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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 25 of 541 Research Studies Displayed
Schnipper JL, Reyes Nieva H, Yoon C
What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study.
The objective of this study was to assess the association of patient exposure to system-level intervention and receipt based on the results of the second Multicenter Medication Reconciliation Quality Improvement Study, which demonstrated a marked reduction in medication discrepancies per patient. Researchers conducted an on-treatment analysis of system-level interventions at 17 North American hospitals. The patient-level interventions most associated with discrepancy reductions were receipt of a best-possible medication history of admitted patients in the ED and admission and discharge medication reconciliation by a trained clinician. System-level interventions were also associated with a minor reduction in discrepancies for the average patient. The researchers concluded that these findings might be used to help hospitals and health systems prioritize interventions to improve medication safety during care transitions.
Citation: Schnipper JL, Reyes Nieva H, Yoon C . What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study. BMJ Qual Saf 2023 Aug; 32(8):457-69. doi: 10.1136/bmjqs-2022-014806..
Keywords: Medication, Medication: Safety, Quality Improvement, Quality of Care, Patient Safety, Hospital Discharge
Silver CM, Yang AD, Shan Y
Changes in surgical outcomes in a Statewide Quality Improvement Collaborative with introduction of simultaneous, comprehensive interventions.
Researchers investigated whether a comprehensive quality improvement program implemented simultaneously across hospitals at the formation of a quality improvement collaborative (QIC) would improve patient outcomes. They analyzed risk-adjusted rates of postoperative morbidity and mortality for patients who had undergone surgery at hospitals in the Illinois Surgical Quality Improvement Collaborative (ISQIC); analyses compared ISQIC hospitals with hospitals in the NSQIP Participant Use File (PUF). Although complication rates decreased at both ISQIC and PUF hospitals, findings showed that participation in ISQIC was associated with a significantly greater improvement in death or serious morbidity. The researchers concluded that these results emphasize the potential of QICs to improve patient outcomes.
Citation: Silver CM, Yang AD, Shan Y . Changes in surgical outcomes in a Statewide Quality Improvement Collaborative with introduction of simultaneous, comprehensive interventions. J Am Coll Surg 2023 Jul 1; 237(1):128-38. doi: 10.1097/xcs.0000000000000679..
Keywords: Surgery, Outcomes, Quality Improvement, Quality of Care, Hospitals
Smith DC, Phillippi JC, Tilden EL
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
The objective of this study was to describe the application and utility of the World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) to compare hospital-level cesarean births rates for use in quality improvement and benchmarking. The authors conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from births from 2002-08 at 12 sites across the US. Results showed a variation in use of cesarean birth, labor induction, and trial of labor after cesarean (TOLAC) across the 12 sites. The authors concluded that TGCS provides a method for between-hospital comparisons and adoption of TGCS in the US would provide an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.
Citation: Smith DC, Phillippi JC, Tilden EL . Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking. J Perinat Neonatal Nurs 2023 Jul-Sep; 37(3):214-22. doi: 10.1097/jpn.0000000000000670..
Keywords: Hospitals, Healthcare Utilization, Maternal Care, Women, Quality Improvement, Quality Measures, Quality of Care
Stierman EK, O'Brien BT, Stagg J
AHRQ Author: Fabiyi CA, Chew E, Harding B, Mistry KB
Statewide perinatal quality improvement, teamwork, and communication activities in Oklahoma and Texas.
The objective of this study was to describe perinatal quality improvement activities, specifically the implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles and use of teamwork and communication tools in obstetric units. Researchers conducted a survey of AIM-enrolled hospitals in Oklahoma and Texas and gathered data on obstetric unit organization and QI processes. Their findings showed that adoption of QI processes varied and also highlighted the need to reinforce support for rural obstetric units, which often face greater barriers to implementing patient safety and QI processes than urban units. The researchers concluded that this has implications for implementing future perinatal QI initiatives.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Stierman EK, O'Brien BT, Stagg J . Statewide perinatal quality improvement, teamwork, and communication activities in Oklahoma and Texas. Qual Manag Health Care 2023 Jul-Sep; 32(3):177-88. doi: 10.1097/qmh.0000000000000407..
Keywords: Quality Improvement, Teams, Communication, Maternal Care, Quality of Care
Griesemer I, Birken SA, Rini C
Mechanisms to enhance racial equity in health care: developing a model to facilitate translation of the ACCURE intervention.
