Development and validation of a new ICD-10-based screening colonoscopy overuse measure in a large integrated healthcare system: a retrospective observational study
Conclusions
An International Classification of Diseases, Tenth Edition based electronic measure of screening colonoscopy overuse has high specificity and improved sensitivity compared with a previous International Classification of Diseases, Ninth Edition based measure. Despite increased focus on reducing low-value care and improving access, a quarter of VHA screening colonoscopies in 2017 were identified as potential low-value procedures, with substantial facility-level variability. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - June 19, 2023 Category: Health Management Authors: Adams, M. A., Kerr, E. A., Dominitz, J. A., Gao, Y., Yankey, N., May, F. P., Mafi, J., Saini, S. D. Tags: Original research Source Type: research
Illness severity characteristics and outcomes of patients remaining on an acute ward following medical emergency team review: a latent profile analysis
Conclusion
The five illness severity clusters may be used to define patients at risk of poorer outcomes who may benefit from enhanced levels of monitoring and targeted care. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - June 19, 2023 Category: Health Management Authors: Batterbury, A., Douglas, C., Jones, L., Coyer, F. Tags: Original research Source Type: research
Predictors and population health outcomes of persistent high GP turnover in English general practices: a retrospective observational study
Conclusions
Persistent high turnover is independently linked to indicators of poorer service and health outcomes. Although causality needs to be further investigated, strategies and policies may be needed to both reduce high turnover and support practices facing challenges with high GP turnover when it occurs. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - June 19, 2023 Category: Health Management Authors: Parisi, R., Lau, Y.-S., Bower, P., Checkland, K., Rubery, J., Sutton, M., Giles, S. J., Esmail, A., Spooner, S., Kontopantelis, E. Tags: Open access Original research Source Type: research
How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory
Conclusions
Our findings support the need for a patient safety paradigm that is meaningful to all stakeholders, incorporating what matters to patients to feel safe in hospital. Additional work should explore and test how the proposed conceptual model can be practically applied and implemented to incorporate the patient conceptualisation of patient safety into everyday clinical practice. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - June 19, 2023 Category: Health Management Authors: Barrow, E., Lear, R. A., Morbi, A., Long, S., Darzi, A., Mayer, E., Archer, S. Tags: Editor's choice Original research Source Type: research
How can routine colorectal cancer screening in the USA be considered low value in other countries?
Low-value services and healthcare overuse are tests, treatments or other medical interventions that provide little to no benefit to patients relative to their risk of harm, their costs and the availability of alternatives.1 Researchers investigating overuse usually base their measures on compliance with some defined standard of care, which can be country or region specific. In some countries, these standards might be based on trade-offs between population costs and outcomes. However, this is often not the case in the USA.2 For example, colonoscopy for the screening of colorectal cancer is routine care in the US, while othe...
Source: Quality and Safety in Health Care - June 19, 2023 Category: Health Management Authors: Chalmers, K., Brownlee, S., Saini, V. Tags: Editorials Source Type: research
Improving risk stratification and decision support for deteriorating hospital patients
In the 1990s, there was increased interest in understanding the antecedents to serious adverse events such as in-hospital cardiac arrest, unplanned admission to the intensive care unit (ICU) and in-hospital death. Studies from multiple countries around the world revealed that such adverse events were often preceded by objective signs of instability that manifested in derangements in vital signs, documentation of staff concern or increasing intensities of treatment such as oxygen therapy.1–3 In addition, staff on hospital wards did not reliably or consistently recognise clinical deterioration, nor respond in a manner ...
Source: Quality and Safety in Health Care - June 19, 2023 Category: Health Management Authors: Orosz, J., Jones, D. A. Tags: Editorials Source Type: research
High cost of broken relationships
Turnover is costly. When primary care physicians (PCPs) leave their practice for another location, leave medicine altogether for another career, partially leave by reducing clinical working time or retire early then relationships are broken, and patients and payors pay a price. Costs are higher and quality is lower. In the USA we found that patients who had lost their PCP incurred additional healthcare expenditures: $61 more per year for non-Medicare patients (typically those under 65 years old) and $189 more per year for Medicare patients.1 This results in an estimated $86 000 additional spending per departing PCP, totall...
Source: Quality and Safety in Health Care - June 19, 2023 Category: Health Management Authors: Sinsky, C. A., Morrow, J. Tags: Editorials Source Type: research
Emotional safety is patient safety
A growing body of research on patients’ and families’ understanding and conceptualisation of patient safety1 2 begs the question of how and why we, in healthcare and the field of patient safety and quality, conceptualise patient safety as a domain separate from patient-centredness and patient experience.3 In this issue, Archer et al contribute to this body of work.4 The authors explored patients’ conceptualisation of safety across three UK teaching hospital inpatient specialty wards in a qualitative interview study with a purposive sample of 24 English-speaking patients, 8 each from gerontology (medicine ...
