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  • JAMA February 28, 2017

    Figure: Identification and Management of Overuse as a Patient Safety Problem

    Patient harm from overuse can be identified in 2 ways. First, overused services delivered in the clinical setting that cause patient harm can be identified and addressed through the patient safety infrastructure. Second, overuse can be actively unmasked in cases of patient harm. Analyses of patient harm from overuse can lead to quality improvement interventions to reduce overuse and improve patient safety.
  • Health Care in the United States: A Right or a Privilege

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    JAMA. 2017; 317(1):29-29. doi: 10.1001/jama.2016.19687
  • Learning by Listening—Improving Health Care in the Era of Yelp

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    JAMA. 2016; 316(23):2483-2484. doi: 10.1001/jama.2016.16754

    This Viewpoint uses Yelp posts about hospital performance to argue for the importance of unstructured online comments and crowdsourcing to health systems’ quality improvement efforts.

  • The New CMS Hospital Quality Star Ratings: The Stars Are Not Aligned

    Abstract Full Text
    JAMA. 2016; 316(17):1761-1762. doi: 10.1001/jama.2016.13679

    This Viewpoint discusses hospital rating systems and ways to improve them to drive quality improvement efforts and provide patients with relevant, accessible composite information.

  • Competencies and Tools to Shift Payments From Volume to Value

    Abstract Full Text
    JAMA. 2016; 316(16):1655-1656. doi: 10.1001/jama.2016.14205

    This Viewpoint from the National Academy of Medicine’s 2016 Vital Directions initiative proposes core changes in health care culture and infrastructure that will be necessary before payment reforms can result in improved patient outcomes and at lower costs.

  • Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes and Association With Reduced Cost and Improved Quality

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    JAMA. 2016; 316(10):1061-1072. doi: 10.1001/jama.2016.12226

    This study compares health care costs and outcomes for patients with joint replacement or sepsis before and after implementation of a value-drive outcomes program designed to give physicians information about clinical outcomes, costs, and variation.

  • JAMA September 13, 2016

    Figure: Perfect Care Indexes During a 3-Year Interval for the Total Joint Replacement Initiative

    Monthly results from quality improvement, using 2 different but overlapping definitions of perfect care, are highlighted. Thick line segments indicate the 4-month baseline and measurement periods used to assess statistical significance of the process redesign. Perfect care index is reported as the percentage of perfect care encounters per period of measurement. For perfect care definition 1, the perfect care index comprised 6 nationally and locally defined quality indicators: (1) 30-day readmission; (2) Surgical Care Improvement Project composite; (3) 35 Hospital Acquired Condition/Patient Safety Indicator measures; (4) admission to the orthopedic acute care unit during hospitalization; (5) early mobility (out of bed on day of surgery); and (6) emergency department visit within 90 days of discharge. Early mobility was identified as a key exposure for improving outcomes and decreasing length of stay and facility costs. For perfect care definition 2, the perfect care index was defined as the following: (1) 35 Hospital Acquired Condition/Patient Safety Indicator measures; (2) admission to the orthopedic acute care unit during hospitalization; (3) emergency department visit within 90 days of discharge; and (4) discharge to home with home health services. First evaluation year corresponds to the implementation year, while second evaluation year was the postimplementation year.
  • Transforming the Health Care Response to Intimate Partner Violence: Addressing “Wicked Problems”

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    JAMA. 2016; 315(23):2517-2518. doi: 10.1001/jama.2016.4837

    This Viewpoint discusses Kaiser Permanente’s systems model approach to addressing intimate partner violence using patient messaging, electronic health records, quality improvement, and implementation science.

  • You’ve Got Mail

    Abstract Full Text
    JAMA. 2016; 315(21):2275-2276. doi: 10.1001/jama.2016.1757
  • JAMA April 12, 2016

    Figure 2: Effect of the Multifaceted Quality Improvement Intervention on Clinical Outcomes

    aAll effect estimates were adjusted for baseline values of outcome variables, except in-hospital mortality odds ratio, which was adjusted for baseline values of intensive care units’ (ICUs’) standardized mortality rate (calculated with Simplified Acute Physiology Score 3 [SAPS3]) and patients’ SAPS3.bThe intracluster correlation coefficient calculated from a random-effects model for the primary outcome was 0.13, and the coefficient of variation K was 0.25.
  • JAMA April 12, 2016

    Figure 3: Effect of the Multifaceted Quality Improvement Intervention on Processes of Care

    RASS indicates Richmond Agitation-Sedation Scale.aAll effect estimates were adjusted for baseline values of outcome variables.
  • Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients: A Randomized Clinical Trial

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    JAMA. 2016; 315(14):1480-1490. doi: 10.1001/jama.2016.3463

    This cluster randomized trial investigated the effects of a quality improvement intervention comprising checklists, goal setting, and clinician follow-up vs routine care on mortality among adults in Brazilian intensive care units.

  • Better Health Care: A Way Forward

    Abstract Full Text
    JAMA. 2016; 315(13):1333-1334. doi: 10.1001/jama.2016.0590

    This Viewpoint discusses what can realistically be expected from the US health care system and how the nation achieve it.

  • Era 3 for Medicine and Health Care

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    JAMA. 2016; 315(13):1329-1330. doi: 10.1001/jama.2016.1509

    In this Viewpoint, Berwick discusses 2 “eras” of the medical profession and offers changes that would be useful to move into a new “moral era.”

  • JAMA March 22, 2016

    Figure: EPA Awards Grants to Assist Small Public Water Systems

    The EPA awarded grants aimed at improving quality and performance of small public water systems.
  • If You Can’t Measure Performance, Can You Improve It?

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    JAMA. 2016; 315(7):645-646. doi: 10.1001/jama.2016.0767
  • JAMA October 27, 2015

    Figure: Medicare ACOs Improving Quality of Care: CMS Report

    The CMS reports that Medicare ACOs are improving quality of care.
  • Medicare ACOs Improving Quality of Care: CMS Report

    Abstract Full Text
    JAMA. 2015; 314(16):1683-1683. doi: 10.1001/jama.2015.12840
  • Facilitating Quality Improvement: Pushing the Pendulum Back Toward Process Measures

    Abstract Full Text
    JAMA. 2015; 314(13):1333-1334. doi: 10.1001/jama.2015.12470

    This Viewpoint defends the use measures in quality improvement initiatives and outlines lessons from past experiences that could make their future use as quality measures more successful.

  • Medicine’s Continuous Improvement Imperative

    Abstract Full Text
    JAMA. 2015; 313(18):1811-1812. doi: 10.1001/jama.2015.4619

    This Viewpoint describes how the continuous process improvement strategies of manufacturing industries can help physicians drive efforts to improve quality and enhance innovation.