ion • Information on routine medical care and practice, with more clinical context than

ii This document is in the public domain and may be used and reprinted without further permission. The opinions presented in this report are those of the authors, who are responsible for its content, and do not necessarily represent the position of the U.S. Department of Health and Human Services or the Agency for Healthcare Research and Quality. None of the authors have any affiliations or financial involvements that conflict with material presented in this report. This goal of this project is to promote patient and family engagement in hospital settings by developing, implementing, and evaluating the Guide to Patient and Family Engagement: Enhancing the Quality and Safety of Hospital Care (hereafter referred to as the Guide). The Guide will comprise tools, materials, and/or training for patients, family members, health professionals (e.g., hospital clinicians, staff), hospital leaders, and those who will implement the materials in the Guide. Our preliminary vision of the Guide included four components, each with a series of " tools " (e.g., materials, resources, items for training): (1) Patient and Family Active Involvement Materials; (2) Patient and Family Organizational Partnership Materials; (3) Health Professional Materials; and (4) Leadership and Implementation Materials. The tools in the Guide are intended to: • Support the involvement of patients and family members in the safety and quality of their care. • Encourage the involvement of patients and family members in improving quality and safety within the hospital setting. • Facilitate the creation of partnerships between health professionals and patients/family members. • Outline the steps needed to implement changes. This report presents the results of the environmental scan that serves as an evidence-based foundation for the development of the Guide. In conducting this environmental scan, our intent was to: be comprehensive while targeting topics and questions that are directly relevant to the goals of the project; reflect the concepts of consumer engagement and patient-and family-centered care around the issues of patient safety and quality in the hospital setting; and incorporate diverse input and perspectives from multiple individuals and organizations representing patients, families, health professionals, and hospitals. We developed a working definition of patient and family engagement and a guiding framework to organize and inform our search. From the framework, we identified five main topic areas for further investigation: 1. Individual characteristics, perspectives, and needs of the target audiences—patients, families, and health care professionals—with regard to patient and family engagement. 2. Organizational context …

correspondence: elizabeth A Hahn Department of Medical social sciences, Feinberg school of Medicine, northwestern University, 710 n Lake shore Drive, Room 725, chicago, iL 60611, UsA Tel +1 312 503 9804 Fax +1 312 503 9800 email e-hahn@northwestern.edu Objectives: To evaluate patient attitudes towards literacy screening, agreement between literacy tests, and associations between literacy, informed consent comprehension, and health-related quality of life (HRQL). Methods: Participants completed three literacy tests, read a sample consent form, and reported their HRQL, experiences, and attitudes. Results: We enrolled 97 cancer patients, of whom 66% were female, 67% were African American, and 65% were high school graduates. Sixty percent of patients with lower reading comprehension had trouble reading health information, and 31% had trouble reading everyday written material. Even patients with higher reading comprehension had trouble reading health information (29%) and everyday written material (10%). Low-literacy patients were more likely to feel anxious about literacy screening. However, the majority of patients (84%) would be willing to have literacy results given to providers. Comprehension of informed consent increased with higher literacy. There were no HRQL differences. Conclusions: Patients report difficulty comprehending written health information. Literacy assessment is acceptable and it is considered important for providers to be aware of their patients’ reading abilities. Patient preference data should be used to improve literacy testing strategies and measures. Enhancing detection of low literacy can facilitate interventions to reduce health disparities.

Wrong-side, wrong-site, wrong-procedure and wrong-patient adverse events (collectively known as WPSEs) are rare but potentially catastrophic mistakes. These events can lead to patient harm, public distrust, and financial burden on an already taxed medical malpractice system. Interestingly, the high malpractice payout rate for WPSEs (84% to 93%) most likely prompted the first investigations of WPSEs by the malpractice industry. Despite the small number of claims, the outcomes and settlements were enough of an impetus for physicians and governmental bodies to get involved and recommend protocols to improve patient safety. Since the malpractice investigations of WPSEs, the surgical community has launched several initiatives to reduce WPSEs including the ‘‘operate through your initials’’ campaign from the Canadian Orthopaedic Association and the ‘‘sign your site’’ initiative from the American Academy of Orthopaedics. In 2001, the Canadian Medical Protective Association conducted a review of outcomes after physician education and implementation of the operate through your initials initiative. The results indicated that the number of lawsuits for wrong-site surgery were decreasing, but still continued to occur despite the interventions. Furthermore, a survey of orthopedic hand surgeons in 2003 by Meinberg and Stern reported that hand surgeons had a 1 in 5 risk of performing a wrong-side surgery in their career.

