Brent James - Academia.edu (original) (raw)

Papers by Brent James

BMJ Quality & Safety, Feb 6, 2014

What’s the role of social networks in preventing burnout, and what can health care leaders do to ... more What’s the role of social networks in preventing burnout, and what can health care leaders do to grow those networks?

There’s a large chance new physicians will burn out, so how do we keep the next generation motiva... more There’s a large chance new physicians will burn out, so how do we keep the next generation motivated?

New England Journal of Medicine, 2000

... The prevention of errors through analysis of human factors has a specific definition in theen... more ... The prevention of errors through analysis of human factors has a specific definition in theengineering literature, and the introduction of the science of error ... To err is human: building a safer health system. ... (2006) An Empirically Derived Taxonomy of Factors Affecting Physicians ...

Journal of Hospital Medicine, 2007

BACKGROUNDChildren with neurological impairment (NI) commonly have gastroesophageal reflux diseas... more BACKGROUNDChildren with neurological impairment (NI) commonly have gastroesophageal reflux disease (GERD) treated with a fundoplication. The impact of this procedure on quality of life is poorly understood.OBJECTIVESTo examine the quality of life of children with NI who have received a fundoplication for GERD and of their caregivers.METHODSThe study was a prospective cohort study of children with NI and GERD who underwent a fundoplication at a children's hospital between January 1, 2005, and July 7, 2006. Quality of life of the children was assessed with the Child Health Questionnaire (CHQ) and of the caregivers with the Short‐Form Health Survey Status (SF‐36) and Parenting Stress Index (PSI), both at baseline and 1 month after fundoplication. Functional status was assessed using the WeeFIM®. Repeated‐measures analyses were performed.RESULTSForty‐four of the 63 parents (70%) were enrolled. The median WeeFIM® score was 31.2 versus the age‐normal score of 83 (P = .001). Compared w...

JAMA: The Journal of the American Medical Association, 1985

Journal of the American Medical Informatics Association, Nov 1, 2003

surveillance during the Games was paramount. A team of informaticists and public health specialis... more surveillance during the Games was paramount. A team of informaticists and public health specialists from Utah and Pittsburgh implemented the Real-time Outbreak and Disease Surveillance (RODS) system in Utah for the Games in just seven weeks. The strategies and challenges of implementing such a system in such a short time are discussed. The motivation and cooperation inspired by the 2002 Olympic Winter Games were a powerful driver in overcoming the organizational issues. Over 114,000 acute care encounters were monitored between February 8 and March 31, 2002. No outbreaks of public health significance were detected. The system was implemented successfully and operational for the 2002 Olympic Winter Games and remains operational today.

Quality and Safety in Health Care, 2009

Background: Colorectal cancer (CRC) is the third-leading cause of cancer death for both men and w... more Background: Colorectal cancer (CRC) is the third-leading cause of cancer death for both men and women in the USA. Despite consensus recommendations for screening, just over half of eligible adults nationally have undergone screening. We therefore implemented a programme to improve the rate of CRC screening. Methods: This study was conducted in the Utah Health Research Network and the University of Utah Community Clinics, a 100 000 patient, seven-practice, universityowned system offering primary and secondary care and ancillary services including endoscopy. We focused on patients aged >50 who were seen between 1 January 2003 and 31 October 2006, and who were not current for CRC screening at the time of the visit. The study included a three-phase intervention: electronic medical record (EMR) reminders, physician and medical assistant (MA) education about CRC screening guidelines, and redesign of patient visit workflow with an expanded role for MAs to review patients' CRC screening status and recommend testing when appropriate. With patient agreement, the MA entered a preliminary order in the EMR, and the physician confirmed or rejected the order. The primary outcome measure was the rate of screening colonoscopy ordered for eligible patients. Results: The baseline colonoscopy referral rate was 6.0%. Provider education and electronic reminders had minimal immediate impact on screening rates. Addition of the expanded MA role was associated with a sustained increase in colonoscopy referral order rate to 13.4%, a relative improvement of 123%. Conclusions: The MA can play a key role in improving CRC screening rates as part of a redesigned system of primary care. Colorectal carcinoma (CRC), cancers of the colon and rectum combined, are the third most common cause of new cancer cases and deaths in the USA for both men and women. 1 An individual's lifetime risk of developing CRC in the USA is nearly 6%, with over 90% of cases occurring after age 50. 2

