changes and delivery system interventions within workers' compensation affect quality and health outcomes for injured workers. This research included a pilot project to study the effects of providing occupationally focused health care through managed care arrangements on health outcomes, worker and employer satisfaction, and medical and disability costs. Based on the results, a new initiative was developed to incorporate several key delivery system components. The Washington State experience in developing a quality improvement initiative may have relevance for health care clinicians, administrators, policymakers, and researchers engaged in similar pursuits within the general medical care arena. [source] Tobacco Screening Multicomponent Quality Improvement Network Program: Beyond EducationACADEMIC EMERGENCY MEDICINE, Issue 11 2009Sharon Kimmel PhD Abstract Objectives:, Due to the addictive nature of the disease and interrelated societal influences on the behavior of tobacco use, repeated interventions are often required before people successfully stop using tobacco. Our objective was to implement a multicomponent clinical intervention initiative enabling health care providers to effectively screen for tobacco use. We also sought to describe changes in emergency medicine providers' documentation of cessation advice to tobacco users. Methods:, The intervention was conducted at three emergency departments (EDs) and four clinics at a community-based teaching hospital and health network. Health care providers with the opportunity to identify and counsel tobacco-using patients in ambulatory health care settings were the study population. The authors initiated a quality improvement initiative for tobacco screening that employed a multicomponent strategy to facilitate systemic changes that support 100% tobacco use identification, documentation, and counseling. Baseline, posteducation, and post,wrap-around documented screening rates were compared within each site across the intervention. Cumulative ED baseline, posteducation, and post,wrap-around rates of provider advice to tobacco users were compared across the intervention. Percentage of possible available gain was calculated in consideration of a 100% ceiling effect. Statistical analysis was performed using SPSS and MetStat. Descriptive statistics and Pearson's chi-square cell frequency were used to analyze and compare sites. Fisher's exact test was used to compare those tests with a chi-square cell frequency of five or less. The statistical tests used for pre-/postintervention percentage comparisons by site had power between 80% and 90%, detecting differences of 10% and 20% or more at a 0.05 level of significance. Results:, Significant increases in posteducation screening rates for all ED sites complemented significant increases in ED post,wrap-around intervention screening rates. Significant increases in ED provider documented cessation advice were also noted. Conclusions:, This initiative successfully changed tobacco screening behavior of health care providers at all sites. It was particularly successful in the ED, typically an environment less likely to be conducive to preventive health interventions. [source] Door-to-Balloon Time: Performance Improvement in the Multidisciplinary Treatment of Myocardial InfarctionJOURNAL FOR HEALTHCARE QUALITY, Issue 4 2010J. Mark Peterman Abstract: The treatment of ST-elevation myocardial infarction with primary percutaneous coronary intervention is a time-sensitive process, with outcomes correlated with the speed with which the healthcare team can make the diagnosis, start preliminary treatment, and successfully perform the intervention. This requires multidisciplinary teamwork involving Emergency Medical Services, Emergency Medicine and Nursing, the cardiac catheterization laboratory team, and interventional cardiology. The success of effectively delivering treatment is enhanced through focused analysis of key steps within the care process to identify systems problems and implement quality improvement initiatives. This article reviews the process whereby our institution achieved top decile performance in this multidisciplinary treatment. [source] Interview with a Quality Leader: Dale W. Bratzler, DO, MPH on Performance MeasuresJOURNAL FOR HEALTHCARE QUALITY, Issue 2 2010Jason Trevor Fogg Abstract: Dale Bratzler, DO, MPH, currently serves as the President and CEO of the Oklahoma Foundation for Medical Quality (OFMQ). In addition, he provides support as the Medical Director of the Patient Safety Quality Improvement Organization Support Center at OFMQ. In these roles, he provides clinical and technical support for local and national hospital quality improvement initiatives. He is a Past President of the American Health Quality Association and a recent member of the National Advisory Council for the Agency for Healthcare Research and Quality. Dr. Bratzler has published extensively and frequently presents locally and nationally on topics related to healthcare quality, particularly associated with improving care for pneumonia, increasing vaccination rates, and reducing surgical complications. He received his Doctor of Osteopathic Medicine degree at the Kansas City University of Medicine and Biosciences, and his Master of Public Health degree from the University of Oklahoma Health Sciences Center College of Public Health. Dr. Bratzler is board certified in internal medicine. [source] Administrative claims data analysis of nurse practitioner prescribing for older adultsJOURNAL OF ADVANCED NURSING, Issue 10 2009Andrea L. Murphy Abstract Title.,Administrative claims data analysis of nurse practitioner prescribing for older adults. Aim., This paper is a report of a study to identify the