医疗保健质量管理 (QMHC) 是一份同行评审期刊，为我们的读者提供了一个探索医疗保健质量管理的理论、技术和战略要素的论坛。该杂志的主要重点是组织结构和流程，因为它们会影响护理质量和患者结果。特别是：-建立有关统计工具、控制图、基准测试和正在进行的其他设备应用的知识监测和评估护理和患者结果；-鼓励研究和评估旨在为患者结果带来可量化改进的各种组织策略的结果；-促进质量管理科学在患者护理过程和临床决策中的应用;-促进医疗保健提供者、支付者和监管机构之间的合作和沟通，以努力提高患者治疗结果的质量；-探索涉及患者护理的各种临床、技术、行政和管理学科之间的联系以及角色和组织治理在持续质量管理中的责任。

Quality Management in Health Care is a peer-reviewed journal that provides a forum for readers to explore the theoretical, technical, and strategic elements of quality management in healthcare. The journal primarily focuses on how organizational structures and processes affect the quality of care and patient outcomes. Specifically, it addresses the following aspects: - Establishing knowledge regarding statistical tools, control charts, benchmarking, and other applications for monitoring and evaluating care and patient outcomes; - Encouraging research and evaluation of various organizational strategies aimed at achieving quantifiable improvements in patient outcomes; - Promoting the application of quality management science in the patient care process and clinical decision-making; - Fostering collaboration and communication among healthcare providers, payers, and regulators to enhance the quality of patient treatment outcomes; - Exploring the connections between various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the responsibilities of roles and organizational governance in ongoing quality management.

《Quality Management in Health Care》是一份同行评审的期刊，旨在为读者提供一个探索医疗保健质量管理的理论、技术和战略要素的论坛。该期刊主要关注组织结构和流程对护理质量和患者结果的影响。具体而言，它包括以下几个方面：- 建立关于统计工具、控制图、基准测试及其他监测和评估护理和患者结果的知识；- 鼓励研究和评估各种组织策略的结果，这些策略旨在为患者结果带来可量化的改进；- 促进质量管理科学在患者护理过程和临床决策中的应用；- 促进医疗保健提供者、支付者和监管机构之间的合作与沟通，以提高患者治疗结果的质量；- 探索涉及患者护理的各种临床、技术、行政和管理学科之间的联系，以及角色和组织治理在持续质量管理中的责任。

Quality Management in Health Care

Background: Bundled interventions and auditing have been recommended to reduce central line-associated bloodstream infection (CLABSI) events at acute care hospitals. We review the outcomes of a bundle audit program at an adult and pediatric academic medical center from April 1, 2021, to May 31, 2022. Objectives: To analyze the impact on CLABSI rates following the introduction of a central line maintenance bundle audit process. Methods: All audit survey data, CLABSI event rates, and line days were collected. Statistical relationships were evaluated for CLABSI bundle performance with CLABSI rates and audit volume with CLABSI rates. Analyses were conducted at the hospital and unit level. Result: No correlation is found between CLABSI rates and audit performance at the hospital level (adult units, P = .619, r-sq = 2.13%; peds/NICU, P = .825, r-sq = 0.43%) or at the unit level (n = 7; P = .8-.896, r-sq = 0.15%-18.2%). There was no correlation in CLABSI rates when reviewing performance by audit volume at the hospital level (adult, P = .65, r-sq = 1.7%; peds/NICU, P = .677, r-sq = 1.5%) or at the unit level (n = 7; P = .25-.8, r-sq = 1.2%-8.5%). By contrast, a single unit that did not participate in the audit program during the sample period reported a lower CLABSI rate than comparable participating units ( P = .008). Conclusion: During the sample period, there was no relationship found between this CLABSI bundle audit program and improvement in CLABSI performance.

Christopher A. Linke

Paul Hodges

Megan E. Edgerton

Johannah D. Bjorgaard

When Auditing Is Not Enough: Analysis of a Central Line Bundle Audit Program

当审计不足时：中心静脉导管集束化审计项目分析

Weeks, Kristina DrPH, MHS; Wyskiel, Rhonda RN, MSN; Cole, Shannon PhD Author Information

Kristina Weeks

Rhonda Wyskiel

Shannon Cole

The Desire Path: Integrating Patient Safety and Patient-Centeredness in Health Care Design

**欲望路径：在医疗保健设计中整合患者安全与以患者为中心**

Esplin, Sean MD; Campbell, Amy MSN, RN, NEA-BC; Fowles, Timothy PhD; Srivastava, Rajendu MD, MPH Author Information

