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AJMQ Newsletter
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Johnson, H., Nagy, P. Tags: Articles Source Type: research

Does Laboratory Testing Decrease During Scheduled Downtime of an Electronic Order Entry System?
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Lipitz-Snyderman, A., Atoria, C. L., Kumar, C., Gendron, M., Killen, A. Tags: Articles Source Type: research

Implementation of a Standardized Sign-Out in the Post-Anesthesia Care Unit
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Bettner, W., Dorbad, M., Gentle, J., Hart, B. Tags: Articles Source Type: research

Training for Identity, Not Behavior, in Quality and Safety
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Leslie, M., Pronovost, P. J. Tags: Articles Source Type: research

Access to Outpatient Specialty Care: Solutions From an Integrated Health Care System
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Kirsh, S., Su, G. L., Sales, A., Jain, R. Tags: Articles Source Type: research

Changing Resident Test Ordering Behavior: A Multilevel Intervention to Decrease Laboratory Utilization at an Academic Medical Center
Hospital laboratory test volume is increasing, and overutilization contributes to errors and costs. Efforts to reduce laboratory utilization have targeted aspects of ordering behavior, but few have utilized a multilevel collaborative approach. The study team partnered with residents to reduce unnecessary laboratory tests and associated costs through multilevel interventions across the academic medical center. The study team selected laboratory tests for intervention based on cost, volume, and ordering frequency (complete blood count [CBC] and CBC with differential, common electrolytes, blood enzymes, and liver function tes...
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Vidyarthi, A. R., Hamill, T., Green, A. L., Rosenbluth, G., Baron, R. B. Tags: Articles Source Type: research

Impact of Electronic Health Record Clinical Decision Support on the Management of Pediatric Obesity
This study assessed the impact of electronic health record–based clinical decision support in improving the diagnosis and management of pediatric obesity. The study team programmed a point-of-care alert linked to a checklist and standardized documentation templates to appear during health maintenance visits for overweight/obese children in an outpatient teaching clinic and compared outcomes through medical record reviews of 574 (287 control and 287 intervention) visits. The results demonstrated a statistically significant increase in the diagnosis of overweight/obesity, scheduling of follow-up appointments, frequency...
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Shaikh, U., Berrong, J., Nettiksimmons, J., Byrd, R. S. Tags: Articles Source Type: research

A Multifaceted Quality Improvement Program Improves Endotracheal Tube Confirmation Documentation in the Emergency Department
Confirmation of endotracheal tube (ETT) position is an essential part of emergency department (ED) airway care. The study team evaluated the effect of a multifaceted quality improvement initiative on improving confirmation documentation rates. Rates of documentation of appropriate methods of ETT position confirmation were better for patients undergoing ETT placement in the study site ED than for those arriving already intubated (103/127 [81.1%] vs 19/71 [26.8%]; relative risk [RR] = 3.03; 95% confidence interval [CI] = 2.04 to 4.49). Overall rates of documentation of appropriate methods of ETT position confirmation were hi...
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Phelan, M. P., Hustey, F. M., Glauser, J. M., Bena, J. Tags: Articles Source Type: research

Do Hospitals Without Physicians on the Board Deliver Lower Quality of Care?
This study examines whether hospitals without physician participation on their boards of directors deliver lower quality of care. Using data from California nonprofit hospitals from 2004 to 2008, the authors document that the absence of physicians on the board is associated with a decrease of 3 to 5 percentage points in 3 of 4 measures of care quality. This result was obtained using regression analysis, which controls for various hospital characteristics. The authors also identify factors that influence quality of care in hospitals. Specifically, hospital size, church affiliation, urban location, and system affiliation are...
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Bai, G., Krishnan, R. Tags: Articles Source Type: research

Validity of ICD-9-CM Codes for the Identification of Complications Related to Central Venous Catheterization
Two complications of central venous catheterization (CVC), iatrogenic pneumothorax and central line–associated bloodstream infection (CLABSI), have dedicated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Despite increasing use of ICD-9-CM codes for research and pay-for-performance purposes, their validity for detecting complications of CVC has not been established. Complications of CVCs placed between July 2010 and December 2011 were identified by ICD-9-CM codes in discharge records from a single hospital and compared with those revealed by medical record abstractio...
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Tukey, M. H., Borzecki, A. M., Wiener, R. S. Tags: Articles Source Type: research

