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Hadian SA, Rezayatmand R, Shaarbafchizadeh N, Ketabi S, Pourghaderi AR. Hospital performance evaluation indicators: a scoping review. BMC Health Serv Res 2024; 24:561. [PMID: 38693562 PMCID: PMC11064245 DOI: 10.1186/s12913-024-10940-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Hospitals are the biggest consumers of health system budgets and hence measuring hospital performance by quantitative or qualitative accessible and reliable indicators is crucial. This review aimed to categorize and present a set of indicators for evaluating overall hospital performance. METHODS We conducted a literature search across three databases, i.e., PubMed, Scopus, and Web of Science, using possible keyword combinations. We included studies that explored hospital performance evaluation indicators from different dimensions. RESULTS We included 91 English language studies published in the past 10 years. In total, 1161 indicators were extracted from the included studies. We classified the extracted indicators into 3 categories, 14 subcategories, 21 performance dimensions, and 110 main indicators. Finally, we presented a comprehensive set of indicators with regard to different performance dimensions and classified them based on what they indicate in the production process, i.e., input, process, output, outcome and impact. CONCLUSION The findings provide a comprehensive set of indicators at different levels that can be used for hospital performance evaluation. Future studies can be conducted to validate and apply these indicators in different contexts. It seems that, depending on the specific conditions of each country, an appropriate set of indicators can be selected from this comprehensive list of indicators for use in the performance evaluation of hospitals in different settings.
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Affiliation(s)
- Shirin Alsadat Hadian
- Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Rezayatmand
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Nasrin Shaarbafchizadeh
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Ketabi
- Department of Management, Faculty of Administrative Sciences and Economics, University of Isfahan, Isfahan, Iran
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Ali KJ, Goeschel CA, DeLia DM, Blackall LM, Singh H. The PRIDx framework to engage payers in reducing diagnostic errors in healthcare. Diagnosis (Berl) 2024; 11:17-24. [PMID: 37795579 DOI: 10.1515/dx-2023-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 08/26/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES No framework currently exists to guide how payers and providers can collaboratively develop and implement incentives to improve diagnostic safety. We conducted a literature review and interviews with subject matter experts to develop a multi-component 'Payer Relationships for Improving Diagnoses (PRIDx)' framework, that could be used to engage payers in diagnostic safety efforts. CONTENT The PRIDx framework, 1) conceptualizes diagnostic safety links to care provision, 2) illustrates ways to promote payer and provider engagement in the design and adoption of accountability mechanisms, and 3) explicates the use of data analytics. Certain approaches suggested by PRIDx were refined by subject matter expert interviewee perspectives. SUMMARY The PRIDx framework can catalyze public and private payers to take specific actions to improve diagnostic safety. OUTLOOK Implementation of the PRIDx framework requires new types of partnerships, including external support from public and private payer organizations, and requires creation of strong provider incentives without undermining providers' sense of professionalism and autonomy. PRIDx could help facilitate collaborative payer-provider approaches to improve diagnostic safety and generate research concepts, policy ideas, and potential innovations for engaging payers in diagnostic safety improvement activities.
