Evaluating the Implementation of Project Re-Engineered Discharge (RED) in Five Veterans Health Administration (VHA) Hospitals.

Background: Improving the process of hospital discharge is a critical priority. Interventions to improve care transitions have been shown to reduce the rate of early unplanned readmissions, and consequently, there is growing interest in improving transitions of care between hospital and home through appropriate interventions. Project Re-Engineered Discharge (RED) has shown promise in strengthening the discharge process.

Factors associated with internal medicine physician job attitudes in the Veterans Health Administration.

Background: US healthcare organizations increasingly use physician satisfaction and attitudes as a key performance indicator. Further, many health care organizations also have an academically oriented mission. Physician involvement in research and teaching may lead to more positive workplace attitudes, with subsequent decreases in turnover and beneficial impact on patient care.

Quality improvement strategies and tools: A comparative analysis between Italy and the United States.

Italian and American hospitals, in two different periods, have been urged by external circumstances to extensively redesign their quality improvement strategies. This paper, through the use of a survey administered to chief quality officers in both countries, aims to identify commonalities and differences between the two systems and to understand which approaches are effective in improving quality of care. In both countries chief quality officers report quality improvement has become a strategic priority, clinical governance approaches, and tools-such as disease-specific quality improvement projects and clinical pathways-are commonly used, and there is widespread awareness that clinical decision making must be supported by protocols and guidelines.

Composite Measures of Health Care Provider Performance: A Description of Approaches.

Context: Since the Institute of Medicine's 2001 report Crossing the Quality Chasm, there has been a rapid proliferation of quality measures used in quality-monitoring, provider-profiling, and pay-for-performance (P4P) programs. Al-though individual performance measures are useful for identifying specific processes and outcomes for improvement and tracking progress, they do not easily provide an accessible overview of performance. Composite measures aggregate individual performance measures into a summary score.

Use of quality improvement interventions and the link to performance on percutaneous intervention for acute myocardial infarction.

Background: Despite numerous calls for hospitals to employ quality improvement (QI) interventions to improve emergency department (ED) performance, their impact has not been explored in multi-site investigations.

Objective: We investigated the association between use of QI interventions (patient flow strategies, ED electronic dashboards, and five-level triage systems) and hospital performance on receipt of percutaneous intervention (PCI) within 90 min for acute myocardial infarction patients, a publicly available quality measure.

Methods: This was an exploratory, cross-sectional analysis of secondary data from 292 hospitals.

Nurse practitioner and physician assistant scope of practice in 118 acute care hospitals.

Background: Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. However, little is understood about APP roles in inpatient medicine.

Objective: Describe APPs role in inpatient medicine.

Impact of provider coordination on nurse and physician perceptions of patient care quality.

The objective of this study was to assess the role of provider coordination on nurse manager and physician perceptions of care quality, while controlling for organizational factors. Findings indicated that nurse-nurse coordination was positively associated with nurse manager perceptions of care quality; neither physician-physician nor physician-nurse coordination was associated with physician perceptions. Organizational factors associated with positive perceptions of care quality included facility support of education for nurses and physicians, and the use of multidisciplinary rounding.

The association of hospital characteristics and quality improvement activities in inpatient medical services.

Background: Quality of U.S. health care has been the focus of increasing attention, with deficiencies in patient care well recognized and documented.

Organizational predictors of coordination in inpatient medicine.

Background: As the care of hospitalized patients becomes more complex, intraprofessional coordination among nurses and among physicians, and interprofessional coordination between these groups are likely to play an increasingly important role in the provision of hospital care.

Purpose: The purpose of this study was to identify the independent effects of organizational factors on provider ratings of overall coordination in inpatient medicine (OCIM).

Methodology/approach: This was an exploratory cross-sectional, descriptive study.

System-level factors affecting clinicians' perceptions and use of interpreter services in California public hospitals.

Professional language interpreters are skilled in the nuances of interpretation and are less likely to make errors of clinical significance but clinicians infrequently use them. We examine system-level factors that may shape clinicians' perceptions and use of professional interpreters. Exploratory qualitative study in 12 California public hospitals.

Hospital implementation of health information technology and quality of care: are they related?

Background: Recently, there has been considerable effort to promote the use of health information technology (HIT) in order to improve health care quality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI) practices and strategies; adherence to process of care measures; risk-adjusted inpatient mortality; patient satisfaction; and assessment of patient care quality by hospital quality managers and front-line clinicians.

Reporting information on emergency department crowding to the hospital board and delivery of time-sensitive care.

