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Results for “quality improvement”

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PubMed1993

The continuous improvement-focused quality improvement plan.

The QI plan of a department or functional area is a statement of philosophy about quality improvement and a guide to doing quality improvement. In that sense, the QI plan is both a roadmap and a description of the journey. The form of the QI plan varies by organization and is a reflection of the individual style of the organization. The substance of the plan is important. QI plan developers who consider structure, process and outcome will generate a viable document that supports meaningful quality improvement.

Hospital Departments↗

PubMed1983

[Evidence of improved quality of urinary calculus analysis using results of 7 surveys with external quality controls. Improvement in the quality of urinary calculus analysis by establishment of uniform methodological assumptions in urinary calculus analysis laboratories. 2].

Seven quality control surveys confirmed the usefulness of standardized urolith analysis by X-ray diffraction. A method is suggested for tabulating the results of the surveys, which permits qualitative comparison of participating analysis centres. Quality improved considerably after the introduction of the standardized instructions for analysis. The results of the survey with international participants clearly demonstrated the superiority of X-ray diffractometric urolith analysis over polarization microscopical, infrared spectroscopic, differential thermoanalytical and wet chemical analytical techniques.

Humans↗

PubMed1994

Performance improvement through quality improvement teamwork.

Quality improvement teams have the ability to enhance processes that impact care delivery. Organizations must use a framework for documentation and communication of the team's work that is congruent with expectations by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and that nurse executives can apply the expectations to the activities of their departments. The author discusses one such framework, based on 1994 standards, and presents a team report form illustrating communication of the team's efforts using JCAHO terminology.

Humans↗

PubMedDate not supplied

Academic quality improvement program: using quality improvement as tool for the accreditation of nursing education.

In this article, the authors discuss an innovative approach to accreditation in higher education. Using a process known as the Academic Quality Improvement Program (AQIP), colleges and universities prepare for accreditation in a process that parallels other continuous quality improvement models. The AQIP moves away from traditional static accreditation processes and requires educational institutions to engage in a continuous effort that mirrors the Plan-Do-Check-Act model used today in many health care organizations. Beginning with a systems portfolio that is based on self-assessment, colleges and universities then use peer feedback to improve system-wide processes that affect their educational outcomes. The article reviews the AQIP model and outlines one college of nursing's experience.

Accreditation↗

PubMed2000

Reinventing VA health care: systematizing quality improvement and quality innovation.

The Veterans Health Administration (VHA) in the US Department of Veterans Affairs (VA) manages the largest fully integrated health care system in the United States. In 1995, the VHA initiated a reinvention effort that included the most radical redesign of VA health care to occur since the veterans health care system was formally established in 1946. The 2 paramount goals of this reinvention effort were to ensure the predictable and consistent provision of high-quality care everywhere in the system and to optimize the value of VA health care. Although still a work in progress, dramatic results have been achieved toward these ends during the past 5 years. This article provides an overview of the veterans health care system, and it highlights selected aspects of the system's reengineering. It also describes various steps that have been taken to better manage performance and to systematize quality improvement and quality innovation. This information provides a global context that should facilitate understanding of the genesis and purposes of the Quality Enhancement Research Initiative that is described in other articles in this issue of Medical Care.

Community Health Planning↗

PubMed1994

A continuous quality improvement project to improve the quality of cervical Papanicolaou smears.

OBJECTIVE: To improve the quality of cervical Papanicolaou smears by continuous quality improvement techniques. METHODS: The study used a Papanicolaou smear data base of over 200,000 specimens collected between June 1988 and December 1992. A team approach employing techniques such as process flow-charting, cause and effect diagrams, run charts, and a randomized trial of collection methods was used to evaluate potential causes of Papanicolaou smear reports with the notation "inadequate" or "less than optimal" due to too few or absent endocervical cells. Once a key process variable (method of collection) was identified, the proportion of Papanicolaou smears with inadequate or absent endocervical cells was determined before and after employment of a collection technique using a spatula and Cytobrush. We measured the rate of less than optimal Papanicolaou smears due to too few or absent endocervical cells. RESULTS: Before implementing the new collection technique fully by June 1990, the overall rate of less than optimal cervical Papanicolaou smears ranged from 20-25%; by December 1993, it had stabilized at about 10%. CONCLUSION: Continuous quality improvement can be used successfully to study a clinical process and implement change that will lead to improvement.