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Affiliation(s)
- Kisha J Ali
- MedStar Institute for Quality and Safety, Columbia, MD, USA
| | - Christine A Goeschel
- MedStar Institute for Quality and Safety, Columbia, MD, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Derek M DeLia
- Rutgers University, Bloustein School of Planning and Public Policy, New Brunswick, NJ, USA
| | | | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
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Zaleski AL, Berkowsky R, Craig KJT, Pescatello LS. Comprehensiveness, Accuracy, and Readability of Exercise Recommendations Provided by an AI-Based Chatbot: Mixed Methods Study. JMIR MEDICAL EDUCATION 2024; 10:e51308. [PMID: 38206661 PMCID: PMC10811574 DOI: 10.2196/51308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/05/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Regular physical activity is critical for health and disease prevention. Yet, health care providers and patients face barriers to implement evidence-based lifestyle recommendations. The potential to augment care with the increased availability of artificial intelligence (AI) technologies is limitless; however, the suitability of AI-generated exercise recommendations has yet to be explored. OBJECTIVE The purpose of this study was to assess the comprehensiveness, accuracy, and readability of individualized exercise recommendations generated by a novel AI chatbot. METHODS A coding scheme was developed to score AI-generated exercise recommendations across ten categories informed by gold-standard exercise recommendations, including (1) health condition-specific benefits of exercise, (2) exercise preparticipation health screening, (3) frequency, (4) intensity, (5) time, (6) type, (7) volume, (8) progression, (9) special considerations, and (10) references to the primary literature. The AI chatbot was prompted to provide individualized exercise recommendations for 26 clinical populations using an open-source application programming interface. Two independent reviewers coded AI-generated content for each category and calculated comprehensiveness (%) and factual accuracy (%) on a scale of 0%-100%. Readability was assessed using the Flesch-Kincaid formula. Qualitative analysis identified and categorized themes from AI-generated output. RESULTS AI-generated exercise recommendations were 41.2% (107/260) comprehensive and 90.7% (146/161) accurate, with the majority (8/15, 53%) of inaccuracy related to the need for exercise preparticipation medical clearance. Average readability level of AI-generated exercise recommendations was at the college level (mean 13.7, SD 1.7), with an average Flesch reading ease score of 31.1 (SD 7.7). Several recurring themes and observations of AI-generated output included concern for liability and safety, preference for aerobic exercise, and potential bias and direct discrimination against certain age-based populations and individuals with disabilities. CONCLUSIONS There were notable gaps in the comprehensiveness, accuracy, and readability of AI-generated exercise recommendations. Exercise and health care professionals should be aware of these limitations when using and endorsing AI-based technologies as a tool to support lifestyle change involving exercise.
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Affiliation(s)
- Amanda L Zaleski
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health Corporation, Hartford, CT, United States
- Department of Preventive Cardiology, Hartford Hospital, Hartford, CT, United States
| | - Rachel Berkowsky
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States
| | - Kelly Jean Thomas Craig
- Clinical Evidence Development, Aetna Medical Affairs, CVS Health Corporation, Hartford, CT, United States
| | - Linda S Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States
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Mangum CD. Journey to STEEEP healthcare: A focus on systems through a patient's experience. Curr Probl Pediatr Adolesc Health Care 2023; 53:101461. [PMID: 37996313 DOI: 10.1016/j.cppeds.2023.101461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Healthcare systems continue to struggle with providing safe, timely, effective, efficient, equitable and patient-centered (STEEEP) care. Upon audit by clinicians, treatment processes such as those completed following clinical pathways appear to manage care safely. However, when reviewing the treatment process through the patient and/or their family's lens, the experience is quite different. This article will use a vignette detailing care provided in a primary care physician's office along with the patient's outpatient testing experience to reveal opportunities for improvement, a glimpse into the patient's experience and share methods for achieving STEEEP healthcare.
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Affiliation(s)
- Christopher D Mangum
- Quality and Safety Department, Children's Hospital of The King's Daughters, Norfolk, VA, USA.
