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Preview: PubMed: Quality of care

pubmed: Quality of care



NCBI: db=pubmed; Term=(("quality assurance, health care"[MeSH Terms] OR "quality indicators, health care"[MeSH Terms] OR "quality of health care"[MeSH Terms] OR "total quality management"[MeSH Terms]) AND quality[TI]) AND English[Lang] AND "adult"[MeSH Te



 



Prophylactic Ureteral Catheters for Colectomy: A National Surgical Quality Improvement Program-Based Analysis.
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Prophylactic Ureteral Catheters for Colectomy: A National Surgical Quality Improvement Program-Based Analysis.

Dis Colon Rectum. 2018 Jan;61(1):84-88

Authors: Coakley KM, Kasten KR, Sims SM, Prasad T, Heniford BT, Davis BR

Abstract
BACKGROUND: Despite improvement in technique and technology, using prophylactic ureteral catheters to avoid iatrogenic ureteral injury during colectomy remains controversial.
OBJECTIVE: The aim of this study was to evaluate outcomes and costs attributable to prophylactic ureteral catheters with colectomy.
DESIGN: This was a retrospective study.
SETTINGS: The study was conducted at a single tertiary care center.
PATIENTS: The colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2014 was queried.
MAIN OUTCOME MEASURES: The primary end point was the rate of 30-day ureteral injury after colectomy. Univariate and multivariate analyses determined factors associated with ureteral injury and urinary tract infection in patients undergoing colectomy.
RESULTS: A total of 51,125 patients were identified with a mean age of 60.9 ± 14.9 years and a BMI of 28.4 ± 6.7 k/m; 4.90% (n = 2486) of colectomies were performed with prophylactic catheters, and 333 ureteral injuries (0.65%) were identified. Prophylactic ureteral catheters were most commonly used for diverticular disease (42.2%; n = 1048), with injury occurring most often during colectomy for diverticular disease (36.0%; n = 120). Univariate analysis of outcomes demonstrated higher rates of ileus, wound infection, urinary tract infection, urinary tract infection as reason for readmission, superficial site infection, and 30-day readmission in patients with prophylactic ureteral catheter placement. On multivariate analysis, prophylactic ureteral catheter placement was associated with a lower rate of ureteral injury (OR = 0.45 (95% CI, 0.25-0.81)).
LIMITATIONS: This was a retrospective study using a clinical data set.
CONCLUSIONS: Here, prophylactic ureteral catheters were used in 4.9% of colectomies and most commonly for diverticulitis. On multivariate analysis, prophylactic catheter placement was associated with a lower rate of ureteral injury. Additional research is needed to delineate patient populations most likely to benefit from prophylactic ureteral stent placement. See Video Abstract at http://links.lww.com/DCR/A482.

PMID: 29215477 [PubMed - indexed for MEDLINE]




Optimizing Surgical Quality Datasets to Care for Older Adults: Lessons from the American College of Surgeons NSQIP Geriatric Surgery Pilot.
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Optimizing Surgical Quality Datasets to Care for Older Adults: Lessons from the American College of Surgeons NSQIP Geriatric Surgery Pilot.

J Am Coll Surg. 2017 Dec;225(6):702-712.e1

Authors: Berian JR, Zhou L, Hornor MA, Russell MM, Cohen ME, Finlayson E, Ko CY, Robinson TN, Rosenthal RA

