Strategic pathways to International Classification of Diseases, 11th Revision, adoption in France and the United States.

The International Classification of Diseases, 11th Revision (ICD-11), developed by the World Health Organization, represents a transformative update to global health data classification systems. Building on the foundation of ICD-10, it introduces innovative features such as multilingual coding, advanced interoperability, postcoordination, and improved specificity, enabling better alignment with modern healthcare and digital information systems. This commentary explores the adoption pathways for ICD-11 in France and the United States, 2 countries with complex healthcare infrastructures and distinct implementation strategies.

Development and validation of an electronic quality measure for postoperative respiratory failure.

Background: Postoperatively, prolonged mechanical ventilation or unplanned intubation-collectively, "postoperative respiratory failure"-has high morbidity and mortality risk, but hospitals' automated ability to detect this complication is currently limited.

Study Design: We developed an electronic clinical quality measure for postoperative respiratory failure on the basis of input from clinical and quality experts. Using 2022 structured electronic health record data from 12 diverse hospitals encompassing 2 common electronic health record vendors, we retrospectively evaluated criteria for postoperative respiratory failure after an operation during an elective hospitalization.

Methodological Techniques to Estimate the Sensitivity of the Agency for Healthcare Research and Quality Patient Safety Indicators.

Background: Little is known about how comprehensively the Agency for Healthcare Research and Quality's patient safety indicators (PSIs) capture true complications. Therefore, the authors sought to assess the PSIs' sensitivity using a novel sampling and analytic strategy tailored for unusual events to ensure adequate capture of false negative cases.

Methods: The authors retrospectively reviewed hospitalization records not flagged by 7 selected PSIs, oversampling those with specific diagnosis or procedure codes suggesting an unreported complication, with a special interest in PSI 09 (Postoperative Hemorrhage or Hematoma) and PSI 10 (Postoperative Physiologic and Metabolic Derangement).

Nursing Home Guide to Adjusting Nurse Staffing for Resident Case-Mix.

Background: Nursing homes (NHs) are required to provide sufficient nursing staff to meet the needs of their residents. This study provides a guide for NHs to align nurse staffing levels with resident needs and calculates the gap between reported and expected NH staffing.

Methods: Using the best available research data and recent federal minimum staffing requirements, expected nurse staffing levels were estimated for the 25 resident case-mix index (CMI) groups established by the Centers for Medicare & Medicaid Services (CMS) using nonlinear least-squares regression analyses.

Unsupervised machine learning identifies opioid taper reversal patterns in a longitudinal cohort (2008-2018).

Chronic pain is commonly treated with long-term opioid therapy, but rapid opioid dose tapering has been associated with increased adverse events. Little is known about heterogeneity in the population of patients on high dose opioids and their response to different treatments. Our aim was to examine opioid dose management and other patient characteristics in a longitudinal, clinically diverse, national population of opioid dependent patients.

Strategic pathways to International Classification of Diseases, 11th Revision adoption in France and the United States.

The International Classification of Diseases, 11th Revision (ICD-11), developed by the World Health Organization, represents a transformative update to global health data classification systems. Building on the foundation of ICD-10, it introduces innovative features such as multilingual coding, advanced interoperability, postcoordination, and improved specificity, enabling better alignment with modern healthcare and digital information systems. This commentary explores the adoption pathways for ICD-11 in France and the United States, 2 countries with complex healthcare infrastructures and distinct implementation strategies.

Protocol for a single-arm feasibility trial of virtual family-centered rounds: increasing opportunities for family engagement among caregivers with language preference other than English.

Background: Telehealth use during family-centered rounds in the neonatal intensive care unit has been shown to shorten length of hospitalization and improve breastfeeding outcomes. For families who speak languages other than English, access to and use of telehealth technologies can be impeded by lack of interpreter services. We aim to evaluate the feasibility of telehealth use during family-centered rounds in the neonatal intensive care unit for families who speak languages other than English.