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Hoefsmit PC, Jansen EK, Does RJMM, Zandbergen HR. The Search for an Outcome Variable That Measures Both Quality and Processes in Cardiac Surgery: Comparing the Quality Process Index and Mortality. Healthcare (Basel) 2023; 11:healthcare11101419. [PMID: 37239707 DOI: 10.3390/healthcare11101419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/22/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The translation of a large quantity of data into valuable insights for daily clinical practice is underexplored. A considerable amount of information is overwhelming, making it difficult to distill and assess quality and processes at the hospital level. This study contributes to this necessary translation by developing a Quality Process Index that summarizes clinical data to measure quality and processes. METHODS The Quality Process Index was constructed to enable retrospective analyses of quality and process evolution from 2011 to 2021 for various surgery types in the Amsterdam Cardiosurgical Database (n = 5497). It is presented alongside mortality rates, which are the golden standard for quality measurement. The two outcome variables are compared as quality and process measurement options. RESULTS Results showed that the mean Quality Process Index appeared rather stable, even though analysis of variance found that the mean Quality Process Index differed significantly over the years (p < 0.001). The 30-day and 120-day mortality rates appeared to fluctuate more, but interestingly, we failed to reject the null hypothesis of equal means. The Quality Process Index and mortality rates were statistically negatively correlated, and the extent of correlation was more pronounced with the 120-day mortality rate, as computed using the Pearson correlation coefficient r (30-day rQPI,30 = -0.07, p < 0.001 and 120-day mortality rates rQPI,120 = -0.12, p < 0.001). CONCLUSIONS The Quality Process Index seeks to address the need to translate data for quality and process improvement in healthcare. While mortality remains the most impactful outcome measure, the Quality Process Index provides a more stable and comprehensive measurement of quality and process improvement or deterioration in healthcare. Therefore, the Quality Process Index as a quantification reinforces the understanding of the definition of quality and process improvement.
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Affiliation(s)
- Paulien C Hoefsmit
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, 1081HV Amsterdam, The Netherlands
| | - Evert K Jansen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, 1081HV Amsterdam, The Netherlands
| | - Ronald J M M Does
- Department of Business Analytics, Amsterdam Business School, University of Amsterdam, 1081TV Amsterdam, The Netherlands
| | - H Reinier Zandbergen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, 1081HV Amsterdam, The Netherlands
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Abuzied Y, Alshammary SA, Alhalahlah T, Somduth S. Using FOCUS-PDSA Quality Improvement Methodology Model in Healthcare: Process and Outcomes. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2023; 6:70-72. [PMID: 37333757 PMCID: PMC10275632 DOI: 10.36401/jqsh-22-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/11/2023] [Accepted: 03/07/2023] [Indexed: 06/20/2023]
Affiliation(s)
- Yacoub Abuzied
- Nursing Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sami Ayed Alshammary
- Palliative Care Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Trad Alhalahlah
- Anesthesia Department, Jordanian Royal Medical Services, Amman, Jordan
| | - Shreemathie Somduth
- Nursing Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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Ruiz Colón GD, Wu A, Ratliff JK, Prolo LM. Quality and patient safety research in pediatric neurosurgery: a review. Childs Nerv Syst 2023; 39:1147-1158. [PMID: 36695845 DOI: 10.1007/s00381-022-05821-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 12/30/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND In 2001, the National Academy of Medicine, formerly known as the Institute of Medicine (IOM), published their seminal work, Crossing the Quality Chasm: A New Health System for the 21st Century. In this work, the authors called for improved safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity in the United States' healthcare system. Two decades after the publication of this work, healthcare costs continue to rise, but outcomes lag other nations. The objective of this narrative review is to describe research efforts in pediatric neurosurgery with respect to the six quality aims proposed by the IOM, and highlight additional research opportunities. METHODS PubMed, Google Scholar, and EBSCOhost were queried to identify studies in pediatric neurosurgery that have addressed the aims proposed by the IOM. Studies were summarized and synthesized to develop a set of research opportunities to advance quality of care. RESULTS Twenty-three studies were reviewed which focused on the six quality aims proposed by the IOM. Out of these studies, five research opportunities emerged: (1) To examine performance of tools of care, (2) To understand processes surrounding care delivery, (3) To conduct cost-effectiveness analyses for a broader range of neurosurgical conditions, (4) To identify barriers driving healthcare disparities, and (5) To understand patients' and caregivers' experiences receiving care, and subsequently develop tools and programs to address their needs and preferences. CONCLUSION There is a growing body of literature examining quality in pediatric neurosurgical care across all aims proposed by the IOM. However, there remains important gaps in the literature that, if addressed, will advance the quality of pediatric neurosurgical care delivery.
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Affiliation(s)
- Gabriela D Ruiz Colón
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Adela Wu
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, 94304, USA
| | - Laura M Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, 94304, USA. .,Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Palo Alto, CA, 94304, USA.
