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Jakovljevic M, Timofeyev Y, Zhuravleva T. The Impact of Pandemic-Driven Care Redesign on Hospital Efficiency. Risk Manag Healthc Policy 2024; 17:1477-1491. [PMID: 38855044 PMCID: PMC11162215 DOI: 10.2147/rmhp.s465167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/26/2024] [Indexed: 06/11/2024] Open
Abstract
Purpose This study aims to identify medical care transformations during the COVID-19 pandemic and to assess the economic efficiency of these care transformations. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviewing and Meta-Analysis (PRISMA) guidelines. The databases used in the search protocol included PubMed, RSCI, and Google Scholar. Results Ten eligible studies in English and one publication in Russian were identified. In general, the following changes in organization of health care processes since 2020 are observed: hospital at home, telemedicine (physician-to-patient), and the adoption of new information communication technologies within physician-to-physician and physician-to-nurse communication. Earlier trends, such as (a) wider use of electronic devices, (b) adoption of Lean techniques, (c) the incorporation of patient and other customer experience feedback, and (d) the implementation of clinical decision support systems and automation of workflow, tend to be preserved. Conclusion The most common changes in hospital care organization and the respective impacts of workflow changes (ie, workflow interventions, redesign, and transformations) on the efficiency of hospital care were summarized and avenues for future research and policy implications were discussed. The pandemic demonstrated a need for building more resilient and adaptive healthcare systems, enhancing crisis preparedness along with rapid and effective responses.
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Affiliation(s)
- Mihajlo Jakovljevic
- UNESCO-TWAS, The World Academy of Sciences, Trieste, Italy
- Shaanxi University of Technology, Hanzhong, People’s Republic of China
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
| | | | - Tatyana Zhuravleva
- International Laboratory for Experimental and Behavioural Economics, HSE University, Moscow, Russia
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2
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Stammers AH, Chores JB, Tesdahl EA, Patel KP, Baeza J, Mosca MS, Varsamis M, Petterson CM, Firstenberg MS, Jacobs JP. Establishment of a national quality improvement process on oxygen delivery index during cardiopulmonary bypass. Perfusion 2023:2676591231198366. [PMID: 37632252 DOI: 10.1177/02676591231198366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Targeted oxygen delivery during cardiopulmonary bypass (CPB) has received significant attention due to its influence on patient outcomes, especially in mitigating acute kidney injury. While it has gained popularity in select institutions, there remains a gap in establishing it globally across multiple centers. The purpose of this investigation was to describe the development of a quality improvement process of targeted oxygen delivery during CPB across hospitals throughout the United States. A systematic approach to utilize oxygen delivery index (DO2i) as a key performance indicator within hospitals serviced by a national provider of perfusion services. The process included a review of the current literature on DO2i, which yielded a target nadir value (272 mL/min/m2) and an area under the curve (DO2i272AUC) cut off of 632. All data is displayed on a dashboard with results categorized across multiple levels from system-wide to individual clinician performance. From January 2020 through December 2022, DO2i data from 91 hospitals and 11,165 coronary artery bypass graft procedures were collected. During this period the monthly proportion of DO2i measurements above the target nadir DO2i272 ranged from 60.5% to 78.4% with a mean+/-SD of 70.8 +/- 4.2%. Binary logistic regression for the first 7 months following monthly DO2i performance reporting has shown a statistically significant positive linear trend in the probability of achieving the target DO2i272 (p < .001), with a crude increase of approximately 7.8% for DO2i272AUC, and a 73.8% success rate (p < .001). A survey was sent to all individuals measuring oxygen delivery during CPB to assess why a target DO2i272 could not be reached. The two most common responses were an 'inability to improve CPB flow rates' and 'restrictive allogeneic red blood cell transfusion policies'. This study demonstrates that targeting a minimum level of oxygen delivery can serve as a key performance indicator during CPB using a structured quality improvement process.