patterns of prescribing by primary health care nurse practitioners for a cohort of older adults. Background., The older adult population is known to receive complex pharmacotherapy. Monitoring prescribing to older adults can inform quality improvement initiatives. In comparison to other countries, research examining nurse practitioner prescribing in Canada is limited. Nurse practitioner prescribing for older adults is relatively unexplored in the international literature. Although commonly used to study physician prescribing, few studies have used claims data from drug insurance programmes to investigate nurse practitioner prescribing. Method., Drug claims for prescriptions written by nurse practitioners from fiscal years 2004/05 to 2006/07 for beneficiaries of the Nova Scotia Seniors' Pharmacare programme were analysed. Data were retrieved and analysed in May 2008. Prescribing was described for each drug using the World Health Organization Anatomical Therapeutic Chemical code classification system by usage and costs for each fiscal year. Results., Antimicrobials and non-steroidal anti-inflammatory drugs consistently represented the top ranked groups for prescription volume and cost. Over the three fiscal years, antimicrobial prescription rates declined relative to rates of other groups of medications. Prescription volume per nurse doubled and cost per prescription increased by approximately 20%. Conclusion., Prescription claims data can be used to characterize the prescribing trends of nurse practitioners. Research linking patient characteristics, including diagnoses, to prescriptions is needed to assess prescribing quality. Some potential areas of improvement were identified with antimicrobial and non-steroidal anti-inflammatory selection. [source] Implementing bedside handover: strategies for change managementJOURNAL OF CLINICAL NURSING, Issue 17-18 2010Anne McMurray Aims and objectives., To identify factors influencing change in two hospitals that moved from taped and verbal nursing handover to bedside handover. Background., Bedside handover is based on patient-centred care, where patients participate in communicating relevant and timely information for care planning. Patient input reduces care fragmentation, miscommunication-related adverse events, readmissions, duplication of services and enhances satisfaction and continuity of care. Design., Analysing change management was a component of a study aimed at developing a standard operating protocol for bedside handover communication. The research was undertaken in two regional acute care hospitals in two different states of Australia. Method., Data collection included 532 semi-structured observations in six wards in the two hospitals and 34 in-depth interviews conducted with a purposive sample of nursing staff involved in the handovers. Observation and interview data were analysed separately then combined to generate thematic analysis of factors influencing the change process in the transition to bedside handover. Results and conclusion., Themes included embedding the change as part of the big picture, the need to link the project to standardisation initiatives, providing reassurance on safety and quality, smoothing out logistical difficulties and learning to listen. We conclude that change is more likely to be successful when it is part of a broader initiative such as a quality improvement strategy. Relevance to clinical practice., Nurses are generally supportive of quality improvement initiatives, particularly those aimed at standardising care. For successful implementation, change managers should be mindful of clinicians' attitudes, motivation and concerns and their need for reassurance when changing their practice. This is particularly important when change is dramatic, as in moving from verbal handover, conducted in the safety of the nursing office, to bedside handover where there is greater transparency and accountability for the accuracy and appropriateness of communication content and processes. [source] Consumer input into standards revision: changing practiceJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2007G. BEAL rn phd cpmhn(c) As part of ongoing quality improvement initiatives, the Canadian Standards for Psychiatric-Mental Health Nursing were recently revised. For the first time since the standards were published in 1995, the input of consumers of mental health services was sought. Thirty-one consumers from across Canada participated in focus groups, and answered questions related to the domains of practice as identified in the standards document. Through this input, consumers were able to inform the committee regarding areas of satisfaction and dissatisfaction from their unique perspective. Through this article, the process of consumer collaboration is illustrated in relation to how it shaped Standards revision, and finally how it affected the practitioners involved. [source] Improving the quality of processing gastric cancer specimens: The pathologist's perspective,JOURNAL OF SURGICAL ONCOLOGY, Issue 3 2010Alyson L. Mahar BSc Abstract Background and Objectives Research into surgeon and pathologist knowledge of guidelines for lymph node (LN) assessment in gastric cancer demonstrated a knowledge deficit. To understand factors affecting optimal assessment we surveyed pathologists to identify external barriers. Methods Pathologists were identified using two Ontario physician databases and surveyed online or by mail, with a 40% response rate. Results The majority (56%) of pathologists stated assessing an additional five LNs would not be a burden. Most (80%) pathologists disagreed with pay for performance for achieving quality standards. Qualitative analysis determined the majority of pathologists believed achieving quality standards was inherent to their profession and should not require incentives. Poor surgical specimen was identified as a barrier and underscores the importance of aiming quality improvement initiatives at the multidisciplinary team. Conclusion In addition to education, tailoring an intervention to address all barriers, including laboratory constraints may be an effective means of improving gastric cancer care. J. Surg. Oncol. 