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At least 685 records · Page 38Linked to original sources
PubMed2001

[Interdisciplinary quality management in the treatment of severely injured patients. Validation of a QM system for the diagnostic and therapeutic process in early clinical management].

A multidisciplinary quality management system (QMS) for the early treatment of severely injured patients was validated in a trauma center in Germany. In the presented prospective study a QMS developed at another trauma center was implemented at the department of trauma surgery of the University of Essen for the presented study. The essential elements of the QMS were the establishment of (1) an adequate protocol for documentation, (2) 20 criteria for the assessment of treatment quality, (3) regular statistical analysis of treatment quality and (4) a quality circle comprising all medical specialties for data discussion. From 5/98-9/99 a cohort of 447 patients with an average injury severity score (ISS) of 22 +/- 17 was treated in the emergency department. The impact of the QMS was assessed in 4 periods (1: 5/1998-8/1998; 2: 9-12/1998; 3: 1-4/1999; 4: 5-8/1999). The quality circle met 8 times. For the improvement of the process 16 long-term changes were introduced. In 60% (n = 12) of the 20 assessment criteria significant improvements were detected. In diagnostics there were significant reductions of the time needed for basic radiological and sonographic check-up (from 24 +/- 12 min in the first to 14 +/- 8 min in the last period) and of the duration until performance of a cranial computed tomography in severe traumatic brain injury (sTBI; from 45 +/- 22 to 28 +/- 8 min). The rate of delayed diagnoses remained low (4% in the first, 5% in the last period). Further positive changes were the time savings in transfusion (from 35 +/- 20 to 20 +/- 4 min) and emergency operations (from 67 +/- 20 to 48 +/- 4 min) in hemorrhagic shock as well as for craniotomies (77 +/- 41 to 54 +/- 19 min) in sTBI. Apart from the significant time reductions other improvements were found. Overall mortality was diminished from 17% in the first to 10% in the last observation period. In conclusion the study revealed that the quality of the early therapy of severely injured patients was significantly improved by implementation of a multidisciplinary quality management system especially with respect to treatment efficiency.

Adolescent↗
PubMed1991

Quality screening and management using claims data in a managed care setting.

Quality screening and management (QSM), developed by United HealthCare Corporation for its own health plans but applicable to other settings, analyzes health care provided to an enrolled population using claims and administrative data supplemented, when necessary, with medical record review. For selected topics/conditions, QSM compares the care received by patients to that recommended by established practice guidelines and also reports and describes quality through incidence rates, condition-specific process and outcome measures, occurrence of adverse events, and use of preventive services. Results of the analyses are linked to appropriate quality management actions and are used to identify strategies for improvement. Data permit health plans to make performance comparisons on individual indicators and longitudinal comparisons on the effectiveness of quality improvement initiatives.

Humans↗
PubMed2005

Ergonomics in total quality management: how can we sell ergonomics to management?

The objective of this paper is to describe how and why ergonomics should be promoted in total quality management (TQM). Ergonomics and TQM activities are compared. An approach is proposed to apply ergonomics in TQM using ergonomics circles. An eight-step approach is introduced for applying ergonomics using ergonomics circles and a study that employed this approach in Korea is discussed. In applying this approach, all processes were first evaluated by workers. Processes that were identified as problematic were analysed by a company-wide committee to set priorities for improvement. An ergonomics improvement team consisting of safety and health personnel, process engineers and management innovation personnel then worked on the processes using a low-cost approach. It was found that applying ergonomics using ergonomics circles as quality circles in TQM was effective in improving workplaces and resulted in increasing productivity, cost saving and improved safety.

Efficiency↗
PubMedDate not supplied

Drinking-water risk management principles for a total quality management framework.

