scholarly journals Longitudinal Impact of APRNs on Nursing Home Quality Measures in the Missouri Quality Initiative

2021 ◽  
Author(s):  
Marilyn Rantz ◽  
G. F. Petroski ◽  
L. L. Popejoy ◽  
A. A. Vogelsmeier ◽  
K. E. Canada ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Phase 1 ◽  
Quality Measures ◽  
The State ◽  
Full Time ◽  
Improve Quality ◽  
Phase 2 ◽  
Intervention Phase ◽  
Tract Infections

Abstract Objectives To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending. Design A four group comparative analysis of longitudinal data from September 2013 thru December 2019. Setting NHs in the interventions of both Phases 1 (2012–2016) and 2 (2016–2020) of MOQI (n=16) in the St. Louis area; matched comparations in the same counties as MOQI NHs (n=27); selected Phase 2 payment intervention NHs in Missouri (n=24); NHs in the remainder of the state (n=406). Participants NHs in Missouri Intervention: Phase 1 of The Missouri Quality Initiative (MOQI), a Centers for Medicare and Medicaid (CMS) Innovations Center funded research initiative, was a multifaceted intervention in NHs in the Midwest, which embedded full-time APRNs in participating NHs to reduce hospitalizations and improve care of NH residents. Phase 2 extended the MOQI intervention in the original intervention NHs and added a CMS designed Payment Intervention; Phase 2 added a second group of NHs to receive the Payment. Intervention Only. Measurements Eight QMs selected by CMS for the Initiative were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint use, activities of daily living, weight loss, and antipsychotic medication use. For each of the monthly QMs (2013 thru 2019) an unobserved components model (UCM) was fitted for comparison of groups. Results The analysis of QMs reveals that that the MOQI Intervention + Payment group (group with the embedded APRNs) outperformed all comparison groups: matched comparison with neither intervention, Payment Intervention only, and remainder of the state. Conclusion These results confirm the QM analyses of Phase 1, that MOQI NHs with full-time APRNs are effective to improve quality of care.

scholarly journals 1107. Impact of Routine Education and Data Feedback on the Durability of an Antimicrobial Stewardship Intervention for Outpatient Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S394-S394
Author(s):  
Jason Funaro ◽  
Rebekah W Moehring ◽  
Beiyu Liu ◽  
Hui-Jie Lee ◽  
Christina Sarubbi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Phase 1 ◽  
Urgent Care ◽  
Phase 2 ◽  
Intervention Phase ◽  
Data Feedback ◽  
Specific Feedback ◽  
Initial Intervention ◽  
Tract Infections

Abstract Background Achieving lasting, sustainable effects in outpatient AS interventions has been a challenge for many programs. Our group observed an initial benefit of an outpatient AS intervention focused on diagnosis and management of urinary tract infections (UTIs). However, prescribing habits trended back toward baseline over time. This study aimed to evaluate the impact of routine education and comparative data feedback on the durability of an outpatient AS intervention for UTIs. Methods We conducted a prospective quasi-experimental study at one primary care (PC) and one urgent care (UC) clinic to evaluate the durability of an outpatient AS intervention implemented in August 2017 and November 2017, respectively. Clinicians who treated adult patients with a diagnosis of acute UTI at either clinic participated in the study. The initial intervention (phase 1) included development of clinic-specific antibiograms and UTI diagnosis and treatment guidelines. Approximately 12 months after the initial intervention, routine education along with clinic- and comparative provider-specific feedback reports were emailed to clinicians at regular intervals (phase 2). The primary outcome was percent of encounters in which first- or second-line antibiotics were prescribed. Pre- and post-intervention phase and trend changes were assessed using an interrupted time-series approach. Results Data were collected on 792 and 3,720 UTI encounters at PC and UC, respectively. In the 12 months after the initial intervention, rates of guideline concordance were 73% at PC and 57% at UC (Figures 1 and 2). After routine data feedback was provided for approximately 7 months at PC and 5 months at UC, rates of guideline concordance remained relatively stable at 75% for PC and 61% at UC. An initial 37% relative reduction in fluoroquinolone (FQ) use was observed during phase 1 which was further reduced by an additional 18% during phase 2. Conclusion Routine provision of clinic-specific feedback and peer comparisons sustained rates of guideline-concordant prescribing at two outpatient clinics. This intervention required significant resources for data analysis and delivery, but it was successful in decreasing rates of FQ prescribing and maintaining clinician engagement. Disclosures All authors: No reported disclosures.