Databases, Factual↗

PubMed2005

Quality improvement efforts and hospital performance: rates of beta-blocker prescription after acute myocardial infarction.

BACKGROUND: Hospitals are under increasing pressure to measure and improve quality of care, and substantial resources are being directed at a variety of quality improvement strategies; however, the evidence base supporting these strategies is limited. OBJECTIVE: We sought to identify quality improvement efforts that were associated with hospitals' beta-blocker prescription rates after acute myocardial infarction (AMI). RESEARCH DESIGN: This was a cross-sectional study using data from a telephone survey of quality management directors at participating hospitals linked with patient-level data from the National Registry of Myocardial Infarction (NRMI) during the study period, October 1997 to September 1999. SUBJECTS: A total of 60,363 patients discharged with a confirmed AMI from 234 US hospitals were included. MEASURES: Hospital performance based on beta-blocker rates characterized as the top 20%, lower 20%, and middle 40% of hospitals; reported quality improvement efforts, including system interventions, physician leadership, administrative support for quality improvement efforts, and data feedback; hospital teaching status, AMI volume, geographic location, and ownership type. RESULTS: The mean hospital-specific beta-blocker rate was 60.2%; however, the variation in beta-blocker use across hospitals was marked (range, 19.4-89.3%, standard deviation, 12.7% points), and quality improvement efforts used varied greatly. None of the quality improvement efforts distinguished higher from medium performers; the higher and the medium performers together were distinguished from the lower performers in organizational support for quality improvement efforts (fully adjusted odds ratio [OR] 1.89, 95% confidence interval [CI] 1.17-3.06) and physician leadership (fully adjusted OR 9.88, 95% CI 2.64-37.02). Among the specific quality improvement interventions, only standing orders were associated with having higher/medium versus lower performance, and their effect had borderline significance (fully adjusted OR 2.26, 95% CI 0.97-5.30, P = 0.07). CONCLUSIONS: Our findings highlight the organizational environment, specifically the absence of administrative support or physician leadership for quality improvement, as an important correlate of poor beta-blocker rates after AMI. Future studies are needed to isolate hospital quality improvement efforts that are associated with superior performance.

Adrenergic beta-Antagonists↗

PubMed2004

The relationship of system-level quality improvement with quality of depression care.

OBJECTIVE: To explore the relationship of systemwide continuous quality improvement (CQI) with depression care quality in the Veterans Health Administration (VHA). STUDY DESIGN: Observational study using data from 2 VHA studies. PATIENTS AND METHODS: The Depression Care Quality Study (DCQS) was a retrospective cohort study of depression care quality in the northeastern United States involving 12 678 patients cared for at 14 VHA facilities; it used guideline-based process measures (ie, dosage and duration adequacy). The VHA CQI survey was a cross-sectional survey of systemwide CQI among a representative sample of VHA hospitals; it assessed CQI and organizational culture (OC) at 116 VHA hospitals nationwide and provided data on the 14 study facilities. We used analysis of variance to identify differences in the adequacy of depression care among these facilities. Pearson's correlation was used to identify the relationship of CQI and OC with facility-level depression care adequacy. RESULTS: Mean depression care adequacy differed among the 14 DCQS facilities (P < .0001). Overall dosage adequacy was 90% (range: 87%-92%). Overall duration adequacy was 45% (range: 39%-64%). There was no correlation between CQI and either dosage adequacy (r= .004, P= .98) or duration adequacy (r= -.17, P= .55). Similarly, there was no correlation between OC and either dosage adequacy (r= -.35, P= .22) or duration adequacy (r= -.12, P= .68). CONCLUSION: Although CQI may help bridge the healthcare quality gap, it may not be associated with higher disease-specific quality of care.

Adult↗

PubMed2001

Clinical governance: a convincing strategy for quality improvement?