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Affiliation(s)
| | | | | | - Kirti P Patel
- Medical Department, SpecialtyCare, Brentwood, TN, USA
| | | | | | | | | | | | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, FL, USA
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3
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Fournie M, Sibbald SL, Harris SB. Exploring quality improvement for diabetes care in First Nations communities in Canada: a multiple case study. BMC Health Serv Res 2023; 23:462. [PMID: 37161499 PMCID: PMC10170692 DOI: 10.1186/s12913-023-09442-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Indigenous peoples in Canada experience higher rates of diabetes and worse outcomes than non-Indigenous populations in Canada. Strategies are needed to address underlying health inequities and improve access to quality diabetes care. As part of the national FORGE AHEAD Research Program, this study explores two primary healthcare teams' quality improvement (QI) process of developing and implementing strategies to improve the quality of diabetes care in First Nations communities in Canada. METHODS This study utilized a community-based participatory and qualitative case study methodology. Multiple qualitative data sources were analyzed to understand: (1) how knowledge and information was used to inform the teams' QI process; (2) how the process was influenced by the context of primary care services within communities; and (3) the factors that supported or hindered their QI process. RESULTS The findings of this study demonstrate how teams drew upon multiple sources of knowledge and information to inform their QI work, the importance of strengthening relationships and building relationships with the community, the influence of organizational support and capacity, and the key factors that facilitated QI efforts. CONCLUSIONS This study contributes to the ongoing calls for research in understanding the process and factors affecting the implementation of QI strategies, particularly within Indigenous communities. The knowledge generated may help inform community action and the future development, implementation and scale-up of QI programs in Indigenous communities in Canada and globally.
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Affiliation(s)
| | - Shannon L Sibbald
- Faculty of Health Sciences, Western University, London, ON, Canada
- The Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Stewart B Harris
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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4
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Harding KE, Camden C, Lewis AK, Perreault K, Taylor NF. Service redesign interventions to reduce waiting time for paediatric rehabilitation and therapy services: A systematic review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:2057-2070. [PMID: 35716009 PMCID: PMC10084082 DOI: 10.1111/hsc.13866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/06/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Despite well-documented benefits of rehabilitation and therapy services for children with disabilities, long waiting lists to access these services are common. There is a growing body of evidence, primarily from mixed or adult services, demonstrating that waiting times can be reduced through strategies that target wasteful processes and support services to keep up with demand. However, providers of rehabilitation and therapy services for children face additional complexities related to the long-term nature of many developmental conditions and the need to consider timing of interventions with developmental milestones and education transition points. This review aimed to synthesise available evidence on service redesign strategies in reducing waiting time for paediatric therapy services. We conducted a systematic review of studies conducted in outpatient paediatric rehabilitation or therapy settings, including physical and mental health services, evaluating a service redesign intervention and presenting comparative data on time to access care. Two reviewers independently applied inclusion criteria, assessed risk of bias and extracted data. Findings were analysed descriptively and the certainty of evidence was synthesised according to criteria for health service research. From 1934 studies identified, 33 met the criteria for inclusion. Interventions were categorised as rapid response strategies, process efficiency interventions or substitution strategies (using alternative providers in place of medical specialists). Reductions in waiting time were reported in 30 studies. Evidence is limited by study designs with high risk of bias, but this is mitigated by consistency of findings and large effect sizes. There is moderate-certainty evidence that service redesign strategies similar to those used in adult populations can be applied in paediatric rehabilitation and therapy settings to reduce waiting time.
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Affiliation(s)
- Katherine E. Harding
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
| | - Chantal Camden
- Sherbrooke University, School of RehabilitationSherbrookeQuébecCanada
| | - Annie K. Lewis
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale‐NationaleQuébec CityQuébecCanada
- Department of Rehabilitation, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
| | - Nicholas F. Taylor
- La Trobe University, School of Allied HealthHuman Services and SportMelbourneVictoriaAustralia
- Eastern Health Allied Health Clinical Research OfficeBox HillVictoriaAustralia
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5
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Lion KC, Faro EZ, Coker TR. All Quality Improvement Is Health Equity Work: Designing Improvement to Reduce Disparities. Pediatrics 2022; 149:184820. [PMID: 35230431 DOI: 10.1542/peds.2020-045948e] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
