Browsing by Author "Hughes, Ashley M."

Now showing 1 - 6 of 6
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    An evidence-based, structured, expert approach to selecting essential indicators of primary care quality
    (Public Library of Science, 2022) Hysong, Sylvia J.; Arredondo, Kelley; Hughes, Ashley M.; Lester, Houston F.; Oswald, Frederick L.; Petersen, Laura A.; Woodard, LeChauncy; Post, Edward; DePeralta, Shelly; Murphy, Daniel R.; McKnight, Jason; Nelson, Karin; Haidet, Paul
    Background The purpose of this article is to illustrate the application of an evidence-based, structured performance measurement methodology to identify, prioritize, and (when appropriate) generate new measures of health care quality, using primary care as a case example. Primary health care is central to the health care system and health of the American public; thus, ensuring high quality is essential. Due to its complexity, ensuring high-quality primary care requires measurement frameworks that can assess the quality of the infrastructure, workforce configurations, and processes available. This paper describes the use of the Productivity Measurement and Enhancement System (ProMES) to compile a targeted set of such measures, prioritized according to their contribution and value to primary care. Methods We adapted ProMES to select and rank existing primary care measures according to value to the primary care clinic. Nine subject matter experts (SMEs) consisting of clinicians, hospital leaders and national policymakers participated in facilitated expert elicitation sessions to identify objectives of performance, corresponding measures, and priority rankings. Results The SMEs identified three fundamental objectives: access, patient-health care team partnerships, and technical quality. The SMEs also selected sixteen performance indicators from the 44 pre-vetted, currently existing measures from three different data sources for primary care. One indicator, Team 2-Day Post Discharge Contact Ratio, was selected as an indicator of both team partnerships and technical quality. Indicators were prioritized according to value using the contingency functions developed by the SMEs. Conclusion Our article provides an actionable guide to applying ProMES, which can be adapted to the needs of various industries, including measure selection and modification from existing data sources, and proposing new measures. Future work should address both logistical considerations (e.g., data capture, common data/programming language) and lingering measurement challenges, such as operationalizating measures to be meaningful and interpretable across health care settings.
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    Churning the tides of care: when nurse turnover makes waves in patient access to primary care
    (Springer Nature, 2024) Arredondo, Kelley; Hughes, Ashley M.; Lester, Houston F.; Pham, Trang N.D.; Petersen, Laura A.; Woodard, LeChauncy; SoRelle, Richard; Jiang, Cheng (Rebecca); Oswald, Frederick L.; Murphy, Daniel R.; Touchett, Hilary N.; Hamer, Joshua; Hysong, Sylvia J.
    Team-based primary care (PC) enhances the quality of and access to health care. The Veterans Health Administration (VHA) implements team-based care through Patient Aligned Care Teams (PACTs), consisting of four core members: a primary care provider, registered nurse (RN) care manager, licensed vocational nurse, and scheduling clerk. RNs play a central role: they coordinate patient care, manage operational needs, and serve as a patient point of contact. Currently, it is not known how varying levels of RN staffing on primary care teams impact patient outcomes.
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    Impact of team configuration and team stability on primary care quality
    (BioMed Central, 2019) Hysong, Sylvia J.; Amspoker, Amber B.; Hughes, Ashley M.; Woodard, Lechauncy; Oswald, Frederick L.; Petersen, Laura A.; Lester, Houston F.
    Background: The science of effective teams is well documented; far less is known, however, about how specific team configurations may impact primary care team effectiveness. Further, teams experiencing frequent personnel changes (perhaps as a consequence of poor implementation) may have difficulty delivering effective, continuous, well-coordinated care. This study aims to examine the extent to which primary care clinics in the Veterans Health Administration have implemented team configurations consistent with recommendations based on the Patient-Centered Medical Home model and the extent to which adherence to said recommendations, team stability, and role stability impact healthcare quality. Specifically, we expect to find better clinical outcomes in teams that adhere to recommended team configurations, teams whose membership and configuration are more stable over time, and teams whose clinical manager role is more stable over time. Methods/design: We will employ a combination of social network analysis and multilevel modeling to conduct a database review of variables extracted from the Veterans Health Administration’s Team Assignments Report (TAR) (one of the largest, most diverse existing national samples of primary care teams (nteams > 7000)), as well as other employee and clinical data sources. To ensure the examination of appropriate clinical outcomes, we will enlist a team of subject matter experts to select a concise set of clear, prioritized primary care performance metrics. We will accomplish this using the Productivity Measurement and Enhancement System, an evidence-based methodology for developing and implementing performance measurement. Discussion: We are unaware of other studies of healthcare teams that consider team size, composition, and configuration longitudinally or with sample sizes of this magnitude. Results from this study can inform primary care team implementation policy and practice in both private- and public-sector clinics, such that teams are configured optimally, with adequate staffing, and the right mix of roles within the team.
