A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents

residencies and acquire increased responsibility for patient care. Many have suggested that these new medical residents may produce errors and worsen patient outcomes—the so-called “July Effect; ” however, we have found no U.S. evidence documenting this effect. OBJECTIVE: Determine whether fatal medication errors spike in July

America's Rural Hospitals: A Selective Review of 1980s Research

We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing-bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities—including conversion of the facility itself—on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities served.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74857/1/j.1748-0361.1990.tb00682.x.pd

Which professional (non-technical) competencies are most important to the success of graduate veterinarians? A Best Evidence Medical Education (BEME) systematic review: BEME Guide No. 38

Background: Despite the growing prominence of professional (non-technical) competencies in veterinary education, the evidence to support their importance to veterinary graduates is unclear. Aim: To summarize current evidence within the veterinary literature for the importance of professional competencies to graduate success. Methods: A systematic search of electronic databases was conducted (CAB Abstracts, Web of Science, PubMed, PsycINFO, ERIC, Australian and British Education Index, Dissertations & Theses) from 1988 to 2015 and limited to the veterinary discipline (veterinar* term required). Evidence was sought from consensus-based competence frameworks, surveys of stakeholder perceptions, and empirical evidence linked to relevant outcomes (e.g. employability, client satisfaction or compliance). Data extraction was completed by two independent reviewers and included a quality assessment of each source. Results: Fifty-two sources were included in the review, providing evidence from expert frameworks (10 sources), stakeholder perceptions (30 sources, including one from the previous category), and empirical research (13 sources). Communication skills were the only competency to be well-supported by all three categories of evidence. Other competencies supported by multiple sources of empirical evidence include empathy, relationship-centered care, self-efficacy, and business skills. Other competencies perceived to be relatively more important included awareness of limitations, professional values, critical thinking, collaboration, and resilience. Conclusions: This review has highlighted the comparatively weak body of evidence supporting the importance of professional competencies for veterinary graduate success, with the exception of communication skills. However we stress this is more indicative of the scarcity of high-quality veterinary-based education research in the field, than of the true priority of these competencies

Consequences of an Intervention to Reduce Restrictive Side Rail Use in Nursing Homes

To examine the effect of an advanced practice nurse (APN) intervention on restrictive side rail usage in four nursing homes and with a sample of 251 residents. A secondary question explored the association between restrictive side rail reduction and bed-related falls. DESIGN : Pre- and posttest design. SETTING : Four urban nursing homes. PARTICIPANTS : All nursing home residents present in the nursing home at three time points (n=710, 719, and 707) and a subset of residents (n=251) with restrictive side rail use at baseline. INTERVENTION : APN consultation with individual residents and facility-wide education and consultation. MEASUREMENTS : Direct observation of side rail status, resident and nurse interview for functional status, mobility, cognition, behavioral symptoms, medical record review for demographics and treatment information, and incident reports for fall data. RESULTS : At the institutional level, one of the four nursing homes significantly reduced restrictive side rail use ( P =.01). At the individual participant level, 51.4% (n=130) reduced restrictive side rail use. For the group that reduced restrictive side rails, there was a significantly ( P <.001) reduced fall rate (−0.053; 95% confidence interval (CI)=−0.083 to −0.024), whereas the group that continued restrictive side rail did not demonstrate a significantly ( P =.17) reduced fall rate (−0.013; 95% CI=−0.056–0.030). CONCLUSION : An APN consultation model can safely reduce side rail use. Restrictive side rail reduction does not lead to an increase in bed-related falls. Although side rails serve many purposes, routine use of these devices to restrict voluntary movement and prevent falls is not supported.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65685/1/j.1532-5415.2007.01082.x.pd

Disclosure, Apology, and Offer Programs: Stakeholders’ Views of Barriers to and Strategies for Broad Implementation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94445/1/j.1468-0009.2012.00679.x.pd

Interhospital Transfers Among Medicare Beneficiaries Admitted for Acute Myocardial Infarction at Nonrevascularization Hospitals

