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N J Banks

Publications and source records attributed to N J Banks.

7 recordsLinked to original sources
PubMed1999

Does the Complications Screening Program flag cases with process of care problems? Using explicit criteria to judge processes.

BACKGROUND: The Complications Screening Program (CSP) aims to identify 28 potentially preventable complications of hospital care using computerized discharge abstracts, including demographic information, diagnosis and procedure codes. OBJECTIVE: To validate the CSP as a quality indicator by using explicit process of care criteria to determine whether hospital discharges flagged by the CSP experienced more process problems than unflagged discharges. METHODS: The (CSP was applied to computerized hospital discharge abstracts from Mledicare beneficiaries > 65 years old admitted in 1994 to hospitals in California and Connecticut for major surgery or medical treatment. ()f 28 CSP complications, 17 occurred sufficient frequently to study. Discharges flagged (cases) and unflagged (controls) by the (CSP were sampled and photocopied medical records were obtained. Physicians specified detailed, objective, explicit criteria, itemizing 'key steps' in processes of care that could potentially have prevented or caused complications. Trained nurses abstracted medical records using these explicit criteria. Process problem rates between cases and controls were compared. RESULTS: The final sample included 740 surgical and 416 medical discharges. Rates of process problems were high, ranging from 24.4 to 82.5% across CSP screens for surgical cases. Problems were lower for medical cases, ranging from 2.0 to 69.1% across CSP screens. Problem rates were 45.7% for surgical and 5.0% for medical controls. Rates of problems did not differ significantly across flagged and unflagged discharges. CONCLUSIONS: The CSP did not flag discharges with significantly higher rates of explicit process problems than unflagged discharges. Various initiatives throughout the USA use techniques similar to the CSP to identify complications of care. Based on these CSP findings, such approaches should be evaluated cautiously.

Aged↗
PubMed1995

Variability in clinical systems: applying modern quality control methods to health care.

BACKGROUND: Quality health care depends on timely completion of sequences of clinical care. This study evaluated the concepts and tools of quality management for measuring system performance in ambulatory care. STUDY DESIGN: Clinical staff in nine centers of a group model health maintenance organization described the procedure for ordering and completing a complete blood count, mammogram, and surgical consultation. Variability was noted among the processes as intended and as actually performed, as well as inconsistencies reported within and among centers. In two centers investigators tracked performance of key sequences of care and the achievement of other key quality characteristics believed desired by physicians and patients. Computerized patient records and departmental files were the only available sources of data for assessing completion and followup of tests and consultations. Even these data were difficult to obtain and, in many instances, incomplete. RESULTS: Although data were often difficult to obtain, the quality management techniques used were helpful in revealing process failures that appeared to be the result of design flaws built into the clinical systems. CONCLUSION: Robust process designs and improved management information systems for monitoring these processes are recommended to reduce variability and improve the quality of clinical care.

Blood Cell Count↗
PubMed1990

Improving the quality of ambulatory health care with enhanced medical information systems: using the computer to diagnose faulty clinical processes.

The lack of consistency in the performance of the processes which implement clinical decisions is an important problem in ambulatory care. Since delayed or neglected actions in patient care may have serious consequences, we studied the use of industrial quality management techniques to determine where three clinical processes could be improved. These quantitative and graphical tools were useful in showing that in some processes, the failure rate could be as high as 33%. However, lack of readily available process data prevented a full analysis of the extent of the failures, so specific suggestions for improvement could not be made. Medical informatics and management specialists have an important role in designing enhanced medical information systems with which to examine and improve patient care processes. This new generation of MIS's should include order entry systems with flags for selected transactions, audit trails for all automated processes, functional integration of the separate departmental information systems, and enhanced communications features.

Ambulatory Care↗
PubMedDate not supplied

Clinical reminders in ambulatory care.

Computerized reminders are a tool to improve patient care, increase compliance, and reduce medical liability in ambulatory health care. Continuity of care is often hard to achieve given large patient loads, cost containment pressures, and regulatory requirements. Recall reminders prompt patients to make or keep appointments for health maintenance or screening exams. Physician reminders are issued to clinicians at or between visits when their patients have specific screening or diagnostic needs. Reminder systems based on clinical protocols have the added advantage of providing explicit instructions for workup or treatment of abnormal conditions. These reminder systems are especially useful to standardize care in offices with many providers. Implementation of reminder systems is aided by careful staff preparation and resource allocation. Ultimately, reminder systems enhance quality of care, increase patient satisfaction, and reduce costs through improved continuity of care and early detection of serious illness.

Ambulatory Care Information Systems↗