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  Subjects -> DISABILITY (Total: 103 journals)
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Journal for Healthcare Quality
Journal Prestige (SJR): 0.633
Citation Impact (citeScore): 1
Number of Followers: 28  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1062-2551 - ISSN (Online) 1945-1474
Published by LWW Wolters Kluwer Homepage  [330 journals]
  • Efficacy of the Crisis Risk Triage Scale in Inpatient Units Within the
           United States

    • Free pre-print version: Loading...

      Authors: Zimbro; Kathie S.; Maduro, Ralitsa S.; Ver Schneider, Patricia; Hahn, Donna S.; Paulson, James F.; Morgan, Merri K.
      Abstract: imagePatient violence toward others, including doctors and nurses, is a serious concern worldwide. A wealth of literature supports the assertion that violent behavior can be prevented with proper screening and management policies. This project aimed to evaluate the Crisis Triage Rating Scale (CTRS) within a 12-hospital integrated healthcare delivery system located in the southeastern United States. An initial sample of 112,708 unique patient visits between January 2019 and December 2020 was included in this retrospective review of electronic health records. We found that the CTRS harm triage question and risk levels were significant predictors of harm to others. Consistent with previous literature, positive predictive values ranged between 0.025 and 0.070 and negative predictive values ranged between 0.991 and 0.995. Our results support the assertion that clinicians should make balanced judgments about using a positive risk score to allocate safety measures. Variations in practice were evident across our healthcare systems. Improving appropriate assessment procedures may improve the diagnostic tools and risk stratification. When documented correctly, the CTRS performed as expected in an environment where harm to others occurred infrequently.
      PubDate: Sun, 01 Jan 2023 00:00:00 GMT-
       
  • Implementation of a Nurse-Driven Medication Ordering Protocol to Improve
           Clinician and Nursing Experiences

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      Authors: Ford; Claire C.; Clements, James B.; Luty, Jacob T.; Sharpe, Jackie K.; Caldera, Brittney N.; Hunter, Alan J.
      Abstract: imagePaging and text messaging to request new orders remain common means of communication between clinicians and nurses in the hospital setting. However, sending and triaging multiple pages can lead to interruptions in other clinical duties. A medication order delegation protocol allowing for nurse-driven ordering of low-risk medications was developed with an objective of decreasing potentially avoidable pages. The aim of this study was to evaluate the impact of implementing this protocol on nurse and clinician perceptions of clerical burden and satisfaction. A survey assessing satisfaction with the process of obtaining medications in this protocol and the perception of clerical burden associated with ordering them before and after delegation protocol implementation was completed by over 160 clinicians and nurses. Survey respondents reported increased satisfaction and decreased clerical burden associated with the implementation of the delegation protocol. These results suggest the potential for delegation protocols to limit clerical burden associated with paging.
      PubDate: Tue, 29 Nov 2022 00:00:00 GMT-
       
  • Increasing Language Interpreter Services Use and Documentation: A Quality
           Improvement Project

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      Authors: Behairy; Mohga; Alenchery, Amala; Cuesta-Ferrino, Claudia; Bhakta, Hemangini; Zayas-Santiago, Arnaldo
      Abstract: imageBackground/Purpose: Based on the Civil Rights Act of 1964, hospitals receiving funding from the Department of Human and Health Services must ensure adequate language assistance via a qualified interpreter for Limited English Proficiency (LEP) patients. Despite availability at our institution, official interpreter services were underutilized with inconsistent documentation of use. Baseline data over a 6-week period revealed a median of 43% of LEP parents reported use of official interpreter services, with a median of 0% documentation of use. We aimed to improve both over a 3-month period.Methods: This quality improvement project was conducted at a children's hospital between April and August 2020. Surveys were provided to inpatient LEP families. Four intervention periods were implemented with ongoing data collection for 12 weeks. Interventions included developing best practices, incorporating language identification into daily workflow, empowering families, and standardizing documentation. Data were analyzed by run chart and descriptive statistics.Results: After interventions and several plan-do-study-act cycles, a median of 73% reported use of official interpreter services, and a median of 59% were documented.Conclusions: After multiple interventions, specifically noted after intervention period #2, improvement of official interpreter service use and documentation were identified in all inpatient units.
      PubDate: Mon, 21 Nov 2022 00:00:00 GMT-
       