Quality improvement (QI) can be a critical means by which to achieve equity in health and health care. QI efforts, however, often fail to be designed and implemented through the lens of health equity. In this article, we will discuss the current state of the intersection between QI and health equity, then lay out specific steps researchers and practitioners can take to ensure that their QI work reduces, rather than increases or maintains, existing disparities. These steps include first, understanding existing disparities and, second, utilizing community engagement to ensure that QI enhances health equity. Before embarking on QI work, QI practitioners should first examine their metric of interest by patient characteristics, starting with race and ethnicity, language, and markers of access to care and socioeconomic status. Developing an understanding of existing disparities relevant to the QI project will ensure that the QI interventions can be designed to be most effective in the disadvantaged populations, thus increasing the likelihood that the intervention reduces existing disparities. In designing QI interventions, practitioners must also plan engagement with stakeholder populations ahead of time, to carefully understand their needs and priorities and how best to address them through QI efforts.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics, University of Washington, Seattle, Washington.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Elissa Z Faro
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington, Seattle, Washington.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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Dupuis F, Déry J, Lucas de Oliveira FC, Pecora AT, Gagnon R, Harding K, Camden C, Roy JS, Lettre J, Hudon A, Beauséjour M, Pinard AM, Bath B, Deslauriers S, Lamontagne MÈ, Feldman D, Routhier F, Desmeules F, Hébert LJ, Miller J, Ruiz A, Perreault K. Strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities: A systematic literature review. J Health Serv Res Policy 2022; 27:157-167. [DOI: 10.1177/13558196211065707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Identifying effective strategies to reduce waiting times is a crucial issue in many areas of health services. Long waiting times for rehabilitation services have been associated with numerous adverse effects in people with disabilities. The main objective of this study was to conduct a systematic literature review to assess the effectiveness of service redesign strategies to reduce waiting times in outpatient rehabilitation services for adults with physical disabilities. Methods We conducted a systematic review, searching three databases (MEDLINE, CINAHL and EMBASE) from their inception until May 2021. We identified studies with comparative data evaluating the effect of rehabilitation services redesign strategies on reducing waiting times. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. A narrative synthesis was conducted. Results Nineteen articles including various settings and populations met the selection criteria. They covered physiotherapy ( n = 11), occupational therapy ( n = 2), prosthetics ( n = 1), exercise physiology ( n = 1) and multidisciplinary ( n = 4) services. The methodological quality varied ( n = 10 high quality, n = 6 medium, n = 3 low); common flaws being missing information on the pre-redesign setting and characteristics of the populations. Seven articles assessed access processes or referral management strategies (e.g. self-referral), four focused on extending/modifying the roles of service providers (e.g. to triage) and eight changed the model of care delivery (e.g. mode of intervention). The different redesign strategies had positive effects on waiting times in outpatient rehabilitation services. Conclusions This review highlights the positive effects of many service redesign strategies. These findings suggest that there are several effective strategies to choose from to reduce waiting times and help better respond to the needs of persons experiencing physical disabilities.
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Affiliation(s)
- Frédérique Dupuis
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Julien Déry
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Fabio Carlos Lucas de Oliveira
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Ana Tereza Pecora
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Rose Gagnon
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Katherine Harding
- Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
| | - Chantal Camden
- École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Josiane Lettre
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Anne Hudon
- École de Réadaptation, Université de Montréal, Montreal, QC, Canada
| | - Marie Beauséjour
- Département des Sciences de la santé communautaire, Université de Sherbrooke, Longueuil, QC, Canada
| | - Anne-Marie Pinard
- Département D’anesthésiologie et de Soins Intensifs, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Brenna Bath
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Marie-Ève Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Debbie Feldman
- École de Réadaptation, Université de Montréal, Montreal, QC, Canada
| | - François Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | | | - Luc J. Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Physical Therapy Program, Queen’s University, Kingston, ON, Canada
| | - Angel Ruiz
- Département d’opérations et systèmes de décision, Faculté des sciences de l’administration, Université Laval, Québec, QC, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada
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Trovó SA, Cucolo DF, Perroca MG. Transfer of patients in hospital units: impacts on nursing workload. Rev Esc Enferm USP 2021; 55:e0327. [PMID: 34161440 DOI: 10.1590/s1980-220x2020024903727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/06/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To measure the average time spent by the nursing team in transferring patients; to compare the activities observed during the performance of this intervention with those described by the Nursing Interventions Classification and to investigate the intensity of its influence on the workload. METHOD Observational study using timekeeping software conducted in two hospitals in the northwest region of the State of São Paulo. 200 patient transfers were monitored by the team using two validated instruments. RESULTS The average time spent by nurses on transfers ranged from 9.3 (standard deviation = 3.5) to 12.2 (standard deviation = 2.5) minutes and by assistants/ technicians between 7.1 (standard deviation = 2,8) and 11.0 (standard deviation = 2.2) minutes. 63 transfers made by nurses and 87 by assistants/technicians were considered qualified (>70% of the score). The team expended 19.3 to 29% of the working day time in this intervention. CONCLUSION The transfer of patients has an impact on the workload of the team and needs to be considered in the measurement of nursing activities for the calculation and distribution of personnel to improve the quality and continuity of care.