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Åhlin P, Almström P, Wänström C. Solutions for improved hospital-wide patient flows - a qualitative interview study of leading healthcare providers. BMC Health Serv Res 2023; 23:17. [PMID: 36611178 PMCID: PMC9825009 DOI: 10.1186/s12913-022-09015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hospital productivity is of great importance for patients and public health to achieve better availability and health outcomes. Previous research demonstrates that improvements can be reached by directing more attention to the flow of patients. There is a significant body of literature on how to improve patient flows, but these research projects rarely encompass complete hospitals. Therefore, through interviews with senior managers at the world's leading hospitals, this study aims to identify effective solutions to enable swift patient flows across hospitals and develop a framework to guide improvements in hospital-wide patient flows. METHODS This study drew on qualitative data from interviews with 33 senior managers at 18 of the world's 25 leading hospitals, spread across nine countries. The interviews were conducted between June 2021 and November 2021 and transcribed verbatim. A thematic analysis followed, based on inductive reasoning to identify meaningful subjects and themes. RESULTS We have identified 50 solutions to efficient hospital-wide patient flows. They describe the importance for hospitals to align the organization; build a coordination and transfer structure; ensure physical capacity capabilities; develop standards, checklists, and routines; invest in digital and analytical tools; improve the management of operations; optimize capacity utilization and occupancy rates; and seek external solutions and policy changes. This study also presents a patient flow improvement framework to be used by healthcare managers, commissioners, and decision-makers when designing strategies to improve the delivery of healthcare services to meet the needs of patients. CONCLUSIONS Hospitals must invest in new capabilities and technologies, implement new working methods, and build a patient flow-focused culture. It is also important to strategically look at the patient's whole trajectory of care as one unified flow that must be aligned and integrated between and across all actors, internally and externally. Hospitals need to both proactively and reactively optimize their capacity use around the patient flow to provide care for as many patients as possible and to spread the burden evenly across the organization.
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Affiliation(s)
- Philip Åhlin
- grid.5371.00000 0001 0775 6028Department of Technology Management and Economics, Chalmers University of Technology, Vera Sandbergs Allé 8, 412 96 Göteborg, Sweden
| | - Peter Almström
- grid.5371.00000 0001 0775 6028Department of Technology Management and Economics, Chalmers University of Technology, Vera Sandbergs Allé 8, 412 96 Göteborg, Sweden
| | - Carl Wänström
- grid.5371.00000 0001 0775 6028Department of Technology Management and Economics, Chalmers University of Technology, Vera Sandbergs Allé 8, 412 96 Göteborg, Sweden
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Federspiel JJ, Kucirka LM, Mallampati DP, Wheeler SM, Menard MK, Hughes BL, Quist-Nelson J, Meng ML. For better care we need better data: towards a national obstetrics registry. Am J Obstet Gynecol MFM 2023; 5:100787. [PMID: 36404523 PMCID: PMC10065844 DOI: 10.1016/j.ajogmf.2022.100787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
Unacceptably high rates of severe maternal morbidity and mortality in the United States and stark racial disparities in outcomes are generating efforts to improve both research capacity and quality improvement in obstetrical care. Comprehensive, high-quality datasets on which to build these efforts are crucial to the success of obstetrical quality improvement efforts. However, existing data sources in obstetrics have notable limitations. Other medical and surgical specialties have addressed similar challenges through the creation of national registries, and we argue that obstetrics must take the same approach to improve outcomes. In this article, we summarized the current availability and limitations of large-scale data in obstetrics research and compared the data with registries developed in other specialties. Moreover, we have outlined the guiding principles for the development of a national obstetrics registry and have proposed future directions.
