Quality management in health care
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Hospitalist practices around the country switch service on different days of the week. It is unclear whether switching clinical service later in the week is associated with an increase in length of stay (LOS). This aim of this study was to examine the association between service switch day for hospitalists at an academic medical center and LOS. ⋯ Change in attending switch day from earlier in the week to later in the week is not associated with an increase in LOS. Other factors such as group preference and institutional needs should drive service switch day selection for hospitalist groups.
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Qual Manag Health Care · Oct 2020
Some Aspects of Patient Experience Assessed by Practices Undergoing Patient-Centered Medical Home Transformation Are Measured by CAHPS, Others Are Not.
Delivering care as a patient-centered medical home (PCMH) is being widely adopted across the United States by primary care practices to better meet patient needs. A key PCMH element is measuring patient experience for practice improvement. The National Committee for Quality Assurance (NCQA) PCMH recognition program requires practices to both measure patient experience and engage in continuous practice/quality improvement to attain PCMH recognition and then throughout full PCMH transformation. The NCQA recommends but does not require that practices administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS) clinician and group patient experience survey (CG-CAHPS) plus 14 CAHPS PCMH items, known as the CAHPS PCMH survey. We examine aspects of patient experience measured by practices with a varying number of years on their journey of PCMH transformation. ⋯ NCQA PCMH practices included CAHPS items on their patient experience surveys even if they did not administer the full CG-CAHPS survey or the recommended CAHPS PCMH survey. To enhance the usefulness of patient experience surveys for practices undergoing PCMH changes, additional CAHPS measures could be developed related to key areas of PCMH change, including expanded access to care (ie, after-hours and weekend visits, ease of scheduling, being informed about delays), use of shared decision-making, and improvements in provider communication (ie, the provider is courteous, communication by other clinical staff members with the patient). These additional measures would assist practice leaders in capturing the breadth and depth of their PCMH transformation and its influence on providing more patient-centered care. Developing such items would help standardize the measurement of changes related to patient experience during PCMH transformation. Research is needed to determine whether a CAHPS survey is the best source of this information.
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Qual Manag Health Care · Oct 2019
The Impact of Service Quality on Patient Satisfaction and Revisiting Intentions: The Case of Public Emergency Departments.
This study attempts to (a) identify the main quality indicators that affect "service quality" and (b) examine the effect of "patient satisfaction" on patient "revisiting intentions." ⋯ The study concludes that "overall satisfaction" acts as a mediator between "perceived service quality" and patient "behavioral intentions," while "perceived waiting time" is the most significant indicator of service quality and the most crucial predictor of ED patient satisfaction. Moreover, it offers empirical evidence concerning the differences in the way patients rate the services offered by a hospital, based on the hospital size and the region it is located (urban or provincial).
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Qual Manag Health Care · Jan 2019
Statistical Process Control Charts for Monitoring Staphylococcus aureus Bloodstream Infections in Australian Health Care Facilities.
Staphylococcus aureus bloodstream infection (SAB) in health care settings contributes significantly to mortality, and improved processes are associated with reduced burden of infection. In Australia, health care-associated SAB (HA-SAB) rates are reported as a health care performance indicator, but standardized methods for analyzing longitudinal data are not applied. Our objective was to evaluate the utility of statistical process control chart methodology for reporting HA-SAB and flagging higher than expected rates. ⋯ The u-chart is an accessible method for monitoring HA-SAB, interpretable by a range of stakeholders. We demonstrate the benefit of NB modeling to account for overdispersion, providing an effective tool to avoid inappropriate flags while maintaining early detection of out-of-control systems throughout a wide range of health care settings.
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Qual Manag Health Care · Oct 2018
A Multidisciplinary Handoff Process to Standardize the Transfer of Care Between the Intensive Care Unit and the Operating Room.
Critically ill patients are at high risk for adverse events on transfer between intensive care unit and operating room. Patient safety concerns were raised within our institution during such transfers, and absence of a standardized patient handoff process was identified as an area of concern. ⋯ A standardized patient handoff process between the ICU and the ORs can be successfully implemented in a large academic medical center. Universal application of this quality improvement tool can reduce patient harm, improve communication between providers, and enhance patient safety.