Care Metrics Research Articles

Mitigation Tactics Discovered During COVID-19 with Long-Term Report Turnaround Time and Burnout Reduction Benefits

Rationales and ObjectivesThe purpose is to describe a hybrid teleradiology solution utilized in an academic medical center and its outcomes on radiology report turnaround time (RTAT) and physician wellness.Materials and MethodsDuring coronavirus disease 2019, we utilized an alternating teleradiology solution with procedural and education attendings working in the hospital and other faculty remote to keep the worklist clean. RTAT data was collected for remote vs. in house emergency department (ED) and inpatient cases over a 6-month period. Pre and post implementation burnout surveys were administered.ResultsRTAT significantly improved for ED and inpatient MR and CT, and inpatient US and radiographs when interpreted remotely compared to in-hospital. Physician wellness scores improved and open-ended comments reflected positive feedback about the hybrid work solution. 74% enjoyed the autonomy and flexibility, and 51% said the solution positively influences my desire to remain in my current institution and improves their clinical and/or academic productivity.ConclusionHybrid work from home solutions allow faculty autonomy and flexibility with work-life balance, improving wellness. It is important to alternate the at-home faculty to maintain interdepartmental relations, particularly for junior faculty, and prevent isolation. The hybrid solution also demonstrated improved patient care metrics, possibly due to decreased distractions at home compared to the reading room.

The ABC targets of diabetes in India

In April 2021, WHO announced the creation of a Global Diabetes Compact (GDC) initiative to address the increasingly urgent global diabetes epidemic. GDC aims to catalyse action on diabetes and specifically seeks to “boost efforts to prevent diabetes and bring treatment to all who need it.”1 To facilitate this effort, WHO has proposed global coverage targets for comprehensive diabetes care that are currently under consideration by member states.2 One important step to achieve these goals will be leveraging the available data to establish how health systems perform on these core metrics of diabetes care, which will be a foundation to monitor future progress toward global targets.

Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol.

Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O'Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.

A Retrospective Review of the Timing of Glasgow Coma Scale Documentation in a Trauma Database: Implications for Patient Care, Research, and Performance Metrics

The Glasgow Coma Scale (GCS) is intended to be an objective, reliable measure of a patient's mental status. It is included as a metric for trauma registries, having implications for performance metrics and research. Our study compared the GCS recorded in the trauma registry (GCS-1) with that recorded in the neurosurgery consultation (GCS-2). This retrospective review compared GCS-1 with GCS-2. The Trauma Injury Severity Score (TRISS) method was used to calculate probability of survival (POS) for patients using both GCS-1 and GCS-2. GCS-1 score significantly differed from GCS-2 score (6.69 vs. 7.84, ± 2.553; P < 0.001). There were 172 patients (37.55%) with a GCS-1 score of 3 and 87 (19.00%) with a GCS-2 score of 3 (χ2P < 0.001). The POS calculated using TRISS methodology with GCS-1 (POS-1) was 74.7% ± 26.6% compared with GCS-2 (POS-2), which was 79.3% ± 24.4%. There was a statistically significant difference in the means of POS-2 and POS-2 (P < 0.001). The actual observed survival for the cohort was 71.0% (325/458). The immediate GCS score recorded on patient arrival after trauma differs significantly from the GCS score recorded at later times. This finding significantly altered the probability of survival as calculated by the TRISS methodology. This situation could have profound effects on risk-adjusted benchmarking, assessments of quality of care, and injury severity stratification for research. More studies into the optimal timing of GCS score recording or changes in GCS score and their impact on survival are warranted.

Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol

Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O’Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.

Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics.

