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At least 307 records · Page 17Linked to original sources
PubMed2001

Features of primary health care teams associated with successful quality improvement of diabetes care: a qualitative study.

BACKGROUND: In quality improvement activities such as audit, some general practices succeed in improving care and some do not. With audit of care likely to be one of the major tools in clinical governance, it would be helpful to establish what features of primary health care teams are associated with successful audit in general practice. OBJECTIVE: The aim of the present study was to identify those features of primary health care teams that were associated with successful quality improvement during systematic audit of diabetes care. METHOD: Semi-structured tape-recorded interviews were carried out with lead GPs and practice nurses in 18 general practices in Leicestershire that had the opportunity to improve their care and had completed two data collections in a multipractice audit of diabetes care. The interviewees were asked to describe their practice's approach to audit and the transcripts were coded for common features and judged for strength of feeling by blinded independent raters. Features common to practices that had, and those that had not, managed to improve diabetes care were identified. RESULTS: Six features were identified reliably in the transcripts by blinded independent raters. Four were significantly associated with the successful improvement of care. Success was more likely in teams in which: the GP or nurse felt personally involved in the audit; they perceived their teamwork as good; they had recognized the need for systematic plans to address obstacles to quality improvement; and their teams had a positive attitude to continued monitoring of care. A positive attitude to audit and a personal interest in the disease were not associated with improvement in care. CONCLUSIONS: Success in improving diabetes care is associated with certain organizational features of primary health care teams. Experimental studies are required to determine whether the development of teamwork enables practice teams to identify and overcome systematically the obstacles to improved quality of patient care that face them.

Diabetes Mellitus↗
PubMed2004

Quality improvement in a federally funded community breast and cervical cancer screening program.

Continuous Quality Improvement (CQI) methods offer healthcare organizations valuable tools for improving services to their patients. These tools are also useful in improving the way an organization delivers its services. In this case study, the authors describe the use of quality improvement activities for improving the enrollment and screening for breast and cervical cancer for the Women's Health Connection (WHC). The WHC is operated by the Nevada Department of Human Resources, Health Division, to provide screening for income eligible women between the ages of 40-64. Funding for the WHC was provided by the Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). By using Quality Improvement Teams, the WHC was able to restructure the way women were being enrolled in the program in order to increase the number of women screened and to help the program meet CDC performance indicators. This article documents the quality improvement process used in the case study, highlights the areas improved, and demonstrates how quality improvement was useful in improving services provided to women. It also describes staff acceptance of the quality improvement process and its potential future applications.

Breast Neoplasms↗
PubMed2003

Research ethics and law of healthcare system quality improvement: the conflict of cost containment and quality.

Quality improvement (QI) activities have been done as long as medicine has been practiced and are integral to safety and efficacy of patient care. The 20th century witnessed sophisticated advances of QI methods, with concurrent advances in research ethics. The suggestion that some interventional QI activities resemble research has led to a complex conundrum, with disparate forces driving for improvement and maintenance of patient care quality vs. the societal mandate to control healthcare costs. In the middle of these conflicting priorities are QI systems charged with effecting cost-effective and efficacious healthcare processes. Given the advances in research ethics, substantially grounded in the Nuremberg Code, and the increasing resemblance of interventional QI activities to research, the concern is raised of widespread and systematic Nuremberg Code violations occurring under the guise of QI in health care. Moreover, evidence is cited to suggest that if this is the case, then such activities may be subject to litigation or prosecutorial action. The ethical and legal foundations exist to support the systematic practice of informing patients of their participation in some types of QI procedures.

Codes of Ethics↗
PubMed1994

Endotracheal tube misplacement: incidence, risk factors, and impact of a quality improvement program.