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    Teammate familiarity and risk of injury in emergency medical services
    (BMJ Publishing Group Limited, 2016) Patterson, P. Daniel; Weaver, Matthew D.; Landsittel, Douglas P.; Krackhardt, David; Hostler, David; Vena, John E.; Hughes, Ashley M.; Salas, Eduardo; Yealy, Donald M.
    Objective: We investigated the association between teammate familiarity and workplace injury in the emergency medical services (EMS) setting. Methods: From January 2011 to November 2013, we abstracted a mean of 29 months of shift records and Occupational Safety Health Administration injury logs from 14 EMS organisations with 37 total bases located in four US Census regions. Total teammate familiarity was calculated for each dyad as the total number of times a clinician dyad worked together over the study period. We used negative binomial regression to examine differences in injury incidence rate ratios (IRRs) by familiarity. Results: We analysed 715 826 shift records, representing 4197 EMS clinicians and 60 701 unique dyads. We determined the mean shifts per dyad was (5.9, SD 19.7), and quartiles of familiarity were 1 shift worked together over the study period, 2–3 shifts, 4–9 shifts and ≥10 shifts worked together. More than half of all dyads worked one shift together (53.9%, n=32 739), 24.8% of dyads 2–3 shifts, 11.8% worked 4–9 shifts and 9.6% worked ≥10 shifts. The overall incidence rate of injury across all organisations was 17.5 per 100 full-time equivalent (FTE), range 4.7–85.6 per 100 FTE. The raw injury rate was 33.5 per 100 FTEs for dyads with one shift of total familiarity, 14.2 for 2–3 shifts, 8.3 for 4–9 shifts and 0.3 for ≥10 shifts. Negative binomial regression confirmed that dyads with ≥10 shifts had the lowest incidence of injury (IRR 0.03; 95% CI 0.02 to 0.04). Conclusions: Familiarity between teammates varies in the EMS setting, and less familiarity is associated with greater incidence of workplace injury.
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    The Morbidity and Mortality Conference: Opportunities for Enhancing Patient Safety
    (Wolters Kluwer Health, Inc., 2022) Lazzara, Elizabeth H.; Salisbury, Mary; Hughes, Ashley M.; Rogers, Jordan E.; King, Heidi B.; Salas, Eduardo
    Since the 20th century, health care institutions have used morbidity and mortality conferences (MMCs) as a forum to discuss complicated cases and fatalities to capitalize on lessons learned. Medical technology, health care processes, and the teams who provide care have evolved over time, but the format of the MMC has remained relatively unchanged. The present article outlines 5 key areas for improvement within the MMC along with prescriptive and actionable recommendations for mitigating these challenges. This work incorporates the contributions of numerous researchers and practitioners from the educational, training, debrief, and health care fields. With the best practices and lessons learned from various domains in mind, we recommend optimizing the MMC by (1) encouraging a culture that leverages expertise from multiple sources, (2) allocating ample time for innovative thinking, (3) using a global approach that considers individual, team, and system-level factors, (4) leveraging learnings from errors as well as near misses, and (5) promoting communication, innovative thinking, and actionable planning. The 5 evidence-based recommendations herein serve to ensure that MMCs are structured learning events that promote, encourage, and support safe, reliable care. Furthermore, the outlined recommendations seek to capitalize upon the MMC’s opportunity to engage early discovery as well as proactive risk assessment and action-oriented solutions.
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    Trauma, Teams, and Telemedicine: Evaluating Telemedicine and Teamwork in a Mass Casualty Simulation
    (Oxford University Press, 2021) Hughes, Ashley M.; Sonesh, Shirley C.; Mason, Rachel E.; Gregory, Megan E.; Marttos, Antonio; Schulman, Carl I.; Salas, Eduardo
    Introduction: Mass casualty events (MASCAL) are on the rise globally. Although natural disasters are often unavoidable, the preparation to respond to unique patient demands in MASCAL can be improved. Utilizing telemedicine can allow for a better response to such disasters by providing access to a virtual team member with necessary specialized expertise. The purpose of this study was to examine the positive and/or negative impacts of telemedicine on teamwork in teams responding to MASCAL events. Methods: We introduced a telemedical device (DiMobile Care) to Forward Surgical Teams during a MASCAL simulated training event. We assessed teamwork-related attitudes, behaviors, and cognitions during the MASCAL scenario through pre-post surveys and observations of use. Analyses compare users and nonusers of telemedicine and pre-post training differences in teamwork. Results: We received 50 complete responses to our surveys. Overall, clinicians have positive reactions toward the potential benefits of telemedicine