  • A Structured Rounding Proforma in the Hyper Acute Stroke Unit (HASU): A
           Quality Improvement Project

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      Authors: Ludley; Alistair; Bahk, Anna; Al-Shihabi, Ahmed
      Abstract: imageStrokes affect 100,000 patients annually in the United Kingdom. These patients are often complex and require multidisciplinary team input, hence why they are often treated within dedicated and highly specialized “hyper acute stroke units”. However, such specialist care can prove challenging to recently qualified or more junior doctors, who may miss pertinent aspects of the history or examination within the daily patient rounding documentation. Building on evidence-based practice using structured rounds and checklists, this quality improvement aimed to improve adherence of documentation for 20 predetermined key components of a stroke round by introducing a structured daily stroke rounding proforma. Adherence to documentation for the 20 components improved with the introduction of the stroke rounding proforma, with seven components demonstrating statistically significant positive changes in documentation rates, p < .05. Qualitative feedback was collected to aid in the development and acceptability of the proforma. Our study concluded a structured daily stroke rounding proforma can improve adherence to documentation in stroke care. Chiefly, the proforma was of greatest benefit to junior members of the medical team, particularly as an aid memoire.
      PubDate: Tue, 18 Oct 2022 00:00:00 GMT-
       
  • Pay-for-Performance in the Massachusetts Medicaid Delivery System
           Transformation Initiative

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      Authors: Sefton; Laura; Tierney, Laxmi
      Abstract: imagePay-for-performance (P4P) is among the alternative payment models (APMs) that are designed to incentivize enhancements to healthcare efficiency and quality. Massachusetts' Office of Medicaid implemented a delivery system transformation initiative (DSTI) through an 1115(a) Demonstration Waiver to support and incentivize seven safety net hospitals to implement clinical care changes and transition to risk-based APMs. Comparative case study design was used to describe achievement of hospital-specific clinical and operational measures. Qualifying hospitals implemented 47 projects across three categories: (1) development of a fully integrated delivery system, (2) health outcomes and quality, and (3) ability to respond to statewide transformation to value-based purchasing and to accept alternatives to fee-for-service payments that promote system sustainability. Projects commonly focused on care transitions improvements, physical and behavioral healthcare integration, and chronic disease care management interventions. Collectively, the hospitals met all or most of 60 population-focused improvement measures and 10 common measures' targets, indicative of the progress. Some hospitals achieved substantial positive gains; however, missed targets suggest substantial organizational and workflow changes over a longer timeframe as well as consistent patient engagement may be necessary. Overall, the P4P structure of DSTI was effective in encouraging organizational change and supporting the transition of these hospitals towards APMs.
      PubDate: Wed, 24 Aug 2022 00:00:00 GMT-
       
  • Group Medical Visits Versus Usual Care for Illness Perception and
           Hypertension: A Randomized Pilot Study

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      Authors: Acehan; Orhan; Bozdemir, Nafiz; Özcan, Sevgi; Duran, Olgun; Kurdak, Hatice
      Abstract: imageDespite separate evidence regarding illness perception (IP) and group medical visits (GMVs) for hypertension, research on both is limited. Here, we have assessed and compared the effectiveness of GMVs and usual care (UC) on IP and blood pressure (BP) in patients with hypertension. This was a two-group parallel randomized controlled study with 1:1 allocation. Patients with essential hypertension on antihypertensive medication and no cognitive impairments were screened for BP control status and eligibility. A web-based program randomly assigned them to the GMV and UC groups. Group medical visits were held once a month for 3 months. Primary and secondary outcome measures included improvements in IP and BP control. Among 152 participants, 40 and 43 were assigned to the GMV and UC groups, respectively. The control group had a 9.3% dropout rate. The chronic timeline and illness coherence improved significantly in the intervention group (p < .01). Systolic BP in the intervention group decreased significantly compared with that of the control group (Δ: −18.8 ± 18.4 mm Hg vs. Δ: −10.6 ± 12.5 mm Hg, p = .025). The participation in GMVs had a significant association with the odds of an increase in BP regulation (OR 3.8, 95% confidence interval 1.4–10.3, p = .007). Therefore, GMVs may be feasible for BP control in hypertensive patients with similar characteristics.
      PubDate: Tue, 16 Aug 2022 00:00:00 GMT-
       
 
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