The purpose of this study was to explore the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) program, which altered systems of care at two United States cancer centers and eliminated the Black-White racial disparity in treatment completion in patients with early-stage breast and lung cancer. The study objective was to identify and document critical characteristics of ACCURE to enable translation of the intervention to other care settings. The researchers conducted semi-structured interviews with 18 participants who were involved in the design and implementation of ACCURE. The study found that participants described transparency and accountability as mechanisms of change that were operationalized through ACCURE's key features. Intervention features were designed to improve either institutional transparency or accountability of the care system to community values and patient needs for minimally biased, tailored communication, and support.
Citation: Griesemer I, Birken SA, Rini C . Mechanisms to enhance racial equity in health care: developing a model to facilitate translation of the ACCURE intervention. SSM Qual Res Health 2023 Jun; 3:100204. doi: 10.1016/j.ssmqr.2022.100204..
Keywords: Racial and Ethnic Minorities, Disparities, Quality Improvement, Quality of Care
Lindner SR, Balasubramanian B, Marino M
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
The purpose of this study was to estimate decreases in 10-year atherosclerotic cardiovascular disease (ASCVD) risk associated with EvidenceNOW, an initiative spanning multiple states that sought to improve cardiovascular preventive care by providing supportive interventions such as practice facilitation to address the “ABCS”: (A)spirin for high-risk patients, (B)lood pressure control for hypertensive people, (C)holesterol management, and (S)moking screening and cessation counseling. The researchers conducted an analytic modeling study that combined 1) data from 1,278 EvidenceNOW practices collected from 2015 to 2017; (2) patient-level information of 1,295 individuals who participated in the 2015 to 2016 National Health and Nutrition Examination Survey; and (3) 10-year ASCVD risk prediction equations. The study found the average 10-year ASCVD risk of these patients before intervention was 10.11%. Improvements in ABCS due to EvidenceNOW reduced their 10-year ASCVD risk to 10.03% which would prevent 3,169 ASCVD events over 10 years and $150 million in 90-day direct medical costs.
Citation: Lindner SR, Balasubramanian B, Marino M . Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW. J Am Board Fam Med 2023 May 8; 36(3):462-76. doi: 10.3122/jabfm.2022.220331R1..
Keywords: Cardiovascular Conditions, Primary Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Blood Pressure
Quigley DD, Slaughter ME, Qureshi N
Associations of pediatric nurse burnout with involvement in quality improvement.
The purpose of this study was to explore the relationships of inpatient pediatric nurse burnout with their perceptions on the importance of quality at the hospital, and with patient experience measurement, quality improvement (QI), unit culture, and staffing. The researchers implemented a cross-sectional study at an urban children's hospital and surveyed pediatric nurses about their perceptions including the Maslach Burnout Inventory. The study found that 27% of pediatric nurses reported burnout. Nurses who possessed greater confidence in patient experience measurement, received frequent patient experience performance reports, felt included in QI, and experienced QI efforts as integrated into patient care reported not being burned out when compared to those reporting burnout. Higher levels of open communication among nurses and unit-level teamwork were also related with lack of burnout, and a higher QI workload was related with burnout.
Citation: Quigley DD, Slaughter ME, Qureshi N . Associations of pediatric nurse burnout with involvement in quality improvement. J Pediatr Nurs 2023 May-Jun; 70:e9-e16. doi: 10.1016/j.pedn.2022.11.001..
Keywords: Children/Adolescents, Burnout, Provider: Nurse, Quality Improvement, Quality of Care
Chandanabhumma PP, Zhou S, Fetters MD
Expanding our methodological toolbox to improve quality: the role of mixed-methods evaluations.
This article discusses ways that using mixed-methods studies can enhance quality improvement interventions instead of relying solely on quantitative evidence. Mixed-methods design helped to advance an evidence-based, customizable infection prevention toolkit for durable left ventricular assist device therapy. Strengths of using mixed-methods studies include: (1) the use of qualitative research methodologies (eg, eliciting patient or clinician perspectives on barriers and facilitators of best practices) and (2) integrating qualitative and quantitative data and analyses to understand more fully effective strategies for achieving optimal care and outcomes for these patients across diverse settings. The study: 1) used quantitative clinical data merged with Medicare claims to evaluate interhospital variability in the incidence of infection; 2) used qualitative methods to understand local practice patterns across low- and high-performing centers; and 3) integrated both data sources to gain a comprehensive understanding of the overall findings.