Improving Service Quality in Primary Care
A framework for improving health care service quality was implemented at a 12-provider family medicine practice in 2010. A national patient satisfaction research vendor conducted weekly telephone surveys of 840 patients served by that practice: 280 patients served in 2009, and 560 served during 2010 and 2011. After the framework was implemented, the proportion of "excellent" ratings of provider service (the highest rating on a 5-point scale) increased by 5% to 9%, most notably thoroughness (P = .04), listening (P = .04), and explaining (P = .04). Other improvements included prompt test result notification and telephone sta...
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Kennedy, D. M., Nordrum, J. T., Edwards, F. D., Caselli, R. J., Berry, L. L. Tags: Articles Source Type: research

Discharge Huddle Outfitted With Mobile Technology Improves Efficiency of Transitioning Stroke Patients Into Follow-Up Care
Disjointed patient care is a well-documented problem in health care systems, often stemming from poor communication between providers, services, and follow-up care resources. A multidisciplinary discharge huddle, augmented with cellular and tablet technology, was implemented on the Neurology Stroke Service to facilitate multidisciplinary communication, improve transition of patients, and increase referrals into affiliated follow-up care. After initiating the huddle, patient length of stay decreased by 1.4 days (25%), patient flow into continuum partners increased by 10%, and the number of patients going without services af...
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Tielbur, B. R., Rice Cella, D. E., Currie, A., Roach, J. D., Mattingly, B., Boone, J., Watwood, C., McGauran, A., Kirshner, H. S., Charles, P. D. Tags: Articles Source Type: research

Incorporating Discrete Event Simulation Into Quality Improvement Efforts in Health Care Systems
This article describes how to incorporate DES into QI departments and programs in order to support QI efforts, develop high-fidelity simulation models, conduct experiments, make recommendations, and support adoption of results. The authors describe how DES-enabled QI teams can partner with clinical services and administration to plan, conduct, and sustain QI investigations. (Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Rutberg, M. H., Wenczel, S., Devaney, J., Goldlust, E. J., Day, T. E. Tags: Articles Source Type: research

Outcome of Adverse Events and Medical Errors in the Intensive Care Unit: A Systematic Review and Meta-analysis
Adverse events and medical errors (AEs/MEs) are more likely to occur in the intensive care unit (ICU). Information about the incidence and outcomes of such events is conflicting. A systematic review and meta-analysis were conducted to examine the effects of MEs/AEs on mortality and hospital and ICU lengths of stay among ICU patients. Potentially eligible studies were identified from 4 major databases. Of 902 studies screened, 12 met the inclusion criteria, 10 of which are included in the quantitative analysis. Patients with 1 or more MEs/AEs (vs no MEs/AEs) had a nonsignificant increase in mortality (odds ratio = 1.5; 95% ...
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Ahmed, A. H., Giri, J., Kashyap, R., Singh, B., Dong, Y., Kilickaya, O., Erwin, P. J., Murad, M. H., Pickering, B. W. Tags: Articles Source Type: research

Impact of an EHR-Based Diabetes Management Form on Quality and Outcomes of Diabetes Care in Primary Care Practices
This study assessed the impact of a diabetes management form (DMF), accessible within an electronic health record. From 2007 to 2009, 2108 diabetes patients were seen in 20 primary care practices; 1103 visits involved use of the DMF in 2008. The primary outcome was "optimal care": HbA1c ≤8%, low-density lipoprotein (LDL) cholesterol <100 mg/dL, blood pressure <130/80 mm Hg, not smoking, and aspirin prescription in patients ≥40 years. After adjusting for number of visits, age, sex, and insulin use, DMF-exposed patients showed less improvement in attaining "optimal care" (estimated difference-in-difference [DID] ...
Source: American Journal of Medical Quality - January 14, 2015 Category: Health Management Authors: Herrin, J., da Graca, B., Aponte, P., Stanek, H. G., Cowling, T., Fullerton, C., Hollander, P., Ballard, D. J. Tags: Articles Source Type: research