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Results for “quality improvement”

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PubMed1998

Clinical effectiveness for health care quality improvement.

This paper describes the work of the Research Unit of the Royal College of Physicians on clinical effectiveness and links with other national initiatives. The overall goal is to improve the quality of care by basing routine care on research evidence, an approach referred to as the 'bridge for health'. Systematic reviews bring together research evidence and are largely carried out by the Cochrane Collaboration, the NHS Centre for Reviews and Dissemination and the NHS Health Technology Assessment programme. Clinical guidelines, now produced according to a more rigorous methodology, are used to package research to support decisions about health care by clinicians, patients and others. Clinical audit, along with outcomes development, is carried out at a national level to support the implementation of clinical guidelines by clinical teams in local health services. To achieve this, it matches the best principles of quality improvement. Future identified trends in clinical effectiveness include a greater emphasis on better integration of effort and exchange of best practice.

Aged↗

PubMed2004

Use of electronic medical record data for quality improvement in schizophrenia treatment.

An understanding of the strengths and limitations of automated data is valuable when using administrative or clinical databases to monitor and improve the quality of health care. This study discusses the feasibility and validity of using data electronically extracted from the Veterans Health Administration (VHA) computer database (VistA) to monitor guideline performance for inpatient and outpatient treatment of schizophrenia. The authors also discuss preliminary results and their experience in applying these methods to monitor antipsychotic prescribing using the South Central VA Healthcare Network (SCVAHCN) Data Warehouse as a tool for quality improvement.

Antipsychotic Agents↗

PubMed1993

Understanding variation: the key to cost reduction and quality improvement.

Analyses of acute hospital services in Australia reveal geographic differences in the rates of utilization. In order to meet the important challenge of improving the quality of services it is necessary to understand the nature and causes of the variation in these utilization measures. This paper provides examples of the variation in admission rates and lengths of stay for selected procedures in Australian States and shows that the length of stay is related to the variation in admission rates. It concludes that a greater understanding of both the admission and discharge processes is necessary to improve quality and produce cost savings.

Australia↗

PubMed2005

From data to wisdom: quality improvement strategies supporting large-scale implementation of evidence-based services.

The Hawaii Department of Health Child and Adolescent Mental Health Division has explored various strategies to promote widespread use of empirical evidence to improve the quality of services and outcomes for youth. This article describes a core set of clinical decisions and how several general and local evidence bases may inform those decisions. Multiple quality improvement strategies are illustrated in the context of a model that outlines four phases of evidence: data, information, knowledge, and wisdom.

Adolescent↗

PubMed2003

National variation in operative mortality rates for esophageal resection and the need for quality improvement.

HYPOTHESIS: Operative mortality rates for esophageal resection vary across hospital volume groups in a nationally representative sample of hospitals. DESIGN: Cross-sectional study of all adult patients in the Nationwide Inpatient Sample who underwent esophageal resection from 1995 through 1999 (N = 3023). Operative mortality was determined for hospital volume quartiles (low, <3 per year; medium, 3-5 per year; high, 6-16 per year; very high, >16 per year). Multiple logistic regression of in-hospital mortality was used for case-mix adjusted analyses. SETTING: Hospitals performing at least 1 esophageal resection from 1995 through 1999 in the Nationwide Inpatient Sample. PATIENTS: Patients having esophageal resection from 1995 through 1999 in the Nationwide Inpatient Sample. RESULTS: Overall mortality was 8.2% and varied 3-fold from 11.8% to 3.7% across hospital volume groups (P<.001). In the case-mix-adjusted multivariate analysis, having surgery at a low-volume hospital (odds ratio, 2.9; 95% confidence interval, 1.7-4.9; P<.001) or medium-volume hospital (odds ratio, 2.4; 95% confidence interval, 1.4-4.3; P =.002) was associated with an increased risk of mortality compared with the reference group of very high-volume hospitals. The effect of volume on mortality was significant for both malignant and benign disease. Given the absolute risk difference of 8.1% between very high- and low-volume hospitals, only 12 patients would need to be referred to prevent 1 death after esophageal resection. CONCLUSIONS: The operative mortality rate for esophageal resection varies across hospitals in the United States. To improve the quality of care and reduce operative mortality rates for patients in need of esophageal surgery, patients should either be referred to higher-volume hospitals, or quality improvement should be directed at lower-volume hospitals.