Citation: Chandanabhumma PP, Zhou S, Fetters MD . Expanding our methodological toolbox to improve quality: the role of mixed-methods evaluations. Circ Cardiovasc Qual Outcomes 2023 May; 16(5):e009629. doi: 10.1161/circoutcomes.122.009629..
Keywords: Research Methodologies, Quality Improvement, Quality of Care
McHugh M, Philbin S, Carroll AJ
An approach to evaluating multisector partnerships to support evidence-based quality improvement in primary care.
This study’s goal was to describe an approach for evaluating the development and effectiveness of a multisector partnership using data from the first year of the Healthy Hearts for Michigan (HH4M) Cooperative, a multisector partnership of nine organizations tasked with designing and implementing evidence-based QI strategies for hypertension management and tobacco cessation in 50 rural primary care practices. A 49-item survey focused on factors that facilitate or hinder multisector partnerships, drawing on implementation science and partnership, engagement, and collaboration research was developed. All 44 members of the HH4M Cooperative (79.5% response rate) were surveyed, interviews conducted with 14 members. Having a clear purpose and trust and respect among members were the strengths reported. A need for common terminology, clarification of roles and functions, and improvement in communication across workgroups were areas for improvement. The Cooperative’s biggest challenge was the lack of engagement from physician practices due to capacity constraints, exacerbated by the COVID-19 pandemic.
Citation: McHugh M, Philbin S, Carroll AJ . An approach to evaluating multisector partnerships to support evidence-based quality improvement in primary care. Jt Comm J Qual Patient Saf 2023 Apr;49(4):199-206. doi: 10.1016/j.jcjq.2023.01.002.
Keywords: Quality Improvement, Evidence-Based Practice, Primary Care, Quality of Care, Patient-Centered Outcomes Research
Bilimoria KY, McGee MF, Williams MV
Development of the Illinois Surgical Quality Improvement Collaborative (ISQIC): implementing 21 components to catalyze statewide improvement in surgical care.
In 2014, a distinctive learning collaborative was established by 56 hospitals in Illinois, known as the Illinois Surgical Quality Improvement Collaborative (ISQIC). The purpose of this study is to present an overview of ISQIC's initial three years, focusing on 1) the formation and financing of the collaborative, 2) the 21 approaches employed for quality improvement (QI) support, 3) maintaining the collaborative, and 4) ISQIC as a foundation for innovative QI research. ISQIC integrates 21 elements that promote QI, targeting the hospital, the surgical QI team, and the perioperative microsystem. These elements were derived from existing evidence, a comprehensive needs assessment of the hospitals, previous experiences from surgical and non-surgical QI collaboratives, and interviews with QI professionals. The elements span five domains: guided implementation (e.g., mentors, coaches, statewide QI projects), education (e.g., process improvement (PI) curriculum), comparative performance reports for hospitals and surgeons (e.g., process, outcomes, costs), networking (e.g., venues for sharing QI experiences and best practices), and financing (e.g., for the overall program, pilot grants, and incentive payments for improvement). The study found that the 21 unique ISQIC components enabled hospitals to utilize their data effectively for the implementation of QI initiatives and enhancement of care. Formal (QI/PI) training, mentorship, and coaching were provided to hospitals as they implemented solutions. Hospitals were funded for the program and collaborated on statewide quality initiatives. Knowledge gained in one hospital was disseminated to all participating hospitals through conferences, webinars, and toolkits, fostering a collective learning environment aimed at improving and ensuring safer care for surgical patients in Illinois. Over the first three years, surgical outcomes in Illinois showed improvement.
Citation: Bilimoria KY, McGee MF, Williams MV . Development of the Illinois Surgical Quality Improvement Collaborative (ISQIC): implementing 21 components to catalyze statewide improvement in surgical care. Ann Surg Open 2023 Mar;4(1):e258. doi: 10.1097/as9.0000000000000258.
Keywords: Quality Improvement, Surgery, Quality of Care
Ervin JN, Vitous CA, Wells EE
Rescue Improvement Conference: a novel tool for addressing failure to rescue.