Source: Quality and Safety in Health Care - June 19, 2023 Category: Health Management Authors: Lyndon, A., Davis, D.-A., Sharma, A. E., Scott, K. A. Tags: Editorials Source Type: research
How can we champion diversity, equity and inclusion within Lean Six Sigma? Practical suggestions for quality improvement
Lean Six Sigma (LSS) is a quality improvement (QI) methodology that has gained popularity in recent decades in health care management as a means to reduce waste and unwarranted variability.1 A combination of Lean Management System and Six Sigma, the principles and tools of LSS have been adapted from the manufacturing sector to the more service-oriented healthcare settings.2 3 At the same time, diversity, equality and inclusion (DEI) are increasingly acknowledged as core tenets of high-quality healthcare delivery and that concerted institutional changes are necessary to support DEI efforts.2 3 For the most part, the increas...
Source: Quality and Safety in Health Care - April 19, 2023 Category: Health Management Authors: Kumar, B., Mosher, H., Farag, A., Swee, M. Tags: Viewpoints Source Type: research
Roles and effectiveness of knowledge brokers for translating clinical practice guidelines in health-related settings: a systematic review
Conclusion
Knowledge manager and capacity builder roles were more frequently studied than linkage agent roles. KBs had mixed impact on translating CPGs into practice. Further RCTs, including those in non-hospital settings, are required.
PROSPERO registration number
CRD42022340365. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - April 19, 2023 Category: Health Management Authors: Cross, A. J., Haines, T. P., Ooi, C. E., La Caze, A., Karavesovska, S., Lee, E. J., Siu, S., Sareen, S., Jones, C., Steeper, M., Bell, J. S. Tags: Systematic review Source Type: research
Does recruiting patients to diabetes prevention programmes via primary care reinforce existing inequalities in care provision between general practices? A retrospective observational study
Conclusion
Recruiting patients to diabetes prevention programmes via primary care reinforces existing inequalities between general practices in the clinical quality of care they provide. This leaves patients registered with practices providing lower quality clinical care even more disadvantaged. Providing additional support to lower quality practices or using alternative recruitment methods may be necessary to avoid differential engagement in prevention programmes from widening these variations and potential health inequalities further. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - April 19, 2023 Category: Health Management Authors: Parkinson, B., McManus, E., Sutton, M., Meacock, R. Tags: Open access Original research Source Type: research
Indirect effect of the COVID-19 pandemic on hospital mortality in patients with hip fracture: a competing risk survival analysis using linked administrative data
Conclusions
Although COVID-19 infections led to increases in hospital mortality, overall hospital mortality risk for older patients with hip fracture remained largely stable during the first year of the pandemic. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - April 19, 2023 Category: Health Management Authors: Grimm, F., Johansen, A., Knight, H., Brine, R., Deeny, S. R. Tags: Open access, COVID-19 Original research Source Type: research
Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study
Conclusions
RN staffing and seniority levels were associated with patient mortality. The lack of association for HCSWs and agency nurses indicates they are not effective substitutes for RNs who regularly work on the ward. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - April 19, 2023 Category: Health Management Authors: Zaranko, B., Sanford, N. J., Kelly, E., Rafferty, A. M., Bird, J., Mercuri, L., Sigsworth, J., Wells, M., Propper, C. Tags: Open access, Editor's choice Original research Source Type: research
Translating evidence into policy and practice: what do we know already, and what would further research look like?
Cross et al’s important new article identifies the ‘poor translation of clinical practice guidelines ... into clinical practice’ and the need to understand how to close the gap between the production of new evidence and its use in clinical settings.1 They analyse 16 studies that focus on how ‘knowledge brokers’ might help, finding a decidedly mixed picture. While knowledge brokerage involves sensible measures—to generate and share guidelines, engage with relevant stakeholders and build greater capacity to share and adopt guidelines—their effectiveness is only clear in half of the r...
Source: Quality and Safety in Health Care - April 19, 2023 Category: Health Management Authors: Cairney, P., Boaz, A., Oliver, K. Tags: Editorials Source Type: research
Breaking the quality-equity cycle when implementing prevention programmes
Globally, health systems are increasingly investing in the delivery of prevention programmes for chronic diseases such as diabetes, with the goal of improving quality of life, reducing long-term costs of medication, use of healthcare services and lost productivity associated with illness.1 However, these investments are only effective if they reach the full range of intended populations, including those populations and settings that would benefit the most from the delivery and health impact of such programmes. The expected benefits of prevention programmes are predicated on successful enrolment of and engagement among thos...
Source: Quality and Safety in Health Care - April 19, 2023 Category: Health Management Authors: McHugh, S., Riordan, F., Shelton, R. C. Tags: Editorials Source Type: research