Aged↗

PubMed1998

Electronic medical records as tools for quality improvement in ambulatory practice: theory and a case study.

Information management is critical in today's health care environment. Traditional paper-based medical records are inadequate information management tools. Electronic medical records (EMRs) overcome many problems with paper records and are ideally suited to help physicians increase productivity and improve the quality of care they provide. The Department of Family Medicine at the Medical University of South Carolina uses the Practice Partner Patient Record EMR system. Department members have developed a quality improvement model based on this EMR system. The model has been used to improve care for acute bronchitis, diabetes mellitus, tobacco abuse, asthma, and postmenopausal osteoporosis.

Academic Medical Centers↗

PubMed2005

Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multi-site intervention by time series analysis.

OBJECTIVES: Misuse of antibiotics in surgical prophylaxis is still quite common. The objectives of this study were to reduce the quantity and improve the quality of surgical prophylaxis and to reduce costs. METHODS: Prospective multi-site study of elective procedures in 13 Dutch hospitals. The quality of prophylaxis was audited before and after an intervention consisting of performance feedback and implementation of national clinical practice guidelines. Process outcome parameters were antibiotic choice, duration, timing, antibiotic volume and costs. Segmented regression analysis was used to estimate the effect size of the intervention. Patient outcome was documented by the incidence of surgical site infections (SSI). RESULTS: Before the intervention, 1763 procedures were recorded and 2050 thereafter. Antimicrobial use decreased from 121 to 79 DDD (defined daily doses)/100 procedures and costs reduced by 25% per procedure. After the intervention, antibiotic choice was inappropriate in only 37.5% of the cases instead of in 93.5% expected cases had the intervention not occurred. Prolonged prophylaxis was observed in 31.4% instead of 46.8% expected cases and inappropriate timing in 39.4% instead of the expected 51.8%. Time series analysis showed that all improvements were statistically significant (P < 0.01) and that they could be fully attributed to the intervention. The overall SSI rates before and after intervention were 5.4% (95% CI: 4.3-6.5) and 4.6% (95% CI: 3.6-5.4), respectively. CONCLUSIONS: The intervention led to improved quality of surgical prophylaxis and to reduced antibiotic use and costs without impairment of patient outcome.

Anti-Bacterial Agents↗

PubMed1998

Comparing change readiness, quality improvement, and cost management among Veterans Administration, for-profit, and nonprofit hospitals.

Health care organizations throughout the country are facing increasing pressure to improve their quality of care while reducing cost. This article describes a model of organizational change and develops a change readiness matrix that managers can use to benchmark their organization's performance on three dimensions: (1) change readiness, (2) quality improvement, and (3) cost management. The model and the matrix combine to offer managers a framework for pursuing organizational change and operational innovation within their organization. A survey methodology is used to compare VA hospitals (n = 44), for-profit hospitals (n = 108), and nonprofit hospitals (n = 449) on the three performance dimensions. The results indicate that Veterans Administration hospitals react differently than either for-profit or nonprofit hospitals on these dimensions. However, responses from for-profit and nonprofit hospitals were not significantly different from each other. Additional insights are presented into how hospitals in general can facilitate the organizational change process.

Financial Management, Hospital↗

PubMed2006

Air quality improvement estimation and assessment using contingent valuation method, a case study in Beijing.