Journal for Healthcare Quality, 2009

This quality improvement project was designed to improve rates of referral for colonoscopy screen... more This quality improvement project was designed to improve rates of referral for colonoscopy screening in the Utah Health Research Network, University of Utah Community Clinics. This study was conducted between October 2004 and June 2007 with the main intervention being a clinic workflow modification using computerized screening reminders embedded in the electronic medical record (EMR). The intervention led to sustained improvement, largely driven by the performance of two network clinics. This study demonstrates that a robust EMR, with decision prompts, accompanied by clinic workflow changes and feedback to providers, can lead to sustained change in the rates of colonoscopy referral.

American Heart Journal, 2020

Background Multiple modern Indian hospitals operate at very low cost while meeting US-equivalent ... more Background Multiple modern Indian hospitals operate at very low cost while meeting US-equivalent quality accreditation standards. Though US hospitals face intensifying pressure to lower their cost, including proposals to extend Medicare payment rates to all admissions, the transferability of Indian hospitals' cost advantages to US peers remains unclear. Methods Using time-driven activity-based costing methods, we estimate the average cost of personnel and space for an elective coronary artery bypass graft (CABG) surgery at two American hospitals and one Indian hospital (NH). All three hospitals are Joint Commission accredited and have reputations for use of modern performance management methods. Our case study applies several analytic steps to distinguish transferable from non-transferable sources of NH's cost savings. Results After removing non-transferable sources of efficiency, NH's residual cost advantage primarily rests on shifting tasks to less-credentialed and/or less-experienced personnel who are supervised by highly-skilled personnel when perceived risk of complications is low. NH's high annual CABG volume facilitates such supervised work "downshifting." The study is subject to limitations inherent in case studies, does not account for the younger age of NH's patients, or capture savings attributable to NH's negligible frequency of re-admission or post-acute care facility placement. Conclusions Most transferable bases for a modern Indian hospital's cost advantage would require more flexible American states' hospital and health professional licensing regulations, greater family participation in inpatient care, and stronger support by hospital executives and clinicians for substantially lowering the cost of care via regionalization of complex surgeries and weekend use of costly operating rooms.

Trustee : the journal for hospital governing boards, 2006

Journal of the American Medical Informatics Association, Sep 19, 2022

American heart journal, 2017

Improving 30-day readmission continues to be problematic for most hospitals. This study reports t... more Improving 30-day readmission continues to be problematic for most hospitals. This study reports the creation and validation of sex-specific inpatient (i) heart failure (HF) risk scores using electronic data from the beginning of inpatient care for effective and efficient prediction of 30-day readmission risk. HF patients hospitalized at Intermountain Healthcare from 2005 to 2012 (derivation: n=6079; validation: n=2663) and Baylor Scott & White Health (North Region) from 2005 to 2013 (validation: n=5162) were studied. Sex-specific iHF scores were derived to predict post-hospitalization 30-day readmission using common HF laboratory measures and age. Risk scores adding social, morbidity, and treatment factors were also evaluated. The iHF model for females utilized potassium, bicarbonate, blood urea nitrogen, red blood cell count, white blood cell count, and mean corpuscular hemoglobin concentration; for males, components were B-type natriuretic peptide, sodium, creatinine, hematocrit, ...

Health Affairs, 2011

It has been estimated that full implementation of the Affordable Care Act will extend coverage to... more It has been estimated that full implementation of the Affordable Care Act will extend coverage to thirty-two million previously uninsured Americans. However, rapidly rising health care costs could thwart that effort. Since 1988 Intermountain Healthcare has applied to health care delivery the insights of W. Edwards Deming's process management theory, which says that the best way to reduce costs is to improve quality. Intermountain achieved such quality-based savings through measuring, understanding, and managing variation among clinicians in providing care. Intermountain created data systems and management structures that increased accountability, drove improvement, and produced savings. For example, a new delivery protocol helped reduce rates of elective induced labor, unplanned cesarean sections, and admissions to newborn intensive care units. That one protocol saves an estimated 50millioninUtaheachyear.Ifappliednationally,itwouldsaveabout50 million in Utah each year. If applied nationally, it would save about 50millioninUtaheachyear.Ifappliednationally,itwouldsaveabout3.5 billion. "Organized care" along these lines may be central to the long-term success of health reform.

