1,499 research outputs found

    Performance Measures Using Electronic Health Records: Five Case Studies

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    Presents the experiences of five provider organizations in developing, testing, and implementing four types of electronic quality-of-care indicators based on EHR data. Discusses challenges, and compares results with those from traditional indicators

    Recommended Core Measures for Evaluating the Patient-Centered Medical Home: Cost, Utilization, and Clinical Quality

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    Outlines the process of the Patient-Centered Medical Home Evaluators' Collaborative for identifying core standardized measures and their recommended principles and measures for evaluating cost and utilization and clinical quality

    Advancing Physician Performance Measurement: Using Administrative Data to Assess Physician Quality and Efficiency

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    Summarizes national initiatives to advance the practice of standardized measurement and outlines goals for developing a method for tracking efficiency and quality that will reward physicians and enable patients to make informed healthcare choices

    Improving Patient Handover from the Pediatric Emergency Department to the Pediatric Intensive Care Unit

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    Patient safety can be at risk during registered nurse handover, particularly when transitioning between high risk areas. According to The Joint Commission (2017), a standardized transition process should be implemented during patient handover. The purpose of this paper was to evaluate the effect of a standardized process with a cognitive aid on handover between a pediatric emergency department and an intensive care unit. Objectives of the project were to decrease conversion time in the emergency department, increase standardized process utilization, and improve patient outcomes, registered nurse perception and satisfaction, and patient proxy satisfaction. This evidence-based quality improvement project took place in a free-standing children’s hospital, and involved registered nurses (N=168) and patients. The Plan, Do, Study, Act model was utilized to direct change. Outcomes were evaluated using pre- and post-data collected from surveys, report reviews, and organizational reports. Implementation of a standardized process with a cognitive aid had a statistically significant impact on use of the standardized handover process and registered nurse satisfaction without increasing transition time. Sustained increase in compliance with the process was achieved with use of the cognitive aid. Improvement was attributed to multiple, evidence-based, and tailored implementation strategies. Implementation of a cognitive aid within an established workflow and compliance tracking is likely to increase and sustain use of the standardized transition process during patient handover and improve registered nurse satisfaction

    Norton Healthcare: A Strong Payer-Provider Partnership for the Journey to Accountable Care

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    Examines the progress of an integrated healthcare delivery system in forming an accountable care organization with payer partners as part of the Brookings-Dartmouth ACO Pilot Program, including a focus on performance measurement and reporting

    Improving Antibiotic Resistant Infection Transmission Situational Awareness in Enclosed Facilities with a Novel Graphical User Interface for Tactical Biosurveillance

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    Serious challenges associated with antibiotic resistant infections (ABRIs) force healthcare practitioners (HCP) to seek innovative approaches that will slow the emergence of new ABRIs and prevent their spread. It was realized that traditional approaches to infection prevention based on education, retrospective reports, and biosurveillance often fail to ensure reliable compliance with infection prevention guidelines and real-time problem solving. The objective of this original research was to develop and test the conceptual design of a situational awareness (SA)-oriented information system for coping with healthcare-associated infection transmission. Constantly changing patterns in spatial distribution of patients, prevalence of infectious cases, clustering of contacts, and frequency of contacts may compromise the effectiveness of infection prevention and control in hospitals. It was hypothesized that providing HCPs with a graphical user interface (GUI) to visualize spatial information on the risks of exposure to ABRIs would effectively increase HCPs’ SA. Increased SA may enhance biosurveillance and result in tactical decisions leading to better patient outcomes. The study employed a mixed qualitative-quantitative research method encompassing conceptualization of GUI content, transcription of electronic health record and biosurveillance data into GUI visual artifacts, and evaluation of the GUI’s impact on HCPs’ perception and comprehension of the conditions that increase the risk of ABRI transmission. The study provided pilot evidence that visualization of spatial disease distribution and spatially-linked exposures and interventions significantly increases HCPs’ SA when compared to current practice. The research demonstrates that the SA-oriented GUI enables the HCPs to promptly answer the question, “At a given location, what are the risks of infection transmission there?” This research provides a new form of medical knowledge representation for spatial population-based decision-making within enclosed environments. The next steps include rapid application development and further hypothesis testing concerning the impact of this GUI on decsion-making

    The Use of Routinely Collected Data in Clinical Trial Research

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    RCTs are the gold standard for assessing the effects of medical interventions, but they also pose many challenges, including the often-high costs in conducting them and a potential lack of generalizability of their findings. The recent increase in the availability of so called routinely collected data (RCD) sources has led to great interest in their application to support RCTs in an effort to increase the efficiency of conducting clinical trials. We define all RCTs augmented by RCD in any form as RCD-RCTs. A major subset of RCD-RCTs are performed at the point of care using electronic health records (EHRs) and are referred to as point-of-care research (POC-R). RCD-RCTs offer several advantages over traditional trials regarding patient recruitment and data collection, and beyond. Using highly standardized EHR and registry data allows to assess patient characteristics for trial eligibility and to examine treatment effects through routinely collected endpoints or by linkage to other data sources like mortality registries. Thus, RCD can be used to augment traditional RCTs by providing a sampling framework for patient recruitment and by directly measuring patient relevant outcomes. The result of these efforts is the generation of real-world evidence (RWE). Nevertheless, the utilization of RCD in clinical research brings novel methodological challenges, and issues related to data quality are frequently discussed, which need to be considered for RCD-RCTs. Some of the limitations surrounding RCD use in RCTs relate to data quality, data availability, ethical and informed consent challenges, and lack of endpoint adjudication which may all lead to uncertainties in the validity of their results. The purpose of this thesis is to help fill the aforementioned research gaps in RCD-RCTs, encompassing tasks such as assessing their current application in clinical research and evaluating the methodological and technical challenges in performing them. Furthermore, it aims to assess the reporting quality of published reports on RCD-RCTs

    Final Defense: Sepsis Screening Tool Assessment at a Freestanding Children’s Hospital in the Midwest

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    Pediatric sepsis is a major contributor to childhood morbidity and mortality. Tools for predicting sepsis in pediatric patients have had poor predictive ability nor been validated. Risk assessment screening tools are effective at earlier detection of sepsis. The implementation of an evidence-based pediatric sepsis screening tool could reduce time to detect and diagnose severe sepsis so that patient treatment could occur earlier. This was a quality improvement project that evaluated a sepsis screening tool predictive validity at a children’s hospital

    Designing Effective Physician Incentives: Assessing the Relationship between Patient Satisfaction and Clinical Quality in an Ambulatory Environment

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    As the United State healthcare system continues to evolve from a reimbursement system based on volume to one based on value, understanding the relationship between physician quality metrics such as patient satisfaction and clinical quality metrics is extremely important. In order to improve value by effectuating behavior change, physician financial incentives must be designed based on desired outcomes. Understanding the relationship between performance indicators and aligning incentives is integral to successfully incentivizing physician behavior change. This study assessed the relationship between patient satisfaction and clinical quality in an ambulatory setting and determined that they are separate domains, but certain types of clinical quality are identifiable by patients and thus impact satisfaction
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