With widespread interest and investments in patient safety in the 13 years following the US Institute of Medicine report To Err is Human ,1 the question has understandably arisen: have we decreased medical harm? One widely cited study showed no significant reductions in either the overall rate of harm or the rate of preventable harm in 10 US hospitals chosen on the basis of patient safety activities.2 A second US study,3 though not focused on temporal trends, reported that one third of patients suffered harm from their medical care at three tertiary care hospitals recognised for their efforts in improving patient safety. Given that previous major studies reported adverse event rates in the range of 3–16%,4–10 progress seems sorely lacking. Adding to this distressing picture, Baines et al 11 report in this issue of the journal that the adverse event rate among hospitalised patients in the Netherlands increased from 4.1% in 2004 to 6.2% in 2008. Somewhat reassuringly, preventable adverse rate did not change. The increase in non-preventable adverse rates may reflect better documentation in medical records as a result of interest in patient safety, with the stable rate of preventable events suggesting that safety has not actually worsened. Nonetheless, the main message of this study11 and the two previous ones2 ,3 remains: sustained attention to patient safety has failed to produce widespread reductions in rates of harm medical care. First, while patient safety and healthcare quality have certainly received substantial attention for more than 10 years now, the actual investments in patient safety still pale beside investments in traditional biomedical research. The US National Institute of Health has a budget of approximately $30 billion,12 roughly 60 times that of the US Agency for Healthcare Research and Quality.13 The ‘war on cancer’ announced …

With the passage of the Patient Protection and Affordable Care Act (PPACA) and ongoing health care reform efforts, this is a critical time for the social work profession. The approaches and values embedded in health care reform are congruent with social work. One strategy is to improve care for people with co-morbid and chronic illnesses by integrating primary care and behavioral health services. This paper defines integrated health and how the PPACA promotes integrated health care through system redesign and payment reform. We consider how social workers can prepare for health care reform and discuss the implications of these changes for the future of the profession.

With the increased acceptance of electronic health records, we can observe the increasing interest in the application of data mining approaches within this field. This study introduces a novel approach for exploring and comparing temporal trends within different in-patient subgroups, which is based on associated rule mining using Apriori algorithm and linear model-based recursive partitioning. The Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality was used to evaluate the proposed approach. This study presents a novel approach where visual analytics on big data is used for trend discovery in form of a regression tree with scatter plots in the leaves of the tree. The trend lines are used for directly comparing linear trends within a specified time frame. Our results demonstrate the existence of opposite trends in relation to age and sex based subgroups that would be impossible to discover using traditional trend-tracking techniques. Such an approach can be employed regarding decision support applications for policy makers when organizing campaigns or by hospital management for observing trends that cannot be directly discovered using traditional analytical techniques.

With the help of appropriate IT support, health care services can be executed in a more effective and secure way. In Sweden, the NPO (National Patients’ Oversikt) stands for National Patients’ Over ...

While coaching and customer involvement can enhance the improvement of health and social care, many organizations struggle to develop their improvement capability; it is unclear how best to accomplish this. We examined one attempt at training improvement coaches. The program, set in the Esther Network for integrated care in rural Jönköping County, Sweden, included eight 1-day sessions spanning 7 months in 2011. A senior citizen joined the faculty in all training sessions. Aiming to discern which elements in the program were essential for assuming the role of improvement coach, we used a case-study design with a qualitative approach. Our focus group interviews included 17 informants: 11 coaches, 3 faculty members, and 3 senior citizens. We performed manifest content analysis of the interview data. Creating will, ideas, execution, and sustainability emerged as crucial elements. These elements were promoted by customer focus—embodied by the senior citizen trainer—shared values and a solution-focused approach, by the supportive coach network and by participants' expanded systems understanding. These elements emerged as more important than specific improvement tools and are worth considering also elsewhere when seeking to develop improvement capability in health and social care organizations.