Background—Patients with acute myocardial infarction (AMI) who are admitted to hospitals without coronary revascularization are frequently transferred to hospitals with this capability, yet we know little about the basis for how such revascularization hospitals are selected. Methods and Results—We examined interhospital transfer patterns in 71 336 AMI patients admitted to hospitals without revascularization capabilities in the 2006 Medicare claims using network analysis and regression models. A total of 31 607 (44.3%) AMI patients were transferred from 1684 nonrevascularization hospitals to 1104 revascularization hospitals. Median time to transfer was 2 days. Median transfer distance was 26.7 miles, with 96.1% within 100 miles. In 45.8% of cases, patients bypassed a closer hospital to go to a farther hospital that had a better 30-day risk standardized mortality rates. However, in 36.8% of cases, another revascularization hospital with lower 30-day risk-standardized mortality was actually closer to the original admitting nonrevascularization hospital than the observed transfer destination. Adjusted regression models demonstrated that shorter transfer distances were more common than transfers to the hospitals with lowest 30-day mortality rates. Simulations suggest that an optimized system that prioritized the transfer of AMI patients to a nearby hospital with the lowest 30-day mortality rate might produce clinically meaningful reductions in mortality. Conclusions—More than 40% of AMI patients admitted to nonrevascularization hospitals are transferred to revascular- ization hospitals. Many patients are not directed to nearby hospitals with the lowest 30-day risk-standardized mortality, and this may represent an opportunity for improvement. (Circ Cardiovasc Qual Outcomes. 2010;3:468-475.)This work was supported by 1K08HL091249-01 from the NIH/ NHLBI and used the Measurement Core of the Michigan Diabetes Research and Training Center (NIH/NIDDK, P60DK-20572). This project was also funded in part under a grant from the Pennsylvania Department of Health, which specifically disclaims responsibility for any analyses, interpretations, or conclusions. The funders were not involved in study design, interpretation, or the decision to publish.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78005/1/10.I.Circ.Outcomes.pd

A Return to Virtue

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75581/1/j.1553-2712.2008.00309.x.pd

Measuring organisational readiness for patient engagement (MORE) : an international online Delphi consensus study

Date of Acceptance: 28/01/2015. © 2015 Oostendorp et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedWidespread implementation of patient engagement by organisations and clinical teams is not a reality yet. The aim of this study is to develop a measure of organisational readiness for patient engagement designed to monitor and facilitate a healthcare organisation’s willingness and ability to effectively implement patient engagement in healthcarePeer reviewedFinal Published versio

Monitoring Community Pharmacist's Quality of Care: A feasibility study of using pharmacy claims data to assess performance

Contains fulltext : 98109.pdf (publisher's version ) (Open Access)BACKGROUND: Public pressure has increasingly emphasized the need to ensure the continuing quality of care provided by health professionals over their careers. Health profession's regulatory authorities, mandated to be publicly accountable for safe and effective care, are revising their quality assurance programs to focus on regular evaluations of practitioner performance. New methods for routine screening of performance are required and the use of administrative data for measuring performance on quality of care indicators has been suggested as one attractive option. Preliminary studies have shown that community pharmacy claims databases contain the information required to operationalize quality of care indicators. The purpose of this project was to determine the feasibility of routine use of information from these databases by regulatory authorities to screen the quality of care provided at community pharmacies. METHODS: Information from the Canadian province of Quebec's medication insurance program provided data on prescriptions dispensed in 2002 by more than 5000 pharmacists in 1799 community pharmacies. Pharmacy-specific performance rates were calculated on four quality of care indicators: two safety indicators (dispensing of contra-indicated benzodiazepines to seniors and dispensing of nonselective beta-blockers to patients with respiratory disease) and two effectiveness indicators (dispensing asthma or hypertension medications to non-compliant patients). Descriptive statistics were used to summarize performance. RESULTS: Reliable estimates of performance could be obtained for more than 90% of pharmacies. The average rate of dispensing was 4.3% (range 0 - 42.5%) for contra-indicated benzodiazepines, 15.2% (range 0 - 100%) for nonselective beta-blockers to respiratory patients, 10.7% (range 0 - 70%) for hypertension medications to noncompliant patients, and 43.3% (0 - 91.6%) for short-acting beta-agonists in over-use situations. There were modest correlations in performance across the four indicators. Nine pharmacies (0.5%) performed in the lowest quartile in all four of the indicators, and 5.3% (n = 95) performed in the lowest quartile on three of four indicators. CONCLUSIONS: Routinely collected pharmacy claims data can be used to monitor indicators of the quality of care provided in community pharmacies, and may be useful in future to identify underperforming pharmacists, measure the impact of policy changes and determine predictors of best practices