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At least 109 records · Page 6Linked to original sources

PubMed2000

From understanding health care provider behavior to improving health care: the QUERI framework for quality improvement. Quality Enhancement Research Initiative.

Basic science and health care research provide the evidence base for the scientific practice of medicine. Over the past 2 decades, as increasingly refined tools for improving health and health care have been developed, the health care community has attempted to bridge the gap between available tools and actual health care practices. This gap can be bridged only by influencing health care provider behavior. The VA Quality Enhancement Research Initiative (QUERI) is a program designed to systematically translate research findings into better health care practices, and thus better health outcomes for enrolled veterans. Integrating provider behavior research considerations and findings into each step of the QUERI process will enhance the effectiveness of the initiative. This article presents a provider behavior research framework for planning, implementing, and evaluating quality improvement interventions within QUERI.

Benchmarking↗

PubMed2004

A new quality improvement study every day? Using QTools to build quality improvement projects around primary care electronic medical record systems.

Greater and more appropriate use of information technology has been proposed by the US Institute of Medicine as one way in which the quality of health care can be improved. Electronic medical record systems offer particular advantages because they can support clinicians at the point of care as well as allowing patient care to be monitored over time. Developing quality improvement tools that make use of the electronic medical record can, however, be difficult and often requires special software. This paper describes a system called QTools that provides a range of general-purpose tools to support quality improvement work in Norwegian primary care. The paper discusses how QTools has been used in two studies involving over 100,000 patient consultations and how it is supporting current work to improve the prescription of anti-hypertensive drugs. Features that have not yet been used in a quality improvement study are also discussed.

Data Collection↗

PubMed1997

Appendectomy. Improving care through quality improvement.

OBJECTIVE: To evaluate the practice of appendectomy in Department of Defense hospitals worldwide in a large-scale quality improvement initiative. DESIGN: Case series study. POPULATION AND SETTING: A total of 4950 consecutive nonincidental appendectomies performed in 147 Department of Defense hospitals worldwide during a 12-month period ending January 31, 1993. RESULTS: The mean age was 25.5 years, with 64% males and 36% females. The patients were assigned a diagnosis of normal appendix (negative appendectomy) in 632 cases (12.8%), acute appendicitis in 3286 cases (66.4%), and perforative appendicitis in 1032 cases (20.9%). The influence of inpatient and outpatient delays on perforation and negative appendectomy rates were studied. In at least 52% of all patients ultimately assigned a diagnosis of perforative appendicitis, the perforation occurred before the first outpatient contact with the health care system, and in at least 68% of all patients ultimately assigned the diagnosis of perforative appendicitis, the perforation occurred before surgical evaluation and admission. Neither outpatient delay in diagnosis nor inpatient delay in diagnosis and treatment was associated with a significant change in the rate of negative appendectomy. CONCLUSIONS: Perforation rates are determined predominantly by patient- and primary care-related factors over which surgeons have little control. Negative appendectomies are predominantly related to the wide overlap in presenting signs and symptoms between appendicitis and the diseases that most often mimic it but do not require operative intervention. Whereas studies of this type are useful for identifying potential problems at the health care system level, the relatively small number of appendectomies performed by each surgeon precludes analysis at the practitioner level.

Adolescent↗

PubMedDate not supplied

Reporting quality improvement data by key functions: one step closer to continuous quality improvement.

Medical care systems must demonstrate that they provide cost-effective, quality care if they are to remain viable in the wake of healthcare reform. A basic premise of continuous quality improvement is that an organization can measure and improve the performance of key functions (a group of goal-directed processes). Accordingly, the Joint Commission on Accreditation of Healthcare Organizations has been restructuring its accreditation manual, moving from department-specific standards to functional standards. In early 1992, our hospital began reporting quality improvement data by key functions rather than by service. As a result of this change, departments communicated and worked together better and more interdisciplinary efforts occurred, resulting in some dramatic improvements in the quality of care.

Data Collection↗

PubMed2005

[How to improve continuing education and quality improvement in general practice?].

BACKGROUND: Research has shown that many activities routinely used for continuing education and quality improvement in general practice, such as written information and lectures, have little or no effect on practice. MATERIAL AND METHODS: The Norwegian Institute of Public Health initiated a consensus-building process on how to improve continuing education and quality improvement in Norwegian general practice. RESULTS AND INTERPRETATION: The work of the consensus panel led to a report in which nine initiatives were proposed: development of a national plan, strengthening of the support available for group-based learning, academic outreach visits, practice based activities, personal learning plans, a national centre for quality improvement in general practice, improved use of referral and discharge information, multidisciplinary collaboration, and patient involvement.