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Affiliation(s)
- Jerome J Federspiel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (Drs Federspiel, Wheeler, and Hughes).
| | - Lauren M Kucirka
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Durham, NC (Drs Kucirka, Mallampati, Menard, and Quist-Nelson)
| | - Divya P Mallampati
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Durham, NC (Drs Kucirka, Mallampati, Menard, and Quist-Nelson)
| | - Sarahn M Wheeler
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (Drs Federspiel, Wheeler, and Hughes)
| | - M Kathyrn Menard
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Durham, NC (Drs Kucirka, Mallampati, Menard, and Quist-Nelson)
| | - Brenna L Hughes
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC (Drs Federspiel, Wheeler, and Hughes)
| | - Johanna Quist-Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Durham, NC (Drs Kucirka, Mallampati, Menard, and Quist-Nelson)
| | - Marie-Louise Meng
- Division of Women's Anesthesiology, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA (Dr Meng)
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Keating NL, Landrum MB, Samuel-Ryals C, Sinaiko AD, Wright A, Brooks GA, Bai B, Zaslavsky AM. Measuring Racial Inequities In The Quality Of Care Across Oncology Practices In The US. Health Aff (Millwood) 2022; 41:598-606. [PMID: 35377762 DOI: 10.1377/hlthaff.2021.01594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Racial inequities in clinical performance diminish overall health care system performance; however, quality assessments have rarely incorporated reliable measures of racial inequities. We studied care for more than one million Medicare fee-for-service beneficiaries with cancer to assess the feasibility of calculating reliable practice-level measures of racial inequities in chemotherapy-associated emergency department (ED) visits and hospitalizations. Specifically, we used hierarchical models to estimate adjusted practice-level Black-White differences in these events and described differences across practices. We calculated reliable inequity measures for 426 and 322 practices, depending on the measure. These practices reflected fewer than 10 percent of practices treating Medicare beneficiaries with chemotherapy, but they treated approximately half of all White and Black Medicare beneficiaries receiving chemotherapy and two-thirds of Black Medicare beneficiaries receiving chemotherapy. Black patients experienced chemotherapy-associated ED visits and hospitalizations at higher rates (54.2 percent and 35.8 percent, respectively) than White patients (45.7 percent and 31.9 percent, respectively). The median within-practice Black-White difference was 8.1 percentage points for chemotherapy-associated ED visits and 2.7 percentage points for chemotherapy-associated hospitalizations. Additional research is needed to identify other reliable measures of racial inequities in health care quality, measure care inequities in smaller practices, and assess whether providing practice-level feedback could improve equity.
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Affiliation(s)
- Nancy L Keating
- Nancy L. Keating , Harvard University and Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Cleo Samuel-Ryals
- Cleo Samuel-Ryals, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Alexi Wright
- Alexi Wright, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gabriel A Brooks
- Gabriel A. Brooks, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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When patients get stuck: A systematic literature review on throughput barriers in hospital-wide patient processes. Health Policy 2021; 126:87-98. [PMID: 34969531 DOI: 10.1016/j.healthpol.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/08/2021] [Accepted: 12/03/2021] [Indexed: 11/21/2022]
Abstract
Hospital productivity is of great importance to policymakers, and previous research demonstrates that improved hospital productivity can be achieved by directing more focus towards patient throughput at healthcare organizations. There is also a growing body of literature on patient throughput barriers hampering the flow of patients. These projects rarely, however, encompass complete hospitals. Therefore, this paper provides a systematic literature review on hospital-wide patient process throughput barriers by consolidating the substantial body of studies from single settings into a hospital-wide perspective. Our review yielded a total of 2207 articles, of which 92 were finally selected for analysis. The results reveal long lead times, inefficient capacity coordination and inefficient patient process transfer as the main barriers at hospitals. These are caused by inadequate staffing, lack of standards and routines, insufficient operational planning and a lack in IT functions. As such, this review provides new perspectives on whether the root causes of inefficient hospital patient throughput are related to resource insufficiency or inefficient work methods. Finally, this study develops a new hospital-wide framework to be used by policymakers and healthcare managers when deciding what improvement strategies to follow to increase patient throughput at hospitals.