The aim of the paper is to estimate and assess residents' willingness to pay to improve air quality in the urban area of Beijing using the Contingent Valuation Method (CVM). The mean willingness to pay (WTP) for a 50% reduction of harmful substances in the air was 143 CNY per household per year, and the total WTP of the residents in the study area was 336 million CNY per year. As a proportion of household annual income, the mean WTP amounted to 0.7%. Four socio-economic variables were found to have significant impacts on residents' willingness to pay. The analysis results illustrated that WTP increases with income and education level, and decreases with household population and age. The willingness was larger for residents in the urban districts than those in the suburban districts. It was found that most of the protest bids lay on interviewees' incomplete perception of the values of environmental amenity. The influence of household income on people's willingness to pay illustrated in this study reflects a causal force of Beijing's transition to market economy that households created to have disposable income are more likely to care about environmental quality. The results of this study strike an optimistic note on the possibility of measuring the total economic value of environmental quality improvement by using the CVM in China. Suggestions on implication of the CVM for both academics and policy makers are provided in the paper.

Air↗

PubMedDate not supplied

Guidelines for appraisal and publication of PDSA quality improvement.

Plan-do-study-act (PDSA) quality improvement is the application of the scientific method to implement and test the effects of change ideas on the performance of the health care system. Users of quality improvement could benefit with markers to gauge the "best" science. Four core questions can determine the value of a quality improvement study: Is the quality improvement study pertinent and relevant? Are the results valid? Are appropriate criteria used to interpret the results? Will the study help you with your practice or organization of care? A set of guidelines is provided to help answer these questions. Similar guidelines exist for randomized clinical trials and clinical-epidemiologic observational studies. Analogous to these existing research guidelines, the PDSA quality improvement guidelines will provide researchers and reviewers with succinct standards of methodological rigor to assist in critical appraisal of quality improvement protocols and publications.

Guidelines as Topic↗

PubMed1992

Improvement in 'stat' laboratory turnaround time. A model continuous quality improvement project.

BACKGROUND: Continuous quality improvement is being advocated as the process that, if adopted, would improve the efficiency, productiveness, and quality of medical institutions, thereby helping to solve the health care crisis our country is facing. To determine if these techniques could be effective in a tertiary-care multispecialty group practice, a model project was undertaken. The model project chosen was to determine if we could improve the turnaround time for "stat" laboratory examinations performed in our large outpatient facility. METHODS: A 10-member team consisting of everyone involved in the process of laboratory testing was empowered to evaluate the present process and make appropriate changes. With traditional techniques of quality improvement, the process was assessed, data were collected and statistically analyzed, changes were introduced, and data were recollected and analyzed. RESULTS: After intervention, the preanalytic delays were reduced by 76% and the postanalytic delays by 88%. Waiting time for patients was reduced by an average of 62%. By instituting the changes suggested, the institution saved $225,000 on a one-time basis and $40,000 to $50,000 on a recurring basis. CONCLUSION: Adoption of quality improvement techniques appears to be a desirable management paradigm that should be explored by all medical institutions interested in maximizing the quality of care offered while at the same time minimizing its cost.

Ambulatory Care Facilities↗

PubMed2005

Continuous quality improvement in rural health clinics.

AIM: Continuous quality improvement has been shown to work in urban and suburban clinics. The objective of this project is to test whether continuous quality improvement would improve the quality of care for patients with diabetes mellitus and/or hypertension in a rural health clinic. SETTING: Rural health clinic with 3 providers and two and half full-time registered nurses. Patients were mostly older adults with Medicare health insurance. PROGRAM DESCRIPTION: Health care providers and nursing staff agreed on the quality improvement project. The intervention included providing quarterly feedback to health care providers, empowering the nurses to remind patients of diabetes care, and flagging the charts to remind providers. PROGRAM EVALUATION: The proportions of diabetic patients who had ophthalmologic exam, pneumococcal vaccine and lipid screening significantly improved over 12-month period. The proportions of patients with hypertension who had blood pressure less than 140/90 and patients who were taking aspirin also significantly improved over 12-month period. CONCLUSION: The quality of care for patients with diabetes and patients with hypertension could be improved in rural health clinics using repetitive cycles of measurements, implementation of interventions and evaluation of outcomes. This process could be used as the backbone for translation of evidence into practice and improving quality of care.

