Adoption and Diffusion

How the latest clinical, technological, and policy advances are incorporated into clinical practice and health care delivery.

Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study

Aug. 28, 2017

Jane E. Ball, Luk Bruyneel, Linda H. Aiken, Walter Sermeus, Douglas M. Sloane, Anne Marie Rafferty, Rikard Lindqvist, Carol Tishelman, Peter Griffiths, RN4CAST Consortium

In International Journal of Nursing Studies, Jane Ball and colleagues, including Linda Aiken, examine if missed nursing care explains the observed association between nurse staffing levels and mortality. Previous research has shown that higher postoperative mortality rates are associated with lower nurse staffing levels. When nurse staffing levels are lower, there is a higher incidence of necessary but missed nursing care. The authors collected data from 422,730 patients from 300 general acute hospitals, and administered surveys to 26,516 registered nurses to understand staffing...

Performance Improvement in Health Care Organizations

Jul. 19, 2017

Hummy Song, Anita Tucker

In Foundations and Trends in Technology, Information, and Operations Management, Hummy Song and Anita Tucker present a framework for performance improvement in health care organizations. Performance improvement is an important organizational capability that is essential for health care organizations to achieve excellence on the three components of the Triple Aim: patient experience, health, and cost. The authors’ model, called the Model of Transformational Performance Improvement, takes a system-level approach to performance improvement and comprises six key components. These...

Development and Validation of the Primary Care Team Dynamics Survey

Jul. 19, 2017

Hummy Song, Alyna T. Chien, Josephine Fisher, Julia Martin, Antoinette S. Peters, Karen Hacker, Meredith B. Rosenthal, Sara J. Singer

In Health Services Research, Hummy Song and colleagues develop and validate a survey instrument designed to measure team dynamics in primary care. The authors study 1,080 physician and non-physician health care professionals at 18 primary care practices participating in a learning collaborative to improve team-based care. They administer a cross-sectional survey addressing team dynamics, and assessed reliability and discriminant validity of survey factors, as well as the overall survey’s goodness-of-fit. They find that this model demonstrated adequate fit, scale reliability, and...

Unicompartmental Knee Arthroplasty Vs. Total Knee Arthroplasty for Medial Compartment Arthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and Complication Rates

Jul. 11, 2017

Homayoun Siman, Atul F. Kamath, Nazly Carrillo, William S. Harmsen, Mark W. Pagnano, Rafael J. Sierra

In The Journal of Arthroplasty, Homayoun Siman and colleagues, including Atul Kamath, assess the effectiveness of unicompartmental knee arthroplasty (UKA) vs. total knee arthroplasty (TKA) in similar patients. Prior studies have shown that UKA procedures have advantages over TKA, including preservation of bone stock, shorter and easier recovery, lower overall cost, lower morbidity, better functional outcome, and subjective feeling of a more natural knee. The authors conducted a retrospective review of patients 75 years and older who underwent UKA or TKA over a 10-year period in...

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

Jul. 10, 2017

Linda H. Aiken, Douglas Sloane, Peter Griffiths, Anne Marie Rafferty, Luk Bruyneel, Matthew McHugh, Claudia B. Maier, Teresa Moreno-Casbas, Jane E. Ball, Dietmar Ausserhofer, Walter Sermeus

In BMJ Quality & Safety, Linda Aiken and colleagues, including Matthew McHugh examine the association of hospital nursing skill mix with patient mortality, patient ratings of care, and indicators of quality care among European hospitals. As policymakers around the world seek to reduce health spending, a popular target in Europe has been to transition from more professional nurses to fewer high-cost nurses supported by more lower-wage assistants. The authors analyzed how nursing skill mix affects indicators of quality patient care. The authors utilized cross-sectional patient...

The Role of Stewardship in Addressing Antibacterial Resistance: Stewardship and Infection Control Committee of the Antibacterial Resistance Leadership Group

Jul. 5, 2017

Deverick J. Anderson, Timothy C. Jenkins, Scott R. Evans, Anthony D. Harris, Robert A. Weinstein, Pranita D. Tamma, Jennifer H. Han, Ritu Banerjee, Robin Patel, Theoklis Zaoutis, Ebbing Lautenbach

In Clinical Infectious Diseases, Deverick Anderson and colleagues, including Jennifer Han and Ebbing Lautenbach, describe the activities of the Antibacterial Resistance Leadership Group (ARLG) in the area of antibacterial stewardship. Antibacterial resistance is increasing globally and has been recognized as a major public health threat. Antibacterial stewardship is the coordinated effort to improve the appropriate use of antibiotics with the aim to decrease selective pressure for multidrug-resistant organisms in order to preserve the utility of antibacterial agents. To date, the...

Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality

Jun. 28, 2017

Marina Serper, Tamar H. Taddei, Rajni Mehta, Kathryn D'Addeo, Feng Dei, Ayse Ayatman, Michelle Baytarian, Rena Fox, Kristel Hunt, David S. Goldberg, Adriana Valderrama

In Gastroenterology, Marina Serper and colleagues, including David Goldberg, assess how various health care system factors affect survival rates in hepatocellular carcinoma (HCC). These factors included uptake of historically underutilized curative therapies, access to a hepatologist, and presentation of the case to a multidisciplinary tumor board. The authors found that, while curative treatments of HCC increased survival rates, only 25% of newly diagnosed HCC patients received treatment intended to cure the disease. Additionally, those who received care from only...

Economic Feasibility of Staffing the Intensive Care Unit with a Communication Facilitator

Jun. 27, 2017

Nita Khandelwal, David Benkeser, Norma B. Coe, Ruth A. Engelberg, and J. Randall Curtis

In Annals of the American Thoracic Society, Nita Khandelwal and colleagues, including Norma Coe, assess the economic feasibility of staffing intensive care units (ICUs) with a communication facilitator. This person assists families in complex decision-making, improves patient-provider communication, and ensures that care is consistent with patient values and goals. The authors conducted a randomized trial with an ICU communication facilitator, and also looked at financial hospital records. Units that had a facilitator saw significantly reduced daily average ICU costs, and maximal...

Sustained improvement in intraoperative efficiency following implementation of a dedicated surgical team for pediatric spine fusion surgery

Jun. 22, 2017

Wallis Muhly, John McCloskey, Jeff Feldman, Barbara Dezayas, Michael Blum, Blair Kraus, Vaidehi Mehta, Devika Singh, Ron Keren, John Flynn

In Perioperative Care and Operating Room Management, Wallis Muhly, Ron Keren, and colleagues assess if dedicated surgical teams can improve and sustain intraoperative efficiency for pediatric posterior spine fusion (PSF). The authors compared OR efficiency data and total time spent in the OR before and after adoption of a dedicated surgical team model. The quality improvement model including developing a multidisciplinary team of surgeons, anesthesiologists nurses, and technicians, structuring weekly team meetings to understand and map the OR process, and identifying areas where...

Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States

Jun. 22, 2017

Maryam Y. Naim, Rita V. Burke, Bryan F. McNally, Lihai Song, Heather M. Griffis, Robert A. Berg, Kimberly Vellano, David Markenson, Richard N. Bradley, Joseph W. Rossano

In JAMA Pediatrics, Maryam Naim and colleagues, including Joseph Rossano, investigate effects of bystander cardiopulmonary resuscitation (CPR) on pediatric out-of-hospital cardiac arrest. The authors analyze data from the Cardiac Arrest Registry to Enhance Survival, and find that out of 3,900 instances of out-of-hospital cardiac arrests, bystander CPR was provided in 1,814. Children who were treated with either conventional bystander CPR or compression-only CPR had higher survival rates and more favorable neurological outcomes than did those who were not treated with CPR....

Development of a Patient-centered Outcome Measure for Emergency Department Asthma Patients

Jun. 21, 2017

Margaret E. Samuels-Kalow, Karin V. Rhodes, Mira Henien, Emily Hardy, Thomas Moore, Felicia Wong, Carlos A. Camargo Jr., Caroline T. Rizzo, Cynthia Mollen

In Academic Emergency Medicine, Margaret Samuels-Kalow and colleagues, including Karin Rhodes and Cynthia Mollen, explore patient-reported outcome measures for Emergency Department care among asthma patients.  As existing patient-reported outcome measures have limited applicability to emergency medicine, the authors seek to identify patient-centered concepts specific to emergent asthma care. They completed a three-phase qualitative study, in which adult asthma patients and parents of pediatric asthma patients identified important concepts for post-ED discharge success. These...

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