Selected articles on quality improvement from a number of journals, including the American Journal of Medicine, Annals of Internal Medicine, Archives of Pediatric and Adolescent Medicine, BMJ, Health Affairs, Health Services Research, International Journal for Quality in Health Care, Joint Commission Journal on Quality and Safety, Journal of the American Medical Association, Journal of General Internal Medicine, Journal of Patient Safety, Journal of Safety and Quality in Health Care, Medical Care, The Milbank Quarterly, The New England Journal of Medicine, and Pediatrics. The articles are nominated by Editorial Advisory Board members from a preselected list.
Quality Tools in Practice
Clinical Pathway Reduces Hospitalizations, Costs
A cluster randomized controlled trial of 680 nursing home residents, ages 65 or older, was used to assess the effectiveness of a clinical pathway for on-site treatment of pneumonia and other lower respiratory tract infections. The pathway, which included use of oral antimicrobials, portable chest radiographs, oxygen saturation monitoring, rehydration, and close monitoring by a research nurse, resulted in clinical outcomes comparable to usual care while reducing hospitalizations and health care costs. M. Loeb et al. (2006) Effect of a Clinical Pathway to Reduce Hospitalizations in Nursing Home Residents with Pneumonia: A Randomized Controlled Trial. Journal of the American Medical Association 295, 2503–2510.
Transformational Change, Four Years In
Ascension Health articulated a call to action in 2002 to provide excellent clinical care with no preventable injuries or deaths by July 2008. The 67-hospital, nonprofit health care system outlined an agenda for "transformational change" that included eight priorities areas such as adverse drug events, falls, and surgical complications. Early results show an observed mortality rate decrease among non–end-of-life-care patients of 21 percent (p < .001), exceeding the 15 percent goal set for July 2008 and corresponding to 1,200 deaths prevented across the system. D. B. Pryor et al. (2006) The Clinical Transformation of Ascension Health: Eliminating All Preventable Injuries and Deaths. Joint Commission Journal on Quality and Patient Safety 32, 299–308.
Directing Care to Improve Outcomes
A retrospective cohort study was used to examine Veterans Health Administration (VA) patients' use of VA or private sector hospitals for coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). Researchers then investigated the effect of directing private sector CABG patients (83 percent) and PCI patients (87 percent) to high performance hospitals. They found a 24 percent reduction in expected mortality for CABG surgery, with an increase in median travel time from 21 to 30 minutes, and minimal benefit for PCI care. W. B. Weeks et al. (2006) Veterans Health Administration Patients' Use of the Private Sector for Coronary Revascularization in New York: Opportunities to Improve Outcomes by Directing Care to High-Performance Hospitals. Medical Care 44, 519–526.
Error Identification and Prevention
Patients' Responses to Error Disclosure
This study examined patients' responses to the disclosure of medical errors under different conditions: type of medication error, level of disclosure, prior positive physician-patient relationship, offer to waive costs, and severity of the clinical outcome. It found that full disclosure is likely to have a positive effect or no effect, while nondisclosure increased patients' likelihood of changing physicians or seeking legal advice. Patients' responses also were influenced by clinical outcomes, but neither the existence of a positive doctor–patient relationship nor an offer to waive costs was found to have a statistically significant impact. K. M. Mazor et al. (2006) Disclosure of Medical Errors: What Factors Influence How Patients Respond? Journal of General Internal Medicine 21, 704–710.
'To Err' Stimulated Patient Safety Research
The authors evaluated the effect of the Institute of Medicine report, To Err Is Human, on subsequent patient safety publications and research awards. A MEDLINE search, from Nov. 1, 1994, to Nov. 1, 2004, found increased rates of publication for all types of patient safety articles following the report's publication in 2000, with a concurrent shift in focus from malpractice to organizational culture. Also, patient safety research awards, based on federal funding for fiscal years 1995–2004, increased from five to 141 awards per 100,000 biomedical research awards. H. T. Stelfox et al. (2006) The To Err Is Human Report and the Patient Safety Literature. Quality and Safety in Health Care 15, 174–178.
Health Care System Performance
Parity and Depression Treatment Quality
This study examined whether parity laws, introduced to reduce inequities in mental health coverage compared with general medical conditions, were associated with improvements in mental health treatment. It found that the greatest improvement was in the likelihood of follow-up at four or more months; these laws also led plans to increase the use of antidepressant medications. A. B. Busch et al. (2006) The Impact of Parity on Major Depression Treatment Quality in the Federal Employees' Health Benefits Program After Parity Implementation. Medical Care 44, 506–512.
Quality Reporting
Public Reporting Facilitates QI Efforts
A retrospective study based on semi-structured interviews of hospital executives in Rhode Island found statewide public reporting of comparative data on patient views can enhance and reinforce hospital quality improvement efforts. J. K. Barr et al. (2006) Using Public Reports of Patient Satisfaction for Hospital Quality Improvement. Health Services Research 41, 663–682.