Characteristics of hospitals receiving the largest penalties by US pay-for-performance programmes
Introduction Healthcare systems around the world are striving to deliver high quality care while controlling costs. One compelling strategy is the use of penalties for low-value care.1 2 The US federal government has made significant efforts to shift towards value-based payments for hospitals by introducing three national pay-for-performance (P4P) schemes which employ penalties: Hospital Readmission Reduction Program (HRRP), Hospital Value-Based-Purchasing (VBP) and, more recently, Hospital-Acquired Condition Reduction (HACR) Program. HRRP penalises hospitals with higher-than-expected readmissions; VBP adjusts hospital pay...
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Figueroa, J. F., Wang, D. E., Jha, A. K. Tags: Short reports Source Type: research
From the closest observers of patient care: a thematic analysis of online narrative reviews of hospitals
Conclusions
A substantial proportion of consumer reviews do not mention HCAHPS domains. Surrogates appear to observe care differently than patients, particularly around safety. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Bardach, N. S., Lyndon, A., Asteria-Penaloza, R., Goldman, L. E., Lin, G. A., Dudley, R. A. Tags: Original research Source Type: research
Differentiating between detrimental and beneficial interruptions: a mixed-methods study
Conclusions
A mixed-methods approach can help distinguish between detrimental and beneficial interruptions. While interruptions breaking the delivery of steady treatment and attention to the patient are detrimental, those returning the RN's focus to the patient, as well as those supporting patient-clinician and clinician-clinician communications are beneficial. This insight may be helpful to healthcare delivery teams tasked with improving interruption-laden processes. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Myers, R. A., McCarthy, M. C., Whitlatch, A., Parikh, P. J. Tags: Original research Source Type: research
Identifying patient safety problems associated with information technology in general practice: an analysis of incident reports
Conclusions
Problems associated with IT include perennial risks with paper records, but additional disruptions in workflow and hazards for patients unique to IT, occasionally affecting multiple patients. Surveillance for such hazards may have general utility, but particularly in the context of migrating historical records to new systems and software updates to existing systems. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Magrabi, F., Liaw, S. T., Arachi, D., Runciman, W., Coiera, E., Kidd, M. R. Tags: Original research Source Type: research
Making comparative performance information more comprehensible: an experimental evaluation of the impact of formats on consumer understanding
Discussion
Particular presentation formats enhanced consumer understanding of CPI, most importantly the use of overall performance scores, word icons and coloured dots, and a reduced number of providers displayed. Public report efforts should use these formats to maximise impact on consumers. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Damman, O. C., De Jong, A., Hibbard, J. H., Timmermans, D. R. M. Tags: Open access Original research Source Type: research
The use of patient experience survey data by out-of-hours primary care services: a qualitative interview study
Conclusions
The lack of clarity around how out-of-hours providers should audit patient experience hinders the utility of the National Quality Requirements. Although surveys were common, patient feedback data had only a limited role in service change. Data derived from the GPPS may be used to benchmark service providers, but refinement of the out-of-hours items is needed. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Barry, H. E., Campbell, J. L., Asprey, A., Richards, S. H. Tags: Open access Original research Source Type: research
Establishing the validity of English GP Patient Survey items evaluating out-of-hours care
Conclusions
Minor modifications are required for the English GPPS items evaluating out-of-hours care to improve comprehension by service users. A modified question set was demonstrated to comprise a valid measure of service users’ overall satisfaction with out-of-hours care received. This demonstrates the potential for the use of as few as four items in benchmarking providers and assisting services in identifying, implementing and assessing quality improvement initiatives. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Mounce, L. T. A., Barry, H. E., Calitri, R., Henley, W. E., Campbell, J., Roland, M., Richards, S. Tags: Open access Original research Source Type: research
Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study
Conclusions
IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at night and weekends, rather than patient case mix, appear to be responsible. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Robinson, E. J., Smith, G. B., Power, G. S., Harrison, D. A., Nolan, J., Soar, J., Spearpoint, K., Gwinnutt, C., Rowan, K. M. Tags: Open access, Editor's choice, BMJQS Noteworthy articles Original research Source Type: research
The multiple aims of pay-for-performance and the risk of unintended consequences
Since the Affordable Care Act introduced financial penalties on hospitals for excess readmission rates in the USA, an intense debate has ensued regarding the value of readmissions as a marker of quality. Under the Hospital Readmission Reduction Program (HRRP), hospitals face penalties of up to 3% of base operating payment from Medicare, the federally funded health insurance system for people aged over 65. Penalties totalled $428 million in 2015,1 and similar policies are in place in Denmark, Germany and England.2 HRRP aimed to ‘reward hospitals that are successful in reducing avoidable readmissions’3 and indeed...