Abstract
BACKGROUND: Surgical quality datasets can be better tailored toward older adults. The American College of Surgeons (ACS) NSQIP Geriatric Surgery Pilot collected risk factors and outcomes in 4 geriatric-specific domains: cognition, decision-making, function, and mobility. This study evaluated the contributions of geriatric-specific factors to risk adjustment in modeling 30-day outcomes and geriatric-specific outcomes (postoperative delirium, new mobility aid use, functional decline, and pressure ulcers).
STUDY DESIGN: Using ACS NSQIP Geriatric Surgery Pilot data (January 2014 to December 2016), 7 geriatric-specific risk factors were evaluated for selection in 14 logistic models (morbidities/mortality) in general-vascular and orthopaedic surgery subgroups. Hierarchical models evaluated 4 geriatric-specific outcomes, adjusting for hospitals-level effects and including Bayesian-type shrinkage, to estimate hospital performance.
RESULTS: There were 36,399 older adults who underwent operations at 31 hospitals in the ACS NSQIP Geriatric Surgery Pilot. Geriatric-specific risk factors were selected in 10 of 14 models in both general-vascular and orthopaedic surgery subgroups. After risk adjustment, surrogate consent (odds ratio [OR] 1.5; 95% CI 1.3 to 1.8) and use of a mobility aid (OR 1.3; 95% CI 1.1 to 1.4) increased the risk for serious morbidity or mortality in the general-vascular cohort. Geriatric-specific factors were selected in all 4 geriatric-specific outcomes models. Rates of geriatric-specific outcomes were: postoperative delirium in 12.1% (n = 3,650), functional decline in 42.9% (n = 13,000), new mobility aid in 29.7% (n = 9,257), and new or worsened pressure ulcers in 1.7% (n = 527).
CONCLUSIONS: Geriatric-specific risk factors are important for patient-centered care and contribute to risk adjustment in modeling traditional and geriatric-specific outcomes. To provide optimal patient care for older adults, surgical datasets should collect measures that address cognition, decision-making, mobility, and function.

PMID: 29054389 [PubMed - indexed for MEDLINE]




Economic and quality of care evaluation of dialysis service models in remote Australia: protocol for a mixed methods study.
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Economic and quality of care evaluation of dialysis service models in remote Australia: protocol for a mixed methods study.

BMC Health Serv Res. 2017 May 03;17(1):320

Authors: Gorham G, Howard K, Togni S, Lawton P, Hughes J, Majoni SW, Brown S, Barnes S, Cass A

Abstract
BACKGROUND: Australia's Northern Territory (NT) has the country's highest incidence and prevalence of kidney disease. Indigenous people from remote areas suffer the heaviest disease burden. Concerns regarding cost and sustainability limit the provision of dialysis treatments in remote areas and most Indigenous people requiring dialysis relocate to urban areas. However, this dislocation of people from their family, community and support networks may prove more costly when the broader health, societal and economic consequences for the individual, family and whole of government are considered.
METHODS: The Dialysis Models of Care Study is a large cross organisation mixed methods study. It includes a retrospective (2000-2014) longitudinal data linkage study of two NT cohorts: Renal Cohort 1- comprising approximately 2000 adults who received dialysis and Renal Cohort 2- comprising approximately 400 children of those adults. Linkage of administrative data sets from the Australian and New Zealand Dialysis and Transplant Registry, NT Departments of Health, Housing and Education by a specialist third party (SA/NT Datalink) will enable extraction of activity, financial and outcome data. Interviews with patients, clinicians and service providers, using a snowball technique, will canvass relevant issues and assist in determining the full costs and impacts of the five most used dialysis Models of Care.
DISCUSSION: The study uses a mixed methods approach to investigate the quantitative and qualitative dimensions of the full costs and outcomes associated with the choice of particular dialysis models of care for any given patient. The study includes a large data linkage component that for the first time links health, housing and education data to fully analyse and evaluate the impact on patients, their families and the broader community, resulting from the relocation of people for treatment. The study will generate a large amount of activity, financial and qualitative data that will investigate health costs less directly related to dialysis treatment, costs to government such as housing and/or education and the health, social and economic outcomes experienced by patients. This approach fills an evidence gap critical to health service planners.

PMID: 28468619 [PubMed - indexed for MEDLINE]




Changes in the quality of care during progress from stage 1 to stage 2 of Meaningful Use.
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Changes in the quality of care during progress from stage 1 to stage 2 of Meaningful Use.