scholarly journals An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]

2013 ◽  
Vol 1 (15) ◽  
pp. 1-208 ◽  
Author(s):  
S Mason ◽  
C O’Keeffe ◽  
A Carter ◽  
R O’Hara ◽  
C Stride
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Longitudinal Study ◽  
Phase 1 ◽  
Well Being ◽  
Junior Doctors ◽  
Phase 2 ◽  
Adequate Quality ◽  
The Impact

BackgroundA major reform of junior doctor training was undertaken in 2004–5, with the introduction of foundation training (FT) to address perceived problems with work structure, conditions and training opportunities for postgraduate doctors. The well-being and motivation of junior doctors within the context of this change to training (and other changes such as restrictions in working hours of junior doctors and increasing demand for health care) and the consequent impact upon the quality of care provided is not well understood.ObjectivesThis study aimed to evaluate the well-being of foundation year 2 (F2) doctors in training. Phase 1 describes the aims of delivering foundation training with a focus on the role of training in supporting the well-being of F2 doctors and assesses how FT is implemented on a regional basis, particularly in emergency medicine (EM). Phase 2 identifies how F2 doctor well-being and motivation are influenced over F2 and specifically in relation to EM placements and quality of care provided to patients.MethodsPhase 1 used semistructured interviews and focus groups with postgraduate deanery leads, training leads (TLs) and F2 doctors to explore the strategic aims and implementation of FT, focusing on the specialty of EM. Phase 2 was a 12-month online longitudinal study of F2 doctors measuring levels of and changes in well-being and motivation. In a range of specialties, one of which was EM, data from measures of well-being, motivation, intention to quit, confidence and competence and job-related characteristics (e.g. work demands, task feedback, role clarity) were collected at four time points. In addition, we examined F2 doctor well-being in relation to quality of care by reviewing clinical records (criterion-based and holistic reviews) during the emergency department (ED) placement relating to head injury and chronic obstructive pulmonary disease (COPD).ResultsPhase 1 of the study found that variation exists in how successfully FT is implemented locally; F2 lacks a clearly defined end point; there is a minimal focus on the well-being of F2 doctors (only on the few already shown to be ‘in difficulty’); the ED presented a challenging but worthwhile learning environment requiring a significant amount of support from senior ED staff; and disagreement existed about the performance and confidence levels of F2 doctors. A total of 30 EDs in nine postgraduate medical deaneries participated in phase 2 with 217 foundation doctors completing the longitudinal study. F2 doctors reported significantly increased confidence in managing common acute conditions and undertaking practical procedures over their second foundation year, with the biggest increase in confidence and competence associated with their ED placement. F2 doctors had levels of job satisfaction and anxiety/depression that were comparable to or better than those of other NHS workers, and adequate quality and safety of care are being provided for head injury and COPD.ConclusionsThere are ongoing challenges in delivering high-quality FT at the local level, especially in time-pressured specialties such as EM. There are also challenges in how FT detects and manages doctors who are struggling with their work. The survey was the first to document the well-being of foundation doctors over the course of their second year, and average scores compared well with those of other doctors and health-care workers. F2 doctors are benefiting from the training provided as we found improvements in perceived confidence and competence over the year, with the ED placement being of most value to F2 doctors in this respect. Although adequate quality of care was demonstrated, we found no significant relationships between well-being of foundation doctors and the quality of care they provided to patients, suggesting the need for further work in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals 1115. Reducing Broad-Spectrum Antibiotics for Uncomplicated Urinary Tract Infections: A Multimodal Stewardship Intervention