The objective of this study was to understand the effectiveness of the Rescue Improvement Conference, a forum that addresses failure to rescue (FTR). FTR is the phenomenon where delayed recognition or response to surgical complications leads to a progressive cascade of adverse events culminating in patient death. The authors used 5 indicators of effectiveness: educational value, conference takeaways, discussion time, changes to surgical practice, and opportunities for improvement and conducted semi-structured interviews. The results showed that conference felt that the Rescue Improvement Conference was effective in all five indicators. The authors concluded that the conference has the potential to support other surgical departments in developing system-level strategies to recognize and manage postoperative complications that contribute to FTR.
AHRQ-funded; HS024403; HS023621.
Citation: Ervin JN, Vitous CA, Wells EE . Rescue Improvement Conference: a novel tool for addressing failure to rescue. Ann Surg 2023 Feb; 277(2):233-37. doi: 10.1097/sla.0000000000004832..
Keywords: Surgery, Adverse Events, Patient Safety, Quality of Care, Quality Improvement
Quigley DD, Quereshi N, Hays RD
Reasons primary care practices chose patient experience surveys during patient-centered medical home transformation.
This study’s objective was to identify reasons primary care practices chose to implement a patient experience survey during their patient-centered medical home transformation. The authors conducted interviews with a stratified-random sample of 105 of these practices. Fifty-one practices used a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and 53 administered another patient survey. The three most common reasons to use a survey were given as: (1) to compare performance against other practices, which requires systematically collected data across large numbers of practices (ie, the Consumer Assessment of Healthcare Providers and Systems survey), (2) participation in an external patient-centered medical home program, and (3) survey administration cost. A second patient survey was used to identify quality improvement needs.
AHRQ-funded; HS016980; HS025920.
Citation: Quigley DD, Quereshi N, Hays RD . Reasons primary care practices chose patient experience surveys during patient-centered medical home transformation. J Ambul Care Manage 2023 Jan-Mar;46(1):34-44. doi: 10.1097/jac.0000000000000442.
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient-Centered Healthcare, Primary Care, Quality Improvement, Practice Improvement
Liao JM, Wang E, Isidro U
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
This research evaluated whether the association between participation in bundled payments for medical conditions and episode outcomes differed for clinically high-risk versus other patients in regard to length of stay (LOS) at skilled nursing facilities (SNFs). Participants included 471,421 Medicare patients hospitalized at bundled payment and propensity-matched non-participating hospitals. Primary outcomes were SNF LOS and 90-day unplanned readmissions. SNF length of stay was differentially lower among frail patients, patients with advanced age (>85 years), and those with prior institutional post-acute care provider utilization compared to non-frail, younger, and patients without prior utilization, respectively. Bundled payment participation was also associated with differentially greater SNF LOS among disabled patients. It was not associated with differential changes in readmissions in any high-risk group but was associated with changes in quality, utilization, and spending measures for some groups.
Citation: Liao JM, Wang E, Isidro U . The association between bundled payment participation and changes in medical episode outcomes among high-risk patients. Healthcare 2022 Dec 12; 10(12). doi: 10.3390/healthcare10122510..
Keywords: Payment, Quality Improvement, Quality of Care, Risk, Policy
Collins CR, Abel MK, Shui A
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
This study aimed to assess where the largest opportunities for care improvement lay with the bundled payment reimbursement model and how best to identify patients at high risk of suffering costly complications, including hospital readmission. The authors used a cohort of patients from 2014 and 2016 who met inclusion criteria for the Major Bowel Bundled Payment Program and performed a cost analysis to identify opportunities for improved care efficiency. Using the results, they identified readmissions as a target for improvement and then assessed whether the American College of Surgeons' National Surgical Quality Improvement Program surgical risk calculator (ACS NSQIP SRC) could accurately identify patients within the bundled payment population who were at high risk of readmission using a logistic regression model. Patients who were readmitted within 90-days post-surgery were 2.53 times more likely to be high-cost (>$60,000) then non-readmitted patients. However, the ACS NSQIP SRC did not accurately predict patients at high risk of readmission within the first 30 days post-surgery.
Citation: Collins CR, Abel MK, Shui A . Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery. Perioper Med 2022 Dec 9;11(1):54. doi: 10.1186/s13741-022-00286-9..
Keywords: Provider Performance, Payment, Hospital Readmissions, Quality Improvement, Quality of Care, Surgery, Medicare, Medicaid
Bolte TB, Swanson MB, Kaldjian AM
Hospitals that report severe sepsis and septic shock bundle compliance have more structured sepsis performance improvement.