2010; 101:195,199. © 2010 Wiley-Liss, Inc. [source] Improving genetic health care: A Northern New England pilot project addressing the genetic evaluation of the child with developmental delays or intellectual disability,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 3 2009John B. Moeschler Abstract In 2006, all clinical genetics practices in Northern New England (Vermont, New Hampshire, and Maine) formed a learning collaborative with the purpose of improving genetic health care and outcomes. This article describes the current status of this effort. The methodology is based on our own modifications of the Institute of Healthcare Improvement "Breakthrough Series" and the Northern New England Cystic Fibrosis Consortium. Because of similarities across practices and the availability of existing published practice parameters, the clinical genetics evaluation of the child with developmental delay or intellectual disability was chosen as the topic to be studied. The aim was to improve the rate of etiological diagnosis of those with developmental delays referred to each genetics center by improving the processes of care. Process and outcomes were evaluated. Four of five sites also evaluated the impact of array comparative genomic hybridization (a-CGH) laboratory testing of such patients. There was significant site-to-site variation in the rate of new diagnoses by a-CGH with the average new diagnosis rate of 11.8% (range 5.4,28.8%). Barriers to implementation of the process and outcome data collection and analysis were significant and related to time pressures, lack of personnel or staff to support this activity, and competing quality improvement initiatives at the institutional home of some genetics centers. © 2009 Wiley-Liss, Inc. [source] Knowledge management and communities of practice in the private sector: lessons for modernizing the National Health Service in England and WalesPUBLIC ADMINISTRATION, Issue 4 2002S.P. Bate The National Health Service (NHS) in England and Wales has embarked upon a radical and far,reaching programme of change and reform. However, to date the results of organizational quality and service improvement initiatives in the public sector have been mixed, if not to say disappointing, with anticipated gains often failing to materialize or to be sustained in the longer term. This paper draws on the authors' recent extensive research into one of the principal methodologies for bringing about the sought after step change in the quality of health care in England and Wales. It explores how private sector knowledge management (KM) concepts and practices might contribute to the further development of public sector quality improvement initiatives in general and to the reform of the NHS in particular. Our analysis suggests there have been a number of problems and challenges in practice, not least a considerable naïvety around the issue of knowledge transfer and ,knowledge into practice' within health care organizations. We suggest four broad areas for possible development which also have important implications for other public sector organizations. [source] Neuroimaging for Pediatric Head Trauma: Do Patient and Hospital Characteristics Influence Who Gets Imaged?ACADEMIC EMERGENCY MEDICINE, Issue 7 2010Rebekah Mannix MD ACADEMIC EMERGENCY MEDICINE 2010; 17:694,700 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to identify patient, provider, and hospital characteristics associated with the use of neuroimaging in the evaluation of head trauma in children. Methods:, This was a cross-sectional study of children (,19 years of age) with head injuries from the National Hospital Ambulatory Medical Care Survey (NHAMCS) collected by the National Center for Health Statistics. NHAMCS collects data on approximately 25,000 visits annually to 600 randomly selected hospital emergency and outpatient departments. This study examined visits to U.S. emergency departments (EDs) between 2002 and 2006. Multivariable logistic regression was used to analyze characteristics associated with neuroimaging in children with head injuries. Results:, There were 50,835 pediatric visits in the 5-year sample, of which 1,256 (2.5%, 95% confidence interval [CI] = 2.2% to 2.7%) were for head injury. Among these, 39% (95% CI = 34% to 43%) underwent evaluation with neuroimaging. In multivariable analyses, factors associated with neuroimaging included white race (odds ratio [OR] = 1.5, 95% CI = 1.02 to 2.1), older age (OR = 1.3, 95% CI = 1.1 to 1.5), presentation to a general hospital (vs. a pediatric hospital, OR = 2.4, 95% CI = 1.1 to 5.3), more emergent triage status (OR = 1.4, 95% CI = 1.1 to 1.8), admission or transfer (OR = 2.7, 95% CI = 1.4 to 5.3), and treatment by an attending physician (OR = 2.0, 95% CI = 1.1 to 3.7). The effect of race was mitigated at the pediatric hospitals compared to at the general hospitals (p < 0.001). Conclusions:, In this study, patient race, age, and hospital-specific characteristics were associated with the frequency of neuroimaging in the evaluation of children with closed head injuries. Based on these results, focusing quality improvement initiatives on physicians at general hospitals may be an effective approach to decreasing rates of neuroimaging after pediatric head trauma. [source] | ||||||||||