美国医学质量杂志 (AJMQ) 专注于让读者了解有助于优质医疗保健服务的资源、流程和观点。这本经过同行评审的期刊提供了一个交流思想、战略和方法的论坛，以改善医疗保健的提供和管理。

The American Journal of Medical Quality focuses on providing readers with resources, processes, and perspectives that contribute to high-quality healthcare services. This peer-reviewed journal serves as a forum for exchanging ideas, strategies, and methods aimed at improving the delivery and management of healthcare.

《美国医学质量杂志》(American Journal of Medical Quality) 专注于为读者提供有助于优质医疗服务的资源、流程和观点。这本经过同行评审的期刊为交流改善医疗服务提供和管理的思想、战略和方法提供了一个平台。

American Journal of Medical Quality

The objective was to determine the relationship between time in the operating room (OR) and hospital-acquired pressure ulcers (HAPUs), controlling for temporality. The research team identified 931 HAPUs among surgical patients and matched them to 4 controls by hospital length of stay at the time the pressure ulcer (PU) was documented. A regression model estimated the relationship between OR time and HAPU after controlling for matching, age, sex, admission and current Braden score, weight, year, and American Society of Anesthesiologists physical status score. OR time in the 24 hours prior to PU documentation was associated with PUs. Only 5% of HAPUs occurred within 24 hours of extended (>4 hours) surgery and 58% occurred after hospital day 5. Extended surgery is confirmed as a risk factor for PU development. Most PUs do not appear in the immediate postoperative period, and prevention efforts should focus on postoperative patient care, when most HAPUs develop.

Rachel M. Hayes

Marcia E. Spear

Sheree I. Lee

Buffy E. Krauser Lupear

Richard A. Benoit

Rainy Valerio

Roger R. Dmochowski

Relationship Between Time in the Operating Room and Incident Pressure Ulcers

In 2020, the US Department of Veterans Affairs Connecticut Healthcare System began its journey to becoming a high-reliability organization as part of Veterans Affairs efforts to become an enterprise-wide high-reliability organization through the Veterans Health Administration. The initiative was launched to create safe enterprise-wide health care systems and environments with robust continuous process improvements as a method for providing patients with safer and higher quality care. In this article, the authors describe a continuous process improvement initiative aimed at implementing system-wide initiatives along the journey to becoming a high-reliability organization. The initiatives are described from the perspectives of individuals representing staff from the frontline to executive leadership. The authors believe that the processes, strategies, and example initiatives described can be readily adopted and implemented in other health care organizations along the journey to high reliability.

Naseema B. Merchant

Jessica O’Neal

Celeste Dealino-Perez

Jenny Xiang

Alfred Montoya

John S. Murray

A High-reliability Organization Mindset

高可靠性组织心态

Provider burnout is a significant health care concern. It is unclear whether high reliability organization (HRO) practices can prevent it. The Truman Veterans Affairs Medical Center (VAMC) undertook an initiative implementing HRO principles and assessed for impact on burnout metrics. This became known as the Transformative HRO Initiative Via Employee Engagement (THRIVE2) model. THRIVE2 consisted of Just Culture training, Clinical Team Training, and continuous process improvement through Lean. Truman VAMC was compared with other Veterans Health Affairs (VHA) facilities regarding burnout and employee satisfaction metrics. Truman VAMC saw significant changes in multiple HRO metrics (P < 0.001) as well as improvements in work group psychological safety and employee exhaustion (P < 0.001). High burnout rates decreased by 52% (6.2%-2.95%; P < 0.001). Truman VAMC went from 75th to the No. 1 ranked VHA facility regarding Best Places to Work. These findings have significant national policy implications given the effects of burnout.

David B. Isaacks

Tim M. Anderson

Scott C. Moore

William Patterson

Sushant Govindan

High Reliability Organization Principles Improve VA Workplace Burnout

高可靠性组织原则改善退伍军人事务部门职场倦怠

Mahip Grewal

Jamie Schlacter

Michael J. Martinez

Kevin P. Eaton

A Multidisciplinary Initiative to Increase Patient Portal Enrollment

多学科合作提高患者门户注册率的举措

Alisha Agrawal

Benjamin H. Shapiro

Joshua D. Prickel

Improving Provider Compliance with Recommended Lab Monitoring for Patients on Mood Stabilizers and Atypical Antipsychotics

提高情绪稳定剂和非典型抗精神病药物治疗患者实验室监测建议的提供者依从性

Veterans are disproportionately affected by chronic pain and are more likely to be prescribed opioids. As a means of risk mitigation, the Centers for Disease Control and Prevention and Department of Defense recommend naloxone for patients on opioids with risk factors, including use of ≥50 morphine milligram equivalents daily, concurrent benzodiazepine/sedative use, and pulmonary or liver disease. An interprofessional quality improvement team consisting of 6 residents, a pharmacist, a nurse educator, and a faculty mentor was formed to increase naloxone coprescriptions at a regional VA medical center Continuity of Care Clinic. Primary intervention identified eligible patients via the VA Primary Care Almanac’s Opioid Therapy Risk Report and alerted providers by email and secure messaging. Naloxone coprescription rates increased from 42% initially in June 2022 to 82% by June 2023 (29/69 to 41/50 patients, P &lt; 0.0001). This project demonstrates that notifying providers of high-risk patients can significantly increase naloxone coprescriptions.