The Walkerton Inquiry Part 2 Report addressed the second part of the mandate from the Government of Ontario under the Public Inquiries Act, following the Walkerton tragedy, namely, "to make such findings and recommendations as the commission considers advisable to ensure the safety of the water supply system in Ontario." In addressing this mandate Justice O'Connor noted: "Perhaps the most significant recommendations in this report address the need for quality management through mandatory accreditation and operational planning. I recommend requiring all operating agencies to become accredited in accordance with a quality management standard-a standard that will be developed by the industry and others knowledgeable in the area and mandated by the MOE." This recommendation reflects a recognition that any narrow set of detailed requirements related to specific water quality issues will not be able to provide sufficiently comprehensive and flexible guidance to cover the diversity of challenges that exist. Rather, by creating and mandating a process to capture and codify the best technical, operating, and managerial practices, a system can be created that will seek to have these best practices adopted across the drinking-water industry. Done well, this will provide the industry and regulators with the culture and capacity to recognize and resolve problems to prevent future drinking-water tragedies. This paper provides some guiding principles that should foster the development of a practical accreditation standard to achieve the foregoing objectives.

Guidelines as Topic↗
PubMed2005

Implementation and outcomes of commercial disease management programs in the United States: the disease management outcomes consolidation survey.

Despite widespread adoption of disease management (DM) programs by US health plans, gaps remain in the evidence for their benefit. The Disease Management Outcomes Consolidation Survey was designed to gather data on DM programs for commercial health plans, to assess program success and DM effectiveness. The questionnaire was mailed to 292 appropriate health plan contacts; 26 plans covering more than 14 million commercial members completed and returned the survey. Respondents reported that DM plays a significant and increasing role in their organizations. Key reasons for adopting DM were improving clinical outcomes, reducing medical costs and utilization, and improving member satisfaction. More respondents were highly satisfied with clinical results than with utilization or cost outcomes of their programs (46%, 17%, and 13%, respectively). Detailed results were analyzed for 57 DM programs with over 230,000 enrollees. Most responding plans offered DM programs for diabetes and asthma, with return on investment (ROI) ranging from 0.16:1 to 4:1. Weighted by number of enrollees per DM program, average ROI was 2.56:1 for asthma (n = 1,136 enrollees) and 1.98:1 for diabetes (n = 25,364). Most (but not all) respondents reported reduced hospital admissions, increasing rates of preventive care, and improved clinical measures. Few respondents provided detailed information about DM programs for other medical conditions, but most that did reported positive outcomes. Lack of standardized methodology was identified as a major barrier to in-house program evaluation. Although low response rate precluded drawing many general conclusions, a clear need emerged for more rigorous evaluation methods and greater standardization of outcomes measurement.

Disease Management↗
PubMed2004

Personal health information management system and its application in referral management.

We developed a web-based personal health record (PHR) that can be used by patients to collect and manage their health information (e.g., medical history, past surgeries, medications, and allergies), to request self-referrals, and to store a record of their consultations. The PHR also includes a messaging system that can be structured into the workflow of referral management as well as allowing more general communications. A preliminary study was conducted with 61 patients. Thirty-two patients completed a survey in which 85% of respondents were satisfied with the usability and 94% were satisfied with the overall online referral process. The consulting physicians were satisfied with the content of subjects' personal health information and referral problem descriptions and found the information detailed enough to triage all requested referrals. Patients, physicians, and patient care coordinators reported that their communications were enhanced by the system and found the messaging component convenient to use.

Adult↗
PubMed2004

Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.

Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.

Confidentiality↗
PubMed1997

Practice management and managed-care issues in onychomycosis.

The author gives a general overview of recommendations for practice success in a managed-care environment and describes a new practice paradigm for the treatment of onychomycosis. Recommendations are provided for ensuring optimal reimbursement, particularly in the treatment of managed-care and Medicare patients.

Documentation↗
PubMed1990

Improving managed care's management.

While health maintenance organizations may offer the best way to manage costs, experts say that their own management leaves a lot of room for improvement. HMOs are beginning to win back control of their companies with incentives aimed at attracting and retaining the leadership they need to counter the industry's obstacles.

Employee Incentive Plans↗
PubMed1996

The synergy of quality management & risk management in home care.

For a number of years the health care risk management industry has been addressing unplanned and unanticipated adverse events. Organizations that are proactive in their approach to risk and quality management will have big payoffs in clinical quality improvement, service quality improvement, employee satisfaction, and customer satisfaction.

Home Care Services↗
PubMedDate not supplied

Physician managers can play key financial management role.