Background: Hospital governing boards influence the quality of care that hospitals provide by holding senior leaders and managers accountable. A study was conducted to determine whether reporting data on emergency department (ED) crowding to hospital boards was associated with better performance on a time-sensitive quality measure for patients with acute myocardial infarction (AMI): Primary PCI [percutaneous intervention] Within 90 Minutes of Hospital Arrival.

Methods: In a survey, hospital chief quality officers were asked whether the following data were reported to the hospital governing board: ED wait times, the percentage of ED patients who left without being seen (LWBS), and the percentage of admitted ED patients who are boarded in the ED.

Bringing responsibility for small area variations in hospitalization rates back to the hospital: the propensity to hospitalize index and a test of the Roemer's Law.

Objective: To assign responsibility for variations in small area hospitalization rates to specific hospitals and to evaluate the Roemer's Law in a way that does not artificially induce correlation between bed supply and utilization.

Data Sources/study Setting: We used data on hospitalizations and outpatient treatment for 15 medical conditions of nonmanaged care Part B eligible Medicare enrollees of 65 years and older in Massachusetts in 2000.

Study Design: We used a Bayesian model to estimate each hospital's pool of potential patients and the fraction of the pool hospitalized (its propensity to hospitalize, PTH).

How well can we identify the high-performing hospital?

Sharing lessons from high-performing hospitals facilitates quality improvement. High-performing hospitals have usually been identified using a small number of performance measures. The objective was to analyze how well 1,006 hospitals performed across a broader range of measures.

Survey-assessed quality and organizational factors related to quality in Pursuing Perfection hospitals.

Background: The goal of the Pursuing Perfection (P2) program was to encourage organizations to push quality improvement to new levels of excellence. As part of an evaluation of P2, we surveyed employees at the 7 participating P2 organizations to (1) assess their perceptions of patient care quality and improvement progress and (2) examine perceived performance on organizational and workgroup characteristics associated with quality.

Methods: Many survey questions were drawn from existing conceptual models and survey instruments.

Estimating a composite measure of hospital quality from the Hospital Compare database: differences when using a Bayesian hierarchical latent variable model versus denominator-based weights.

Background: A single composite measure calculated from individual quality indicators (QIs) is a useful measure of hospital performance and can be justified conceptually even when the indicators are not highly correlated with one another.

Objective: To compare 2 basic approaches for calculating a composite measure: an extension of the most widely-used approach, which weights individual indicators based on the number of people eligible for the indicator (referred to as denominator-based weights, DBWs), and a Bayesian hierarchical latent variable model (BLVM).

Methods: Using data for 15 QIs from 3275 hospitals in the Hospital Compare database, we calculated hospital ranks using several versions of DBWs and 2 BLVMs.

A survey of hospital quality improvement activities.

Five years after the Institute of Medicine (IOM) called for a redesigned U.S. health care system, relatively little was known about the extent to which hospitals had undertaken quality improvement (QI) efforts to address deficiencies in patient care.

Do variations in disease prevalence limit the usefulness of population-based hospitalization rates for studying variations in hospital admissions?

Background: Studies of geographic variation in hospitalizations commonly examine age- and gender-adjusted population-based hospitalization rates (ie, the numbers of persons hospitalized relative to what is expected given the age/gender distributions in the area population).

Objective: To determine whether areas identified as extreme using population-based hospitalization rates remain extreme when ranked by disease-based hospitalization rates (the numbers of persons hospitalized relative to what is expected given the amount of disease in the area).

Design: The authors examined 1997 Medicare data on both inpatient admissions and outpatient visits of patients 65 years and older in each of 71 small areas in Massachusetts for 15 medical conditions.

Comparing the importance of disease rate versus practice style variations in explaining differences in small area hospitalization rates for two respiratory conditions.

Many studies have reported large variations in age- and sex-adjusted rates of hospitalizations across small geographic areas. These variations have often been attributed to differences in medical practice style which are not reflected in differences in health care outcomes. There is, however, another potentially important source of variation that has not been examined much in the literature: geographic differences in the age-sex adjusted size of the pool of patients who present with the disease and are candidates for hospitalization.

Does more "appropriateness" explain higher rates of cardiac procedures among patients hospitalized with coronary heart disease?

Background: There have been few studies of the extent to which differences in the pool of patients being managed might account for geographic variations in treatment rates.

Objective: For two cardiac procedures, cardiac catheterization and revascularization, we evaluate the hypothesis that differences in "the percentage of patients for whom the procedure is appropriate" is a factor explaining variations in use rates among those hospitalized with coronary heart disease (CHD).

Research Design: Based on hospital utilization patterns in Massachusetts in 1990, we created 70 small geographic areas.