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Biomedical subjects

Gregg S Meyer

Publications and source records attributed to Gregg S Meyer.

13 recordsLinked to original sources
PubMed2004

The roles of government in improving health care quality and safety.

BACKGROUND: Discussions surrounding the role of government have been and continue to be a favorite American pastime. A framework is provided for understanding the 10 roles that government plays in improving health care quality and safety in the United States. Examples of proposed federal actions to reduce medical errors and enhance patient safety are provided to illustrate the 10 roles: (1) purchase health care, (2) provide health care, (3) ensure access to quality care for vulnerable populations, (4) regulate health care markets, (5) support acquisition of new knowledge, (6) develop and evaluate health technologies and practices, (7) monitor health care quality, (8) inform health care decision makers, (9) develop the health care workforce, and (10) convene stakeholders from across the health care system. CONCLUSION: Government's responsibility to protect and advance the interests of society includes the delivery of high-quality health care. Because the market alone cannot ensure all Americans access to quality health care, the government must preserve the interests of its citizens by supplementing the market where there are gaps and regulating the market where there is inefficiency or unfairness. The ultimate goal of achieving high quality of care will require strong partnerships among federal, state, and local governments and the private sector. Translating general principles regarding the appropriate role of government into specific actions within a rapidly changing, decentralized delivery system will require the combined efforts of the public and private sectors.

Federal Government↗
PubMed2004

Clinical practice guidelines and performance indicators as related--but often misunderstood--tools.

BACKGROUND: Widespread variation in medical practice indicates that existing scientific evidence is often not translated into appropriate clinical care. Two tools have evolved that try to address this variation: clinical practice guidelines (CPGs) and performance indicators (PIs). TENSIONS BETWEEN CPGS AND PIS: CPGs present available evidence that is subsequently reviewed and frequently adopted by professional organizations, so that clinicians may judge whether specific management recommendations are appropriate for each patient. PIs are devised to measure and document performance to motivate organizations to improve through the use of common metrics. IMPLICATIONS OF THESE TENSIONS: The increasingly widespread use of PIs with CPGs (and clinicians' confusion of them with CPGs) risks lowering the standards of clinical care. PIs are not intended to set optimal standards of care for any individual patient. Clinicians should not restrict their quality monitoring to a focus on PIs because they could miss important opportunities to learn and to improve the care they deliver to their individual patients. CONCLUSION: Tensions between CPGs and PIs do not mean that these tools should be abandoned but rather that they need to be refined. Recognition of the imperfections of CPGs and PIs should not blind clinicians to the ultimate goals of these tools--to promote quality (through changes in practice and/or selection) and ensure that medical care is based on scientific evidence.

Humans↗
PubMed2004

The effects of HMO penetration on preventable hospitalizations.

OBJECTIVE: To examine the effects of health maintenance organization (HMO) penetration on preventable hospitalizations. DATA SOURCE: Hospital inpatient discharge abstracts for 932 urban counties in 22 states from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), hospital data from American Hospital Association (AHA) annual survey, and population characteristics and health care capacity data from Health Resources and Services Administration (HRSA) Area Resource File (ARF) for 1998. METHODS: Preventable hospitalizations due to 14 ambulatory care sensitive conditions were identified using the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators. Multiple regressions were used to determine the association between preventable hospitalizations and HMO penetration while controlling for demographic and socioeconomic characteristics and health care capacity of the counties. PRINCIPAL FINDINGS: A 10 percent increase in HMO penetration was associated with a 3.8 percent decrease in preventable hospitalizations (95 percent confidence interval, 2.0 percent-5.6 percent). Advanced age, female gender, poor health, poverty, more hospital beds, and fewer primary care physicians per capita were significantly associated with more preventable hospitalizations. CONCLUSIONS: Our study suggests that HMO penetration has significant effects in reducing preventable hospitalizations due to some ambulatory care sensitive conditions.

Adolescent↗
PubMed2003

The US Agency for Healthcare Research and Quality's activities in patient safety research.

PURPOSE: To update the international community on the US Agency for Healthcare Research and Quality's (AHRQ) recent and current activities in improving patient safety. DATA SOURCES: Review of the literature concerning the importance of patient safety as a health care quality issue, international perspectives on patient safety, a review of research solicitations, and early results of funded studies. STUDY SELECTION: A representative sample of patient safety studies from those currently being funded by AHRQ. RESULTS: In response to a growing interest in patient safety in general and a recent US Institute of Medicine report on patient safety in particular, the US Agency for Healthcare Research and Quality has refocused its quality research mission. In the fiscal year 2002, AHRQ spent US$55 million on patient safety research. This investment was spread across six complementary research areas: (1) health systems error reporting, analysis, and safety improvement research demonstrations; (2) Clinical Informatics to Promote Patient Safety (CLIPS); (3) Centers of Excellence for patient safety research and practice (COE); (4) Developmental Centers for Evaluation and Research in Patient Safety (DCERPS); (5) The Effect of Health Care Working Conditions on Quality of Care; and (6) Partnerships for Quality: Patient Safety Research Dissemination and Education. Internal teams of researchers at AHRQ have published studies on patient safety, such as documenting the impact of medication errors. In addition to funding research on patient safety, AHRQ is an integral partner in several national and international collaborations to form strategic synergies that build upon each member organization's strengths, reduce redundant efforts, and benefit from each other's successes. As evidence on patient safety is generated, AHRQ also serves the important mission of disseminating information to the public. CONCLUSION: The patient safety research field has undergone a period of rapid evolution. It is now incumbent upon the international health care quality improvement community to translate the future results of this research investment into improved safety for patients.

Community-Institutional Relations↗
PubMed2002

Outcome following mitral valve replacement in patients with mitral stenosis and moderately reduced left ventricular ejection fraction.