This study linked survey data on quality improvement (QI) practices from Iowa hospitals to severe sepsis/septic shock (SEP-1) performance data and mortality. All Iowa hospitals (100%) completed the survey. SEP-1 reporting hospitals were more likely to have sepsis QI practices, including reporting sepsis quality to providers (64% versus 38%) and using the case review process to develop sepsis care plans. Increased SEP-1 scores were not associated with sepsis QI practices. A sepsis registry was associated with decreased odds of being in the bottom quartile of sepsis mortality, and presence of a sepsis committee was associated with lower hospital-specific mortality.
Citation: Bolte TB, Swanson MB, Kaldjian AM . Hospitals that report severe sepsis and septic shock bundle compliance have more structured sepsis performance improvement. J Patient Saf 2022 Dec 1;18(8):e1231-e36. doi: 10.1097/pts.0000000000001062..
Keywords: Sepsis, Hospitals, Quality Improvement, Quality Indicators (QIs), Quality of Care
Cohen DJ, Balasubramanian BA, Lindner S
How does prior experience pay off in large-scale quality improvement initiatives?
This study’s goal was to examine the association of prior investment on the effectiveness of organizations delivering large-scale external support to improve primary care. A mixed-methods study was conducted with 7 EvidenceNOW grantees and their recruited primary practices (n = 1720). Data was analyzed on the grantees’ implementation of helping primary care practice improve (1) clinical quality, measured as practices' performance on Aspirin, Blood Pressure, Cholesterol, and Smoking (ABCS); and (2) practice capacity, measured using the Adaptive Reserve (AR) score and Change Process Capacity Questionnaire (CPCQ). Grantees with higher levels of prior experience with and investment in large-scale QI before EvidenceNOW recruited more geographically dispersed and diverse practices. They also had lower baseline ABCS performance (differences ranging from 2.8% for blood pressure to 41.5% for smoking), delivered more facilitation (mean=+20.3 hours), and made greater improvements in practices' QI capacity (CPCQ: +2.04) and smoking performance (+6.43%) than grantees with less experience. Having established networks of facilitators at the start of EvidenceNOW and leadership experienced in supporting this workforce explained their better recruitment, delivery of facilitation, and improvement in outcomes.
Citation: Cohen DJ, Balasubramanian BA, Lindner S . How does prior experience pay off in large-scale quality improvement initiatives? J Am Board Fam Med 2022 Dec; 35(6):1115-27. doi: 10.3122/jabfm.2022.AP.220088..
Keywords: Quality Improvement, Primary Care, Quality of Care
Richards JE, Yarborough BJH, Holden E
Implementation of suicide risk estimation analytics to support mental health care for quality improvement.
The purpose of this mixed-methods quality improvement study was to examine and describe the use of estimation analytics to enhance existing suicide prevention practices during routine mental health specialty engagements. The study found that during the 3.5 month observation period there were 4,789 patient engagements by 1939 patients. This included 161 engagements newly identified by suicide risk estimation analytics. The researchers reported that the engagement-based risk identifications did not consistently trigger additional suicide risk assessment as intended. During newly identified engagements: 57 patients reported frequent suicidal ideation and, as per preexisting workflow, 54 completed a Columbia-Suicide Severity Rating Scale (C-SSRS); 75 patients reported no or infrequent suicidal ideation, but only 10 completed a C-SSRS, per new workflow; 29 patients did not answer the Patient Health Questionnaire-9 (PHQ-9), and only 1 patient completed a C-SSRS, per new workflow. The providers interviewed (n = 8) reported important implementation concerns, including 1) lack of follow-up, 2) electronic health record- (EHR-) related inefficiencies, and 3) reliability and accuracy of the trigger. The patients interviewed (n = 20) repeated concerns about reliability and accuracy of estimation analytics. In addition, providers described concerns about access to care and potential liability associated with known suicide risk. Patients repeated the provider concerns about access and reported fears about identification of suicide risk resulting in coercive care. The researchers conclude that this unique quality improvement study underscores important implications for health care organizations considering implementation of estimation analytics to support engagement-based identification of suicide risk.
Citation: Richards JE, Yarborough BJH, Holden E . Implementation of suicide risk estimation analytics to support mental health care for quality improvement. JAMA Netw Open 2022 Dec;5(12):e2247195. doi: 10.1001/jamanetworkopen.2022.47195..