Clinical governance is a new policy introduced by the UK government to improve quality of care in the National Health Service; it imposes a "duty of quality" on all NHS organisations, and aims to bring together managerial, organisational and clinical approaches to improving quality of care. Infrastructures have been established to support quality improvement in NHS organisations and priorities for quality improvement have been established. Initial approaches are largely educational. However, information on quality of care is starting to be shared, and experiments are being conducted with a range of financial and contractual incentives for quality improvement. For widespread cultural change to occur, a "no blame" approach to quality improvement will be necessary; this may be incompatible with the need to identify and eliminate bad practice. Other tensions include the rapid pace of change being centrally driven and uneven development of the infrastructure to support clinical governance. What has not yet been shown is that quality of care has improved. It is too early to say this yet. Given the magnitude both of the vision and the work required, it is unlikely that change will be rapid, or seen on a widespread scale.

Clinical Competence↗

PubMed2002

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance.

OBJECTIVES: To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. DESIGN: Qualitative case studies using semi-structured interviews and documentation review. SETTING: Twelve purposively sampled PCG/Ts in England. PARTICIPANTS: Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. MAIN OUTCOME MEASURES: Participants' perceptions of the role of clinical governance in PCG/Ts. RESULTS: PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). CONCLUSION: PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.

Attitude of Health Personnel↗

PubMed2001

The role of performance measures for improving quality in managed care organizations.

OBJECTIVES: To understand how managed care plans use performance measures for quality improvement and to identify the strengths and weaknesses of currently used standardized performance measures such as the Health Plan Employer Data and Information Set (HEDIS) and the Consumer Assessment of Health Plans (CAHPS) survey. DATA SOURCES/STUDY SETTING: Representatives (chief executive officers, medical directors, and quality-improvement directors) from 24 health plans in four states were surveyed. The overall response rate was 58.3 percent, with a mean of 1.8 respondents per plan. STUDY DESIGN: This exploratory qualitative research used a purposive sample of respondents. Two study authors conducted separate one-hour tape-recorded telephone interviews with multiple respondents from each health plan. PRINCIPAL FINDINGS: All managed care organizations interviewed use performance measures for quality improvement but the degree and sophistication of use varies. Many of our respondent plans use performance measures to target quality-improvement initiatives, evaluate current performance, establish goals for quality improvement, identify the root cause of problems, and monitor performance. CONCLUSION: Performance measures are used for quality improvement in addition to informing external constituents, but additional research is needed to understand how the benefits of measurement can be maximized.

Consumer Behavior↗

PubMedDate not supplied

Quality improvement in ambulatory care: a network approach to quality improvement.

Quality Improvement in Ambulatory Care (QIAC), a national demonstration project undertaken in northern Minnesota, recently was honored by the American College of Physician Executives at its 1992 national meeting in San Francisco. The Merck, Sharp & Dohme Award for Advances in Quality, an award recognizing significant advances in improving the quality of healthcare delivery, was awarded for the first time ever to the QIAC project. Impartial reviewers, using objective criteria, selected this project as this year's most significant advance in improving healthcare quality because of its magnitude and its innovation.

Ambulatory Care Facilities↗

PubMed1992

Achieving the Health Care Financing Administration limits by quality improvement and quality control. A real-world example.

With the enactment of the Clinical Laboratory Improvement Amendments of 1988 (CLIA 88), the federal government is now using proficiency testing as the primary indicator of laboratory quality. Laboratories with proficiency test failures are now at risk of a variety of harsh penalties including large monetary fines and suspension of operations. To minimize the risk of failed proficiency testing, we initiated a continuous quality improvement program in our general chemistry laboratory in conjunction with the use of a new survey-validated quality control product. This article describes the quality improvement program and our success in reducing the long-term random error in general chemistry. Despite our improvement program, significant analytical errors (greater than 30% of the CLIA limits) still exist in analytes measured by our chemistry analyzer. These errors are present in nearly the same analytes measured by other common chemistry analyzers indicating the need for improvement in their design and manufacture.

Blood Chemical Analysis↗

PubMed2004

Physician professionalism and organizational efforts to improve quality: a systems perspective.

The issue of physician professionalism has grown in importance in recent years, in part because of perceptions that our rapidly changing health care system and the incentives associated with managed care threaten professionalism. Inherent conflicts between physician professionalism and the financial and non-financial incentives used by health care organizations in quality management may be undermining the effectiveness of quality improvement initiatives. This paper examines the role of system redesign in quality improvement and the implications of a systems approach for physician job satisfaction, professionalism, and the quality of patient care. We contend that a systems perspective may be more compatible with physician professionalism and may be a more effective method of quality improvement that could alleviate some of the resistance that accompanies the implementation of quality improvement efforts. Disease management programs and multidisciplinary patient care teams are discussed as examples of potentially useful system-level interventions.