BACKGROUND: Some patients with mitral stenosis (MS) have moderately reduced left ventricular (LV) ejection fraction (EF), due to either depressed myocardial contractility or alterations in loading conditions. The effect of moderately reduced LV EF on outcome after mitral valve replacement (MVR) is not known. METHODS: We studied 16 consecutive patients with LV EF < or = 0.50 and MS without significant mitral regurgitation or other valvular or coronary artery disease (Group I). We selected four controls with LV EF >0.50 for each patient, matched for time of surgery (Group II, n=64). Mean EF in Groups I and II was 0.45 and 0.66, respectively. We compared short- and long-term outcome between the two groups. RESULTS: There were no perioperative deaths. Group I patients had a higher incidence of in-hospital postoperative heart failure (25% vs. 6%, P=0.02). Mean follow-up was 9 years in both groups. Mean New York Heart Association class improved from 2.4 to 1.7 in both groups. Group I patients had a higher incidence of heart failure deaths (13% vs. 2%, P=0.03) and admissions (40% vs. 13%, P=0.01). There were, however, no differences between Groups I and II in overall mortality (27% vs. 21%), rate of cardiac admissions (69% vs. 53%), or mean Specific Activity Scale Score (2.5 vs. 2.5). CONCLUSIONS: Although patients with MS and moderately reduced LV EF are at higher risk for heart failure after MVR, overall mortality is not different from that of patients with normal EF. Moderate depression of LV EF should not be a contraindication to MVR for MS.

Aged↗
PubMed2002

Use of evidence-based data to drive your patient safety program.

The Agency for Health Care Research and Quality (AHRQ) is committed to conducting and supporting health services research and promoting technical improvements that enhance the quality of health care delivered in the United States. A significant focus of AHRQ's efforts has been its work on patient safety, and it had depended on numerous collaborative efforts both inside and outside of the federal government to exponentially increase what it could accomplish alone. In 2001 fiscal year, Congress appropriated $50 million for the AHRQ's patient safety research initiatives that were collectively aimed at expanding the nation's capacity to conduct research in this field. The portfolio is guided by a user-driven patient safety research agenda that was developed at the September 2000 National Summit on Medical Errors and Patient Safety Research. The research results generated by this initiative will provide an evidentiary base for system improvements that, when implemented, will greatly enhance the safety of the nation's health care system.

Health Services Research↗
PubMed2002

Consumer assessments of care for children and adults in health plans: how do they compare?

OBJECTIVES: The Consumer Assessment of Health Plans Survey (CAHPS) includes an adult version and also a child version for parents or caretakers to rate children's care in health plans. This study examined how adult and child assessments differed in ranking health plans and explored whether the differences justified the additional cost and respondent burden in administering both surveys. METHODS: Data were from 136 commercial health plans participating in the National CAHPS Benchmarking Database, with 80,539 adults and 40,003 children. We compared mean assessments for adults and children on four global ratings and five composites, and determined respondent characteristics predictive of these assessments using regression analysis. We calculated correlations of plan mean scores for adults and children and kappa statistics for agreement when health plans are ranked as above average, average, or below average performers based on adult and child scores. RESULTS: CAHPS scores for children were significantly (P <0.001) higher than those for adults, except for customer service (lower for children) and specialist ratings. Similar respondent characteristics predicted adult and child scores. Plan-level correlations between corresponding adult and child mean scores were moderate to high (r = 0.60-0.85), which translate into fair to moderate agreement (kappa = 0.27-0.61) in ranking health plans. CONCLUSIONS: Adult and child CAHPS provide similar scores and plan rankings on many aspects of care. Child reports include information that may be useful for consumer choice and to health plans for targeting quality improvement. Methods should be developed for assessing health care for children that minimize cost and respondent burden.

Adolescent↗
PubMedDate not supplied

Relationship between performance measurement and accreditation: implications for quality of care and patient safety.

This study examined the association between the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation scores and the Agency for Healthcare Research and Quality's Inpatient Quality Indicators and Patient Safety Indicators (IQIs/PSIs). JCAHO accreditation data from 1997 to 1999 were matched with institutional IQI/PSI performance from 24 states in the Healthcare Cost and Utilization Project. Most institutions scored high on JCAHO measures despite IQI/PSI performance variation with no significant relationship between them. Principal component analysis found 1 factor each of the IQIs/PSIs that explained the majority of variance on the IQIs/PSIs. Worse performance on the PSI factor was associated with worse performance on JCAHO scores (P=.02). No significant relationships existed between JCAHO categorical accreditation decisions and IQI/PSI performance. Few relationships exist between JCAHO scores and IQI/PSI performance. There is a need to continuously reevaluate all measurement tools to ensure they are providing the public with reliable, consistent information about health care quality and safety.

Accreditation↗
PubMedDate not supplied

Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network.

Confusion about patients' medication regimens during the hospital admission and discharge process accounts for many preventable and serious medication errors. Many organizations have begun to redesign their clinical processes to address this patient safety concern. Partners HealthCare, an integrated delivery network in Boston, Massachusetts, has answered this interdisciplinary challenge by leveraging its multiple outpatient electronic medical records (EMR) and inpatient computerized provider order entry (CPOE) systems to facilitate the process of medication reconciliation. This manuscript describes the design of a novel application and the associated services that aggregate medication data from EMR and CPOE systems so that clinicians can efficiently generate an accurate pre-admission medication list. Information collected with the use of this application subsequently supports the writing of admission and discharge orders by physicians, performance of admission assessment by nurses, and reconciliation of inpatient orders by pharmacists. Results from early pilot testing suggest that this new medication reconciliation process is well accepted by clinicians and has significant potential to prevent medication errors during transitions of care.

Clinical Pharmacy Information Systems↗