When asking me to write this piece, the Medical Care editor observed that relatively few health services research (HSR) articles address individuals with disabilities despite their disproportionate health care costs, needs, and growing numbers. I agreed with alacrity, allowing myself a private smile. Many HSR investigators who study individuals with disabilities have discovered that we share the experience of frequent journal rejections. Disappointment about editorial decisions is endemic throughout academe; thus, our laments (whining?) are easily dismissed. Nonetheless, the reasons for these rejections raise important questions. Two dominant critiques involve data validity and definitions of disability. Less frequent but more perplexing, editors assert that their readers are uninterested in individuals with disabilities (3 journal editors have told me this). Becoming scholarly serious, this last rational—readers being uninterested in individuals with disabilities—is (choose your metaphor) “hiding your head in the sand,” given the implications for health care costs, delivery system workforce and design, and the well-being of millions of historically disadvantaged Americans of all ages. HSR addressing individuals with disabilities is essential to bolster evidence for critical federal and state policy and programmatic decisions. Simultaneously, HSR experts can lead efforts to improve data, methods, and the overall science of disability-related HSR.

What is the role of the built environment in healing? What aspects of the built environment promote healing, staff efficiency, and patient safety? How can we know if these assertions hold true? Can scientific research help us validate these assumptions? These questions are important to explore, especially for our most vulnerable patients—those in critical care settings. This article explores the historical influences on health care design, reveals how the current health care transformation movement has accelerated the incorporation of elements of the built environment into patient safety and quality improvement effort, discusses how healing environments are constructed, and examines how the literature of health care and health care design organizations have incorporated the impact of the built environment on patient, family, and staff outcomes and satisfaction. Finally, a case study of applying “design hypotheses” and a scientific method to the design of an intensive care unit setting is offered. This article will help critical care nurses understand the role the built environment has in creating optimal healing environments.

Welcome to a new age in publishing systematic reviews. We hope the launch of Systematic Reviews will resonate with a broad spectrum of readers interested in using them in a variety of ways, such as providing comprehensive and up to date evidence for patient management, informing health policy, and developing rigorous practice guidelines. Systematic reviews are increasingly popular. Our journal is committed to publishing a wide variety of well conducted and transparently reported systematic reviews and associated research. We are open access and electronic and not confined by space and so offer scope for publishing reviews in detail and providing a modern and innovative approach to publishing. We look forward to participating in the voyage with all of our readers.

We use the classical model of structured expert judgment to examine the return on investment (ROI) in a health surveillance network. The US Centers for Disease Control and Prevention launched the Environmental Public Health Tracking Program (Tracking Program) in 2002 to collect available data to better understand the link between health and the environment. The Tracking Program’s annual budget is $25 million, but little is known about the value of its potential benefits. Past evaluations of the Tracking Program have focused on its ability to meet its own goals rather than on broader impact. This study is the first quantitative assessment of the ROI of the Tracking Program. We make novel use of structured expert judgment to establish a counterfactual allowing us to examine the program’s impact. We then link the estimated impact to existing literature on the economic benefits associated with the improved indicators. We estimate that the Tracking Program may have yielded between $5.22 billion to $17.1 billion in societal benefits in 2011, with $6.24 billion estimated by the optimized combination of experts. The estimates have a wide range of uncertainty, but these amounts are significantly greater than the annual $25 million cost of the program.

We review the context of the environment of care in the intensive care unit setting in relation to patient safety and quality, specifically addressing healthcare-associated infection issues and solutions involving interdisciplinary teams. Issues addressed include current and future architectural design and layout trends, construction trends affecting intensive care units, and prevention of construction-associated healthcare-associated infections related to airborne and waterborne risks and design solutions. Specific elements include single-occupancy, acuity-scalable intensive care unit rooms; environmental aspects of hand hygiene, such as water risks, sink design/location, human waste management, surface selection (floor covering, countertops, furniture, and equipment) and cleaning, antimicrobial-treated or similar materials, ultraviolet germicidal irradiation, specialized rooms (airborne infection isolation and protective environments), and water system design and strategies for safe use of potable water and mitigation of water intrusion. Effective design and operational use of the intensive care unit environment of care must engage critical care personnel from initial planning and design through occupancy of the new/renovated intensive care unit as part of the infection control risk assessment team. The interdisciplinary infection control risk assessment team can address key environment of care design features to enhance the safety of intensive care unit patients, personnel, and visitors. This perspective will ensure the environment of care supports human factors and behavioral aspects of the interaction between the environment of care and its occupants.