Biomedical Research↗

PubMed1997

Quality improvement in neurology residency programs. Report of the Quality Improvement Committee of the Association of University Professors of Neurology.

The neurology residency programs in the United States are facing a crisis of quality. The Association of University Professors of Neurology (AUPN) approved the Quality Improvement Committee to examine this situation and make recommendations, which have been accepted by the AUPN. The recommendations are (1) that the educational goals of neurology residency training be dissociated from patient-care needs in academic medical centers and (2) that minimum levels of quality be applied to residents in neurology residency programs and to these programs themselves. These minimum criteria should include minimum educational criteria for entry into the program, minimum criteria for advancement from one year to the next in the program, and minimum criteria for performance of the graduates of neurology residency programs for program accreditation. The implementation of these recommendations will require a shift of funding of the care of indigent patients from the graduate medical education budget to direct patient-care sources. These recommendations will significantly improve the quality of neurologists and neurologic care in the United States.

Academic Medical Centers↗

PubMedDate not supplied

The role of clinical information systems in health care quality improvement.

This article addresses the increasing use of electronic medical records and supporting clinical information systems in US hospitals. It also addresses the current barriers to implementation of digital technology, which include cost, cultural factors, and the reluctance to embrace new technology. However, despite the barriers, there is evidence from the Veteran's Administration, Partners' HealthCare, Kaiser Permanente, and other organizations that electronic medical records and clinical information systems are a worthwhile investment. The benefits of the electronic medical records include the reduction of errors, improvement in clinical decision making during patient encounters, and universal access to information in real time. From a managerial perspective, health care organizations should adopt such systems to improve quality of care and to stay competitive in the marketplace. From a policy perspective, the electronic medical record provides an opportunity for integration of patient information and improves efficiency and quality of care across a wide range of patient populations.

Hospital Information Systems↗

PubMed1999

Improving quality in small hospitals.

Often, the organizations profiled by THE QUALITY LETTER are the powerhouses of the healthcare industry, with the resources, researchers and technology to make quality improvements at the cutting edge of the field. This month, THE QUALITY LETTER looks at small and rural hospitals--often with 100 or fewer beds, isolated from competition or the pressures of managed care--that have made the most of their opportunities to improve the quality of care they deliver. Many of the issues they face and the answers they find are applicable to organizations of any size.

Cooperative Behavior↗

PubMed1999

Anticoagulation services: quality improvement direction pursuing a certification process. Anticoagulation Provider Certification Working Group.

There is still in a certification process for anticoagulant therapy providers. The primary, and certainly most important, goal is to improve patient care. Defining measurable competencies to which the anticoagulation provider is made accountable is but one mechanism to help improve quality in patient care. Great improvements have been achieved in the field of anticoagulation. For example, determining optimum intensity levels, for the traditional as well as the newer indications for treatment, have yielded greater efficacy and safety. Additionally, the acceptance of the INR reporting system has greatly reduced hemorrhagic and thromboembolic complications. However, the process of care, that is, how patients are managed and by whom, remains a variable that is difficult to quantify and measure. Anticoagulation providers are comprised of professionals from three major disciplines, namely, medicine, nursing, and pharmacy. This multidisciplinary approach enriches the quality of care for patients. However, this very fact presents a dilemma when seeking an appropriate certifying body. Nevertheless, keeping quality patient care as the primary focus, a multidisciplinary group has developed a body of knowledge that is unique to anticoagulant and antithrombotic therapies. The foundation of this project stems from the Fourth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy and the recently published paper by Ansell et al. on consensus guidelines for coordinated outpatient oral anticoagulation therapy management. This work in progress includes a mission statement and outlines five major knowledge domains along with measurable competencies for each section. This effort will help standardized the process of care across the country.

Anticoagulants↗

PubMedDate not supplied

The benefits of inpatient diabetes care: improving quality of care and the bottom line.

OBJECTIVE: To analyze the impact of a hospital-wide inpatient diabetes management program on quality of care, length of stay, and cost. METHODS: A retrospective review was conducted for diabetes identification and treatment in a large tertiary care hospital in Oklahoma City, Oklahoma. Cultural change was accomplished by educating the healthcare professionals and medical staff. Systems were implemented to better identify patients with diabetes and to focus on quality improvement. Protocols were developed and implemented as tools for improving care. Results were monitored, and quality of care was assessed by examining lengths of stay and financial outcomes. RESULTS: Hospital-wide training, earlier identification of patients with diabetes, and the implementation of inpatient protocols had positive results on both quality of care and the hospital's bottom line. More patients with diabetes were identified earlier in their stays, care was managed effectively to reduce blood glucose levels, lengths of stay were reduced, and coding was improved to more accurately reflect the complexity of care provided. CONCLUSION: By increasing diabetes awareness hospital-wide and implementing effective identification and management systems, hospitals are well positioned to provide higher-quality diabetes care, which also translates into a positive impact on the bottom line.