J Am Med Inform Assoc. 2017 03 01;24(2):394-397

Authors: Levine DM, Healey MJ, Wright A, Bates DW, Linder JA, Samal L

Abstract
Background: The Centers for Medicare and Medicaid Services (CMS) canceled Meaningful Use (MU), replacing it with Advancing Care Information, which preserves many MU elements. Therefore, transitioning from MU stage 1 to MU stage 2 has important implications for the new policy, yet the quality of care provided by physicians transitioning from MU1 to MU2 is unknown.
Methods: Retrospective longitudinal evaluation of the quality of care delivered by outpatient physicians at an academic medical center in the transition between MU1 and MU2.
Results: Between MU1 and MU2, 4 measures improved: hypertension control (35% vs 40%), influenza immunization (63% vs 68%), tobacco use assessment/counseling (86% vs 96%), and diabetes control (93% vs 96%; P all <.01). One worsened: senior weight screening/follow-up (54% vs 49%; P  < .01). Two were unchanged: chlamydia screening and adult weight screening/follow-up.
Conclusion: In this single-site study, when clinicians progressed from MU1 to MU2, 4 quality measures improved, 2 were unchanged, and 1 worsened. Analysis of national data should guide policy decisions about the content of MU's successor.

PMID: 27567000 [PubMed - indexed for MEDLINE]




The Ohio Gestational Diabetes Postpartum Care Learning Collaborative: Development of a Quality Improvement Initiative to Improve Systems of Care for Women.
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The Ohio Gestational Diabetes Postpartum Care Learning Collaborative: Development of a Quality Improvement Initiative to Improve Systems of Care for Women.

Matern Child Health J. 2016 Nov;20(Suppl 1):71-80

Authors: Shellhaas C, Conrey E, Crane D, Lorenz A, Wapner A, Oza-Frank R, Bouchard J

Abstract
Objectives To improve clinical practice and increase postpartum visit Type 2 diabetes mellitus (T2DM) screening rates in women with a history of gestational diabetes mellitus (GDM). Methods We recruited clinical sites with at least half of pregnant patients enrolled in Medicaid to participate in an 18-month quality improvement (QI) project. To support clinical practice changes, we developed provider and patient toolkits with educational and clinical practice resources. Clinical subject-matter experts facilitated a learning network to train sites and promote discussion and learning among sites. Sites submitted data from patient chart reviews monthly for key measures that we used to provide rapid-cycle feedback. Providers were surveyed at completion regarding toolkit usefulness and satisfaction. Results Of fifteen practices recruited, twelve remained actively engaged. We disseminated more than 70 provider and 2345 patient toolkits. Documented delivery of patient education improved for timely GDM prenatal screening, reduction of future T2DM risk, smoking cessation, and family planning. Sites reported toolkits were useful and easy to use. Of women for whom postpartum data were available, 67 % had a documented postpartum visit and 33 % had a postpartum T2DM screen. Lack of information sharing between prenatal and postpartum care providers was are barriers to provision and documentation of care. Conclusions for Practice QI and toolkit resources may improve the quality of prenatal education. However, postpartum care did not reach optimal levels. Future work should focus on strategies to support coordination of care between obstetrical and primary care providers.

PMID: 27502198 [PubMed - indexed for MEDLINE]




What Constitutes High-Quality Implementation of SEL Programs? A Latent Class Analysis of Second Step® Implementation.
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What Constitutes High-Quality Implementation of SEL Programs? A Latent Class Analysis of Second Step® Implementation.

Prev Sci. 2016 Nov;17(8):981-991

Authors: Low S, Smolkowski K, Cook C

Abstract
With the increased number of schools adopting social-emotional learning (SEL) programming, there is increased emphasis on the role of implementation in obtaining desired outcomes. Despite this, the current knowledge of the active ingredients of SEL programming is lacking, and there is a need to move from a focus on "whether" implementation matters to "what" aspects of implementation matter. To address this gap, the current study utilizes a latent class approach with data from year 1 of a randomized controlled trial of Second Step® (61 schools, 321 teachers, over 7300 students). Latent classes of implementation were identified, then used to predict student outcomes. Teachers reported on multiple dimensions of implementation (adherence, dosage, competency), as well as student outcomes. Observational data were also used to assess classroom behavior (academic engagement and disruptive behavior). Results suggest that a three-class model fits the data best, labeled as high-quality, low-engagement, and low-adherence classes. Only the low-engagement class showed significant associations with poorer outcomes, when compared to the high-quality class (not the low-adherence class). Findings are discussed in terms of implications for program development and implementation science more broadly.

