PubMed · 10520689
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J R Beck, S G Pauker. Does DEALE-ing stack the deck?. https://doi.org/10.1177/0272989x9901900419
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BACKGROUND: As described in the Institute of Medicine's Crossing the Quality Chasm report, the quality of health care in the U.S. today leaves much to be desired. DISCUSSION: One major opportunity for improving quality relates to increasing the use of information technology, or IT. Health care organizations currently invest less in IT than in any other information-intensive industry, and not surprisingly current systems are relatively primitive, compared with industries such as banking or aviation. Nonetheless, a number of organizations have demonstrated that quality can be substantially improved in a variety of ways if IT use is increased in ways that improve care. Specifically, computerization of processes that are error-prone and computerized decision support may substantially improve both efficiency and quality, as well as dramatically facilitate quality measurement. This report discusses the current levels of IT and quality in health care, how quality improvement and management are currently done, the evidence that more IT might be helpful, a vision of the future, and the barriers to getting there. SUMMARY: This report suggests that there are five key policy domains that need to be addressed: standards, incentives, security and confidentiality, professional involvement, and research, with financial incentives representing the single most important lever.
Habitual snoring needs to be taken seriously, both as a symptom of other sleep disorders and as a condition in its own right. GPs approached by patients with problematic snoring face a dilemma regarding whether (and to which service) those patients should be referred for a specialist opinion. Using the Sparks Chart, snoring patients can be grouped according to the two symptomatic dimensions of excessive daytime sleepiness and nocturnal hypoxaemia. We believe that the approach outlined in this article offers GPs a coherent and pragmatic guideline for referring and/or managing problematic snoring by using a simple questionnaire and pulse oximetry. The method has the potential to improve primary and secondary liaison. Most importantly, it offers patients a straight path to treatment.
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