Simple SummaryMeasuring the quality of care is important in health care to improve the treatment of patients. In this investigation, we sought to identify five indicators (“pentafecta”) that reflect the quality of care of patients who have cancer of the upper urinary tract (kidney and/or ureter) and are treated with surgical removal of the affected kidney and ureter. Furthermore, we searched for conditions that can predict a failure to achieve these criteria during treatment. The five indicators that define the pentafecta are the complete removal of the tumor without residuals, the complete removal of the ureter and its bladder part, the absence of complications related to the blood, the absence of severe complications related to the surgery, and the absence of tumor recurrence 12 months after the surgery. Of the 1718 patients included, 844 (49%) achieved all pentafecta criteria. These patients had higher chances at 5 years after the surgery to be alive and not to die from any cause (A) or from cancer (B) compared to those who did not achieve the pentafecta criteria (A: 68.7 vs. 50.1% and B: 79.8 vs. 62.7%, respectively). There were no conditions related to the patient that were found to predict a failure to achieve the pentafecta. Using quality indicators such as the proposed pentafecta for the assessment of the treatment of cancer patients may help define prognosis and improve patient care.Background: Measuring quality of care indicators is important for clinicians and decision making in health care to improve patient outcomes. Objective: The primary objective was to identify quality of care indicators for patients with upper tract urothelial carcinoma (UTUC) and to validate these in an international cohort treated with radical nephroureterectomy (RNU). The secondary objective was to assess the factors associated with failure to validate the pentafecta. Design: We performed a retrospective multicenter study of patients treated with RNU for EAU high-risk (HR) UTUC. Outcome measurements and statistical analysis: Five quality indicators were consensually approved, including a negative surgical margin, a complete bladder-cuff resection, the absence of hematological complications, the absence of major complications, and the absence of a 12-month postoperative recurrence. After multiple imputations and propensity-score matching, log-rank tests and a Cox regression were used to assess the survival outcomes. Logistic regression analyses assessed predictors for pentafecta failure. Results: Among the 1718 included patients, 844 (49%) achieved the pentafecta. The median follow-up was 31 months. Patients who achieved the pentafecta had superior 5-year overall- (OS) and cancer-specific survival (CSS) compared to those who did not (68.7 vs. 50.1% and 79.8 vs. 62.7%, respectively, all p < 0.001). On multivariable analyses, achieving the pentafecta was associated with improved recurrence-free survival (RFS), CSS, and OS. No preoperative clinical factors predicted a failure to validate the pentafecta. Conclusions: Establishing quality indicators for UTUC may help define prognosis and improve patient care. We propose a pentafecta quality criteria in RNU patients. Approximately half of the patients evaluated herein reached this endpoint, which in turn was independently associated with survival outcomes. Extended validation is needed.

HSR22-151: Access to Care and Health Care Quality Metrics in Urban Versus Rural Patients With Advanced Genitourinary Cancers

HSR22-151: Access to Care and Health Care Quality Metrics in Urban Versus Rural Patients With Advanced Genitourinary Cancers

591 Transition to an Advanced Practice Provider led burn service: process and lessons learned

IntroductionBurn is not a required rotation for general surgery residency training. Additionally, mandates on resident work hours have created a deficiency in resident support for many burn programs across the country. Subsequently, the need to transition to an Advanced Practice Provider (APP) service was identified. At our institution, a medium volume (~250 admissions/year) burn center, we created an APP service and evaluated the evolution and lessons learned during the transition.MethodsTimeline of recruitment of APPs was reviewed along with the recruitment process, onboarding process and orientation process. Exit interviews were conducted with all APPs who resigned to delineate strengths and weakness of the APP program. Functionality of the institution’s APP recruiter, manager and Lead Burn APP (LAPP) were reviewed as well.ResultsBetween 2014 and 2021 the daytime burn APP service expanded from two to six APPs and the Night House Officer (NHO) APP service was created and expanded to four APPs. Based on thorough review of the APP program, key changes were made including improvements in team communication, daily nurse-driven rounds, the 90-day focused professional performance evaluation (FPPE), enhanced and structured education, and critical care exposure.The need for a LAPP was identified and designated in 2019. The LAPP is responsible for making an equitable schedule, execution of new APP orientation, organizing the 90 day FPPE and ongoing professional performance evaluation (OPPE), monthly APP peer review and APP meetings, coordinating OR coverage, and functioning as an APP advocate at division leadership. The LAPP enacted changes to the existing hiring/onboarding process as described below.All APPs are now recruited through an APP recruiter who discusses the hospital contract and salary as well as organizes the logistics of the interview, formalizes the offer, and aids with the transition to credentialing. All new APPs are given a hospital onboarding checklist, that includes hospital orientation, APP boot camp, simulation and electronic health record training classes. In addition they are given a clinical orientation checklist, which includes BLS/ABLS/ACLS/ATLS certification, exposure to various phases of patient care, tracking of quantitative patient care metrics, participation in monthly burn APP peer review and burn triage simulation. There are subtle differences with the NHO APP clinical checklist. After 90 days of employment a new employee FPPE is held with the LAPP and burn director. This allows for direction of areas to focus on, comprehensive feedback, and discussion about increasing autonomy.ConclusionsThrough a focused process, APPs can play an integral role in the daily functioning of a burn center. We believe that a similar effective and financially sound model can be created for similar sized units.

