International Comparison of Quality Indicators for Adults Hospitalized for Heart Failure: A Systematic Review.

Background: There is limited international agreement on defining care quality for the millions of people hospitalized with heart failure worldwide. Our objective was to compare and measure agreement across existing internationally published quality indicators (QIs) for the care of adults hospitalized for heart failure.

Methods: Systematic review and evidence gap map of internationally published articles reporting on QIs for adults hospitalized for heart failure, using PubMed, MEDLINE, EMBASE, and TRIP from inception to July 18, 2022.

Potentially avoidable admissions to general internal medicine at an academic teaching hospital: an observational study.

Background: Identifying potentially avoidable admissions to Canadian hospitals is an important health system goal. With general internal medicine (GIM) accounting for 40% of hospital admissions, we sought to develop a method to identify potentially avoidable admissions and characterize patient, provider and health system factors.

Methods: We conducted an observational study of GIM admissions at our institution from August 2019 to February 2020.

Understanding Patient Personality in Medical Care: Five-Factor Model.

Personality is the description of an individual's tendencies when acting or reacting to others. Clinicians spontaneously form impressions of a patient's apparent personality yet such unstructured impressions might lead to snap judgments or unhelpful labels. Here we review the evidence-based five-factor model from psychology science for understanding personalities (OCEAN taxonomy).

Multivariable risk scores for predicting short-term outcomes for emergency department patients with unexplained syncope: A systematic review.

Objectives: Emergency department (ED) patients with unexplained syncope are at risk of experiencing an adverse event within 30 days. Our objective was to systematically review the accuracy of multivariate risk stratification scores for identifying adult syncope patients at high and low risk of an adverse event over the next 30 days.

Methods: We conducted a systematic review of electronic databases (MEDLINE, Cochrane, Embase, and CINAHL) from database creation until May 2020.

A Mobile Phone-Based Telemonitoring Program for Heart Failure Patients After an Incidence of Acute Decompensation (Medly-AID): Protocol for a Randomized Controlled Trial.

Background: Patients with heart failure (HF) are at the highest risk for hospital readmissions during the first few weeks after discharge when patients are transitioning from hospital to home. Telemonitoring (TM) for HF management has been found to reduce mortality risk and hospital readmissions if implemented appropriately; however, the impact of TM targeted for patients recently discharged from hospital, for whom TM might have the biggest benefit, is still unknown. Medly, a mobile phone-based TM system that is currently being used as a standard of care for HF at a large Canadian hospital, may be an effective tool for the management of HF in patients recently discharged from hospital.

Linking Quality Improvement and Health Information Technology through the QI-HIT Figure 8.

The implementation of health information technology (HIT) is complex. A method for mitigating complexity is incrementalism. Incrementalism forms the foundation of both incremental software development models, like agile, and the Plan-Do-Study-Act cycles (PDSAs) of quality improvement (QI), yet we often fail to be incremental at the union of the disciplines.

Did This Patient Have Cardiac Syncope?: The Rational Clinical Examination Systematic Review.

Importance: Syncope can result from a reduction in cardiac output from serious cardiac conditions, such as arrhythmias or structural heart disease (cardiac syncope), or other causes, such as vasovagal syncope or orthostatic hypotension.

Objective: To perform a systematic review of studies of the accuracy of the clinical examination for identifying patients with cardiac syncope.

Study Selection: Studies of adults presenting to primary care, emergency departments, or referred to specialty clinics.

Major reductions in unnecessary aspartate aminotransferase and blood urea nitrogen tests with a quality improvement initiative.

Background/context: Unnecessary laboratory testing leads to considerable healthcare costs. Aspartate aminotransferase (AST), commonly ordered with alanine aminotransferase (ALT) and blood urea nitrogen (BUN), commonly ordered with creatinine (Cr), often add little value to patient management at significant cost. We undertook a choosing wisely based quality improvement initiative to reduce the frequency of testing.

Cystic Fibrosis-Related Diabetes Screening in Adults: A Gap Analysis and Evaluation of Accuracy of Glycated Hemoglobin Levels.

Objectives: We sought to identify the gap in cystic fibrosis-related diabetes (CFRD) screening by means of an oral glucose tolerance test (OGTT) in our tertiary care clinic. Our second aim was to identify the glycated hemoglobin level (A1C) threshold that optimizes sensitivity and specificity for predicting CFRD and impaired glucose tolerance.

Methods: This retrospective study used data housed in the Toronto cystic fibrosis (CF) database.

Do Combined Pharmacist and Prescriber Efforts on Medication Reconciliation Reduce Postdischarge Patient Emergency Department Visits and Hospital Readmissions?

Background: Although medication reconciliation (Med Rec) has demonstrated a reduction in potential adverse drug events, its effect on hospital readmissions remains inconclusive.

Objective: To evaluate the impact of an interprofessional Med Rec bundle from admission to discharge on patient emergency department visits and hospital readmissions (hospital visits).

Methods: The design was a retrospective, cohort study.

Closing the Care Gap: A Primer on Quality Improvement for Heart Failure Clinicians.

Quality improvement (QI) initiatives have become an integral part of patient-centered care. In this primer, we outline 6 steps for initiating, implementing, and monitoring improvement in heart failure care. These steps include acknowledging that improvement is needed and setting a culture for improvement; forming a QI team; understanding the local problem; generating improvement strategies that will fit with the local problem; monitoring; testing; and refining improvements, analysis of data, and interpretation of run charts.