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Biomedical subjects

S Leatherman

Publications and source records attributed to S Leatherman.

At least 19 recordsLinked to original sources
PubMed2003

Quality or financing: what drives design of the health care system?

The scope and scale of problems in the quality of health service provision have been increasingly recognised in recent years. Policy and planning for financing are usually concerned with how funding is made available and allocated, rather than with what is being achieved, including the quality of health services delivered. A fundamental challenge is how to improve the delivery of health services to achieve improved patient outcomes and to optimize financial outcomes. To accomplish this it is essential that the debates on quality of care and financing are aligned. Approaches to improving the quality of care are drawn from Australia, the US, and the UK. Financing arrangements for care at a national level have a bearing on how payment incentives can be used to promote or impede quality. The level of overall expenditure is obviously important, as are the mechanisms for payment. Long term programs to build knowledge, standardise processes, provide credible performance data and foster accountability are required to ensure that further investments lead to improvement in care.

Australia↗
PubMed2001

Improving performance using indicators. Recent experiences in the United States, the United Kingdom, and Australia.

This article describes recent national performance improvement initiatives in the United States, United Kingdom, and Australia. This comparison is of particular interest because each of these three countries faces similar challenges in delivering health care and improving health. Each has elevated a focus on safety and quality improvement to a national level. Marked differences in the organization and financing of health care across these three countries provide a unique opportunity to compare and contrast approaches. Drawing on the experience of the authors in each of the three countries and publicly available data sources about specific national initiatives, we describe the national context for improvement and outline recent performance improvement initiatives and emerging issues and challenges. Similarities and differences in the current evolution of national performance initiatives are described and conclusions are drawn about challenges that all three countries face, particularly in terms of developing meaningful sets of national indicators of health system performance. The challenges for future work include the importance of information infrastructure, the paucity of accurate and accessible clinical data, the need for effective performance measurement processes at a local level to capture useful data, and the tensions of balancing accountability and improvement agendas for measurement.

Australia↗
PubMed2000

The public release of performance data: what do we expect to gain? A review of the evidence.

CONTEXT: Information about the performance of hospitals, health professionals, and health care organizations has been made public in the United States for more than a decade. The expected gains of public disclosure have not been made clear, and both the benefits and potential risks have received minimal empirical investigation. OBJECTIVE: To summarize the empirical evidence concerning public disclosure of performance data, relate the results to the potential gains, and identify areas requiring further research. DATA SOURCES: A literature search was conducted on MEDLINE and EMBASE databases for articles published between January 1986 and October 1999 in peer-reviewed journals. Review of citations, public documents, and expert advice was conducted to identify studies not found in the electronic databases. STUDY SELECTION: Descriptive, observational, or experimental evaluations of US reporting systems were selected for inclusion. DATA EXTRACTION: Included studies were organized based on use of public data by consumers, purchasers, physicians, and hospitals; impact on quality of care outcomes; and costs. DATA SYNTHESIS: Seven US reporting systems have been the subject of published empirical evaluations. Descriptive and observational methods predominate. Consumers and purchasers rarely search out the information and do not understand or trust it; it has a small, although increasing, impact on their decision making. Physicians are skeptical about such data and only a small proportion makes use of it. Hospitals appear to be most responsive to the data. In a limited number of studies, the publication of performance data has been associated with an improvement in health outcomes. CONCLUSIONS: There are several potential gains from the public disclosure of performance data, but use of the information by provider organizations for quality improvement may be the most productive area for further research.

Attitude to Health↗
PubMed2000

A framework for evaluating government quality initiatives: the Wimpole Street principles.

Quality is increasingly on the clinical, management and policy agenda internationally. It is indeed important for quality initiatives to be scrutinized against explicit criteria to ascertain their effectiveness, utility, and evidence base. Quality initiatives in the USA and the UK, as well as a growing number of other countries, are beginning to garner attention for governmental funding thus increasing the onus and responsibility to evaluate the contribution of quality initiatives to the goals of the health system(s).

Guidelines as Topic↗
PubMed1996

Health of the public: The private-sector challenge.

The rapid growth of managed care poses challenges and opportunities for the health of the public. The fundamental risk is that both mission and accountability will be defined too narrowly; the opportunity lies in broadening both. What would a socially responsible managed care system look like? Such a system would provide excellent individual care to its enrollees, yet it would also include programs and activities that address broader populations and policies. We propose 8 attributes of such a system that can be used as a guide by managed care systems and to judge whether a managed care system is a responsible, accountable, and responsive contributor to the health of its community. As the role of the public sector shrinks, the private sector must expand its responsibility. It is both prudent and reasonable for managed care systems to seize their unique opportunity to improve the health of the public.

Delivery of Health Care↗
PubMed1993

Using claims data for epidemiologic research. The concordance of claims-based criteria with the medical record and patient survey for identifying a hypertensive population.

In this study, a method was developed to identify health plan members with hypertension from insurance claims, using medical records and a patient survey for validation. A sample of 2,079 patients from two study sites with medical service or pharmacy claims indicating a diagnosis of essential hypertension were surveyed, and the medical records of 182 of the 1,275 survey respondents were reviewed. Where the criteria to identify hypertensive patients used both the medical and pharmacy claims, there was 96% agreement with either the medical record or the patient survey. Where the criteria relied on medical claims alone, the agreement rate decreased to 74% with the medical record and 64% with the patient survey. Where the criteria relied on the pharmacy claims alone, the agreement rate was 67% with the medical record and 75% with the patient survey. Combined evidence from medical service and pharmacy claims yielded a high level of agreement with alternative, more costly sources of data in identifying patients with essential hypertension. As it is more thoroughly investigated, claims data should become a more widely accepted resource for epidemiologic research.

Adolescent↗
PubMed1991

Quality screening and management using claims data in a managed care setting.

Quality screening and management (QSM), developed by United HealthCare Corporation for its own health plans but applicable to other settings, analyzes health care provided to an enrolled population using claims and administrative data supplemented, when necessary, with medical record review. For selected topics/conditions, QSM compares the care received by patients to that recommended by established practice guidelines and also reports and describes quality through incidence rates, condition-specific process and outcome measures, occurrence of adverse events, and use of preventive services. Results of the analyses are linked to appropriate quality management actions and are used to identify strategies for improvement. Data permit health plans to make performance comparisons on individual indicators and longitudinal comparisons on the effectiveness of quality improvement initiatives.

Humans↗
PubMedDate not supplied

Sheila Leatherman on healthcare policy and evaluation and international quality agendas. Interview by Patti Klingel.

Sheila Leatherman has broad experience in health management, public policy, and academic research. She has held positions in federal and state healthcare agencies and served as CEO of a large HMO and as an executive of one of the largest managed care companies in the United States. Ms. Leatherman's time is currently devoted to healthcare research, both in the United States and the United Kingdom. In the United States, she is founder and chair of the Center for Health Care Policy Evaluation, an independent private-sector research institute, and adjunct professor in the Department of Health Policy and Management, School of Public Health at the University of North Carolina. In the United Kingdom, she is a senior adviser to The Nuffield Trust, which commissioned her to evaluate the National Health Service strategy for quality of care management (1997-1998 and 2002-2003), and in which she is involved in an ongoing policy and research program in quality evaluation. She is a Senior Associate at the Judge Institute of Management Studies and Distinguished Associate at Darwin College, both at Cambridge University. Her areas of research are quality of care, health policy, and managed care, and she has written more than 25 articles, which have been published in such prestigious journals as the Journal of the American Medical Association, Health Affairs, Medical Care, and the International Journal of Quality.

Health Maintenance Organizations↗