Societal and technological changes experienced in the past few years have been instrumental in the creation of a new medical specialty--medical management. In this age of scarce resources for health care, physicians must be involved in management and leadership roles in the financial, managerial, and strategic planning aspects of their institutions.

Cost Control↗
PubMed1997

Value-based formulas for purchasing. Pursuing value in Medicaid managed care: access to care and enrollee information management.

Medicaid and other publicly funded health coverage programs face special challenges in managed care purchasing. This article discusses two of those challenges based on the state of Minnesota's experience: how to develop, evaluate, and communicate access to care; and how to manage the transfer of enrollee eligibility and health status information.

Catchment Area, Health↗
PubMed1997

Managing health and welfare plans instead of letting them manage you.

The explosive growth and change in the health care provider industry is presenting a considerable challenge to employers that manage these benefits for their employees. Corporate mergers, supportive federal and state legislation expanding benefit availability and access to new consumer markets are a few of the forces changing the shape of the industry. Furthermore, participants are more knowledgeable about their benefit plans and are more vocal about their needs. The authors discuss these challenges and possible solutions for the employer that is attempting to determine how plan delivery and management needs can be served in a way that supports business environment and strategy.

Consumer Behavior↗
PubMedDate not supplied

The effect of normative social forces on managed care organizations: implications for strategic management.

Drawing on institutional theory, this study examines how adherence to a number of "institutional" and "technical" environmental forces can influence the business success of managed care organizations (MCOs). The standards studied include: (1) institutional forces: socially accepted procedures for delivering care (access to quality care, availability of information, and delivery of care in a personal manner); and (2) technical forces: industry standards for cost control and efficient use of financial and medical resources. The most significant finding is that successful MCOs must conform to both institutional and technical forces to be successful. MCOs that conform to either one or the other type of standard were no more successful than those that conformed to neither. These findings have several important implications for MCO strategy. First, to be successful, MCO executives must understand the external environment in which they operate. They must anticipate and respond to shifts in that environment. Second, this understanding of the external environment must place equal emphasis on societal demands (e.g., for accessible care and information) and on technical demands (e.g., for cost-efficient care). These findings may well reflect that once managed care penetration reaches relatively high levels, marketshare can no longer be gained through cost-efficiency alone; rather, enrollee satisfaction based on societal demands becomes a key factor in maintaining and gaining marketshare. Institutional theory provides' some strategies for accomplishing these goals. Cost-containment strategies include implementing policies for cutting costs in areas that do not affect the quality of care, such as using generic drugs and reducing administrative excesses and redundancies. At the same time, MCOs must implement strategies aimed at improving conformity to prevailing societal perceptions of appropriate care, including providing patients more freedom to choose their physicians and encouraging and rewarding care providers for being friendly and personable. An MCO should work to inform the public of the organization's efforts to provide high-quality, low-cost medical care in a friendly, convenient manner.

Commerce↗
PubMed1999

Managing managed care.

Managed care trends--such as acquisitions of local physician practices, mergers among payor and provider organizations and changes to the current role of managing care--means a difference in the way information systems must operate.

Accounts Payable and Receivable↗
PubMedDate not supplied

Patient retention: the practice management challenge under managed care.

The increasingly competitive environment of practice management has become more complicated with the growing penetration of managed care and capitation. Although successful growing practices have always focused on attracting new patients into the office, future efforts must also be directed at retaining the current patient. Additionally, capitation will require that a practice redefine the profile of a patient valuable to the practice. This article provides a perspective on the valuable patient in a capitated setting as well as some strategies to build better relationships with patients to retain their loyalty. Finally, this article proposes a system to monitor the ongoing satisfaction of patients to retain loyalty.

Humans↗
PubMed2000

The management of depression: the implications for managed care--roundtable discussion: Part 3.

From the standpoint of managed care, the rising cost of depression can be addressed in multiple ways. In the final portion of the roundtable discussion, the faculty discuss not only disease management programs for depression, but other initiatives health plans (including at the pharmacy level) are undertaking to address the rising costs associated with depression. They also discuss the effect of mental health coverage "parity" laws, which can be expected to drive costs even higher.

Antidepressive Agents↗