To assess the impact of a quality improvement program on the occurrence of serious complications related to endotracheal tube misplacement and to identify risk factors, we did a before and after comparison in the adult intensive care units of a military referral hospital. All adult patients requiring endotracheal intubation during two 12-month periods comprised the study population. After the identification of a sentinel case, a retrospective review identified 278 adult patients requiring endotracheal intubation over a 12-month period. Twenty-two of these patients had at least one significant endotracheal tube misplacement; five of these misplacements (23%) were associated with serious complications (anoxic encephalopathy, atelectasis and respiratory failure, gastric aspiration, pneumothorax, and hypoxemia). In four of these patients the complications directly contributed to patient morbidity and mortality. During a subsequent 12-month period, after the initiation of a quality improvement program, 246 patients requiring tracheal intubation were prospectively studied. Of these 246 patients, 113 (46%) were identified as having at least one endotracheal tube misplacement requiring immediate repositioning. The incidence of serious complications related to endotracheal tube misplacement was significantly less during the implementation of the quality improvement program (0 of 246 patients) than during the retrospective period (5 of 278 patients). Multivariate analysis showed that a longer duration of endotracheal intubation, the lack of chemical paralysis, and the occurrence of cardiac arrest were independently predictive of endotracheal tube misplacement. These results suggest that a specific ICU quality improvement program can have a favorable impact on patient outcome.

Adult↗
PubMed1998

Incentives for cooperation in quality improvement among hospitals--the impact of the reimbursement system.

Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.

Belgium↗
PubMed2003

Designing a quality improvement intervention: a systematic approach.

Most quality improvement or change management interventions are currently designed intuitively and their results are often disappointing. While improving the effectiveness of interventions requires systematic development, no specific methodology for composing intervention strategies and programmes is available. This paper describes the methodology of systematically designing quality of care improvement interventions, including problem analysis, intervention design and pretests. Several theories on quality improvement and change management are integrated and valuable materials from health promotion are added. One method of health promotion-intervention mapping-is introduced and applied. It describes the translation of knowledge about barriers to and facilitators of change into a concrete intervention programme. Systematic development of interventions, although time consuming, appears to be worthwhile. Decisions that have to be made during the design process of a quality improvement intervention are visualised, allowing them to serve as a starting point for a systematic evaluation of the intervention.

Decision Making, Organizational↗
PubMed1998

Introducing a quality improvement programme to primary healthcare teams.

OBJECTIVES: To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect. METHOD: Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues. OUTCOME MEASURES: To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended. RESULTS: 10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority. CONCLUSIONS: The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes.

Decision Making, Organizational↗
PubMed2002

Measuring and improving quality in emergency medicine.

The findings are presented of a consensus committee created to address the measuring and improving of quality in emergency medicine. The objective of the committee was to critically evaluate how quality in emergency medicine can be measured and how quality improvement projects can positively affect the care of emergency patients. Medical quality is defined as "the care health professionals would want to receive if they got sick." The literature of quality improvement in emergency medicine is reviewed and analyzed. A summary list of measures of quality is included with four categories: condition-specific diseases, diagnostic syndromes, tasks/procedures, and department efficiency/efficacy. Methods and tools for quantifying these measures are examined as well as their accuracy in assessing quality and adjusting for differences in environment, and patient populations. Successful strategies for changing physician behavior are detailed as well as barriers to change. Examples are given of successful quality improvement efforts. Also examined is how to address the emergency care needs of vulnerable populations such as older persons, women, those without health insurance, and ethnic minorities.

Emergency Medicine↗
PubMed1991

Managing for change: a departmental quality improvement program (QIP).

The development and implementation of an integrated Quality Improvement Program (QIP) for the Department of Surgery at The Hospital for Sick Children was approached as a problem-solving process by which departmental managers could bring about change so that actual results would align more closely with desired outcomes. A planned and systematic process was developed, through which managers are able to reach decisions about when and where to make useful changes that result in improved quality of care and services provided. Three useful techniques were employed: team-building, continuing education and quality circles.

Education, Continuing↗
PubMed2006

Improving compliance with postpolypectomy surveillance guidelines: an interventional study using a continuous quality improvement initiative.