Exploratory analysis of novel electronic health record variables for quantification of healthcare delivery strain, prediction of mortality, and prediction of imminent discharge.

To explore the relationship between novel, time-varying predictors for healthcare delivery strain (eg, counts of patient orders per hour) and imminent discharge and in-hospital mortality. We conducted a retrospective cohort study using data from adults hospitalized at 21 Kaiser Permanente Northern California hospitals between November 1, 2015 and October 31, 2020 and the nurses caring for them. Patient data extracted included demographics, diagnoses, severity measures, occupancy metrics, and process of care metrics (eg, counts of intravenous drip orders per hour). We linked these data to individual registered nurse records and created multiple dynamic, time-varying predictors (eg, mean acute severity of illness for all patients cared for by a nurse during a given hour). All analyses were stratified by patients' initial hospital unit (ward, stepdown unit, or intensive care unit). We used discrete-time hazard regression to assess the association between each novel time-varying predictor and the outcomes of discharge and mortality, separately. Our dataset consisted of 84162161 hourly records from 954477 hospitalizations. Many novel time-varying predictors had strong associations with the 2 study outcomes. However, most of the predictors did not merely track patients' severity of illness; instead, many of them only had weak correlations with severity, often with complex relationships over time. Increasing availability of process of care data from automated electronic health records will permit better quantification of healthcare delivery strain. This could result in enhanced prediction of adverse outcomes and service delays. New conceptual models will be needed to use these new data elements.

OP001: Quality of care metrics in patients with inborn errors of metabolism

Despite widespread acknowledgment of the importance of urgent lab evaluation and timeliness of care for patients with metabolic disorders, there are few published quality of care studies for patients with metabolic disease. There is also little evidence for broad adoption in integrated health systems. This stands in stark contrast to a strong emphasis on timeliness of care in metabolic disease consensus guidelines. Without clearly defined process-driven metrics for measuring care, improving existing patient care is difficult.

Patient Satisfaction Scores Are a Poor Metric of Orthopedic Care.

Patient satisfaction scores are a popular metric used to evaluate orthopedic care. There is little consistency with how satisfaction is described in the orthopedic literature. Online physician reviews are a growing trend that directly and indirectly affect a surgeon's reputation. There is little correlation of higher satisfaction with improved surgical outcomes, so rating surgical care may be misguided and possibly dangerous. Patient satisfaction is an important part of the patient-centered care model, so rating systems should directly reflect quality. More research is needed to determine the relationship between patient satisfaction and the delivery of quality care. [Orthopedics. 2022;45(3):e127-e133.].

Understanding the Economic Impact of an Essential Service: Applying Time-Driven Activity-Based Costing to the Hospital Airway Response Team.