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Affiliation(s)
- Simone Aparecida Trovó
- Faculdade de Medicina de São José do Rio Preto, Programa de Pós-Graduação em Enfermagem, São José do Rio Preto, SP, Brazil
| | - Danielle Fabiana Cucolo
- Universidade Federal de São Carlos, Programa de Pós Graduação em Enfermagem, São Carlos, SP, Brazil.,Pontifícia Universidade Católica de Campinas, Programa de Pós Graduação de Residência Multiprofissinal em Saúde, Campinas, SP, Brazil
| | - Márcia Galan Perroca
- Faculdade de Medicina de São José do Rio Preto, Programa de Pós-Graduação em Enfermagem, São José do Rio Preto, SP, Brazil
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Baker M, Jaeger C, Hafley C, Waymack J. Appropriate CT cervical spine utilisation in the emergency department. BMJ Open Qual 2020; 9:bmjoq-2019-000844. [PMID: 33028655 PMCID: PMC7542617 DOI: 10.1136/bmjoq-2019-000844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 07/30/2020] [Accepted: 09/18/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Over 40 000 CT scans are performed in our emergency department (ED) annually and utilisation is over 80% capacity. Improving medical appropriateness of CT scans may reduce total number of scans, time, cost and radiation exposure. Methods Lean Six Sigma methodology was used to improve the process. A National Emergency X-Radiography Utilisation Study (NEXUS)-based PowerForm was implemented in the electronic health record and providers were educated on the criteria. Results The rate of potentially medically inappropriate CT C-spine scans decreased from 45% (19/42) to 22% (90/403) (two-proportion test, p=0.002). After the intervention, there was no longer a difference between midlevel providers and physicians in the rate of medically inappropriate orders (19% vs 22%) (two-proportion test, p=0.850) compared with that before the intervention (56% vs 31%) (two-proportion test, p<0.01). Overall rates of CT C-spine scans ordered decreased from 69.3 to 62.6/week (t-test, p=0.019). Conclusion A validated clinical decision-making tool implemented into the medical record can improve quality of care. This study lays a foundation for other imaging studies with validated support tools with similar potential improvements.
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Affiliation(s)
- Mark Baker
- Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Cassie Jaeger
- Department of Operations Improvement, Memorial Health System, Springfield, Illinois, USA
| | - Carol Hafley
- Midwest Healthcare Quality Alliance, Memorial Health System, Springfield, Illinois, USA
| | - James Waymack
- Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Downen J, Jaeger C. Quality improvement of intravenous to oral medication conversion using Lean Six Sigma methodologies. BMJ Open Qual 2020; 9:bmjoq-2019-000804. [PMID: 31986120 PMCID: PMC7011893 DOI: 10.1136/bmjoq-2019-000804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Lack of medication conversion from intravenous to oral contributes to increased risk of infection, delayed discharges and higher medication costs. At our institution, intravenous to oral medication conversion rate was 76% with missed opportunity for conversion of 37%. The goal of the project was to reduce the percent of missed opportunities for intravenous to oral conversion for applicable medications. Methods A pharmacy-driven intravenous to oral policy and procedure was implemented. To identify potential opportunities, a patient worklist of applicable intravenous to oral medications was created for pharmacy review in real time. An intravenous to oral conversion order was implemented in the computerised provider order entry. ‘Convert to oral’ was added as an option in the electronic medication request and highlighted reminders were added to the electronic medication administration record for eligible medications. Results After improvements, the missed opportunity rate for intravenous to oral conversion decreased from 37% (19/51) to 21% (24/113) (p=0.04, two-proportion test), a 43% improvement. The trend in intravenous to oral conversion rate increased from 76% (39/51) to 85% (171/201) and severity adjusted length of stay was reduced from 8.1 days to 6.4 days post improvements (p<0.001, t-test).
