Rationale and protocol for estimating the economic value of a multicomponent quality improvement strategy for diabetes care in South Asia

Abstract Background: Kidney transplantation remains the optimal therapy for patients with end stage kidney disease (ESKD), though a small fraction of patients on dialysis are on organ waitlists. An important barrier to preemptive kidney transplantation and successful waitlisting is timely referral to a kidney transplant center. We implemented a quality improvement strategy to improve outpatient kidney transplant referrals in a single center academic outpatient nephrology clinic. Methods: Over a 3 month period (July 1 - September 30, 2016), we assessed the baseline kidney transplantation referral rate at our outpatient nephrology clinic for patients 18 - 75 years old with an estimated glomerular filtration rate (eGFR) of less than 20 mL/min/1.73m 2 (2 values over 90 days apart). Charts were manually reviewed by two reviewers to look for kidney transplant referrals and documentation of discussions about kidney transplantation. We then performed a root cause analysis to explore potential barriers to kidney transplantation. Our intervention began on July 1, 2017 and included the implementation of a column in the electronic medical record (EMR) which displayed the patient's last eGFR as part of the clinic schedule. Physicians were given a document listing their patients to be seen that day with an eGFR of < 20 mL/min/1.73m 2 . Results: 54 unique patients with eGFR ≤ 20 ml/min/1.73 m 2 were identified who were seen in the Clinic between July 1, 2016 and September 30, 2016. 29.6% (16) eligible patients were referred for kidney transplantation evaluation. 69.5% (37) of these patients were not referred for kidney transplant evaluation. 46.3% (25) did not have documentation regarding kidney transplant in the EMR. Following the intervention, 66 unique patients met criteria for eligibility for kidney transplant evaluation. Kidney transplant referrals increased to 60.6% (p < 0.001). Conclusions: Our pilot implementation study of a strategy to improve outpatient kidney transplant referrals showed that a free, simple, scalable intervention can significantly improve kidney transplant referrals in the outpatient setting Next steps include further study of the impact of early referral to kidney transplant centers on preemptive and living donor kidney transplantation as well as successful waitlisting.

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Profit Model Analysis and Management Quality Improvement Strategy of Bike-Sharing

Advances in Applied Mathematics ◽

10.12677/aam.2021.106215 ◽

2021 ◽

Vol 10 (06) ◽

pp. 2050-2059

Author(s):

卿瑜王

Keyword(s):

Quality Improvement ◽

Model Analysis ◽

Improvement Strategy ◽

Quality Improvement Strategy ◽

Profit Model ◽

Management Quality ◽

Bike Sharing

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The implementation of a surgeon-directed quality improvement strategy in breast cancer surgery

Breast Diseases A Year Book Quarterly ◽

10.1016/j.breastdis.2015.04.031 ◽

2015 ◽

Vol 26 (2) ◽

pp. 149-150

Author(s):

J. Landercasper

Keyword(s):

Breast Cancer ◽

Quality Improvement ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Improvement Strategy ◽

Quality Improvement Strategy

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An environmental analysis of the evolution of readmission reduction strategies: A study of United States hospitals

Journal of Hospital Administration ◽

10.5430/jha.v6n5p40 ◽

2017 ◽

Vol 6 (5) ◽

pp. 40

Author(s):

Soumya Upadhyay ◽

William Opoku-Agyeman ◽

Nancy Borkowski

Keyword(s):

Quality Improvement ◽

Environmental Factors ◽

Improvement Strategy ◽

Quality Improvement Strategy ◽

Hospital Administrators ◽

Search Terms ◽

Time Period ◽

Key Stakeholders ◽

Reduction Strategies ◽

Specific Search

Objective: Environmental factors have changed the manner in which issues in the U.S. healthcare industry are addressed. One of these changes is in the area of quality improvement, specifically readmission reduction. The purpose of this paper is two-fold: (1) analyze macro-environmental segments (political, technological, economic, and socio-demographic); and (2) trace the historic evolution of readmission reduction programs to understand how macro-environmental factors have shaped the development of readmission reduction strategies.Methods: Scopus, PubMed, and ABI/Inform electronic databases were searched for articles on readmission reduction programs from 2000 to 2014. In addition, literature on macro-environment was retrieved from these sources for the same time period. Studies were identified using specific search terms and inclusion criteria. A total of 24 articles were selected for review. Data on the following variables were extracted: type of organization studied, type of quality improvement strategy used, type of patients studied, and results of the strategy. In addition, an examination of macro-environmental factors that may have affected the above variables was done. Finally, results were integrated and presented in a chronological order.Results: Findings suggest that macro-environmental factors have influenced the development of readmission reduction strategies over time. This paper informs healthcare managers about being cognizant of environmental trends when devising readmission reduction strategies within hospitals.Conclusions: Insights from this paper urge hospital administrators to forge collaborations with key stakeholders while developing new quality improvement strategies when facing an unstable and complex environment.

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