PMID: 27457205 [PubMed - indexed for MEDLINE]




Embedding continuous quality improvement processes in multidisciplinary teams in cancer care: exploring the boundaries between quality and implementation science.
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Embedding continuous quality improvement processes in multidisciplinary teams in cancer care: exploring the boundaries between quality and implementation science.

Aust Health Rev. 2017 Jul;41(3):291-296

Authors: Robinson TE, Janssen A, Harnett P, Museth KE, Provan PJ, Hills DJ, Shaw T

Abstract
Objective The aim of the present study was to identify key enabling factors for engaging multidisciplinary teams (MDTs) in cancer care across the spectrum of translational research and quality improvement (QI) projects. Methods The study was conducted in two large Sydney metropolitan hospitals. Qualitative methods, including structured observations of MDT meetings and semi-structured interviews with MDT leaders and champions, were used to identify how teams interact with and generate research and implementation initiatives. Enabling factors for and barriers to the engagement of MDTs in translational research and QI were identified. Results Four key enabling factors emerged from the analysis of data generated from observing 43 MDT meetings and 18 semi-structured interviews: (1) access to high-quality data around individual and team performance; (2) research-active team leaders; (3) having experts, such as implementation scientists, embedded into teams; and (4) having dedicated research or QI-focused meetings. Barriers included a lack of time, administrative support, research expertise and access to real-time data. Conclusions The identification of enabling factors for and barriers to translational research and QI provides evidence for how multidisciplinary cancer care teams may best be engaged in research and QI that aims to improve service and care outcomes. What is known about the topic? MDTs are key to the delivery of cancer care in Australia, but there is scant research into how teams can best be engaged in translating research from basic science through to implementation science and QI. What does this paper add? This paper provides new evidence from an immersive study of cancer care MDTs in two large metropolitan hospitals in Sydney (NSW, Australia), regarding the key enabling factors for and barriers to successful engagement in translational research and QI in cancer care. What are the implications for practitioners? Cancer care professionals in MDTs are presented with an opportunity to embed translational research and QI into cancer care. MDTs can operate as an ideal vehicle to look beyond individual patient outcomes to broader trends and population health outcomes.

PMID: 27372543 [PubMed - indexed for MEDLINE]




Medical Record Quality Assessments of Palliative Care for Intensive Care Unit Patients. Do They Match the Perspectives of Nurses and Families?
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Medical Record Quality Assessments of Palliative Care for Intensive Care Unit Patients. Do They Match the Perspectives of Nurses and Families?

Ann Am Thorac Soc. 2016 May;13(5):690-8

Authors: Mularski RA, Hansen L, Rosenkranz SJ, Leo MC, Nagy P, Asch SM

Abstract
RATIONALE: To understand how well palliative care is provided in the intensive care unit (ICU) and to direct improvements, measurement of the quality of care delivered is requisite.
OBJECTIVES: To measure the quality of palliative care delivered in the ICU, using chart review-derived process quality measures of palliative care in critically ill patients, and to compare these measures with family and nursing perspectives on the quality of care provided.
METHODS: We developed and operationalized a comprehensive quality evaluation measure set from previously endorsed palliative care measure statements, using a rigorous multidisciplinary Delphi process focused on optimizing the validity and feasibility of chart review-derived metrics. Fourteen process measures assessed the quality of care delivered across established domains of palliative care for the ICU. We assessed the quality of care for ICU patients with ICU length of stay exceeding 2 days from three perspectives: medical record reviews, family satisfaction reports, and nurse ratings from those providing care in the ICU.
MEASUREMENTS AND MAIN RESULTS: We evaluated the care over a 7-month period of 150 patients (mean age, 63.9 yr [SD 13.4], average ICU length of stay, 7.5 d [SD 7.2]). Overall, ICU patients received 53.1% of recommended palliative care. The Family Satisfaction with Care in the Intensive Care Unit total scores from 136 family members (response rate, 91%) were high, 85.7 (SE 2.0) and 86.0 (SE 1.6), at the two sites but not correlated to measured quality delivered. Nurses rated the quality of care higher than medical record review (mean, 77.3% [SD 13.4]; n = 135) and similarly correlation with chart based process measures was poor.
CONCLUSIONS: Delivering high-quality palliative care in the ICU requires assessing key patient-centered domains. However, assessments from different perspectives do not always agree with technical quality of care as measured through chart-based metrics. We found deficits across seven domains of technical quality that were not correlated with either nurse or family ratings. Despite care gaps, families were generally satisfied with the care delivered. We conclude that each measurement perspective provides an independent view that can guide quality improvement and innovation work as well as subsequent research.