We examined the impact of HBV/HIV coinfection on outcomes in hospitalized patients compared to those with HBV or HIV monoinfection. Using the 2011 US Nationwide Inpatient Sample, we identified patients who had been hospitalized with HBV or HIV monoinfection or HBV/HIV coinfection using ICD‐9‐CM codes. We compared liver‐related admissions between the three groups. Multivariable logistic regression was performed to identify independent predictors of in‐hospital mortality, length of stay and total charges. A total of 72 584 discharges with HBV monoinfection, 133 880 discharges with HIV monoinfection and 8156 discharges with HBV/HIV coinfection were included. HBV/HIV coinfection was associated with higher mortality compared to HBV monoinfection (OR 1.67, 95% CI 1.30–2.15) but not when compared to HIV monoinfection (OR 1.22, 95% CI 0.96–1.54). However, the presence of HBV along with cirrhosis or complications of portal hypertension was associated with three times greater in‐hospital mortality in patients with HIV compared to those without these complications (OR 3.00, 95% CI 1.80–5.02). Length of stay and total hospitalization charges were greater in the HBV‐/HIV‐coinfected group compared to the HBV monoinfection group (+1.53 days, P < 0.001; $17595, P < 0.001) and the HIV monoinfection group (+0.62 days, P = 0.034; $8840, P = 0.005). In conclusion, HBV/HIV coinfection is a risk factor for in‐hospital mortality, particularly in liver‐related admissions, compared to HBV monoinfection. Overall healthcare utilization from HBV/HIV coinfection is also higher than for either infection alone and higher than the national average for all hospitalizations, thus emphasizing the healthcare burden from these illnesses.

We evaluated the implementation of a labor and delivery unit team training program that included didactic sessions and simulation training with an active clinical unit. Over an 18-month follow-up time period, our team training program showed improvements in patient outcomes as well as in perceptions of patient safety including the dimensions of teamwork and communication.

We discuss the impact of organizational workload on professional service outcomes, such as survival rates in hospitals. The prevailing view in the literature is that service quality deteriorates when organizational workload increases. In contrast, we argue that the relationship between workload and service outcomes is nonlinear and that there is a quality-optimal workload level. Whilst outcomes deteriorate with increasing workload when workload levels are already high, they will improve if workload increases from a low level. We reach this hypothesis by combining three perspectives: (i) the queuing theory perspective, with its focus on congestion, (ii) a discretionary choice perspective, with a focus on decisions made by professionals in response to changes in workload, and (iii) an endocrinological perspective, with a focus on the subconscious eff ects of workload on worker performance through the cognitive impact of stress hormones. Using a patient census of 1.4 million patients in 624 departments across 101 hospitals, we provide empirical support for the nonlinearity hypothesis in the context of hospital survival rates. We further discuss the implications for hospital capacity planning and the wider implications for service operations management.

We developed a content validated computerized epilepsy treatment clinical decision support system to assist clinicians with selecting the best antiepilepsy treatments. Before disseminating our computerized epilepsy treatment clinical decision support system, further rigorous validation testing was necessary. As reliability is a precondition of validity, we verified proof of reliability first. We evaluated the consistency of the epilepsy treatment clinical decision support system in three areas including the preferred antiepilepsy drug choice, the top three recommended choices, and the rank order of the three choices. We demonstrated 100 % reliability on 15,000 executions involving a three-step process on five different common pediatric epilepsy syndromes. Evidence for the reliability of the epilepsy treatment clinical decision support system was essential for the long-term viability of the system, and served as a crucial component for the next phase of system validation.

We conducted a document analysis that explored publication ethics and authorship in the context of population biobanks from both a theoretical (e.g. normative documents) and practical (e.g. biobank-specific documentation) perspective. The aim was to provide an overview of the state of authorship attribution in population biobanks and attempt to fill the gap in discussions around the issue. Our findings demonstrate that the most common approach adopted in both the normative and biobank-specific documentation is acknowledgment. A co-authorship approach was second and highlighted concerns surrounding the fairness of imposing authorship of the scientific leadership as a condition to access data and biosamples, as well as the alignment with the International Committee of Medical Journal Editors’ criteria such as what is deemed a significant contribution and how to ensure accountability. Based on these findings, we propose a three-prong approach, that may be cumulative, to address the issue of authorship attribution in the context of population biobanks, namely 1) the biobank should be appropriately acknowledged; 2) an invitation for co-authorship should be made based on the spirit of collaboration and provided a substantial contribution has been made; and 3) a citation/referencing option should be available.

V Designing for Patient Safety: Developing Methods to Integrate Patient Safety Concerns in the Design Process i Design ng for Patient Safety: Developing et Integrate Patient Safety Concerns in the Design r