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5 recordsLinked to original sources
PubMed1994

The search for value: a quality improvement cycle linking process, outcomes, and patient satisfaction.

American industry has been implementing continuous quality improvement (CQI) for several years. The business community and accrediting organizations are applying pressure to health care organizations to implement CQI to assure the delivery of cost-effective, quality health care services. In their rush to embrace the demands of industry, health care organizations must realize that many within their ranks long ago adopted the philosophy of CQI without calling it by name. The key is to adapt the concepts of CQI to existing quality improvement efforts rather than simply following a new recipe. By looking primarily at hospital systems like administration and finance, health care organizations may not be significantly addressing the clinical system. Consumers, however, want patient care to be addressed immediately. The author reflects on his experience that process improvement, not personnel change, is the key to successes in health care management.

Data Collection↗
PubMed2003

Lessons learned from the DIG trial.

The Digitalis Investigation Group (DIG) trial was the first large simple trial conducted by the National Heart, Lung, and Blood Institute in conjunction with the Department of Veterans Affairs. A large simple trial is a major undertaking. Simplification at the sites requires careful planning and discipline. Lessons learned from the DIG trial were: (1) keep a large simple trial very simple and keep all study procedures very simple; (2) ancillary studies are important and can complement a large simple trial but require careful advanced planning; (3) anticipate special needs when shipping study drugs internationally; (4) regional coordinating centers can be very useful; (5) recruit as many capable sites as possible; (6) provide research-inexperienced sites/investigators with extra help to obtain federalwide assurance statements from the Office for Human Research Protections and institutional review board approvals; (7) adequately reimburse sites for the work completed; (8) maintain investigator enthusiasm; (9) monitor the slow performers and sites with numerous personnel changes; (10) choose an endpoint that is easy to ascertain; (11) keep the trial simple for participants; and (12) plan early for closeout and for activities between the end of the trial and publication of results.

Canada↗
PubMed2002

Improving treatment outcomes with a clinical pathway for hysterectomy and myomectomy.

OBJECTIVE: To determine if using a postoperative clinical pathway for women having hysterectomy or myomectomy would improve clinical care. STUDY DESIGN: Data from the literature and patient focus groups guided development of a clinical pathway. Nurses, pharmacists and physicians participated in the development process. Implementation relied on accepted quality improvement methods. We used a case-control design to compare administrative and clinical data for patients managed with (n = 28) and without (n = 28) the aid of the clinical pathway between June 1997 and January 1998. RESULTS: Case and control groups did not differ in age, race, payer status, severity of illness or procedure type. Clinical differences between pathway and nonpathway patients included a mean six-hour-shorter period of indwelling bladder catheters (P = .019), mean 11-hour more rapid return to regular diet (P = .014) and more pain assessments among pathway patients (mean, five vs. two; P < .001). There was no significant difference in length of stay between groups. Clinicians used the pathway for approximately one year, but with personnel changes the pathway gradually fell out of use. CONCLUSION: Clinical pathways can improve quality of care, even if they do not reduce length of stay. A team approach that focuses on patient concerns during pathway development may help ensure that quality improvement, rather than simply cost reduction, arises from the use of clinical pathways.

Adult↗