Diabetes Mellitus↗

PubMed2003

Improving care for minorities: can quality improvement interventions improve care and outcomes for depressed minorities? Results of a randomized, controlled trial.

OBJECTIVE: Ethnic minority patients often receive poorer quality care and have worse outcomes than white patients, yet practice-based approaches to reduce such disparities have not been identified. We determined whether practice-initiated quality improvement (QI) interventions for depressed primary care patients improve care across ethnic groups and reduce outcome disparities. STUDY SETTING: The sample consists of 46 primary care practices in 6 U.S. managed care organizations; 181 clinicians; 398 Latinos, 93 African Americans, and 778 white patients with probable depressive disorder. STUDY DEIGN: Matched practices were randomized to usual care or one of two QI programs that trained local experts to educate clinicians; nurses to educate, assess, and follow-up with patients; and psychotherapists to conduct Cognitive Behavioral Therapy. Patients and physicians selected treatments. Interventions featured modest accommodations for minority patients (e.g., translations, cultural training for clinicians). DATA EXTRACTION METHODS: Multilevel logistic regression analyses assessed intervention effects within and among ethnic groups. PRINCIPAL FINDINGS: At baseline, all ethnic groups Latino, African American, white) had low to moderate rates of appropriate care and the interventions significantly improved appropriate care at six months (by 8-20 percentage points) within each ethnic group, with no significant difference in response by ethnic group. The interventions significantly decreased the likelihood that Latinos and African Americans would report probable depression at months 6 and 12; the white intervention sample did not differ from controls in reported probable depression at either follow-up. While the intervention significantly improved the rate of employment for whites and not for minorities, precision was low for comparing intervention response on this outcome. It is important to note that minorities remained less likely to have appropriate care and more likely to be depressed than white patients. CONCLUSIONS: Implementation of quality improvement interventions that have modest accommodations for minority patients can improve quality of care for whites and underserved minorities alike, while minorities may be especially likely to benefit clinically. Further research needs to clarify whether employment benefits are limited to whites and if so, whether this represents a difference in opportunities. Quality improvement programs appear to improve quality of care without increasing disparities, and may offer an approach to reduce health disparities.

Black or African American↗

PubMed1995

[Quality improvement in primary care: experience of four years of a quality improvement program].

OBJECTIVE: To assess the effectiveness of the quality improvement programme (QIP) at the centre. DESIGN: A retrospective analysis of the "improvable situations" detected between 1988 and 1992, their causes and the methods used for their detection. The present status of the improvable situations (solutions) was then studied. SETTINGS: La Mina Primary Care Centre. PATIENTS AND OTHER PARTICIPANTS: The improvable situations detected from the start of the QIP in March 1989 until December 1992. MEASUREMENTS AND MAIN RESULTS: 172 situations were identified, corresponding to 83 different problems, situations or opportunities of improvement. The method which identified the most different and solvable situations (64.5%) was the use of the improvable situation report sheet (problem report) by the professionals at the centre. The component of quality most often affected was accessibility; and the least, satisfaction. The effectiveness component had the highest percentage of situations solved (64.3%) and external problems, the lowest (30%). 62 out of the 180 causes (34.4%) for the 73 improvable situations, which did not affect external aspects of care, were solved. The commonest and most solvable causes were due to lack of internal organisation (64%). 51.8% of the 83 situations detected were solved. There was 73.2% effectiveness of the QIP, measured as a percentage of solved situations, not including those situations with external causes or depending on the user. CONCLUSIONS: The most useful method of detecting solvable solutions is the use of the improvable situations report sheet by the professional.

Primary Health Care↗

PubMed2006

Use of an institutional intervention to improve quality of care for adolescents treated in pediatric ambulatory settings for pelvic inflammatory disease.