Keywords: Behavioral Health, Quality Improvement, Quality of Care
Sikora A, Martin GS
Critical care pharmacists: improving care by increasing access to medication expertise.
This article discusses the shortage and need for critical care pharmacists in ICUs to improve care and prevent medication errors. There is a gap in critical care pharmacists with both low supply and low demand. Identifying the optimal patient:pharmacist ratio in the ICU is a key question. The authors discuss ways to reduce the gap by increasing the number of critical care pharmacy residency programs and including critical care pharmacists more in multidisciplinary rounds. The authors developed a toolkit for increasing critical care pharmacy services in five actionable steps and provide an annotated bibliography of key references.
Citation: Sikora A, Martin GS . Critical care pharmacists: improving care by increasing access to medication expertise. Ann Am Thorac Soc 2022 Nov;19(11):1796-98. doi: 10.1513/AnnalsATS.202206-502VP..
Keywords: Provider: Pharmacist, Medication, Quality Improvement, Quality of Care, Critical Care
Krauss DM, Molefe A, Hung L
AHRQ Author: Henderson S, Miller M
Emergent themes from a quality improvement programme for CLABSI/CAUTI prevention in ICUs amid the COVID-19 pandemic.
In this study, researchers summarized themes for maintaining infection prevention activities learned from the implementation of a quality improvement (QI) program during the COVID-19 pandemic. They concluded that future shocks such as the pandemic must be anticipated, and the healthcare system must be resilient to the resulting disruptions to healthcare-associated infection prevention activities. Their study encountered four themes for successful maintenance of infection prevention activities during the current pandemic: the value of a pre-existing infection prevention infrastructure; a flexibility in approach; broad buy-in for maintaining QI programs; and the facilitation of idea-sharing.
AHRQ-authored; AHRQ-funded; 233201500016I.
Citation: Krauss DM, Molefe A, Hung L . Emergent themes from a quality improvement programme for CLABSI/CAUTI prevention in ICUs amid the COVID-19 pandemic. BMJ Open Qual 2022 Nov;11(4):e001926. doi: 10.1136/bmjoq-2022-001926..
Keywords: COVID-19, Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Quality Improvement, Quality of Care, Critical Care, Intensive Care Unit (ICU), Prevention, Urinary Tract Infection (UTI), Infectious Diseases
Thompson MP, Yaser JM, Forrest A
Evaluating the feasibility of a statewide collaboration to improve cardiac rehabilitation participation: the Michigan Cardiac Rehab Network.
The purpose of this study as to assess the feasibility of the Michigan Cardiac Rehab Network to improve Cardiac Rehabilitation (CR) participation. The researchers utilized Multipayer claims data from the Michigan Value Collaborative to identify 95 hospitals and 84 CR facilities and convene a multidisciplinary group of advisors. Three CR facilities were selected for virtual site visits to identify areas of success and barriers to improvement. The study found that 51% of hospitals provided interventional cardiology services and 35% provided cardiac surgical services. The multidisciplinary group of advisors was convened and represented a broad range of roles within 13 institutions. CR enrollment statewide among eligible admissions was 33.4%, with broad differences in CR performance measures among participating hospitals and eligible admissions. Virtual site visits highlighted successes in increasing CR participation but an array of barriers to participation associated with referrals, capacity and staffing constraints, and geographic and financial barriers.
Citation: Thompson MP, Yaser JM, Forrest A . Evaluating the feasibility of a statewide collaboration to improve cardiac rehabilitation participation: the Michigan Cardiac Rehab Network. J Cardiopulm Rehabil Prev 2022 Nov 1;42(6):e75-e81. doi: 10.1097/hcr.0000000000000706..
Keywords: Cardiovascular Conditions, Rehabilitation, Quality Improvement, Quality of Care
Campbell JI, Menzies D
Testing and scaling interventions to improve the tuberculosis infection care cascade.
The purpose of this study was to review and summarize current literature on barriers and solutions occurring within the tuberculosis (TB) infection care cascade, focusing on children in high- and low-burden settings, and obtaining data and information from studies on both children and adults. The researchers concluded that identifying and addressing gaps in the TB care cascade requires the utilization of tools both novel and long-standing, and will be facilitated by shared clinical practice with primary care providers, methods of quality improvement, and innovative study designs.
