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Emergency Department Return Visits Resulting in Admission: Do They Reflect Quality of Care?
The objective was to evaluate factors that contribute to admission within 72 hours of ED discharge. Each return visit resulting in admission was independently reviewed by 3 physicians. Analysis was by descriptive statistics. Of 45 071 ED discharges, 4.1% returned within 72 hours; 0.96% returned for related reasons and were admitted to wards (91.2%), intensive care units (6.5%), or operating rooms (1.2%). Management was acceptable in 92.6%, suboptimal in 7.4%. Admissions were illness (94.9%), patient (1.6%), and physician related (3.5%). Almost all admissions within 72 hours after ED discharge are illness related, including...
Source: American Journal of Medical Quality - November 1, 2016 Category: Health Management Authors: Cheng, J., Shroff, A., Khan, N., Jain, S. Tags: Articles Source Type: research

The VA Medical Foster Home Program, Ambulatory Care Sensitive Conditions, and Avoidable Hospitalizations
This quality control study analyzes whether the Veterans Administration Medical Foster Home (VA MFH) program has been successful in improving access and effectiveness of ambulatory care. Individuals hospitalized for one or more of 22 adult ambulatory care sensitive conditions were identified. Pre and post comparisons of a specified population of participants in the program were conducted to determine rates of avoidable hospitalizations for 6 months prior to and following MFH enrollment. The overall rate of avoidable hospitalizations declined from 18.5 to 14.9 per 100 enrollees following enrollment. The number of bed days u...
Source: American Journal of Medical Quality - November 1, 2016 Category: Health Management Authors: Pracht, E. E., Levy, C. R., Williams, A., Alemi, F., Williams, A. E. Tags: Articles Source Type: research

Attitudes Toward Collaboration Among Practitioners in Newly Established Medical Homes: A Survey of Nurses, General Practitioners, and Specialists
The objective was to evaluate the attitudes toward collaboration of nurses, general practitioners (GPs), and specialists practicing in newly established Medical Homes (MHs) in Parma Local Health Authority (LHA), Emilia-Romagna region, Italy. The 15-item Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered electronically to 172 physicians (66 GPs, 106 specialists) and 113 nurses practicing in 12 MHs. In all, 191 surveys (45 GPs, 59 specialists, 87 nurses) were completed (67% response rate). The mean total score among nurses (51.5, standard deviation [SD] = 3.7) reflected a significantly (P <...
Source: American Journal of Medical Quality - November 1, 2016 Category: Health Management Authors: Alcusky, M., Ferrari, L., Rossi, G., Liu, M., Hojat, M., Maio, V. Tags: Articles Source Type: research

Partnering With a Family Advisor to Improve Communication in a Pediatric Intensive Care Unit
The objective was to understand why communication between the clinical team and families was not occurring consistently in the pediatric intensive care unit and improve the system using a multidisciplinary improvement team including a family advisor. This improvement project used Lean Six Sigma. The team observed updates and collected documented communication, survey, interview, and focus group data from families and staff. Root causes of failures included lack of assigned responsibility, lack of defined daily update, and lack of a daily communication standard. Process changes were implemented, resulting in an increased me...
Source: American Journal of Medical Quality - November 1, 2016 Category: Health Management Authors: Czulada, L., Leino, P., Willis, T. S. Tags: Articles Source Type: research

Together We Learn: Analyzing the Interprofessional Internal Medicine Residents and Master of Public Health Students Quality Improvement Education Experience
Although the value of interprofessional collaborative education has been promoted, it is unclear how teams of clinical and nonclinical learners perceive this experience. The authors studied an interprofessional quality improvement (QI) curriculum implemented in 2013 integrating internal medicine residents (n = 90) and Master of Public Health (MPH) students (n = 33) at an urban safety net academic medical center. Pre and post curriculum surveys assessed attitudes toward QI and interprofessional education and team performance. Resident attitudes toward learning and engaging in QI work improved at the end of the curriculum. O...
Source: American Journal of Medical Quality - November 1, 2016 Category: Health Management Authors: Gupte, G., Noronha, C., Horny, M., Sloan, K., Suen, W. Tags: Articles Source Type: research

