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At least 325 records · Page 18Linked to original sources
PubMed2004

Quality improvement in the continuum of care: impact of atherothrombosis in managed care pharmacy.

OBJECTIVE: To review the clinical and economic impact of atherothrombosis, the use of antiplatelet therapy for patients with atherothrombosis, and the impact of disease management programs on quality improvement and health care costs. SUMMARY: Atherothrombosis is a new term that describes the formation of a thrombus on an existing atherosclerotic plaque. While simple, this pathophysiologic mechanism underlies a vast array of vascular diseases, including myocardial infarction, ischemia, peripheral arterial disease, vascular death, and many forms of stroke. In fact, atherothrombosis is the leading cause of death worldwide. Treatment approaches include lifestyle modification and the use of pharmacologic agents such as lipid-lowering therapy, antihypertensive agents, hypoglycemic therapy, ACE inhibitors, and beta-blockers. Despite these treatments, studies have indicated that not all patients receive recommended therapies. The continuing upward spiral in health care costs in the United States has spurred numerous initiatives aimed at improving the quality of care while maintaining or reducing costs. Among these approaches to quality improvement are programs that promote adherence to evidence-based clinical data, including published guidelines, and improve the appropriate use of pharmaceuticals. Although expenditures for prescription drugs are rising, they remain a minority of overall health care expenditures, and evidence suggests that improved usage of medications can reduce other direct costs, such as hospitalizations and inpatient care, which may account for a far greater proportion of total costs. CONCLUSION: The utilization of quality improvement techniques and disease management tools can be used to improve the quality of care of patients with atherothrombosis. A key component of this strategy is pharmacologic therapy. The appropriate use of prescription drugs involves several key factors, including the proper selection of the agent based on available clinical evidence, choosing regimens that enhance patient compliance, and sound methodologies to evaluate outcomes. Improvements in the quality of care for patients with atherothrombosis can have a significant impact on the overall quality of health care as well as total costs.

Arteriosclerosis↗
PubMed1998

Continuous quality improvement in primary care: what's happening?

OBJECTIVES: Despite much health care interest in quality and Continuous Quality Improvement, there is little quantitative information about it. The purpose of this study was to measure the attitudes, activities, and organizational cultures concerning Continuous Quality Improvement in a group of Midwestern primary care clinics. METHODS: Three surveys of the clinicians, nurses, and other staff in 44 primary care clinics in the metropolitan area of Minneapolis and St. Paul were conducted. These surveys assessed: (1) attitudes about quality improvement, (2) previous efforts in these clinics to use process improvement teams, and (3) the extent to which the clinics' organizational cultures were perceived as supporting quality. The Provider Attitude Survey was completed by clinicians and nurses; the Process Improvement Progress was completed by members of the best Continuous Quality Improvement teams, if any; and the Quality Systems Inventory was completed by all personnel. RESULTS: Most of the clinical personnel reported support for various Continuous Quality Improvement concepts, but their understanding and experience were limited. Only 20 (45%) clinics had had at least one Continuous Quality Improvement team in the past, only five of the 12 teams with adequate information had completed an improvement cycle, and only seven reported improving a process with it. The mean clinic scores for quality culture were no better than those in other types of organizations. CONCLUSIONS: Despite relatively favorable attitudes and some Continuous Quality Improvement activities, there appears to be a need to help clinics build skill and experience for the required care improvements.

Attitude of Health Personnel↗
PubMed2006

Statewide quality improvement outreach improves preventive services for young children.

OBJECTIVE: Although clinical trials demonstrate the efficacy of quality improvement outreach in improving service delivery, evidence for broad community effectiveness has been lacking. The objective of this study was to test the effectiveness of a statewide pediatric quality improvement outreach program in improving preventive services for children who are younger than 5 years. METHODS: All pediatric practices in Vermont (n = 35) were invited to participate in a preventive services quality improvement initiative. Ninety-one percent agreed. Participating practices serve >80% of all Vermont children who are younger than 5 years. The main outcome measured was change in 9 preventive services areas: (1) immunizations up to date; (2) anemia screening; (3) tuberculosis risk assessment and indicated screening; (4) lead screening; (5) infant sleep position counseling; (6) environmental tobacco smoke-exposure risk assessment; (7) blood pressure screening; (8) vision screening; and (9) dental risk assessment. RESULTS: All practices demonstrated improvement in 1 or more preventive services areas. The mean number of areas chosen was 5 (range: 1-9). Practices that selected a specific preventive service area as a quality improvement goal were more likely to demonstrate improvement in that area than practices that did not choose to focus on that preventive services area. CONCLUSIONS: The work in this project has provided the evidence for an effective statewide pediatric quality improvement outreach program to improve preventive services for children who are younger than 5 years. Practices' decision to focus on a specific preventive service area as a quality improvement goal seems necessary for improvement in that area. This approach may be effective in other states or regions.