Sean Esplin

Amy Campbell

Timothy Fowles

Rajendu Srivastava

Implementation of a Standardized Approach to the Category II Fetal Heart Tracing

实施标准化方法对II类胎心监护图的分类

Background and Objectives: Basal cell carcinoma (BCC) is the most common form of skin cancer, originating from basal cells in the skin’s outer layer. It frequently arises from prolonged exposure to ultraviolet (UV) radiation from the sun or tanning beds. Although BCC rarely metastasizes, it can cause significant local tissue damage if left untreated. Early detection is essential to prevent extensive damage and potential disfigurement. The United States Preventive Services Task Force (USPSTF) currently remains uncertain about the benefits and potential harms of routine skin cancer screenings in asymptomatic individuals. This paper evaluates the accuracy of predicting BCC using patients’ medical histories to address this uncertainty and support early detection efforts. Methods: We analyzed the medical histories of 405,608 patients, including 7733 with BCC. We categorized 25,154 diagnoses into 16 body systems based on the hierarchy in the Systematized Nomenclature of Medicine (SNOMED) ontology. For each body system, we identified the most severe condition present. Logistic Least Absolute Shrinkage and Selection Operator (LASSO) regression was then employed to predict BCC, using demographic information, body systems, and pairwise and triple combinations of body systems, as well as missing value indicators. The dataset was split into 90% for training and 10% for validation. Model performance was evaluated using McFadden’s R 2 , Percentage Deviance Explained (PDE), and cross-validated with the area under the receiver operating characteristic curve (AUC). Results: Diagnoses related to the Integument system showed an 8-fold higher likelihood of being associated with BCC compared to diagnoses related to other systems. Older (age from 60 to 69) white individuals were more likely to receive a BCC diagnosis. After training the model, it achieved a McFadden’s R 2 of 0.286, an AUC of 0.912, and a PDE of 28.390%, reflecting a high level of explained variance and prediction accuracy. Conclusions: This study underscores the potential of LASSO Regression models to enhance early identification of BCC. Extant medical history of patients, available in electronic health records, can accurately predict the risk of BCC. Integrating such predictive models into clinical practice could significantly improve early detection and intervention.

Yili Lin

Early Detection of Basal Cell Carcinoma of Skin From Medical History

皮肤基底细胞癌的早期诊断：从病史出发

Background and Objectives: Individuals with low income or from minoritized racial or ethnic groups experience a high burden of hypertension and other chronic conditions (eg, diabetes, chronic kidney disease, and mental health conditions) and often lack access to specialist care when compared to their more socially advantaged counterparts. We used a mixed-methods approach to describe the deployment of a Remote Collaborative Specialist Panel intervention aimed at the comprehensive and coordinated management of patients with hypertension and comorbid conditions to address health disparities. Methods: Participants of the collaborative care/stepped care arm of the Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone ( RICH LIFE ) Project, a cluster-randomized trial comparing the effectiveness of enhanced standard of care to a multilevel intervention (collaborative care/stepped care) for improving blood pressure control and reducing disparities, were included. Participants were eligible for referral by their care manager to the Specialist Panel if they continued to have poorly controlled hypertension or had uncontrolled comorbid conditions (eg, diabetes, hyperlipidemia, depression) after 3 months in the RICH LIFE trial. Referred participant cases were discussed remotely with a panel of specialists in internal medicine, cardiology, nephrology, endocrinology, and psychiatry. Qualitative data on the Specialist Panel recommendations and interviews with care managers to understand barriers and facilitators to the intervention were collected. We used available components of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to examine the impact of the intervention. Results: Of 302 participants in the relevant RICH LIFE arm who were potentially eligible for the Specialist Panel, 19 (6.3%) were referred. The majority were women (53%) and of Black race (84%). Referral reasons included uncontrolled blood pressure, diabetes, and other concerns (eg, chronic kidney disease, life-stressors, medication side effects, and medication nonadherence). Panel recommendations centered on guideline-recommended diagnostic and management algorithms, minimizing intolerable medication side effects and costs, and recommendations for additional referrals. Panel utilization was limited. Barriers reported by care managers were lack of perceived need by clinicians due to redundant specialists, a cumbersome referral process, the remote nature of the panel, and the sensitivity of relaying recommendations back to the primary care physician. Care managers who made panel referrals reported it was overwhelmingly valuable. Conclusion: The use of a Remote Collaborative Specialist Panel was limited but well-received by referring clinicians. With modifications to enhance uptake, the Remote Collaborative Specialist Panel may be a practical care model for addressing some disparities in hypertension and multi-morbidity care.

Lena Mathews

Edgar R. Miller

Lisa A. Cooper

Jill A. Marsteller

Chiadi E. Ndumele

Denis G. Antoine

Kathryn A. Carson

Rexford Ahima

Gail L. Daumit

Modupe Oduwole

Chioma Onuoha

Deven Brown

Katherine Dietz

Gideon D. Avornu

Suna Chung

Deidra C. Crews

Remote Collaborative Specialist Panel Deployment to Address Health Disparities in the RICH LIFE Project

远程协作专家小组部署以解决RICH LIFE项目中的健康差异

Abbreviation	Qual. Manag. Health. Care.
Journal Impact	1.28
Quartiles(Global)	HEALTH POLICY & SERVICES(Q4)

ISSN	1063-8628, 1550-5154
h-index	38

Publication Information	Publisher: Lippincott Williams and Wilkins Ltd.，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1992，Proportion of original research papers: 91.43%，Self Citation Rate:8.30%， Gold OA Rate: 9.62%

Quality Management in Health Care

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When Auditing Is Not Enough: Analysis of a Central Line Bundle Audit Program

The Desire Path: Integrating Patient Safety and Patient-Centeredness in Health Care Design

Implementation of a Standardized Approach to the Category II Fetal Heart Tracing

Early Detection of Basal Cell Carcinoma of Skin From Medical History

Remote Collaborative Specialist Panel Deployment to Address Health Disparities in the RICH LIFE Project

The Desire Path: Integrating Patient Safety and Patient-Centeredness in Health Care Design

When Auditing Is Not Enough: Analysis of a Central Line Bundle Audit Program

Implementation of a Standardized Approach to the Category II Fetal Heart Tracing

Early Detection of Basal Cell Carcinoma of Skin From Medical History

Remote Collaborative Specialist Panel Deployment to Address Health Disparities in the RICH LIFE Project