Risk of Home Falls Among Older Adults After Acute Care Hospitalization: A Cohort Study.

Background: Acute care hospitalization has been associated with older adult home falls after discharge, but less is known about the effects of hospital- and patient-related factors on home fall risk.

Objectives: This study compares the effects of hospital length of stay, medical condition, history of falls, and home health care on period rates of home falls after discharge from acute care hospitalization.

Methods: This was a retrospective cohort study comparing period rates of home injury falls among older adults (age ≥ 65) occurring after discharge from an acute care hospitalization.

Improving the Safety of Computed Tomography Through Automated Quality Measurement: A Radiologist Reader Study of Radiation Dose, Image Noise, and Image Quality.

Objectives: The Centers for Medicare and Medicaid Services funded the development of a computed tomography (CT) quality measure for use in pay-for-performance programs, which balances automated assessments of radiation dose with image quality to incentivize dose reduction without compromising the diagnostic utility of the tests. However, no existing quantitative method for assessing CT image quality has been validated against radiologists' image quality assessments on a large number of CT examinations. Thus to develop an automated measure of image quality, we tested the relationship between radiologists' subjective ratings of image quality with measurements of radiation dose and image noise.

Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation.

Background: Risk-adjustment (RA) models are used to account for severity of illness in comparing patient outcomes across hospitals. Researchers specify covariates as main effects, but they often ignore interactions or use stratification to account for effect modification, despite limitations due to rare events and sparse data. Three Agency for Healthcare Research and Quality (AHRQ) hospital-level Quality Indicators currently use stratified models, but their variable performance and limited interpretability motivated the design of better models.

Longitudinal Care Patterns and Utilization Among Patients With New-Onset Neck Pain by Initial Provider Specialty.

Study Design: Retrospective cohort study.

Objective: To compare utilization patterns for patients with new-onset neck pain by initial provider specialty.

Summary Of Background Data: Initial provider specialty has been associated with distinct care patterns among patients with acute back pain; little is known about care patterns among patients with acute neck pain.

Virtual family-centered hospital rounds in the neonatal intensive care unit: protocol for a cluster randomized controlled trial.

Background: Family-centered rounds is recognized as a best practice for hospitalized children, but it has only been possible for children whose families can physically be at the bedside during hospital rounds. The use of telehealth to bring a family member virtually to the child's bedside during hospital rounds is a promising solution. We aim to evaluate the impact of virtual family-centered hospital rounds in the neonatal intensive care unit on parental and neonatal outcomes.

Virtual Family-Centered Rounds in the Neonatal Intensive Care Unit: Protocol for a Cluster Randomized Controlled Trial.

Family-centered rounds is recognized as a best practice for hospitalized children, but it has only been possible for children whose families can physically be at the bedside during hospital rounds. The use of telehealth to bring a family member virtually to the child’s bedside during rounds is a promising solution. We aim to evaluate the impact of virtual family-centered rounds in the neonatal intensive care unit on parental and neonatal outcomes.

Nurse-to-family telehealth for pediatric transfers: protocol for a feasibility and pilot cluster randomized controlled trial.

Background: Children presenting to emergency departments of community hospitals may require transfer to a children's hospital for more definitive care, but the transfer process can be distressing and burdensome to patients, families, and the healthcare system. Using telehealth to bring the children's hospital nurse virtually to the bedside of the child in the emergency department has the potential to promote family-centered care and minimize triage issues and other transfer-associated burdens. To explore the feasibility of the nurse-to-family telehealth intervention, we are conducting a pilot study.

Postdischarge Noninvasive Telemonitoring and Nurse Telephone Coaching Improve Outcomes in Heart Failure Patients With High Burden of Comorbidity.

Background: Noninvasive telemonitoring and nurse telephone coaching (NTM-NTC) is a promising postdischarge strategy in heart failure (HF). Comorbid conditions and disease burden influence health outcomes in HF, but how comorbidity burden modulates the effectiveness of NTM-NTC is unknown. This study aims to identify patients with HF who may benefit from postdischarge NTM-NTC based on their burden of comorbidity.