Child Health Services↗
PubMed1996

Quality improvement in health care--a fundamental analysis and South African perspective.

This article is based on the opening address that was delivered at a national conference with the launching of the South African Society for Quality in Health Care (SASQuaH). The quality improvement process and principles are analyzed, as well as an exposition of the South African situation. The concepts regarding quality, quality improvement and quality assurance are clarified, the different stakeholders in formalised quality improvement explained, as well as the motives for and principles of quality improvement in health services. The different external and internal mechanisms in quality improvement are analyzed, including the principle of community ownership and international collaboration. Continuous development and capacity building regarding quality improvement is recommended at all levels of health service delivery.

Accreditation↗
PubMed1997

Focused quality improvement in health care: the quality, satisfaction, performance technique applied in internal medicine.

Service quality assessments are dominated by simple analysis of questionnaire data. Such methods generally lack validity and reliability. Moreover, they do not have a target side defining what actions patient satisfaction should lead to from a management point of view. The quality, satisfaction, performance method, a technique with high validity, was applied in an internal medicine setting. The method appears to offer a unique way to relate desired results of care to different processes and structures in the clinic as well as incentives to intervene to improve the quality of care.

Chest Pain↗
PubMed1990

Clinical practice guidelines at an HMO: development and implementation in a quality improvement model.

Harvard Community Health Plan (HCHP) is adapting to clinical medicine the managerial principles and methods of quality improvement theory that were originally developed and successfully applied in industrial settings. An essential step in applying the quality improvement cycle to clinical medicine is the setting of standards or specifications for clinical care. HCHP has chosen to focus its standard-setting efforts on the development of clinical algorithms, which provide an excellent basis for specifying and communicating optimal care processes and for evaluating actual clinical care. When implemented effectively, clinical algorithms may improve quality and decrease costs by guiding clinicians toward more standardized, high-quality, cost-effective clinical strategies and by facilitating more valid measurement of clinical process and outcomes. This article describes the evolution, structure, methods, and future agenda of the Algorithm Based Clinical Quality Improvement Process (ABCQIP) at HCHP.

Algorithms↗
PubMed2005

Continuing medical education, quality improvement, and organizational change: implications of recent theories for twenty-first-century CME.

Healthcare providers and systems are being asked to measure and improve the quality of care delivered to their patients. Additionally, the American Board of Medical Specialties now requires physicians to participate in systems-based practice and practice-based learning and improvement activities as part of maintenance of specialty board certification. These changing paradigms provide opportunities for continuing medical education to become more aligned with health system goals and help prepare clinicians to practice in this new environment. Organizational change and quality improvement principles have much in common with continuing medical education planning processes. Medical education can play a role in helping organizations improve. Continuing medical education must move beyond delivering content to individual clinicians towards becoming a facilitator of organizational improvement. Research is needed to determine the effect of integrating continuing medical education with organizational change approaches on professional competence, organizational processes and patient outcomes.

Clinical Competence↗
PubMed1999

Macroergonomics and total quality management: how to improve quality of working life?

In this paper, we present a macroergonomic model of work design that is applied and tested to examine Total Quality Management (TQM) in the public sector. According to the model, TQM can influence different aspects of work design and quality of working life (QWL). Questionnaire data collected in 2 public sector organizations in the USA show that TQM can have both positive and negative impact on work design and QWL. The main positive impact of TQM was found on job content, job control and participation, and social relationships. The main negative impact of TQM was on workload, uncertainty, and clarity of job duties. The impact of TQM on QWL was mixed. Our results show that the impact of TQM on work design and QWL varied very much across the 6 participating departments, as well as within the departments. Further research is warranted to assess the human impact of TQM, in particular research on the linkage between various aspects of TQM, on one hand, and work design and QWL, on the other hand.

Analysis of Variance↗
PubMedDate not supplied

A survey of academic medical centers to distinguish between quality improvement and research activities.

OBJECTIVES: Institutional Review Boards (IRBs) are charged with ensuring the protection of humans enrolled in research. IRB activities are governed by the United States Office for Human Research Protections, which does not clearly differentiate quality improvement from research. More clear standards are needed so that the protection of human subjects (including their right to privacy) can be ensured and health care providers can efficiently meet their objective of improving patient care through quality improvement efforts. While past commentaries on this subject have provided some guidance, no standard definitions exist that distinguish "quality improvement" from "research." METHODS: We conducted a national survey of IRBs serving academic medical centers to determine whether local guidelines exist that make this distinction, and if so, what criteria are used to guide decision making. RESULTS: On the basis of the findings of our survey, we propose a decision algorithm to guide IRBs and quality improvement oversight committees as they define local policies that distinguish research projects from quality improvement efforts. CONCLUSIONS: The decision algorithm should result in greater ability to conduct quality improvement work in an efficient manner without compromising the protection of human subjects. The criteria identified are consistent with, but clearer than, the exemption standards provided in the common rule.