Adolescent↗

PubMed2006

Preoperative and intraoperative risk factors associated with 30-day morbidity following urological surgery: the National Surgical Quality Improvement Program.

PURPOSE: The National Surgical Quality Improvement Program was established in 1994 to measure and enhance of the quality of surgical care. Since its inception, 30-day postoperative morbidity after major surgery in the Veterans Administration has decreased by 45%. We performed a pilot study to assess risk factors associated with 30-day morbidity using National Surgical Quality Improvement Program indicators in a private setting. MATERIALS AND METHODS: A total of 643 subjects were accrued by a trained surgical reviewer from our institution between December 2003 and December 2004. Patient preoperative, intraoperative and nonNational Surgical Quality Improvement Program data elements were abstracted from clinical records. Bivariate relationships between preoperative risk factors, intraoperative process measures and 30-day postoperative morbidity were determined. Multiple variable logistic regression analysis was used to identify patient preoperative and intraoperative risk factors associated with 30-day morbidity. RESULTS: On multivariate analysis the preoperative risk factors history of congestive heart failure (OR 14.42, 95% CI 2.66 to 78.30), diabetes with end organ damage (OR 12.56, 95% CI 2.09 to 75.53), angioplasty (OR 2.75, 95% CI 1.27 to 5.93), quadriplegia (OR 4.39, 95% CI 1.36 to 14.14), low albumin (OR 2.49, 95% CI 1.18 to 5.24) and hydronephrosis (OR 2.51, 95% CI 1.11 to 5.69) were statistically significant predictors of 30-day postoperative morbidity. Intraoperative process measures, that is operative time in hours (OR 1.24, 95% CI 1.12 to 1.37) and transfusion (OR 3.11, 95% CI 1.49 to 6.50), were also significant contributors to postoperative morbidity. CONCLUSIONS: We found that patient preoperative risk factors and intraoperative process measures were important determinants of postoperative morbidity. Implementation of the National Surgical Quality Improvement Program in urology may be used to measure processes of care that are associated with surgical outcomes and, thereby, improve the quality of urological care.

Humans↗

PubMed2001

Continuous quality improvement in public health in Ghana: CQI as a model for primary health care management and delivery.

This article describes the context and examines factors influencing the quality of primary health care delivery and management in Ghana, West Africa. It describes the potential of continuous quality improvement as a management philosophy and tool to improve the quality of primary health care delivery and management in Ghana. It compares the Ghanaian context in which the use of continuous quality improvement in health care is new and untried with the developed country context (mainly the U.S.), where continuous quality improvement has a relatively long history of use in health care and is a requirement for the accreditation of health institutions. Finally, the article discusses the steps that have to be taken to translate continuous quality improvement from a theoretical management concept to improve quality of care to an actual managerial intervention in Ghana. In conclusion, continuous quality improvement is shown to be a potential viable approach to improving quality of care in the Ghanaian context and merits further investigation.

Delivery of Health Care↗

PubMed1998

Using hospital performance data in quality improvement: the Cleveland Health Quality Choice experience.

BACKGROUND: Cleveland Health Quality Choice is a regional initiative to assess hospital performance which was implemented in 1989. The project developed and validated CHOICE, a severity adjustment system that includes diagnosis-specific models for medical, surgical, and obstetrical patients which are based on clinical data abstracted from patients' medical records. METHODOLOGY: Since 1992 Cleveland Health Quality Choice has disseminated semi-annual reports that profile hospital mortality rates, lengths of stay, and cesarean section rates using the CHOICE severity adjustment models. Hospitals receive tabular and graphical representations of hospital outcomes and electronic patient-level data files that can be used to further examine outcomes in clinical subgroups. RESULTS: Four case studies illustrate how outcomes data derived from the CHOICE models led to the development of successful hospital programs to decrease lengths of stay, cesarean section rates, and hospital mortality rates. Although each case study reflected a unique approach to process improvement, several common characteristics were observed: (1) establishment of interdisciplinary process improvement teams with senior physician and nursing leadership; (2) detailed review of the process of care to identify modifiable clinical practices likely to affect outcomes; (3) development of practice guidelines based on group consensus or published recommendations that were designed to affect modifiable practices; and (4) aggressive sharing of serial data with individual practitioners. CONCLUSIONS: Although outcomes data can provide powerful insight on where to target quality improvement efforts, hospitals must identify influential and modifiable clinical practices. Such efforts are most likely to be successful if driven by interdisciplinary work groups, supported by senior clinicians and administrators, and based on locally accepted practice standards.

