How Can We Move Clinical Genomics Beyond the Hype?

Examines the debate over increased use of genetic testing, due in part to lax regulation, and its consequences: wasteful spending, patient harm, and health system challenges. Makes recommendations for implementation of and data on promising technologies

Electronic health record data quality assessment and tools: A systematic review

OBJECTIVE: We extended a 2013 literature review on electronic health record (EHR) data quality assessment approaches and tools to determine recent improvements or changes in EHR data quality assessment methodologies. MATERIALS AND METHODS: We completed a systematic review of PubMed articles from 2013 to April 2023 that discussed the quality assessment of EHR data. We screened and reviewed papers for the dimensions and methods defined in the original 2013 manuscript. We categorized papers as data quality outcomes of interest, tools, or opinion pieces. We abstracted and defined additional themes and methods though an iterative review process. RESULTS: We included 103 papers in the review, of which 73 were data quality outcomes of interest papers, 22 were tools, and 8 were opinion pieces. The most common dimension of data quality assessed was completeness, followed by correctness, concordance, plausibility, and currency. We abstracted conformance and bias as 2 additional dimensions of data quality and structural agreement as an additional methodology. DISCUSSION: There has been an increase in EHR data quality assessment publications since the original 2013 review. Consistent dimensions of EHR data quality continue to be assessed across applications. Despite consistent patterns of assessment, there still does not exist a standard approach for assessing EHR data quality. CONCLUSION: Guidelines are needed for EHR data quality assessment to improve the efficiency, transparency, comparability, and interoperability of data quality assessment. These guidelines must be both scalable and flexible. Automation could be helpful in generalizing this process

Adherence Patterns to Extended Cervical Screening Intervals in Women Undergoing HPV and Cytology Cotesting

Although guidelines have recommended extended interval cervical screening using concurrent human papillomavirus (HPV) and cytology (“cotesting”) for over a decade, little is known about its adoption into routine care. Using longitudinal medical record data (2003-2015) from Kaiser Permanente Northern California (KPNC), which adopted triennial cotesting in 2003, we examined adherence to extended interval screening. We analyzed predictors of screening intervals among 504,202 women undergoing routine screening, categorizing interval length into early

Mobilising Clinical Practice Data to Improve Multidisciplinary Oncology Care

As cancer incidence grows, healthcare services are increasingly pressured to provide timely, efficient, evidence-based care. The use of quality indicators are essential to identify and address variations in care delivery and patient outcomes. This thesis aims to inform best-practice quality measurement, feedback, and improvement utilising routinely collected data in cancer care. A systematic review of electronic medical record enabled measurement feedback systems found 12 of 14 studies reported mostly positive outcomes, but were of low-quality and lacking implementation context to replicate findings. A qualitative study identified significant consensus among key informant interviews on factors influencing success of data use and measurement feedback systems. A common theme between the review and interviews was the importance of clinical relevance and engagement. The findings were applied to a case study in colorectal cancer (CRC), including a systematic review and modified Delphi to identify clinically relevant quality indicators and a quantitative study to test the feasibility of the identified indicators against a population-based linked dataset of clinical practice data. The review identified 93 indicators in the literature and 56 CRC professionals prioritised 26 of those indicators. The feasibility study found that only six of the clinically prioritised indicators were feasible using available data in NSW. Feasible indicators were predominantly surgical, whereas indicators related to imaging, (neo)adjuvant therapy, and supportive care were lacking required data. As the use of data and value-based care continues to grow, this thesis provides direction for future data driven quality measurement for clinically meaningful quality improvement. System-wide coordination and standardised data capture, management, and operable exchange is required to transform data and quality indicators into actionable information to improve care

Health Information Technology in the United States: The Information Base for Progress

Health information technology (HIT) has the potential to advance health care quality by helping patients with acute and chronic conditions receive recommended care, diminishing disparities in treatment and reducing medical errors. Nevertheless, HIT dissemination has not occurred rapidly, due in part to the high costs of electronic health record (EHR) systems for providers of care—including the upfront capital investment, ongoing maintenance and short-term productivity loss. Also, many observers are concerned that, if HIT follows patterns observed with other new medical technologies, HIT and EHRs may diffuse in ways that systematically disadvantage vulnerable patient populations, thus increasing or maintaining existing disparities in access to and quality of care. These and other concerns have led to public and private efforts that aim to increase the pace of and reduce disparities in HIT diffusion by formulating national plans for dissemination, catalyzing the development of standards to encourage interoperability and promoting public-private partnerships to develop HIT infrastructures at the local and regional levels

Building Medical Homes in State Medicaid and CHIP Programs

Presents strategies, best practices, and lessons learned from ten states' efforts to advance the medical home model of comprehensive and coordinated care in Medicaid and Children's Health Insurance Programs in order to improve quality and contain costs

Critical Choices Conversation Pilot Project

Background: Advance care planning (ACP) and advance directives (AD) inform the provision of health care that aligns with clients’ goals and wishes. Less than 30% of female cancer care clients presented AD when admitted for care to a Magnet® designated hospital located in the Southwest United States (U.S.). Methods: A quality improvement project took place on a 25 bed in-patient cancer care unit to improve these rates. The nurses received ACP training and used a clinical support tool to facilitate discussions with clients. A Palliative Care Clinical Nurse Specialist assisted as needed. Results: Seven nurses accomplished a self-paced learning activity during a one-month timeframe. Although the nurses reported increased ACP skills after the training, the AD documentation decreased from 27% to 13% and remained below the 30% national norm. Similarly, combined ACP and AD documentation decreased from 33% to 20%. The nurses stated barriers such as time constraints, limited clinical experiences, and inabilities to accept the additional duties. Conclusions: Nurses who completed the evidence-based training reported increased knowledge, but were unable to implement the tool within the health care setting. Additional trained ACP facilitators or workload adjustments may be needed as well as additional education to normalize the accomplishments of ACP and ADs. Implications: The literature review, lessons learned, and recommendations may be used by hospital leaders to improve ACP and AD documentation, promote client-centered care, and increase compliance with federal and state laws and the Joint Commission’s requirements

Implementation of a Transitional Care Model to Decrease Readmissions for Ischemic Stroke and TIA Patients

Background: Poor continuity of care after hospitalization can increase the risk of adverse health outcomes such as unplanned readmissions for stroke and transient ischemic attack (TIA) patients. Transitional care models (TCMs) can be used to improve the coordination of care post-discharge. Objectives: The purpose of this doctoral Quality Improvement (QI) project was to develop, implement, and evaluate a TCM for ischemic stroke/TIA patients over a 3-month period. This project had four aims: 1) to decrease the unplanned 30-day readmission rate, 2) for all eligible patients to be enrolled after discharge, 3) to have all enrolled participants receive all components, and 4) for all participants to express satisfaction with the TCM. Methods: A TCM was designed and piloted for adult patients discharged home from the project site hospital with a diagnosis of ischemic stroke or TIA. The TCM consisted of patient education materials, scheduling of a primary care provider appointment, and two phone surveys at 7-days and 30-days post-discharge. Unplanned 30-day readmission rates were compared before and after project implementation. Results:Nine participants were enrolled. Five of these participants (55.6%) completed both the 7-day and 30-day surveys and comprised the intervention group. 100% of all eligible patients were contacted for enrollment. The post-intervention mean 30-day readmission rate of 3.7% (SD = 2.97) was significantly lower (p Conclusions: While this was a small pilot project, results demonstrated that the TCM may have had a positive impact on readmission rates. It was also well-received by participants and provided useful feedback on the hospital’s stroke program. Long-term implementation of a TCM may be of benefit in this patient population to improve health outcomes