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Journal of Health Care Management (Full-text available)

Quality and Safety in Health Care  (Full-text available via NHS OPenAthens)

Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals.

Key points

  • In a systematic review and meta-analysis of randomised controlled trials, palliative care services resulted in a reduction of healthcare utilisation as well as symptom burden for patients without cancer. JAMA. 13 Oct 2020.

  • Even in hospitals with ready access to interpretation services, children of non-English-speaking parents experienced a higher rate of medical errors compared with their counterparts without language barriers. JAMA Pediatr. 19 Oct 2020.

  • The COVID-19 pandemic has led to an increase in opioid overdoses, disproportionately affecting...

  • Posted: February 18, 2021, 3:05 pm
    Introduction

    The last 10 years have seen an extraordinary surge of interest in ‘stepped wedge’ designs for evaluating interventions to improve health and social care. Reviews of published trials and registered protocols have shown an exponential increase in the number of trials citing a stepped wedge approach.1–6 A growing body of work on methods for the design, conduct and analysis of stepped wedge trials has emerged, building on seminal work by Hussey and Hughes in 2007.7 The Consolidated Standards of Reporting Trials reporting guidelines for stepped wedge cluster randomised trials are now available, making it easier for investigators to appraise evidence and plan their own evaluations.8

    But published examples of stepped wedge evaluations in quality improvement illustrate some of the practical challenges. On the one hand, limited research resources may force investigators...

    Posted: February 18, 2021, 3:05 pm
    Background

    Opioids are prescribed in excess after surgery. We leveraged our continuous quality improvement infrastructure to implement opioid prescribing guidelines and subsequently evaluate changes in postoperative opioid prescribing, consumption and patient satisfaction/pain in a statewide regional health system.

    Methods

    We collected data regarding postoperative prescription size, opioid consumption and patient-reported outcomes from February 2017 to May 2019, from a 70-hospital surgical collaborative. Three iterations of prescribing guidelines were released. An interrupted time series analysis before and after each guideline release was performed. Linear regression was used to identify trends in consumption and patient-reported outcomes over time.

    Results

    We included 36 022 patients from 69 hospitals who underwent one of nine procedures in the guidelines, of which 15 174 (37.3%) had complete patient-reported outcomes data following surgery. Before the intervention, prescription size was decreasing over time (slope: –0.7 tablets of 5 mg oxycodone/month, 95% CI –1.0 to –0.5 tablets, p<0.001). After the first guideline release, prescription size declined by –1.4 tablets/month (95% CI –1.8 to –1.0 tablets, p<0.001). The difference between these slopes was significant (p=0.006). The second guideline release resulted in a relative increase in slope (–0.3 tablets/month, 95% CI –0.1 to –0.6, p<0.001). The third guideline release resulted in no change (p=0.563 for the intervention). Overall, mean (SD) prescription size decreased from 25 (17) tablets of 5 mg oxycodone to 12 (8) tablets. Opioid consumption also decreased from 11 (16) to 5 (7) tablets (p<0.001), while satisfaction and postoperative pain remained unchanged.

    Conclusions

    The use of procedure-specific prescribing guidelines reduced statewide postoperative opioid prescribing by 50% while providing satisfactory pain care. These results demonstrate meaningful impact on opioid prescribing using evidence-based best practices and serve as an example of successful utilisation of a regional health collaborative for quality improvement.

    Posted: February 18, 2021, 3:05 pm

    During the last decade healthcare leaders, along with campaigns such as Choosing Wisely, have called for major efforts to curb the high cost of healthcare by reducing unnecessary care and eliminating waste.1 2 While these efforts have enjoyed substantial success in terms of raising awareness of unnecessary care among selected physician groups, there has been limited uptake among the majority of patients and providers. Members of the public have continued to worry more about underuse than overuse.3 Healthcare providers continue to deliver low-value care because of the lack of sufficient incentive to behave otherwise.4–6 The COVID-19 pandemic may lead to fundamental behaviour change. Now patients and healthcare providers will need to do a new kind of calculus of weighing the benefits of care against the ‘cost of contact’.

    For patients and providers, the risk of acquiring COVID-19...

    Posted: February 18, 2021, 3:05 pm
    Introduction

    Clear communication of statistical approaches can ensure healthcare research is well understood, reduce major errors and promote the advancement of science. Yet in contrast to the increasing complexity of data and analyses, published methods sections are at times insufficient for describing necessary details. Therefore, ensuring the quality, transparency and reproducibility of statistical approaches in healthcare research is essential.1 2

    Such concerns are not just theoretical and have direct implications for research in the quality and safety field. For example, the Hospital Readmissions Reduction Program was instituted in 2012 by the US Centers for Medicare & Medicaid Services (CMS) and imposed financial penalties on hospitals with high readmission rates. Subsequent studies sought to determine the extent to which this programme was successful in reducing readmissions without promoting unintended consequences, such as increased mortality. Clearly defining the success or failure of this programme is essential,...

    Posted: February 18, 2021, 3:05 pm

    Journal of Behavioural Decision Making ( Free Full text)

    Author: Tom Gordon‐Hecker, Iris K. Schneider, Shaul Shalvi, Yoella Bereby‐Meyer
    Author: Angela R. Dorrough, Maria I.T. Olsson, Laura Froehlich, Andreas Glöckner, Sarah E. Martiny
    Author: Patricia Kanngiesser, Jahnavi Sunderarajan, Jan K. Woike
    Author: Sabrina Bruyneel, Laurens Cherchye, Sam Cosaert, Bram De Rock, Siegfried Dewitte

    See also Health Management Update

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    There is "strong evidence" services for female patients in England need improving, ministers say.

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