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Friebel, R., Steventon, A. Tags: Editorials Source Type: research
Balancing quality of care and resource utilisation in acute care hospitals
Healthcare organisations have a mandate to provide the highest standard of care for patients and their families. While it may be difficult to empirically demonstrate that an organisation provides a high standard of care using basic outcomes such as mortality,1 the foundations of both measuring and improving healthcare quality include consideration of adequate structures and processes of care with proven relationships to better outcomes.2 3 Healthcare organisations rely on evidence-based processes of care (eg, proven medication for the treatment of acute myocardial infarction and appropriate prevention strategies for avoidi...
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Amaral, A. C. K. B., Cuthbertson, B. H. Tags: Editorials Source Type: research
High-value care programmes from the bottom-up... and the top-down
The introduction of high-value care into medical education is emerging as a global imperative.1 While delivering on the promise of ‘best care at lower cost’ will require major shifts at every level of the healthcare system,2 training the new pipeline of health professionals in both the ideals and the execution of high-value care remains a critical target for creating future change.3 4 Stinnett-Donnelly and colleagues describe a programme at their academic institution aimed at simultaneously reducing unnecessary or harmful care, improving patient experience and educating resident trainees about high-value care.5...
Source: BMJ Quality and Safety - October 18, 2016 Category: Journals (General) Authors: Moriates, C., Wong, B. M. Tags: Editorials Source Type: research
Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review
Conclusions
Results to date are promising and this relatively young field is now close to a point where these kinds of cognitive interventions can be recommended to educators. Further research with refined methodology and more diverse samples is required before firm recommendations may be made for medical education and policy; however, these results suggest that such interventions hold promise, with much current enthusiasm for new research. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 18, 2016 Category: Journals (General) Authors: Lambe, K. A., O'Reilly, G., Kelly, B. D., Curristan, S. Tags: Systematic review Source Type: research
Balancing stakeholder needs in the evaluation of healthcare quality improvement
Quality improvement (QI) efforts affect a broader range of people than we often assume. These are the potential stakeholders for QI and its evaluation, and they have valuable perspectives to offer when they are consulted in planning, conducting and interpreting evaluations. QI practitioners are accustomed to consulting stakeholders to assess unintended consequences or assess patient experiences of care, but in many cases there are additional benefits to a broad inclusion of stakeholders. These benefits are better adherence to ethical standards, to assure that all legitimate interests take part, more useful and relevant eva...
Source: BMJ Quality and Safety - September 18, 2016 Category: Journals (General) Authors: Leviton, L. C., Melichar, L. Tags: Open access Research and reporting methodology Source Type: research
Implementing an institution-wide quality improvement policy to ensure appropriate use of continuous cardiac monitoring: a mixed-methods retrospective data analysis and direct observation study
Conclusions
The observed improvements in process measures coupled with no adverse effects to patient outcomes suggest that the overall system became more resilient to current and emerging demands. This study indicates that when collaboration across a diverse team is coupled with strong leadership support, policies and procedures such as this one can improve clinical practice and patient care. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 18, 2016 Category: Journals (General) Authors: Rayo, M. F., Mansfield, J., Eiferman, D., Mignery, T., White, S., Moffatt-Bruce, S. D. Tags: Original research Source Type: research
Primary care physicians willingness to disclose oncology errors involving multiple providers to patients
Conclusion
To make meaningful progress towards improving disclosure; physicians, risk managers, organisational leaders, professional organisations and accreditation bodies need to understand the factors which influence disclosure. Such an understanding is required to inform institutional policies and provider training. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - September 18, 2016 Category: Journals (General) Authors: Mazor, K., Roblin, D. W., Greene, S. M., Fouayzi, H., Gallagher, T. H. Tags: Original research Source Type: research