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S396-S397
Author(s):  
Maryrose R Laguio-Vila ◽  
Mary L Staicu ◽  
Mary Lourdes Brundige ◽  
Jose Alcantara-Contreras ◽  
Hongmei Yang ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Phase I ◽  
Urinary Tract Infections ◽  
Broad Spectrum ◽  
Phase 1 ◽  
Phase 2 ◽  
Intervention Phase ◽  
Broad Spectrum Antibiotics ◽  
Stewardship Program ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are the second most common reason for antibiotics in hospitalized patients, with most receiving broad-spectrum antibiotics (BSA) regardless of infection severity. The antimicrobial stewardship program (ASP) conducted a multimodal stewardship intervention targeting reduction in one BSA, ceftriaxone, and promoted narrow-spectrum antibiotics (NSA) such as cefazolin and cephalexin for uncomplicated UTIs. Methods Phase 1: In February 2018, the ASP created a pocket card (Figure 1) containing (1) a urinary antibiogram outlining the most common urine pathogens and their local susceptibility to NSA and (2) NSA guidelines for UTIs with 0–1 systemic inflammatory response syndrome (SIRS) criteria. ASP performed a daily prospective audit with feedback on all new orders of ceftriaxone and promoted prescription of NSA. Phase 2: In August 2018, a Best Practice Alert (BPA) in the electronic medical record (EMR) was designed to interrupt providers ordering ceftriaxone with the indication of a UTI, and prompted NSA prescription instead. Quarterly didactic sessions on UTI antibiotic use and BPA functionality were done. We compared antibiotics usage rates across the 3 study phases (pre-intervention, phase I and phase II) by computing rate ratios (RRs) using Poisson regression. Results Compared with pre-intervention, phase 1 resulted in a significant decrease in ceftriaxone DOT (RR: 1.06, CI: 1.03–1.09, P < 0.001) and ceftriaxone orders for UTI (RR: 1.14, P < 0.001) and an increase in cefazolin DOT (RR: 0.89, P = 0.029) and orders for UTI (RR; 0.12, P < 0.001). It also resulted in a significant increase in cephalexin DOT (RR: 0.92, P = 0.002) and orders for UTI (RR: 0.58, P < 0.001). In phase 2, an additional significant reduction in ceftriaxone DOT (RR: 1.04, CI: 1.01–1.08, P = 0.018) and orders for UTI (RR: 1.62, P < 0.001) and an increase in cefazolin DOT (RR: 0.96, P < 0.001) and orders for UTI (RR; 0.56, P < 0.001) occurred, when comparing phase I to phase 2. It also resulted in a decrease in cephalexin DOT (RR: 0.83, P < 0.001) and orders for UTI (RR: 0.70, P < 0.001). Conclusion A multimodal stewardship intervention using a pocket card with guidelines and urine antibiogram, and an EMR BPA successfully reduced BSA and increased NSA for treatment of uncomplicated UTIs. Disclosures All authors: No reported disclosures.

scholarly journals Effective coverage and budget implications of skill-mix change to improve neonatal nursing care: an explorative simulation study in Kenya

2019 ◽  
Vol 4 (6) ◽  
pp. e001817 ◽  
Author(s):  
Apostolos Tsiachristas ◽  
David Gathara ◽  
Jalemba Aluvaala ◽  
Timothy Chege ◽  
Edwine Barasa ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Neonatal Mortality ◽  
Nursing Care ◽  
Public Hospitals ◽  
Sensitivity Analyses ◽  
Full Time ◽  
Skill Mix ◽  
Neonatal Nursing ◽  
Low Middle Income Countries

IntroductionNeonatal mortality is an urgent policy priority to improve global population health and reduce health inequality. As health systems in Kenya and elsewhere seek to tackle increased neonatal mortality by improving the quality of care, one option is to train and employ neonatal healthcare assistants (NHCAs) to support professional nurses by taking up low-skill tasks.MethodsMonte-Carlo simulation was performed to estimate the potential impact of introducing NHCAs in neonatal nursing care in four public hospitals in Nairobi on effectively treated newborns and staff costs over a period of 10 years. The simulation was informed by data from 3 workshops with >10 stakeholders each, hospital records and scientific literature. Two univariate sensitivity analyses were performed to further address uncertainty.ResultsStakeholders perceived that 49% of a nurse full-time equivalent could be safely delegated to NHCAs in standard care, 31% in intermediate care and 20% in intensive care. A skill-mix with nurses and NHCAs would require ~2.6 billionKenyan Shillings (KES) (US$26 million) to provide quality care to 58% of all newborns in need (ie, current level of coverage in Nairobi) over a period of 10 years. This skill-mix configuration would require ~6 billion KES (US$61 million) to provide quality of care to almost all newborns in need over 10 years.ConclusionChanging skill-mix in hospital care by introducing NHCAs may be an affordable way to reduce neonatal mortality in low/middle-income countries. This option should be considered in ongoing policy discussions and supported by further evidence.