As the United States moves toward value-based care metrics, it will become essential for anesthesia groups nationwide to understand the costs of their services. Time-driven activity-based costing (TDABC) estimates the amount of time it takes to perform a clinical activity by dividing complex tasks into process steps and mapping each step and has historically been used to estimate the costs of various health care services. TDABC is a tool that can be adapted for variable staffing models and the volume of service provided. Anesthesia departments often provide staffing for airway response teams (ART). The economic implications of staffing ART have not been well described. We present a TDABC model for ART activation in a tertiary-care center to estimate the cost incurred by an anesthesiology department to staff an ART. Pages received by the Brigham and Women's Hospital ART over a 24-month time period (January 2019 to December 2020) were analyzed and categorized. The local administrative database was queried for the Current Procedural Terminology (CPT) code used to bill for emergency airway placements. Sessions were held by multiple members of the ART to create process maps for the different types of ART activations. We estimated the staffing costs using the estimated time it took for each type of ART activation as well as the data collected for local ART activations. From the paging records, we analyzed 3368 activations of the ART. During the study period, 1044 airways were billed for with emergency airway CPT code. The average revenue collected per airway was $198.45 (95% CI, $190-$207). For STAT/Emergency airway team activations, process maps and non-STAT airway team activations were created, and third subprocess map was created for performing endotracheal intubation. Using the TDABC, the total staffing costs are estimated to be $218,601 for the 2-year study period. The ART generated $207,181 in revenue during the study period. Our analysis of ART-activation pages suggests that while the revenue generated may cover the cost of staffing the team during ART activations, it does not cover consumable equipment costs. Additionally, the current fee-for-service model relies on the team being able to perform other clinical duties in addition to covering the airway pager and would be impossible to capture using traditional top-down costing methods. By using TDABC, anesthesia groups can demonstrate how certain services, such as ART, are not fully covered by current reimbursement models and how to negotiate for subsidy agreements.As the transition from traditional fee-for-service payments to value-based care models continues in the United States, improving the understanding and communication of medical care costs will be essential. In the United States, it is common for anesthesia groups to receive direct revenue from hospitals to preserve financial viability, and therefore, knowledge of true cost is essential regardless of payer model.1 With traditional payment models, what is billable and nonbillable may not reflect either the need for or the cost of providing the service. As anesthesia departments navigate the transition of care from volume to value, actual costs will be essential to understand for negotiations with hospitals for support when services are nonbillable, when revenue from payers does not cover anesthesia costs, and when calculating the appropriate share for anesthesia departments when bundled payments are distributed.

Evidence-Based Disparities in Stroke Care Metrics and Outcomes in the United States: A Systematic Review.

Stroke disproportionately affects racial minorities, and the level to which stroke treatment practices differ across races is understudied. Here, we performed a systematic review of disparities in stroke treatment between racial minorities and White patients. A systematic literature search was performed on PubMed to identify studies published from January 1, 2010, to April 5, 2021 that investigated disparities in access to stroke treatment between racial minorities and White patients. A total of 30 studies were included in the systematic review. White patients were estimated to use emergency medical services at a greater rate (59.8%) than African American (55.6%), Asian (54.7%), and Hispanic patients (53.2%). A greater proportion of White patients (37.4%) were estimated to arrive within 3 hours from onset of stroke symptoms than African American (26.0%) and Hispanic (28.9%) patients. A greater proportion of White patients (2.8%) were estimated to receive tPA (tissue-type plasminogen activator) as compared with African American (2.3%), Hispanic (2.6%), and Asian (2.3%) patients. Rates of utilization of mechanical thrombectomy were also lower in minorities than in the White population. As shown in this review, racial disparities exist at key points along the continuum of stroke care from onset of stroke symptoms to treatment. Beyond patient level factors, these disparities may be attributed to other provider and system level factors within the health care ecosystem.

Towards codesign in respiratory care: development of an implementation-ready intervention to improve guideline-adherent adult asthma care across primary and secondary care settings (The SENTINEL Project)

Short-acting beta agonist (SABA) overuse (≥3 canisters annually) is associated with worse asthma outcomes and accounts for the majority of greenhouse gas emissions from asthma inhalers in England. Reducing SABA...

Abstract WP26: Covid Pandemic Versus Pre-pandemic Care Of Stroke Patients Within The Florida Stroke Registry