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Affiliation(s)
- Julie Downen
- Pharmacy, Memorial Medical Center, Springfield, Illinois, USA
| | - Cassie Jaeger
- Operations Improvement, Memorial Medical Center, Springfield, Illinois, USA
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10
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Abstract
As improvement practice and research begin to come of age, Mary Dixon-Woods considers the key areas that need attention if we are to reap their benefits
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11
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Kutz TL, Roszhart JM, Hale M, Dolan V, Suchomski G, Jaeger C. Improving comprehensive care for patients with diabetes. BMJ Open Qual 2018; 7:e000101. [PMID: 30397656 PMCID: PMC6202994 DOI: 10.1136/bmjoq-2017-000101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 12/15/2022] Open
Abstract
Patients with diabetes require access to systematic and ongoing care delivered by a team of healthcare providers. Despite national attention and well-accepted best practices, diabetic care, blood pressure and haemoglobin A1c (A1c) levels for patients with diabetes in our primary care setting were highly variable and below the Healthcare Effectiveness Data and Information Set (HEDIS) 75th percentile benchmark. From January 2015 to January 2016, 22% of patients with diabetes in our primary care setting had both blood pressure and A1c levels controlled and 23% had their annual diabetic care bundle completed, which includes A1c and blood pressure measurements, foot examination and nephropathy attention. Lack of standardised care algorithms, electronic health record documentation and education was identified. Lean Six Sigma methodologies were used to re-engineer the care that patients with diabetes receive. Key improvement initiatives focused on standardisation of accepted care practices through electronic templates, education and re-evaluation of patients to make 90-day, rapid cycle changes. Interventions were piloted in one primary care clinic then expanded to eight additional clinics. At the pilot site, the per cent of patients who completed the diabetic care bundle increased from 33% to 71% and the per cent of patients with diabetes with both A1c and blood pressure controlled increased from 31% to 43% (two-proportion test, p<0.01) postintervention. On rollout to eight additional clinics, the per cent of patients who completed the diabetic care bundle increased from 23% to 67% and the per cent of patients with diabetes with both their A1c and their blood pressure controlled increased from 22% to 41% (two-proportion test, p<0.01). After the interventions, nephropathy attention, A1c and blood pressure metrics exceeded HEDIS 75th percentile. Standardisation of accepted care practices for patients with diabetes improved compliance with diabetic care bundle completion and patient outcomes in the primary care setting.
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Affiliation(s)
- Tamar L Kutz
- Ambulatory Networks, Memorial Health System, Springfield, Illinois, USA
| | | | - Marshall Hale
- Memorial Physician Services, Memorial Health System, Springfield, Illinois, USA
| | - Virginia Dolan
- Memorial Physician Services, Memorial Health System, Springfield, Illinois, USA
| | - Gerald Suchomski
- Memorial Physician Services, Memorial Health System, Springfield, Illinois, USA
| | - Cassie Jaeger
- Department of Operations Improvement, Memorial Medical Center, Springfield, Illinois, USA
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12
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Goldberg LR, Crocombe LA. Advances in medical education and practice: role of massive open online courses. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 8:603-609. [PMID: 28860891 PMCID: PMC5573056 DOI: 10.2147/amep.s115321] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Massive open online courses (MOOCs) are increasingly available in the area of health and medicine. These MOOCs are offered through various commercial and noncommercial online platforms. When offered through reputable institutions, they can provide valuable access to reliable information without the constraints of time, geographical location, or level of education. Most current courses appear introductory in nature. In its drive for quality health care, the National Academy of Medicine has prioritized a focus on known chronic care conditions. Many of these conditions are shared internationally. Among its initiatives, the academy encourages consumer and professional groups, patients, clinicians, health care organizations, and universities to work together to identify evidence-based care processes consistent with best practices, organize major prevention programs to target key associated health risk behaviors, and develop systems to measure and evaluate improvements in the provision of patient- and family-centered health care. Carefully designed and collaboratively developed MOOCs would appear a valuable resource to contribute to these initiatives. Such MOOCs can, 1) increase the health literacy of the public with regard to the prevention and treatment of known chronic care conditions, 2) provide ready access to continuing professional, and interprofessional, education, and 3) explore innovative teaching models for student learning focused on patient- and family-centered care. MOOCs would also appear helpful to facilitate effective communication among international communities of patients and clinicians, including student clinicians, with shared interests. Further, the accumulation of MOOC data through large-scale measurement and analysis, obtained nationally and internationally, has the potential to assist in greater understanding of the risk for diseases and their prevention, with this translating into medical education, and authentic, patient- and family-centered methods for student learning. This paper explores these issues.
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Affiliation(s)
| | - Leonard A Crocombe
- Centre for Rural Health, Faculty of Health Sciences, University of Tasmania, Hobart, TAS, Australia
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