Citation: Campbell JI, Menzies D . Testing and scaling interventions to improve the tuberculosis infection care cascade. J Pediatric Infect Dis Soc 2022 Oct 31;11(Suppl 3):S94-s100. doi: 10.1093/jpids/piac070..
Keywords: Respiratory Conditions, Infectious Diseases, Quality Improvement, Quality of Care
Kuzel AJ, Cuellar A, Nichols L
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
The purpose of this study was for The Heart of Virginia Health care (HVH) collaborative (one of the Agency for Healthcare Research and Quality's (AHRQ) Evidence Now project’s 7 collaboratives) to test different ways to improve performance and outcomes on ABCS clinical quality measures (appropriate Aspirin use, Blood pressure control, Cholesterol control, and Smoking cessation counseling) within small primary care practices. The researchers recruited 264 eligible practices and randomized them to 3 cohorts in a stepped wedge design, with 173, utilizing 16 different EHRs, participated through the entire initiative. Trained coaches delivered the practice support curriculum to improve performance on the ABCS measures. The program included an initial kickoff meeting, 3 months of focused support, 9 months of continued support, and access to online materials and faculty. The intervention phase was shortened due to difficulty in recruiting a sufficient number of practices. The study found that the short HVH intervention had a small but statistically significant positive average effects on appropriate use of aspirin and other anti-thrombotics, small negative effects on blood pressure control, except for those practices which did not attend the kickoff, and small negative effects on smoking cessation counseling. The researchers concluded that the truncation of the intervention contributed to the lack of substantial improvements in the ABCS.
Citation: Kuzel AJ, Cuellar A, Nichols L . The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare. J Am Board Fam Med 2022 Oct 18;35(5):979-89. doi: 10.3122/jabfm.2022.05.210021..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Primary Care, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Healthcare Delivery
Quigley DD, Qureshi N, Palimaru A
Content and actionability of recommendations to providers after shadow coaching.
This paper examined the content of the recommendations given to shadow-coached providers aimed at improving provider-patient interactions, to characterize these recommendations, and to examine their actionability. Using CAHPS data, the study’s findings showed that patient experience surveys were effective at identifying where improvement is needed but are not always informative enough to instruct providers on how to modify and improve their interactions with patients. Analyzing the feedback given to coached providers as part of an effective shadow-coaching program provides details about implementation on shadow-coaching feedback.
Citation: Quigley DD, Qureshi N, Palimaru A . Content and actionability of recommendations to providers after shadow coaching. Qual Manag Health Care 2022 Oct-Dec;31(4):199-209. doi: 10.1097/qmh.0000000000000354..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Quality Improvement, Quality of Care, Practice Improvement, Clinician-Patient Communication, Communication
Carroll AR, Smith CM, Frazier SB
Designing and conducting scholarly quality improvement: a practical guide for improvers everywhere.
The purpose of this article was to assist quality improvement teams to disseminate their work more expansively through publication by providing methods that many journals want in QI articles with specific examples of published works cited throughout the article. The researchers present improvement frameworks that teams should identify and utilize as a basis throughout their projects. The researchers review critical elements of QI projects, such as the formation of teams, the development of a concise and clear purpose statement, definitions of measures, and other QI tools such as fishbone diagrams and Pareto charts. Lastly, the researchers emphasize the importance of analyzing data longitudinally to explore the impacts of plan-do-study-act cycles on data.
Citation: Carroll AR, Smith CM, Frazier SB . Designing and conducting scholarly quality improvement: a practical guide for improvers everywhere. Hosp Pediatr 2022 Oct; 12(10):e359-e63. doi: 10.1542/hpeds.2022-006717..
Keywords: Quality Improvement, Quality of Care
Bradford A, Shofer M, Singh H
AHRQ Author: Shofer M, Singh H
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
This paper discusses Measure Dx, a new AHRQ resource that translates knowledge from diagnostic measurement research into actionable recommendations. This resource guides healthcare organizations to detect, analyze, and learn from diagnostic safety events as part of a continuous learning and feedback cycle. The goal of Measure Dx is to advance new frontiers in reducing preventable diagnostic harm to patients.
AHRQ-authored; AHRQ-funded; 233201500022I; HS027363.
Citation: Bradford A, Shofer M, Singh H . Measure Dx: implementing pathways to discover and learn from diagnostic errors. Int J Qual Health Care 2022 Sep 10;34(3). doi: 10.1093/intqhc/mzac068..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality Improvement, Quality of Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Systems, Learning Health Systems