PURPOSE: To evaluate the impact of a quality improvement intervention for outpatient management of pelvic inflammatory disease (PID) on provider compliance with published guidelines and to explore issues affecting patient adherence to outpatient care regimens. METHODS: This study utilized an interrupted time series design. The intervention included an algorithm and clinical practice guideline based on the 2002 Centers for Disease Control STD Guidelines, a complete course of medications to be given at discharge after initial doses given in the site, standardized discharge instructions, close follow-up at 24-48 hours and after two weeks of treatment by a member of the PID team, and a referral for follow-up. RESULTS: At baseline, 38% of patients did not receive an appropriate medication regimen and only 10% of clinic outpatients returned for follow-up evaluations within 72 hours. In the postintervention group, 91% of patients received an appropriate outpatient regimen and 43% of emergency department and clinic patients returned for care. Based on the results of logistic regression models, adolescents in the postintervention group were 8.4 times more likely (adjusted odds ratio [AOR]: 8.4, confidence interval [CI]: 2.6-26.8, p <. 001) to receive an appropriate outpatient medication regimen than girls in the baseline group. Follow-up interview revealed that 61% of postintervention patients completed all doses of the medication, 67% practiced temporary abstinence, 86% notified their partner for treatment, and 96% were satisfied with their care. CONCLUSIONS: Interventions utilizing a multi-level approach to the management of outpatient PID improve provider compliance with published guidelines and quality of care delivered to adolescents in academic settings. Many adolescents, however, continue to have difficulty with adherence. Additional research is warranted to address adherence to outpatient regimens for the treatment of PID in adolescent girls.

Adolescent↗

PubMedDate not supplied

The Quality Improvement for Depression collaboration: general analytic strategies for a coordinated study of quality improvement in depression care.

It is difficult to evaluate the promise of primary care quality-improvement interventions for depression because published studies have evaluated diverse interventions by using different research designs in dissimilar populations. Preplanned meta-analysis provides an alternative to derive more precise and generalizable estimates of intervention effects; however, this approach requires the resolution of analytic challenges resulting from design differences that threaten internal and external validity. This paper describes the four-project Quality Improvement for Depression (QID) collaboration specifically designed for preplanned meta-analysis of intervention effects on outcomes. This paper summarizes the interventions the four projects tested, characterizes commonalities and heterogeneity in the research designs used to evaluate these interventions, and discusses the implications of this heterogeneity for preplanned meta-analysis.

Adult↗

PubMed2003

Using clinical microsystems to improve quality at all levels.

Clinical microsystems--with their emphasis on patients, people, process, and performance patterns--still isn't as well known as other quality improvement terms. But many people familiar with healthcare quality issues think these systems can potentially change the front lines of care delivery--which in turn influence how care is provided throughout larger healthcare organizations.

Delivery of Health Care↗

PubMedDate not supplied

Status of quality improvement activities to improve immunization practices and delivery: findings from the immunization quality improvement symposium, October 2003.

The Centers for Disease Control and Prevention convened a symposium on 22-23 October 2003 to bring together investigators and stakeholders working to apply the quality improvement (QI) approaches to immunization delivery in individual medical practices. The goal was to identify effective program components and further development of model programs. A call for projects was widely disseminated; of 61 submissions received, eight projects were selected. Three of the eight programs used the "train the trainer" approach, three used site-specific training, one used a "practice collaborative" approach, and one employed the use of tracking and outreach workers to effect change. At the symposium, invited experts reviewed each program. Common program features that appeared effective included involvement of a variety of staff within the office environment, collection and review of site-specific performance measurements to identify gaps in delivery, periodic monitoring of performance measurement to revise interventions and maintain the improvements, and provision of formal continuing education credits. While research is needed on ways to promote and integrate QI into practices, it is likely that a variety of QI strategies will be shown to be effective, depending on the clinical settings. The field will benefit from standardized outcome measures, cost analysis, and evaluation, so comparisons can be made among different programs.

Centers for Disease Control and Prevention, U.S.↗

PubMed1990

How to use continuous quality improvement theory and statistical quality control tools in a multispecialty clinic.

The management philosophy of continuous quality improvement (CQI) and the tools of statistical quality control (SQC) have the potential for advancing quality management in medicine as they have in industry. The authors report their favorable experience with the approach and explain how to adapt CQI principles and SQC charts and graphs, citing examples from their participation in a quality improvement effort in a multispecialty clinic serving a large hospital. The coupling of statistical techniques with modern approaches to outcome analysis may provide powerful tools not only for quality assurance and assessment but also for technology evaluation and resource allocation.

Data Collection↗

PubMed2000

Evidence-based surgery at ASERNIP-S. Can this improve quality in surgical practice? Australian Safety and Efficacy Register of New Interventional Procedures-Surgical.

The Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S) project has been established to form a register of new surgical procedures which have been assessed for their safety and efficacy. The ASERNIP-S project systematically reviews the evidence and produces recommendations on the future use of surgical procedures in clinical practice. Further data may be collected to provide information on the outcomes of procedures in use in Australia. Horizon Scanning of new and emerging techniques and technologies complements the ASERNIP-S process. This research identifies procedures that will impact on clinical practice in the near future. Dissemination of information from ASERNIP-S assessments, both locally and internationally, is important for quality improvement. The ultimate aim is for appropriate changes in practice to ensure the highest quality of Australian healthcare.

Australia↗