BMJ quality & safety
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BMJ quality & safety · Oct 2015
ReviewIntegrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes.
While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. ⋯ An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement.
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BMJ quality & safety · Sep 2015
Randomized Controlled TrialExploring demographic and lifestyle associations with patient experience following telephone triage by a primary care doctor or nurse: secondary analyses from a cluster randomised controlled trial.
The ESTEEM trial was a cluster randomised controlled trial that compared two telephone triage management systems (general practitioner (GP) or a nurse supported by computer decision support software) with usual care, in response to a request for same-day consultation in general practice. ⋯ Patient characteristics, such as age, ethnicity and ability to attend their practice during work hours, were associated with their experiences of care following a same-day consultation request in general practice. Telephone triage did not increase satisfaction among patients who were unable to attend their practice during working hours.
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BMJ quality & safety · Aug 2015
Comparative Study Observational StudyThe Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week.
To examine the association of mortality by day of the week for emergency and elective patients. ⋯ We show that mortality outcomes for our sample vary within each country and per day of the week in agreement with previous studies of the 'weekend effect'. Due to limitations of administrative datasets, we cannot determine the reasons for these findings; however, the international nature of our database suggests that this is a systematic phenomenon affecting healthcare providers across borders. Further investigation is needed to understand the factors that give rise to the weekend effect. The participating hospitals represent varied models of service delivery, and there is a potential to learn from best practice in different healthcare systems.
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BMJ quality & safety · Aug 2015
ReviewMeasuring the effect of Choosing Wisely: an integrated framework to assess campaign impact on low-value care.
The Choosing Wisely campaign began in the USA in 2012 to encourage physicians and patients to discuss inappropriate and potentially harmful tests, treatments and procedures. Since its inception, the campaign has grown substantially and has been adopted by 12 countries around the world. Of great interest to countries implementing the campaign, is the effectiveness of Choosing Wisely to reduce overutilisation. This article presents an integrated measurement framework that may be used to assess the impact of a Choosing Wisely campaign on physician and provider awareness and attitudes on low-value care, provider practice behaviour and overuse of low-value services.
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BMJ quality & safety · Aug 2015
Improving the care of patients with a hip fracture: a quality improvement report.
Hip fractures are associated with high rates of morbidity and mortality and their incidence is set to increase. The National Hip Fracture Database and the Best Practice Tariff were introduced with the aim of improving patient care. This complete audit cycle charts the substantial clinical improvements that were achieved in a busy district general hospital. ⋯ Significant improvements in the quality of hip fracture care were achieved following this audit. These were accomplished by rigorously analysing the variation in Best Practice Tariff achievement according to the day of the week on which patients were admitted. Targeted interventions could therefore be introduced that addressed specific problems in local service provision.