Development and Psychometric Evaluation of a Caregiver Survey to Assess Family-Centered Care in the Emergency Department.

Objective: To develop and evaluate the psychometric properties of a family caregiver-reported survey that assesses family-centeredness of care in the context of pediatric emergency department (ED) encounters.

Methods: We created a caregiver-reported scale, incorporated content expert feedback, and iteratively revised it based on cognitive interviews with caregivers. We then field tested the scale in a survey with caregivers.

Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UCRC).

Background: Few interventions are known to reduce the incidence of respiratory failure that occurs following elective surgery (postoperative respiratory failure; PRF). We previously reported risk factors associated with PRF that occurs within the first 5 days after elective surgery (early PRF; E-PRF); however, PRF that occurs six or more days after elective surgery (late PRF; L-PRF) likely represents a different entity. We hypothesized that L-PRF would be associated with worse outcomes and different risk factors than E-PRF.

The three-part model for coding causes and mechanisms of healthcare-related adverse events.

ICD-11 provides a promising new way to capture healthcare-related harm or injury. In this paper, we elaborate on the framework for describing healthcare-related events where there is a presumed causal link between an event and underlying healthcare-related factors. The three-part model for describing healthcare-related harm or injury in ICD-11 consists of (1) a healthcare-related activity that is the cause of injury or other harm (selected from Chapter 23 of ICD-11); (2) a mode or mechanism of injury or harm, related to the underlying cause (also from Chapter 23 of ICD-11); and (3) the harmful consequences of the event to the patient, selected from any of Chapters 1 through 22 of ICD-11 (most importantly, the injury or harm experienced by the patient).

Incorporating harms into the weighting of the revised Agency for Healthcare Research and Quality Patient Safety for Selected Indicators Composite (Patient Safety Indicator 90).

Objective: To reweight the Agency for Healthcare Research and Quality Patient Safety for Selected Indicators Composite (Patient Safety Indicator [PSI] 90) from weights based solely on the frequency of component PSIs to those that incorporate excess harm reflecting patients' preferences for outcome-related health states.

Data Sources: National administrative and claims data involving hospitalizations in nonfederal, nonrehabilitation, acute care hospitals.

Study Design: We estimated the average excess aggregate harm associated with the occurrence of each component PSI using a cohort sample for each indicator based on denominator-eligible records.

Emergency Department Pediatric Readiness and Potentially Avoidable Transfers.

Objective: To determine the association between potentially avoidable transfers (PATs) and emergency department (ED) pediatric readiness scores and the score's associated components.

Study Design: This cross-sectional study linked the 2012 National Pediatric Readiness Project assessment with individual encounter data from California's statewide ED and inpatient databases during the years 2011-2013. A probabilistic linkage, followed by deterministic heuristics, linked pretransfer, and post-transfer encounters.

Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals.

Purpose: Pediatric readiness scores may be a useful measure of a hospital's preparedness to care for children. However, there is limited evidence linking these scores with patient outcomes or other metrics, including the need for interfacility transfer. This study aims to determine the association of pediatric readiness scores with the odds of interfacility transfer among a cohort of noninjured children (< 18 years old) presenting to emergency departments (EDs) in small rural hospitals in the state of California.

The Use of Telemedicine for Stabilization of Neonates Transferred from Rural Community Hospitals.

For newborns requiring transfer to a higher level of care, stabilization before the arrival of the transport team is essential. Telemedicine consultations with a neonatologist may improve local providers' ability to stabilize a newborn during this critical interval. The purpose of this study was to describe the use of telemedicine for stabilizing newborns who were transferred from one of six rural hospitals to a regional neonatal intensive care unit in northern California and to examine the association between telemedicine use and time needed to stabilize the newborn.