BACKGROUND: Despite guidelines, physicians tend to perform postpolypectomy surveillance colonoscopies too frequently. OBJECTIVE: The objective of the study was to determine the baseline compliance rate with postpolypectomy guidelines in our unit and to determine the influence of a continuous quality improvement (CQI) intervention on improving the compliance rate and on decreasing the potential additional costs because of the scheduling of postpolypectomy surveillance colonoscopies earlier than indicated. DESIGN: This was a single-arm, pretest-posttest design. SETTING: This study took place at a tertiary care, academic medical center. PATIENTS: The medical records of all patients who underwent colonoscopy with polypectomy in our unit retrospectively during 6 months preceding (baseline period) and prospectively for 6 months after an intervention (postintervention period) were reviewed for patient demographics, colonoscopy findings, and scheduling of repeat colonoscopies. INTERVENTION: We used 3 components: (1) distribution of a wallet-size card with a summary of postpolypectomy guidelines to all endoscopists, (2) placement of guideline charts near computers used for typing endoscopy reports, and (3) distribution and reinforcement of the guidelines in a monthly continuous quality improvement meeting. MAIN OUTCOME MEASURES: The main outcome measures were compliance rates, mean times to repeat colonoscopy, and additional costs from surveillance colonoscopies being scheduled earlier than indicated were compared between the two periods. RESULTS: There were 278 patients in the baseline period and 242 in the postintervention period, with similar patient and polyp characteristics. After the intervention, the compliance rate with guidelines improved from 57.2% to 81% (p < 0.001). The mean time to a repeat colonoscopy increased from 4.5 to 5.2 years (p = 0.003) (i.e., a 14% reduction in the number of postpolypectomy surveillance colonoscopies performed per year). This would result in a reduction of a total of 73 surveillance colonoscopies per year in our unit, with a projected cost savings of 171,331 dollars per year (cost of a colonoscopy assumed at 2347 dollars). LIMITATIONS: The limitation of the study was possible enhanced performance secondary to being observed (Hawthorne effect). Because more than 1 intervention was used, we do not know which one is more effective. CONCLUSIONS: Relatively simple and easy-to-implement quality improvement initiatives can significantly enhance compliance with postpolypectomy guidelines and result in cost savings because of a reduction in the number of postpolypectomy surveillance colonoscopies being scheduled earlier than recommended guidelines.

Colonoscopy↗
PubMedDate not supplied

The extent of quality improvement activities in nursing homes.

The quality of nursing home care has long been a cause for concern. The federal government has recently launched the Nursing Home Quality Initiative, in which Quality Improvement Organizations assist nursing homes in quality improvement (QI) activities. In addressing how well nursing homes are prepared for QI, this article examines the sort of QI activities that nursing homes are currently undertaking and the preparation of Administrators and Directors of Nursing to lead QI efforts. Drawing on data from surveys of 2 random samples of Kansas nursing homes, the article concludes that questions about QI activities in nursing homes tend to elicit socially acceptable answers unless the questions are carefully structured; that few nursing homes appear to have functioning QI programs; and that high leadership turnover and limited leadership training make it difficult for nursing homes to sustain effective QI programs.

Humans↗
PubMed2005

Development and implementation of a quality improvement program for Ryan White Title I care services using a stakeholder-based model.

Both medical and community support services for people living with HIV and/or AIDS have been implemented on a widespread basis since the implementation of the 1990 Ryan White CARE Act. However, many services are provided without adequate evaluation or quality assurance, in spite of federal directions to both evaluate and ensure quality. This report details the development and implementation of a quality improvement project to evaluate Ryan White CARE services using a community stakeholder-based effort. The evaluation was consumer rather than administratively driven, including both consumers and providers to define, measure, and improve services. Project phases included: (1) developing service standards for 14 areas of service provided under Title I of the Ryan White CARE Act; (2) creating and implementing a provider/consumer peer site visit instrument to assess agencies' activities in meeting the service standards; and (3) developing a mechanism to improve quality by linking agencies to technical assistance resources in the metropolitan provider community. By involving providers and consumers in evaluation roles, recommendations by peers could serve as the basis for ongoing quality improvement.