Background: The coronavirus 2019 (COVID-19) pandemic has affected all aspects of stroke care delivery and resource allocation. We sought to study this effect utilizing the Florida Stroke Registry (FSR), which collects data from hospitals in large metropolitan cities and small communities, each facing pandemic peaks at different timepoints and within various healthcare system organizations. Methods: From March 2019 to March 2021, the FSR identified 82,899 patients with the final diagnosis of ischemic stroke and TIA. Stroke care metrics were compared in patients enrolled during the COVID-19 pandemic (March 2020 to February 2021) to those enrolled in the immediate pre-pandemic year. These metrics included utilization of intravenous thrombolytic (IVT), Endovascular therapy (EVT), Door-To-Needle time (DTN), Door-To-Puncture time (DTP), Door-To-Computed Tomography time (DTCT) and overall Defect-Free Care (DFC). Results: Pre-pandemic patients (n= 41,929, 49.0% female, mean age 70.1 ± 14.6 years, 64.3% white, 20.4% black, 15.3% Hispanic) had similar demographics to pandemic patients (48.8% female, mean age 69.9 ± 14.4 years, 65.4% white, 19.9% black, 14.7% Hispanic). Pandemic stroke patients had more severe presentations (median NIHSS 3 [IQR 8] vs 3 [7], p &lt; .0001), longer onset-to-arrival time (242 [677] vs 229 [654] minutes, p = 0.002), and were more likely to arrive via emergency medical services (62.3% vs. 60.8%, p &lt; .0001) than pre-pandemic stroke patients. Although both groups received IVT equally (13.4% vs. 13.5%, p = 0.67), pandemic stroke patients were more likely to receive EVT (7.0% vs. 6.5%, p = 0.005) and had longer DTP (84 [60] vs. 81 [64] minutes, p = 0.01), shorter DTCT (22 [52] vs 23 [56] minutes, p = 0.01) and similar DTN (36 [22] vs. 37 [22] minutes, p = 0.05) times, with an increased DFC rate of 2.2% (86.6% vs. 84.4%, p &lt; .0001). Conclusions: In this large registry based study, we found that compared to pre-pandemic care, ischemic stroke patients treated during the COVID19 pandemic presented sicker and later to the hospital and were more likely to receive EVT, but had longer door-to-puncture times. Despite many healthcare delivery challenges imposed by COVID19, Florida hospitals within the FSR maintained high quality of stroke care overall.

Utilization of Telestroke Prior to and Following the COVID-19 Pandemic.

For over two decades, telestroke has been utilized as a means for improving acute access to a stroke specialist when this expertise is otherwise unavailable. During this time, telestroke use has increased and improvements in care metrics have been widely reported. Several telestroke model variations are utilized; each has different workflow implications. A successful telestroke system should include adequate protocols and training, equipment, documentation system, and tracking of quality metrics. Upfront costs of needed technology and devices, credentialing hurdles, and limited reimbursement are all reported barriers to the utilization of telestroke. Emphasis on safety measures during the COVID-19 pandemic resulted in the dramatic upscaling of telehealth utilization, although overall stroke volumes declined in many areas in the early phases of the pandemic. Going forward, continued reduction in cost of required devices and broadband connections, increased use of automated and advanced analytical software, and a universal licensing and credentialing system are needed to continue the expansion of telestroke use.

Abstract TMP56: Quality Of Ischemic Stroke Care Before And After The Covid-19 Pandemic

Objective: To compare metrics of acute care for ischemic stroke (IS) before and after the first cases of COVID-19 were diagnosed and major changes were made to the workflow. Methods: Data were prospectively collected as part of the institutional Stroke Database project. Patients with IS &gt; 18 years admitted from January 2019 until March 2020 were considered to be part of the group treated in the “pre-COVID” era and those admitted from April 2020 until December 2020, in the “post-COVID” era. The primary outcome was the door-to-needle time in subjects treated with intravenous thrombolysis. Secondary outcomes were: rate of thrombolysis, rates of complications (pneumonia, urinary tract infection, deep venous thrombosis or pressure injury) and death during hospital admission. Patients’ characteristics, primary and secondary outcomes were compared with unpaired t-tests, Mann-Whitney or chi-square tests, according to the nature and distribution of the data. Results: Data from 932 patients with IS in the pre-COVID and 520, in the post-COVID group were prospectively collected. There were no significant differences in age (pre-COVID, 64.2±14.7 years; post-COVID, 63.3±15 years; p=0.296), gender (pre-COVID, 55.5% male; post-COVID, 55% male; p=0.862) or NIHSS scores (pre-COVID, median 5, range 0-38; post-COVID, median 6, range 0-36; p=0.346). Thrombolysis rates were 19.6% pre-COVID and15.7% post-COVID. All eligible subjects received thrombolysis. The increase in door-to-needle time in subjects treated with thrombolysis (pre-COVID, median 36 minutes; post-COVID, median 39 minutes) was statistically significant (p=0.048). Rates of complications in all ISs during admission increased significantly from 8.3% (pre-COVID) to 20.2% (post-COVID) (p&lt;0.001). The increase in death rate from 8.4% (pre-COVID) to 12.1% (post-COVID) did not reach statistical significance (p=0.059). Conclusions: The increases in door-to-needle times, complication and death rates, despite the lack of significant differences in age or stroke severity, likely reflect the impact of the COVID-pandemic on public health care. Despite major changes in workflow, door-to-needle times were below 40 minutes in more than 50% of patients treated with thrombolysis.