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Squires A, Ma C, Miner S, Feldman P, Jacobs EA, Jones SA. Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: A retrospective analysis. Int J Nurs Stud 2021; 125:104093. [PMID: 34710627 DOI: 10.1016/j.ijnurstu.2021.104093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined. OBJECTIVE To determine if home care patients' language preference is associated with their risk for hospital readmission from home health care within 30 days of hospital discharge. DESIGN Retrospective cross-sectional study of hospital readmissions from an urban home health care agency's administrative records and the national electronic home health care record for the United States, captured between 2010 and 2015. SETTING New York City, New York, USA. PARTICIPANTS The dataset comprised 90,221 post-hospitalization patients and 6.5 million home health care visits. METHODS First, a Chi-square test was used to determine if there were significant differences in crude readmission rates based on language group. Inverse probability of treatment weighting was used to adjust for significant differences in known hospital readmission risk factors between to examine all-cause hospital readmission during a home health care stay. The final matched sample included 87,561 patients with a language preference of English, Spanish, Russian, Chinese, or Korean. English-speaking patients were considered the comparison group to the non-English speaking patients. A Marginal Structural Model was applied to estimate the impact of non-English language preference against English language preference on rehospitalization. The results of the marginal structural model were expressed as an odds ratio of likelihood of readmission to the hospital from home health care. RESULTS Home health patients with a non-English language preference had a higher hospital readmission risk than English-speaking patients. Crude readmission rate for the limited English proficiency patients was 20.4% (95% CI, 19.9-21.0%) overall compared to 18.5% (95% CI, 18.7-19.2%) for English speakers (p < 0.001). Being a non-English-speaking patient was associated with an odds ratio of 1.011 (95% CI, 1.004-1.018) in increased hospital readmission rates from home health care (p = 0.001). There were also statistically significant differences in readmission rate by language group (p < 0.001), with Korean speakers having the lowest rate and Spanish speakers having the highest, when compared to English speakers. CONCLUSIONS People with a non-English language preference have a higher readmission rate from home health care. Hospital and home healthcare agencies may need specialized care coordination services to reduce readmission risk for these patients. Tweetable abstract: A new US-based study finds that home care patients with language barriers are at higher risk for hospital readmission.
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Affiliation(s)
- Allison Squires
- Director, Florence S. Downs PhD Program, Rory Meyers College of Nursing, Research Associate Professor, Department of General Internal Medicine, Grossman School of Medicine, New York University, 433 First Avenue, 6th floor, New York, NY 10010, United States.
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, United States.
| | - Sarah Miner
- Wegman's School of Nursing, St. John Fischer College, Rochester, NY, United States.
| | - Penny Feldman
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10017, United States.
| | - Elizabeth A Jacobs
- Maine Medical Center Research Institute, MaineHealth, Scarborough, ME 04047, United States.
| | - Simon A Jones
- Department of Population Health, Division of General Internal Medicine, Grossman School of Medicine, New York University, New York, NY 10010, United States.
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Cohen MAO, McQuaid J, Remington R. Need to Intervene: An Exploratory Study of Nurses' Experiences With Patienthood. J Patient Exp 2021; 8:2374373521998846. [PMID: 34179406 PMCID: PMC8205407 DOI: 10.1177/2374373521998846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Much has been written about the patient experience, but there is little information about experiences of providers as patients. Since lay patients and providers have differing perspectives and expectations, it is important to identify those elements shared by those in each group and those that diverge. This study identified experiences of nurses as being a patient or a family caregiver of a patient as well as identified assessments of the healthcare system by nurses. An exploratory study using a self-administered electronic questionnaire with a group of registered nurses was conducted. Assessments of the system by responders were positive when addressing quality of care, interactions among healthcare personnel, and interactions with patients. However, when discussing their experiences as patient, nurses reported they encountered problems with coordination of care, responses of medical personnel, attention to details of care, and responses to their attempts to become more involved. Results confirm issues raised by patients who are not medical experts in patient satisfaction studies. Adding a professional perspective highlights where problems with the healthcare system lie.
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Affiliation(s)
| | - Jim McQuaid
- Framingham State University, Framingham, MA, USA
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