Engaging Physicians in Quality Improvement in a Hospital Setting: A Scoping Review.

Health care is at a critical moment. High rates of medical errors and decreasing quality of health care make it crucial that organizations focus on quality improvement (QI). For this work to be successful, it is essential to engage physicians, as they are key decision-makers, leaders, and influencers of care. Despite this fact, few organizations have successfully sustained physician engagement in QI. A scoping review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to understand barriers to and strategies for engaging physicians in QI. The most commonly cited strategies were: (1) having engaged and supportive senior leadership and (2) having data support for QI work. Additional strategies included: dedicated time, resources, and education for QI work; financial incentives; clarifying organizational goals; and developing pathways for promotion. A framework was then created to operationalize physician engagement in QI in the organization.

Diagnosis of Child Maltreatment: A Family Medicine Physician's Dilemma.

OBJECTIVES: Cases of child maltreatment (CM) in the United States remain high, and primary care providers lack the confidence and training to diagnose these cases. This study provides recommendations to improve family medicine physicians' confidence in diagnosing CM. METHODS: We e-mailed an electronic survey to family medicine residents and physicians practicing in the United States. Responses were collected during August and September 2015. Respondents were asked about their familiarity and competence level regarding the diagnosis of CM. They also were asked about the frequency of their correctly diagnosing CM, timeliness of diagnosis, barriers to a diagnosis or early diagnosis of CM, and receipt of adequate CM training. RESULTS: Of the 420 surveys emailed, 258 (61%) were completed. The majority of respondents stated their self-reported level of competence in diagnosing CM as average or below average, with few (8%) indicating a competence level of above average. A timely diagnosis of child maltreatment was reported by 46% of respondents, whereas 54% were either late (19.2%) in diagnosing or could not recall (34.6%). The barriers to diagnosis cited by responders were inexperience (58%), lack of confidence and certainty (50%), lack of diagnosis protocol (43.3%), lack of confidence in communicating with parents (38.3%), and inadequate training (34.9%). CONCLUSIONS: The introduction of CM training into the family medicine residency training curriculum, coupled with the development of a standardized CM diagnosis protocol, may improve self-reported family medicine physicians' confidence and competence levels in diagnosing CM.

A Feasibility Study for an Integrated Approach to Fall Prevention in Community Care: Stay Up and Active in Orange County.

INTRODUCTION: Falls among persons over 60 present significant risks for serious injury or debility. Falls place burdens on Emergency Medical Services (EMS), hospitals, and the adults themselves. Recognizing a need to provide interventions to minimize risk, Orange County Emergency Services (OCES), the Orange County Department on Aging (OCDoA), and the University of North Carolina at Chapel Hill (UNC) partnered to create the Stay Up and Active Program (SUAA). The purpose of this study was to determine if SUAA was a feasible program to implement in the community. METHODS: A streamlined workflow algorithm between the OCES and OCDoA was created and employed to provide falls risk assessment and necessary services. Qualitative techniques were used to assess the need for such a program and its potential impact. A subset of individuals was interviewed 3 months after the intervention to assess the impact of the intervention on their fall risk. Formal stakeholder interviews were not conducted, but anecdotal information from EMS providers was obtained and reported. RESULTS: In the first 7 months, 478 instances of individuals who called OCES screened positive for falls risk. Of the 478 positive screenings, 55 individuals were identified as having received more than one positive fall screen due to multiple calls. The maximum number of positive screenings by one individual was 14. More women (61.3%) than men screened positive for fall risk. Individuals 88 years of age (6.9%) represented the highest number of individuals with positive screens. Nineteen (4.0%) people who called OCES and received the intervention completed a 3-month follow-up survey. Of the 19, 86% (n = 16) reported no recurrent fall. CONCLUSION: The number of individuals who screened positive supports the need for early identification and intervention through SUAA. This program identified several challenges connecting older adults with services already available to keep them independent, which provided insight to all stakeholders regarding factors that inhibit the program's success. The program evaluation should continue to provide suggestions for improvement and ensure sustainability.