Dry vs aqueous inhalers.
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Administration, Inhalation↗
Biomedical subjects
David Engler
Publications and source records attributed to David Engler.
The GDAHA hospital performance reports project: a successful community-based quality improvement initiative.
During the past decade there has been increasing distribution of hospital performance information but few examples of how this information is affecting the quality of health care delivery. This article describes the methods of implementation and factors influencing a successful community-based quality improvement initiative in Dayton, Ohio, involving a collaborative of five competing hospitals in partnership with the business community and local and state hospital associations. The initiative contributed to a 36% reduction in acute myocardial infarction mortality over a 3-year period by changing reperfusion patterns in patients with ST segment elevated myocardial infarction. Identification of an opportunity gap, root cause analysis, and development of process measures used to facilitate health care provider change are summarized. The driving and restraining forces that have shaped this initiative from a report card to a quality improvement program are outlined and a list of five contributors to success are presented. These factors can serve as a basis for how other communities can benefit from this collaborative model.
Cardiology Service, Hospital↗
Lack of relationship between the Cleveland Health Quality Choice project and decreased inpatient mortality in Cleveland.
The Cleveland Health Quality Choice (CHQC) project was previously suggested to have been responsible for declines in inpatient mortality in Cleveland hospitals during the first years of the project (1992-1993). We sought to (a) verify this decline in mortality and (b) better understand its possible relationship to CHQC. We employed regression analysis to compare mortality rate trends for Cleveland versus the rest of Ohio using Ohio Hospital Association inpatient mortality data. We found that the rate of decline in mortality in Cleveland (-.218% per 6 months; 95% confidence limits, -.278% to -.159% per 6 months) was statistically indistinguishable from that in the rest of the state (-.188% per 6 months; 95% confidence limits, -.234% to -.143% per 6 months) (P = .35). We could not demonstrate a significant beneficial effect of the CHQC project on hospital mortality in Cleveland. Inpatient mortality was simultaneously declining at a statistically indistinguishable rate throughout the state.
Health Services Research↗