Jeremy Zhang

Kathie Zhang

Joseph Phillips

Michael C. Sauer

Sarah Van Dorin

Patrick Watson

Lauren Zabel

Emily Peters

Yvonne De Sloover Koch

Ethan F. Kuperman

Matthew D. Soltys

Expanding Naloxone Coprescribing at a Regional VA Medical Center

地区退伍军人医疗中心纳洛酮联合处方扩展

Measurable improvements in the American Healthcare System have been elusive. To understand why, a survey measuring improvement capabilities in a health system was developed from a 2002 tool that measured an outdated quality improvement methodology. That survey was tested for content validity and achieved an overall representativeness content validity index of 87.5%. From the responses and discussions with the subject matter experts, 3 reasons emerged as to why a lack of improvement occurs in key metrics on a balanced scorecard. These 3 were the decentralization of improvement efforts, waning leadership attention, and presenting information rather than insights.

Steve Meurer

Suzy Escalante

Measuring Improvement Capabilities in a Health System: Findings From a Content Validity Study

健康系统改进能力评估：一项内容效度研究的结果

The purpose was to investigate clinical staff perceptions of pay-for-performance human papillomavirus (HPV) vaccination financial incentives. In 2022, the authors conducted a national survey of clinical staff (N = 2527; response rate = 57%). Respondents were (1) certified to practice in the United States; (2) practiced as a physician, physician assistant, nurse practitioner, advanced practice nurse, registered nurse, licensed practical/vocational nurse, medical assistant, or certified nursing assistant; (3) worked in pediatrics, family medicine, or general medicine specialties; and (4) had a role in HPV vaccination for children ages 9 through 12 years. The team used ordered regressions to model whether respondents agreed with (ie, “Strongly agreed” or “Agreed” on a 5-point Likert scale) each of the 9 statements. The statements were mapped to domains based on the theory of planned behavior: attitudes (5 statements), perceived behavioral control (2), and norms (2). Favorable responses to 9 statements ranged from 32% to 85%; 5/9 items had more than 50% favorable responses. The following example odds ratios (ORs) are for “agree” versus “neutral” or “disagree” to change their behavior to obtain the incentive. Clinical staff with prior experience with incentives were more likely to agree with 8/9 positive statements about incentives (eg, OR = 1.32 [95% confidence interval {CI}: 1.12–1.57]). Family medicine clinics were more likely than pediatric clinics to agree with 5/9 statements (eg, OR = 1.42 [95% CI: 1.18–1.70]). Clinical staff with more years of experience were less likely to agree with 6/9 statements (eg, OR = 0.97 [95% CI: 0.97–0.98]). Clinical staff’s perceptions of pay-for-performance HPV vaccination financial incentives were generally favorable.

Vanessa Rodriguez

Kathryn Brignole

Tara Licciardello Queen

Justin G. Trogdon

Clinical Staff Perceptions of Pay-for-Performance Financial Incentives for HPV Vaccine Promotion

临床人员对HPV疫苗推广绩效薪酬激励的认知

Abbreviation	Am J Med Qual
Journal Impact	1.00
Quartiles(Global)	HEALTH CARE SCIENCES & SERVICES(Q4)

ISSN	1062-8606, 1555-824X
h-index	61

Publication Information	Publisher: Wolters Kluwer Health，Publishing cycle: Bimonthly，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1992，Proportion of original research papers: 95.38%，Self Citation Rate:0.00%， Gold OA Rate: 13.18%
Average review cycle	网友分享经验：较慢,6-12周
Average recruitment ratio	网友分享经验：容易

American Journal of Medical Quality

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Relationship Between Time in the Operating Room and Incident Pressure Ulcers

A High-reliability Organization Mindset

High Reliability Organization Principles Improve VA Workplace Burnout

A Multidisciplinary Initiative to Increase Patient Portal Enrollment

Improving Provider Compliance with Recommended Lab Monitoring for Patients on Mood Stabilizers and Atypical Antipsychotics

Expanding Naloxone Coprescribing at a Regional VA Medical Center

A Multidisciplinary Initiative to Increase Patient Portal Enrollment

Improving Provider Compliance with Recommended Lab Monitoring for Patients on Mood Stabilizers and Atypical Antipsychotics

Measuring Improvement Capabilities in a Health System: Findings From a Content Validity Study

Clinical Staff Perceptions of Pay-for-Performance Financial Incentives for HPV Vaccine Promotion