Humans↗

PubMedDate not supplied

The role of physicians and certification boards to improve quality.

Amid growing focus on individual physician performance, it is timely to examine what evidence exists that physicians can be facilitators and leaders for health care quality improvement in their local health care environments. Despite the importance of governmental policy and national initiatives, change in health care quality must occur in the context of local communities. Therefore, individual physician involvement, working with other local health care leaders and providers, will be crucial to future quality improvement. The objectives of this article are as follows: (1) outline why physicians must be involved in quality improvement, (2) delineate the barriers and facilitators to physician involvement, and (3) discuss how medical certification boards can facilitate greater physician involvement in quality improvement.

Certification↗

PubMed2006

[Effectiveness of an intervention to improve quality care in reducing cardiovascular risk in hypertense patients].

OBJECTIVE: To evaluate the effectiveness of an intervention on health workers, based on quality improvement through reduction of cardiovascular risk in patients with hypertension. DESIGN: Quasi-experimental study. SETTING: Primary care. Two urban health centres. PARTICIPANTS: A thousand hypertense patients selected by stratified random sampling. One centre (500) was assigned to implement a quality improvement intervention, while at the other centre (500) "usual care" procedures were followed (control group). INTERVENTIONS: The quality improvement intervention consisted of a combined program designed for the medical and nursing staff that comprised audit, feedback, training sessions, and implementation of clinical practice guidelines. MAIN MEASUREMENTS: Coronary risk using the Framingham scale and cardiovascular mortality risk using the SCORE project. RESULTS: Absolute coronary risk decreased from 16.94% (95% CI, 15.92-17.66) to 13.81% (95% CI, 13.09-14.52) (P<.001) in the intervention group; whilst there was no significant change in the control group, which dropped from 17.63% (95% CI, 16.68-18.53) to 16.82% (95% CI, 15.91-17.74). The intervention led to a 2.28% point decrease (95% CI, 1.35-3.21) (P<.001) in coronary risk. Cardiovascular mortality risk decreased from 2.48% (95% CI, 2.35-2.62) to 2.19% (95% CI, 2.07-2.31) (P<.001) in the intervention group, with no significant change in the control group, which changed from 2.45% (95% CI, 2.30-2.59) to 2.52% (95% CI, 2.38-2.66). The intervention led to a 0.36% point decrease (95% CI, 0.05-0.73) (P<.001) in cardiovascular mortality risk. CONCLUSIONS: The quality improvement intervention was effective in decreasing coronary risk and cardiovascular mortality risk in patients with hypertension.

Aged↗

PubMed1993

Improving quality of care with practice guidelines.

In sum, I believe that we know how to develop good practice guidelines today, even though we currently invest paltry sums to do so. Well-constructed guidelines can have a substantial positive impact on quality. By focusing on problems of overuse, costs can be reduced as well. Implementation of guidelines is an absolutely central step in the application of this important quality improvement tool. Practitioners of continuous quality improvement require few external incentives to capitalize on the value of guidelines in the effort to improve quality and are likely to experience their full potential benefit. They may require some prodding to address problems of overuse. Others will need additional inducements. Using reimbursement to reward the attainment of high quality, publishing data on provider performance on various quality measures, and recognizing the salutary effect of adherence to guidelines on liability can provide such incentives.

Physician Incentive Plans↗

PubMed2000

Improving quality of care in nursing facilities. Gerontological clinical nurse specialist as research nurse consultant.

It is becoming increasingly common for nursing facilities to use Quality Indicators (QI) derived from Minimum Data Set (MDS) data for quality improvement initiatives within their facilities. It is not known how much support facilities need to effectively review QI reports, investigate problems areas, and implement practice changes to improve care. In Missouri, the University of Missouri-Columbia MDS and Nursing Home Quality Research Team has undertaken a Quality Improvement Intervention Study using a gerontological clinical nurse specialist (GCNS) to support quality improvement activities in nursing homes. Nursing facilities have responded positively to the availability of a GCNS to assist them in improving nursing facility care quality.

Aged↗