scholarly journals Improving nursing documentation for surgical patients in a referral hospital in Freetown, Sierra Leone: protocol for assessing feasibility of a pilot multifaceted quality improvement hybrid type project

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Nataliya Brima ◽  
Nick Sevdalis ◽  
K. Daoh ◽  
B. Deen ◽  
T. B. Kamara ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Sierra Leone ◽  
Referral Hospital ◽  
Audit And Feedback ◽  
Health System Strengthening ◽  
Theory Of Change ◽  
Improve Quality ◽  
Nursing Documentation

Abstract Background There is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently, there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings. To address this gap, we have developed a multifaceted quality improvement intervention to improve nursing documentation in a low-income country hospital setting. The aim of this pilot project is to test the intervention within the surgical department of a national referral hospital in Freetown, Sierra Leone. Methods This project was co-developed and co-designed by in-country stakeholders and UK-based researchers, after a multiple-methodology assessment of needs (qualitative, quantitative), guided by a participatory ‘Theory of Change’ process. It has a mixed-method, quasi-experimental evaluation design underpinned by implementation and improvement science theoretical approaches. It consists of three distinct phases—(1) pre-implementation(project set up and review of hospital relevant policies and forms), (2) intervention implementation (awareness drive, training package, audit and feedback), and (3) evaluation of (a) the feasibility of delivering the intervention and capturing implementation and process outcomes, (b) the impact of implementation strategies on the adoption, integration, and uptake of the intervention using implementation outcomes, (c) the intervention’s effectiveness For improving nursing in this pilot setting. Discussion We seek to test whether it is possible to deliver and assess a set of theory-driven interventions to improve the quality of nursing documentation using quality improvement and implementation science methods and frameworks in a single facility in Sierra Leone. The results of this study will inform the design of a large-scale effectiveness-implementation study for improving nursing documentation practices for patients throughout hospitals in Sierra Leone. Trial registration Protocol version number 6, date: 24.12.2020, recruitment is planned to begin: January 2021, recruitment will be completed: December 2021.

scholarly journals Physician beliefs about the impact of meaningful use of the EHR

2014 ◽  
Vol 05 (03) ◽  
pp. 789-801 ◽  
Author(s):  
D.Y. Ting ◽  
M. Healey ◽  
S.R. Lipsitz ◽  
A.S. Karson ◽  
J. S. Einbinder ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Primary Care Physicians ◽  
Meaningful Use ◽  
The United States ◽  
Improve Quality ◽  
Cross Sectional ◽  
Incentive Program ◽  
Physician Beliefs ◽  
The Impact

SummaryBackground: As adoption and use of electronic health records (EHRs) grows in the United States, there is a growing need in the field of applied clinical informatics to evaluate physician perceptions and beliefs about the impact of EHRs. The meaningful use of EHR incentive program provides a suitable context to examine physician beliefs about the impact of EHRs.Objective: Contribute to the sparse literature on physician beliefs about the impact of EHRs in areas such as quality of care, effectiveness of care, and delivery of care.Methods: A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who were preparing to qualify for the meaningful use of EHR incentive program.Results: Of the 1,797 physicians at both AMCs who were preparing to qualify for the incentive program, 967 completed the survey for an overall response rate of 54%. Only 23% and 27% of physicians agreed or strongly agreed that meaningful use of the EHR will help them improve the care they personally deliver and improve quality of care respectively. Physician specialty was significantly associated with beliefs; e.g., 35% of primary care physicians agreed or strongly agreed that meaningful use will improve quality of care compared to 26% of medical specialists and 21% of surgical specialists (p=0.009). Satisfaction with outpatient EHR was also significantly related to all belief items.Conclusions: Only about a quarter of physicians in our study responded positively that meaningful use of the EHR will improve quality of care and the care they personally provide. These findings are similar to and extend findings from qualitative studies about negative perceptions that physicians hold about the impact of EHRs. Factors outside of the regulatory context, such as physician beliefs, need to be considered in the implementation of the meaningful use of the EHR incentive program.Citation: Emani S, Ting DY, Healey M, Lipsitz SR, Karson AS, Einbinder JS, Leinen L, Suric V, Bates DW. Physician beliefs about the impact of meaningful use of the EHR: A cross-sectional study. Appl Clin Inf 2014; 5: 789–801http://dx.doi.org/10.4338/ACI-2014-05-RA-0050

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