As the science of quality improvement in health care advances, the importance of sharing its accomplishments through the published literature increases. Current reporting of improvement work in health care varies widely in both content and quality. It is against this backdrop that a group of stakeholders from a variety of disciplines has created the Standards for QUality Improvement Reporting Excellence, which we refer to as the SQUIRE publication guidelines or SQUIRE statement. The SQUIRE statement consists of a checklist of 19 items that authors need to consider when writing articles that describe formal studies of quality improvement. Most of the items in the checklist are common to all scientific reporting, but virtually all of them have been modified to reflect the unique nature of medical improvement work.This “Explanation and Elaboration” document (E & E) is a companion to the SQUIRE statement. For each item in the SQUIRE guidelines the E & E document provides one or two examples from the published improvement literature, followed by an analysis of the ways in which the example expresses the intent of the guideline item. As with the E & E documents created to accompany other biomedical publication guidelines, the purpose of the SQUIRE E & E document is to assist authors along the path from completion of a quality improvement project to its publication. The SQUIRE statement itself, this E & E document, and additional information about reporting improvement work can be found at http://www.squire-statement.org.

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In two large datasets, using different methods to measure HbA(1c), the association of age with higher HbA(1c) levels: was consistent and similar; was both statistically and clinically significant; was unexplained by features of aging; and reduced diagnostic specificity. Age should be taken into consideration when using HbA(1c) for the diagnosis and management of diabetes and prediabetes.

Previous observational research confirms abundant variation in primary care practice. While variation is sometimes viewed as problematic, its presence may also be highly informative in uncovering ways to enhance health care delivery when it represents unique adaptations to the values and needs of people within the practice and interactions with the local community and health care system. We describe a theoretical perspective for use in developing interventions to improve care that acknowledges the uniqueness of primary care practices and encourages flexibility in the form of intervention implementation, while maintaining fidelity to its essential functions.

Background Lifestyle change programs are aimed to improve health, yet little is known about their impact once translated into clinical settings. The Veterans Health Administration (VA) MOVE! program is the largest lifestyle change program in the U.S., and our objective was to determine whether participation in MOVE! is associated with reduced diabetes incidence. Methods This retrospective analysis used VA databases to examine patients with ≥3 years of continuous outpatient care during 2005–2012, who were overweight or obese. We used generalized estimating equations to examine characteristics associated with MOVE! participation, and Cox proportional hazards regression to analyze the association between participation and diabetes incidence (defined by ICD-9 code or diabetes prescription). Findings Of 1·8 million eligible individuals, 238,540 (13%) participated in MOVE! between 2005–2012, and19,367 (1% overall, 8% of participants) met criteria for “intense and sustained” participation. Intense and sustained participation was associated with greater weight loss at three years compared to less active participation and nonparticipation (−2·2% vs. −0·64% and +0·46%, respectively). Among patients who did not have diabetes at baseline, MOVE! participation was associated with lower diabetes incidence: the hazard ratio comparing less active participants to non-participants was 0·80 (95% CI, 0·77–0·83), and comparing intense and sustained participants to non-participants was 0·67 (95% CI, 0·61–0·74). These patterns were consistent across sex, race/ethnicity, and age. Participation appeared to be most beneficial among patients with higher BMI or random glucose (p-values <0·0001). Interpretation Participation in this large-scale, healthcare-based lifestyle change program was associated with weight loss and lower diabetes incidence. However, the observed impact may have been exaggerated by selection bias, as the program reached only a fraction of the eligible population. Funding VA HSR&D IIR 07-138 and NIH R21DK099716.

Contextual characteristics independently associated with BCS identify areas in which women are at increased risk for delayed breast cancer diagnosis. The approach described here can inform the planning phase of regional, state, or federal initiatives to enhance BCS and reduce subsequent disparities in treatment outcomes.

Previous observational research confirms abundant variation in primary care practice. While variation is sometimes viewed as problematic, its presence may also be highly informative in uncovering ways to enhance health care delivery when it represents unique adaptations to the values and needs of people within the practice and interactions with the local community and health care system. We describe a theoretical perspective for use in developing interventions to improve care that acknowledges the uniqueness of primary care practices and encourages flexibility in the form of intervention implementation, while maintaining fidelity to its essential functions.

BackgroundThe importance and complexity of handovers is well-established. Progress for intervening in the emergency department change of shift handovers may be hampered by lack of a conceptual framework. The objectives were to gain a better understanding of strategies used for change of shift handovers in an emergency care setting and to further expand current understanding and conceptualizations.MethodsObservations, open-ended questions and interviews about handover strategies were collected at a Veteran's Health Administration Medical Center in the United States. All relevant staff in the emergency department was observed; 31 completed open-ended surveys; 10 completed in-depth interviews. The main variables of interest were strategies used for handovers at change of shift and obstacles to smooth handovers.ResultsOf 21 previously identified strategies, 8 were used consistently, 4 were never used, and 9 were used occasionally. Our data support ten additional strategies. Four agent types and 6 phases of the process were identified via grounded theory analysis. Six general themes or clusters emerged covering factors that intersect to define the degree of handover smoothness.ConclusionIncluding phases and agents in conceptualizations of handovers can help target interventions to improve patient safety. The conceptual model also clarifies unique handover considerations for the emergency department setting.