Quality care metrics for nurses working in general practice, mapping the evidence: a scoping review protocol

Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands over the past three decades. However, as nursing care in general practice advances at pace, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to carefully assess the role and facilitate development of services are required. Nursing quality care metrics (QCM) are an established mechanism which measure nursing care process, evaluate quality, and impact of care, and inform service development. The use of nursing QCM has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development of QCM within Irish GPN settings. Aim: To explore and map the literature regarding the use, application, and impact of nursing quality care metrics within a general practice, primary care setting. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O’Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCM which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about QCM, their use in general practice or primary care settings, and enrich understanding of their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary care in Ireland.

An update to collaborating for improving diabetes care in Ealing, London: investment, integration and innovation, years 2011–2020

AbstractMore than a decade of investment, integration and innovation in primary and community diabetes care in Ealing, UK, is now showing tangible and sustainable improvements in metrics of good diabetes care. From a low baseline, data from the National Diabetes Audit show improvements in both the care processes delivered and, crucially, the biomedical outcomes achieved in the Three Treatment Targets – for both type 1 and type 2 diabetes. This was accomplished while the prevalence of diabetes increased from 6.4% to 9%. Analysis of hospital admissions data suggests that a number of diabetes‐related admissions reduced with possible associated cost savings of greater than £400,000. Factors contributing to these improvements are discussed. Ealing is therefore an exemplar case study for improving diabetes care services within the future Integrated Care Systems. Copyright © 2022 John Wiley &amp; Sons.

Association Between Area-Level Socioeconomic Deprivation and Diabetes Care Quality in US Primary Care Practices

Diabetes management operates under a complex interrelationship between behavioral, social, and economic factors that affect a patient's ability to self-manage and access care. To examine the association between 2 complementary area-based metrics, area deprivation index (ADI) score and rurality, and optimal diabetes care. This cross-sectional study analyzed the electronic health records of patients who were receiving care at any of the 75 Mayo Clinic or Mayo Clinic Health System primary care practices in Minnesota, Iowa, and Wisconsin in 2019. Participants were adults with diabetes aged 18 to 75 years. All data were abstracted and analyzed between June 1 and November 30, 2020. The primary outcome was the attainment of all 5 components of the D5 metric of optimal diabetes care: glycemic control (hemoglobin A1c <8.0%), blood pressure (BP) control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg), lipid control (use of statin therapy according to recommended guidelines), aspirin use (for patients with ischemic vascular disease), and no tobacco use. The proportion of patients receiving optimal diabetes care was calculated as a function of block group-level ADI score (a composite measure of 17 US Census indicators) and zip code-level rurality (calculated using Rural-Urban Commuting Area codes). Odds of achieving the D5 metric and its components were assessed using logistic regression that was adjusted for demographic characteristics, coronary artery disease history, and primary care team specialty. Among the 31 934 patients included in the study (mean [SD] age, 59 [11.7] years; 17 645 men [55.3%]), 13 138 (41.1%) achieved the D5 metric of optimal diabetes care. Overall, 4090 patients (12.8%) resided in the least deprived quintile (quintile 1) of block groups and 1614 (5.1%) lived in the most deprived quintile (quintile 5), while 9193 patients (28.8%) lived in rural areas and 2299 (7.2%) in highly rural areas. The odds of meeting the D5 metric were lower for individuals residing in quintile 5 vs quintile 1 block groups (odds ratio [OR], 0.72; 95% CI, 0.67-0.78). Patients residing in rural (OR, 0.84; 95% CI, 0.73-0.97) and highly rural (OR, 0.81; 95% CI, 0.72-0.91) zip codes were also less likely to attain the D5 metric compared with those in urban areas. This cross-sectional study found that patients living in more deprived and rural areas were significantly less likely to attain high-quality diabetes care compared with those living in less deprived and urban areas. The results call for geographically targeted population health management efforts by health systems, public health agencies, and payers.