E Pappius | PubMed Health

PubMed1984

Medical consequences of missed appointments.

"No-show" patients (n = 100) were matched by age and number of appointments scheduled in a six-month period with 100 control patients who kept an appointment. No-show patients were less likely than control patients to have chronic medical problems (78% v 94%, respectively) and to be receiving long-term medications (58% v 73%, respectively) at the time of entry into this study. At follow-up at 29 to 51 weeks, no-show and control patients did not differ significantly in the development of new medical problems or the exacerbation of old medical problems either before or after controlling for differences in baseline health status. No hospitalizations or deaths could be directly attributed to a missed appointment. No-show patients were more likely than control patients to say they felt better at follow-up (42% v 26%, respectively). No-show patients may believe the benefit of keeping an appointment is not worth the inconvenience or expense. We suggest that physicians should carefully justify the need for a follow-up visit and consider negotiating follow-up schedules with their patients.

Adolescent↗

PubMedDate not supplied

Using information systems to measure and improve quality.

Information systems (IS) are increasingly important for measuring and improving quality. In this paper, we describe our integrated delivery system's plan for and experiences with measuring and improving quality using IS. Our belief is that for quality measurement to be practical, it must be integrated with the routine provision of care and whenever possible should be done using IS. Thus, at one hospital, we now perform almost all quality measurement using IS. We are also building a clinical data warehouse, which will serve as a repository for quality information across the network. However, IS are not only useful for measuring care, but also represent powerful tools for improving care using decision support. Specific areas in which we have already seen significant benefit include reducing the unnecessary use of laboratory testing, reporting important abnormalities to key providers rapidly, prevention and detection of adverse drug events, initiatives to change prescribing patterns to reduce drug costs and making critical pathways available to providers. Our next major effort will be introduce computerized guidelines on a more widespread basis, which will be challenging. However, the advent of managed care in the US has produced strong incentives to provide high quality care at low cost and our perspective is that only with better IS than exist today will this be possible without compromising quality. Such systems make feasible implementation of quality measurement, care improvement and cost reduction initiatives on a scale which could not previously be considered.

Computer Communication Networks↗