https://www.commed.vcu.edu/Chronic_Disease/2012/cochranrvwrschbias.pdf

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

About 1 in 5 Medicare fee-for-service patients discharged from the hospital is rehospitalized within 30 days In this systematic review of 43 studies evaluating interventions to reduce readmission 

Interventions to Reduce 30-Day Rehospitalization: A Systematic Review

Background Formal evaluations of programmes are an important source of learning about the challenges faced in improving quality in healthcare and how they can be addressed. The authors aimed to integrate lessons from evaluations of the Health Foundation's improvement programmes with relevant literature.

Methods The authors analysed evaluation reports relating to five Health Foundation improvement programmes using a form of ‘best fit’ synthesis, where a pre-existing framework was used for initial coding and then updated in response to the emerging analysis. A rapid narrative review of relevant literature was also undertaken.

Results The authors identified ten key challenges: convincing people that there is a problem that is relevant to them; convincing them that the solution chosen is the right one; getting data collection and monitoring systems right; excess ambitions and ‘projectness’; organisational cultures, capacities and contexts; tribalism and lack of staff engagement; leadership; incentivising participation and ‘hard edges’; securing sustainability; and risk of unintended consequences. The authors identified a range of tactics that may be used to respond to these challenges.

Discussion Securing improvement may be hard and slow and faces many challenges. Formal evaluations assist in recognising the nature of these challenges and help in addressing them.

https://qualitysafety.bmj.com/content/qhc/21/10/876.full.pdf

Ten challenges in improving quality in healthcare: lessons from the Health Foundation's programme evaluations and relevant literature.

New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.

Reducing Hospital Readmission Rates: Current Strategies and Future Directions

Much attention has been paid to the inappropriate underuse of tests and treatments but until recently little attention has focused on the overuse that does not add value for patients and may even cause harm. Choosing Wisely is a campaign to engage physicians and patients in conversations about unnecessary tests, treatments and procedures. The campaign began in the United States in 2012, in Canada in 2014 and now many countries around the world are adapting the campaign and implementing it. This article describes the present status of Choosing Wisely programs in 12 countries. It articulates key elements, a set of five principles, and describes the challenges countries face in the early phases of Choosing Wisely. These countries plan to continue collaboration including developing metrics to measure overuse.

https://qualitysafety.bmj.com/content/qhc/24/2/167.full.pdf

‘Choosing Wisely’: a growing international campaign

Over the past 12 years, since the publication of the Institute of Medicine's report, “To Err is Human: Building a Safer Health System,” improving patient safety has been the focus of considerable public and professional interest. Although such efforts required changes in policies; education; workforce; and health care financing, organization, and delivery, the most important gap has arguably been in research. Specifically, to improve patient safety we needed to identify hazards, determine how to measure them accurately, and identify solutions that work to reduce patient harm. A 2001 report commissioned by the Agency for Healthcare Research and Quality, “Making Health Care Safer: A Critical Analysis of Patient Safety Practices” (1), helped identify some early evidence-based safety practices, but it also highlighted an enormous gap between what was known and what needed to be known.

/pdf/the-top-patient-safety-strategies-that-can-be-encouraged-for-1xvux4j9mb.pdf

The Top Patient Safety Strategies That Can Be Encouraged for Adoption Now

Despite a decade's worth of effort, patient safety has improved slowly, in part because of the limited evidence base for the development and widespread dissemination of successful patient safety practices. The Agency for Healthcare Research and Quality sponsored an international group of experts in patient safety and evaluation methods to develop criteria to improve the design, evaluation, and reporting of practice research in patient safety. This article reports the findings and recommendations of this group, which include greater use of theory and logic models, more detailed descriptions of interventions and their implementation, enhanced explanation of desired and unintended outcomes, and better description and measurement of context and of how context influences interventions. Using these criteria and measuring and reporting contexts will improve the science of patient safety.

/pdf/advancing-the-science-of-patient-safety-2823qhtsmh.pdf

John Haughom

Papers

The Top Patient Safety Strategies That Can Be Encouraged for Adoption Now

Advancing the Science of Patient Safety