The American Journal of Medicine, 2002

The American Journal of Medicine, Volume 112, Issue 2, Pages 165-167, 1 February 2002, Authors:Ma... more The American Journal of Medicine, Volume 112, Issue 2, Pages 165-167, 1 February 2002, Authors:Mark L Zeidel, MD; Brent C James, MD.

Journal of the American Medical Informatics Association, 2021

Clinical decision-making is based on knowledge, expertise, and authority, with clinicians approvi... more Clinical decision-making is based on knowledge, expertise, and authority, with clinicians approving almost every intervention—the starting point for delivery of “All the right care, but only the right care,” an unachieved healthcare quality improvement goal. Unaided clinicians suffer from human cognitive limitations and biases when decisions are based only on their training, expertise, and experience. Electronic health records (EHRs) could improve healthcare with robust decision-support tools that reduce unwarranted variation of clinician decisions and actions. Current EHRs, focused on results review, documentation, and accounting, are awkward, time-consuming, and contribute to clinician stress and burnout. Decision-support tools could reduce clinician burden and enable replicable clinician decisions and actions that personalize patient care. Most current clinical decision-support tools or aids lack detail and neither reduce burden nor enable replicable actions. Clinicians must prov...

AORN Journal, 1996

... It focuses on the existing quality movement within health care and on the specific ... Chapte... more ... It focuses on the existing quality movement within health care and on the specific ... Chapter 5 discusses issues of meeting customer satisfaction re-quirements together with methods and ... care environment and the requirement that, for CQI to meet its expectations, managers and ...

International Journal for Quality in Health Care, 1998

Annals of Internal Medicine, 2007

Quality improvement (QI) activities can improve health care but must be conducted ethically. The ... more Quality improvement (QI) activities can improve health care but must be conducted ethically. The Hastings Center convened leaders and scholars to address ethical requirements for QI and their relationship to regulations protecting human subjects of research. The group defined QI as systematic, data-guided activities designed to bring about immediate improvements in health care delivery in particular settings and concluded that QI is an intrinsic part of normal health care operations. Both clinicians and patients have an ethical responsibility to participate in QI, provided that it complies with specified ethical requirements. Most QI activities are not human subjects research and should not undergo review by an insti-tutional review board; rather, appropriately calibrated supervision of QI activities should be part of professional supervision of clinical practice. The group formulated a framework that would use key characteristics of a project and its context to categorize it as QI, human subjects research, or both, with the potential of a customized institutional review board process for the overlap category. The group recommended a period of innovation and evaluation to refine the framework for ethical conduct of QI and to integrate that framework into clinical practice.

Advances in Patient Safety: From Research to …, 2005

The Institute of Medicine (IOM) released To Err Is Human: Building a Safer Health System, 1 its s... more The Institute of Medicine (IOM) released To Err Is Human: Building a Safer Health System, 1 its seminal summary of preventable patient injuries suffered within American hospitals, on November 29, 1999. This report was unique in one important way: it was the first IOM report directed as much to the general American public as at the U.S. government, the health care industry, members of the healing professions, and health policy experts. While evidence documenting high rates of treatment-associated injury and mortality have appeared in the peerreviewed medical literature since the 1950s, neither the health professions nor the health care industry have ever prioritized patient safety as a critical imperative. The IOM's Committee on the Quality of Health Care in America, which produced To Err Is Human, sought-through its new public relations direction-to force patient safety to the pinnacle of the policy and care delivery improvement agendas. The committee set a goal of reducing fatalities associated with hospitalbased care delivery by 50 percent within 5 years.