Community Networks↗
PubMed1992

The big picture. Total quality management and continuous quality improvement.

The pressure to improve the quality of clinical and customer service outcomes continues to escalate. In most cases, sustained improvement (either incremental or breakthrough) is a direct result of improving service delivery and work processes. The challenge, for managers, is to design work processes that predictably lead to satisfying and cost-effective results. Total quality management (TQM) and continuous quality improvement (CQI) may seem like "this year's fads," but they are form, not fashion. TQM and CQI processes generate a customer-responsive environment in which employees can contribute to achieving the organization's mission, vision, and strategic objectives.

Humans↗
PubMed2001

Computerised clinical pathway as process quality improvement tool.

Experiences from other industries show that process quality improvement (PQI) is far more effective than product quality assurance in ensuring quality outputs and cost savings. The PQI approach is becoming more important to the healthcare industry as healthcare professionals struggle to cope with increasing demands for productivity gains, the raising patient acuity and need to curtail the large number of adverse medical events. This paper presents a continuous process quality improvement operational model for healthcare quality improvement and operationalization of the model through the implementation of a computerised clinical pathway management system (CCPMS). It also reports on a small-scale evaluative study conducted to assess the effectiveness of the PQI approach using the CCMPS prototype.

Attitude of Health Personnel↗
PubMed1992

Staff empowerment: a medical record department's preliminary experiences with continuous quality improvement.

After observing the results of continuous quality improvement, no one would argue against its value in the workplace. However, learning to apply the concepts requires change on everyone's part, and the challenge lies in effecting this change. Not everyone will want to work in this type of environment and, if the organization is truly committed to continuous quality improvement, those individuals may have to make hard decisions as to whether the organization is the right place for them to work. Certain skills are required for staff empowerment to be successful, and training in these skills is essential. The medical record department staff learned early in this process that, although the group possessed job skills, interaction and team skills were lacking. The Development Dimensions International program helped the managers and staff identify the weaknesses of the group and provided educational tools for improvement. The changes often are so subtle, the group does not realize anything has changed. It was not until recently, when the medical record department staff was requested by administration to identify department quality improvement projects, that the group looked back at where the process started and realized how different things are today from three years ago--now staff members lead team meetings, work-groups are redesigning their job processes, and teams update the rest of the department staff on its progress at department meetings. Everyone expressed a sense of pride and accomplishment that the group had indeed responded to the challenge. The experiences of the medical record department thus far clearly support empowerment of employees.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1997

Toward quality improvement in a French hospital: structures and culture.

This paper describes the evolution of quality improvement efforts over the past decade in a 600-bed French teaching hospital, after reviewing some characteristics of the French hospital system. The sequential attempts to improve drug dispensation illustrate the evolution of quality improvement efforts. Initial studies conducted in voluntary medical wards led to the modification of traditional prescription forms. Resulting improvements were presented in Evaluation Committee meetings, inducing other wards, to undertake similar changes on their own. A more systemic program currently is underway. The success of initial efforts can be credited to the willingness of physicians and nurses to engage in changes when the need for change was evident in their daily work experience, in spite of the questionable validity of some of the original findings. Focusing on systemic processes rather than on individual faults allowed this involvement. Reassessing the validity of so-called medication errors also highlighted the importance of careful process analysis, which should be stressed during the development of quality assurance procedures. The variability inherent in clinical conditions calls for a flexible, outcome-oriented approach, as used in quality improvement methods. Quality improvement efforts are spreading throughout the hospital. However, diffusion of change from motivated work groups to the larger community remains a challenge. To obtain a consistent performance level across all parts of the organization, and to avoid losing impetus due to uncoordinated efforts, innovation must become a consistent feature of the hospital structure.

Drug Utilization Review↗