PMID: 27144795 [PubMed - indexed for MEDLINE]




Assessment of sleep quality post-hospital discharge in survivors of critical illness.
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Assessment of sleep quality post-hospital discharge in survivors of critical illness.

Respir Med. 2016 May;114:97-102

Authors: Solverson KJ, Easton PA, Doig CJ

Abstract
BACKGROUND: Sleep quality is impaired during critical illness and may remain abnormal after discharge from hospital. Sleep dysfunction in patients after critical illness may impair recovery and health related quality of life. The purpose of this study was to use objective and subjective measures to evaluate sleep quality in critical illness survivors 3 months after hospital discharge.
METHODS: This was a prospective cohort study of 55 patients admitted to a multidisciplinary intensive care unit (ICU) between April 1st, 2009 and March 31, 2010. Patients enrolled were over 17 years of age and stayed a minimum of 4 days in the ICU. Patients were assessed in an outpatient clinic 3-months after hospital discharge. Sleep quality was measured using multi-night sleep actigraphy and the Pittsburgh Sleep Quality Index (PSQI).
RESULTS: A total of 62% of patients had poor sleep quality measured with the PSQI. The average (SD) sleep time, sleep efficiency and number of sleep disruptions per night was 6.15 h (3.4), 78% (18), and 11 disruptions (5) respectively. The APACHE II score was correlated with total sleep time (β = -12.6, P = 0.019) and sleep efficiency (β = -1.18, P = 0.042). The PSQI score was associated with anxiety (β = 4.00, p = 0.001), reduced mobility (β = 3.39, p = 0.002) and EuroQol-5D visual analogue scale score (β = -0.85, p = 0.003) and low Physical Composite Scores (β = -0.13, p = 0.004) and Mental Composite Scores (β = -0.15, p = 0.002) of the Short-Form 36 survey.
CONCLUSIONS: Reduced sleep quality following critical illness is common and associated with reduced health related quality of life. Critical illness severity is a predictor of reduced sleep duration and sleep disruption 3 months after hospital discharge. This cohort study highlights the important role sleep may contribute to the long-term recovery from critical illness.

PMID: 27109818 [PubMed - indexed for MEDLINE]




Quality of prior warfarin therapy in ischemic stroke patients with a pre-stroke diagnosis of atrial fibrillation.
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Quality of prior warfarin therapy in ischemic stroke patients with a pre-stroke diagnosis of atrial fibrillation.

Duodecim. 2016;132(15):1366-74

Authors: Tiili P, Lehto M, Meretoja A, Nieminen T, Pakarinen S, Tatlisumak T, Putaala J

Abstract
In atrial fibrillation (AF), warfarin prevents ischemic strokes (IS), but its implementation varies. We conducted a retrospective registry study on clinical features and prior warfarin therapy in AF patients with IS. Of our 540 patients, 143 had a prior diagnosis of AF, of which 51% used warfarin. Warfarin use was more common in those having permanent than paroxysmal AF (76% versus 36%, p<0.001). On admission, 42% had INR within the therapeutic range. Average TTR was 64%. Advanced age (p=0.009) and permanent AF (p<0.001) were associated with higher TTR. Better warfarin therapy quality was associated with advanced age and permanent AF.

PMID: 29160645 [PubMed - indexed for MEDLINE]