Academic Medical Centers↗
PubMedDate not supplied

Study designs for PDSA quality improvement research.

OBJECTIVE: The purpose of this article is to discuss strengths and weaknesses of quasi-experimental designs used in health care quality improvement research. The target groups for this article are investigators in plan-do-study-act (PDSA) quality improvement initiatives who wish to improve the rigor of their methodology and publish their work and reviewers who evaluate the quality of research proposals or published work. SUMMARY: A primary purpose of PDSA quality improvement research is to establish a functional relationship between process changes in systems of health care and variation in outcomes. The time series design is the fundamental paradigm for demonstrating such functional relationships. The rigor of a PDSA quality improvement study design is strengthened using replication schemes and research methodology to address extraneous factors that weaken validity of observational studies. CONCLUSION: The design of PDSA quality improvement research should follow from the purpose and context of the project. Improving the rigor of the quality improvement literature will build a stronger foundation and more convincing justification for the study and practice of quality improvement in health care.

Health Services Research↗
PubMed2001

Quality improvement within Independent Practitioner Associations: lessons from New Zealand.

AIMS: To ascertain what quality improvement activities are being performed by associations of general practitioners (GPs) in New Zealand, to find out how they are supporting these activities, and learn about their experience of the process. METHOD: A cross sectional questionnaire study of 25 independent practitioner associations (IPAs) in New Zealand. RESULTS: All respondents (n=25) believed quality improvement was a responsibility of their organization, and for 48% it was their highest priority. All organizations carried out and supported a range of quality improvement activities. The major perceived barriers to quality improvement were negative attitudes and lack of time and money to support the process. Strategies to overcome these barriers included providing comparative data to staff in a peer group setting and providing financial incentives, management support and education. CONCLUSIONS: Considerable quality improvement activity is occurring in primary care in New Zealand. A variety of barriers to the process and methods of overcoming them have been identified by some, but not all IPAs.

Attitude of Health Personnel↗
PubMed2003

Oversight of quality improvement: focusing on benefits and risks.

Quality improvement (QI) may substantially improve patient outcomes while posing little risk to subjects. However, the term quality improvement is used to refer to a broad range of projects, which vary widely in the potential benefits and risks to participants. Some projects raise ethical concerns. An explicit protocol for the ethical review of QI would benefit both patients and leaders of QI projects. If a project is considered research rather than QI, review by an institutional review board and informed consent from subjects may be required. In contrast, QI projects may require little oversight beyond what is already in place for clinical care. However, a monolithic approach to oversight of QI is inappropriate in light of the variation in benefits and risks of QI projects and their overlap with research. The key ethical issue is not the classification of a project as QI or research, but the balance of anticipated benefits and harms in the project. We propose a protocol for independent review of QI projects and patient consent that will protect subjects from serious harm while encouraging QI projects that will substantially benefit participants and pose only minimal risk.

Ethical Review↗
PubMed1993

Quality improvement techniques: value to improve the timeliness of preoperative chest radiographic reports.

OBJECTIVE: Continuous quality improvement is being advocated as a process that, if adopted, could lead to greater efficiency and productivity in medical institutions. To determine whether continuous quality improvement techniques could be effective in radiology departments, we undertook a model project that sought to improve our ability to interpret preoperative chest radiographs before surgery. All the preoperative films had been ordered by internists who determined, after seeing the patient, that the radiographic examination was warranted. MATERIALS AND METHODS: An eight-member team consisting of all persons involved in obtaining and interpreting preoperative chest radiographs was empowered to evaluate the existing process and make appropriate changes. Techniques used included studying and plotting the process, collecting data on the causes of delay, and basic statistical analysis of the data using histograms, Pareto diagrams, and control charts. On the basis of the data analysis, the team instituted changes, which included identifying the preoperative cards with a small flag, placing the processed films in yellow-colored jackets, and collating these jacketed films after their interpretation. RESULTS: After continuous quality improvement intervention, when the process for obtaining and interpreting preoperative radiographs was modified, the percentage of chest radiographs interpreted before surgery improved from approximately 83% to 98% (p < .001). The average waiting period between patient check-in at the outpatient reception area and interpretation of the preoperative chest radiograph was reduced from 275 to 77 min, a 72% reduction (p < .0302). CONCLUSION: Adoption of the quality improvement techniques of analyzing customer-supplier relations, understanding the causes of variation, and using data to solve problems appears to be a desirable management option that should be considered by all medical institutions interested in maximizing the quality of care offered while concurrently minimizing its cost.

Humans↗