A Multidisciplinary Sepsis Program Enabled by a Two-Stage Clinical Decision Support System: Factors That Influence Patient Outcomes
Sepsis is an inflammatory response triggered by infection, with risk of in-hospital mortality fueled by disease progression. Early recognition and intervention by multidisciplinary sepsis programs may reverse the inflammatory response among at-risk patient populations, potentially improving outcomes. This retrospective study of a sepsis program enabled by a 2-stage sepsis Clinical Decision Support (CDS) system sought to evaluate the program’s impact, identify early indicators that may influence outcomes, and uncover opportunities for quality improvement. Data encompassed 16 527 adult hospitalizations from 2014 and 20...
Source: American Journal of Medical Quality - November 1, 2016 Category: Health Management Authors: Amland, R. C., Haley, J. M., Lyons, J. J. Tags: Articles Source Type: research

AJMQ Newsletter: A New Recipe From CMS--MACRAmoni
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - August 30, 2016 Category: Health Management Authors: Lyles, M. A. Tags: AJMQ Newsletter Source Type: research

Addressing Our Deficiencies in End-of-Life Care: Perspectives From a Resident Physician
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - August 30, 2016 Category: Health Management Authors: Sedhom, R. Tags: Letter to the Editor Source Type: research

Chest Radiographs Immediately After Cardiac Surgery
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - August 30, 2016 Category: Health Management Authors: Parker, R., Doyle, R., Vaja, R. Tags: Letter to the Editor Source Type: research

Burnouts Prevalence Estimations: A House of Cards?
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - August 30, 2016 Category: Health Management Authors: Bianchi, R., Schonfeld, I. S., Laurent, E. Tags: Letter to the Editor Source Type: research

Using Statistical Process Control to Improve Clinical Productivity
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - August 30, 2016 Category: Health Management Authors: Mayberry, M. E. Tags: Q-Tip Source Type: research

Geographic Localization: The Need for Better Reporting and Outcome Selection
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - August 30, 2016 Category: Health Management Authors: Johnson-Martinez, K., Wheeler, R., Clevenger, C., Tomolo, A. Tags: Commentary Source Type: research

Using Organizational Science to Improve the Resident Selection Process: An Outsiders Perspective
(Source: American Journal of Medical Quality)
Source: American Journal of Medical Quality - August 30, 2016 Category: Health Management Authors: Friedman, A. M. Tags: Commentary Source Type: research

Adverse Drug Event Prevention: 2014 Action Plan Conference
Adverse drug events (ADEs) have been highlighted as a national patient safety and public health challenge by the National Action Plan for Adverse Drug Event Prevention (ADE Action Plan), which was released by the Office of Disease Prevention and Health Promotion in August 2014. The following October, the ADE Prevention: 2014 Action Plan Conference provided an opportunity for federal agencies, national experts, and stakeholders to coordinate and collaborate in the initiative to reduce preventable ADEs. The single-day conference included morning plenary sessions focused on the surveillance, evidence-based prevention, incenti...
Source: American Journal of Medical Quality - August 30, 2016 Category: Health Management Authors: Ducoffe, A. R., Baehr, A., Pena, J. C., Rider, B. B., Yang, S., Hu, D. J. Tags: Articles Source Type: research

A Model of Regulatory Alignment to Enhance the Long-Term Care Survey Process in a Veterans Health Care Network
Regulatory oversight aims to promote quality of care in US nursing homes. A survey of long-term care (LTC) inspection practices in a Veterans Administration network in 2006 revealed great variability in monitoring and reporting processes, with opportunities for improvement. Modern organization theory and the PARIHS Implementation Framework provide a model for process improvement to enhance oversight for LTC facilities. Over a 3-year time frame, 6 facility inspection teams utilized a modified Delphi approach to arrive at and adopt a standardized structured inspection process. In the 2 districts where 10 facility contracts w...
Source: American Journal of Medical Quality - August 30, 2016 Category: Health Management Authors: Powers, J. S., Preshong, M., Smith, P. Tags: Articles Source Type: research