Adult↗

PubMedDate not supplied

Quality improvement in the cutaneous micrographic surgery laboratory.

A nationwide advocacy for improving health-care quality--including the dimensions of efficiency, productivity, and customer satisfaction--is rapidly growing. This initiative is evolving in an environment of total quality management (TQM) and continuous quality improvement (CQI). Quality assessment and improvement (QI) is a quality management program through which laboratories ensure the quality of their health-care services by continually monitoring, evaluating, and resolving opportunities for improvement. Using a systematic, FOCUS-PDCA approach, the Mohs histology laboratory implemented improvement of the quality management of frozen-section slide production and turnaround time (TAT). The Mohs laboratory achieved improved technical process performance, faster TAT time, more efficacious patient care support, and increased customer satisfaction. Using a comprehensive quality assessment and improvement process can overwhelm quality management assets if it is not approached in a systematic, prioritized manner. However, when judiciously used, the process can become a key instrument for ensuring and improving high-quality laboratory services in an efficient manner.

Data Collection↗

PubMedDate not supplied

Learning helpers: how they facilitated improvement and improved facilitation--lessons from a hospital-wide quality improvement initiative.

Quality improvement is a leading approach to the difficult yet inevitable task of managing organizational change. The literature suggests that facilitators can help organizations apply improvement principles and tools but it is unclear how facilitators actually do this and how they develop their own skills. Using a case study design we therefore examined how facilitators worked with 93 improvement projects in over 1000 sessions at one Swedish university hospital where systematic process improvement was successfully established over a 5-year period. They facilitated improvement by providing a framework and methods' support for improvement efforts--relying on experiential learning rather than didactic teaching--while letting clinical teams and managers maintain control over the content of improvement projects. They developed extensive experience that they documented and could transfer between teams, so that each team could benefit from lessons learned elsewhere. They improved facilitation through participant feedback and systematic review and reflection regarding their own practice. We suggest that facilitators can help organizations manage change by assuming responsibility for demanding tasks related to improvement work, developing specialized skill and extensive experience regarding improvement, and transferring insights across the organization, while using a learning approach throughout including to their own work.

Hospitals, University↗

PubMed2002

Continuous quality improvement in the ambulatory endoscopy center.

What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit of improvement. Second, learning must be viewed as a process. A quality improvement plan that is successful in one setting may not be as favorable in another situation. Clinicians must be able to focus on their individual situations and adapt what others have implemented to their own practice. Third, the most important aspect of the quality improvement is the implementation step. It matters little if elegant studies of endoscopic complications or patient satisfaction are completed if the information is not used to improve the delivery of health care to every single patient. The delivery of medical care continues to evolve. Resources are becoming increasingly scarce and the progressive rise of health care expenditures suggests a need for control. In this zeal for cost constraint, quality must not be sacrificed. This new-found attention to quality must be extended to the level of the individual practitioner to ensure that individual patients' interests are protected and the best possible care is delivered regardless of the economic implications. As providers of health care, endoscopists need to take an active role in these efforts both in understanding and implementing the techniques of quality assessment into their practices. If physicians are not actively involved in data collection and measurement to improve the quality and value of their own work, someone else will undoubtedly assume this role.

Ambulatory Surgical Procedures↗