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Results for “Process Assessment, Health Care”

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At least 19 recordsLinked to original sources
PubMedDate not supplied

[Methodological obstacles encountered in the evaluation of psychotherapies of schizophrenic patients. A general review].

Through a critical review of literature, authors suggest a methodological reflexion about problems in evaluation of effects of psychotherapies of schizophrenics, taking into account not only individual techniques but also institutional ones with psychotherapeutic orientations. Among the main difficulties are: evaluation with too much unspecific and over simplified criteria, for example criterium of rehospitalisation; lack of real comparability between groups, or techniques, and lack of validity of randomisation, still considered as a pawn of methodological rigour; diversity of levels of experience, and education of therapists, too unmatched model of functional organisation of the different centers, and in the same time too unequal recruitment of patients and at length of proposed therapeutic programs. Moreover, and even before these methodological bias, a more basic obstacle must be considered. It is the non-opening of models to the falsification, denounced by Bignami as the impossible verification of the heuristic value of the proposed models, ie the impossible verification of the utility of the proposed programs for individual therapies of schizophrenics.

Bias↗
PubMed1991

Issues in measuring outcomes of nursing.

The upsurge in interest in measuring patient outcomes of nursing, it is argued, has been occasioned firstly by management changes and secondly by the professionalizing thrust of the nursing profession. Within this overall context, however, the objectives of individual patient outcome studies vary considerably. The current status of outcome measurement in nursing is outlined through a description of the use of different outcome measures to suit different purposes. Ascertaining whether nursing care makes a difference by using outcome measures raises methodological as well as professional issues, for example that of separating nursing from the inputs of other professional groups and incorporating individual patients' perspectives. While these challenges are complex and measuring the effectiveness of nursing in terms of patient outcomes is in its infancy, it is argued that, in this, nursing is no different from other professional groups. The paper goes on to suggest ways of moving forward in the measurement of outcomes of nursing for patients.

Humans↗
PubMed1992

Accident analysis of large-scale technological disasters applied to an anaesthetic complication.

The occurrence of serious accidents in complex industrial systems such as at Three Mile Island and Bhopal has prompted development of new models of causation and investigation of disasters. These analytical models have potential relevance in anaesthesia. We therefore applied one of the previously described systems to the investigation of an anaesthetic accident. The model chosen describes two kinds of failures, both of which must be sought. The first group, active failures, consists of mistakes made by practitioners in the provision of care. The second group, latent failures, represents flaws in the administrative and productive system. The model emphasizes the search for latent failures and shows that prevention of active failures alone is insufficient to avoid further accidents if latent failures persist unchanged. These key features and the utility of this model are illustrated by application to a case of aspiration of gastric contents. While four active failures were recognized, an equal number of latent failures also became apparent. The identification of both types of failures permitted the formulation of recommendations to avoid further occurrences. Thus this model of accident causation can provide a useful mechanism to investigate and possibly prevent anaesthetic accidents.

Accidents↗
PubMed1992

Current issues in profiling quality of care.

Profiling provider performance for the assessment of quality involves a number of issues related to selection of appropriate quality measures, subsequent data collection and analysis, and selection of standards of comparison. This article emphasizes the limitations of current data systems for this purpose and discusses hierarchical modeling as the optimal analytic approach for analyzing resulting data. Mention is made of the difficulties of achieving large enough sample sizes for statistical significance at the individual provider level. Finally, the article discusses feasible options for profiling quality.

Data Collection↗
PubMed1992

The short-term effect of patient health status assessment in a health maintenance organization.

This study was designed to test the short-term effects of health assessment on the process of care and patient satisfaction. The 29 Chart physicians used the Dartmouth COOP Charts to measure their adult patients' health status during a single clinical encounter; the 27 control clinicians used no measure of health status. We compared the change between baseline and post-intervention information for a sample of all study clinicians' patients. Most of the patients were female (67%), well educated (70% had at least a college education) and young (approximately 90% were aged 59 years or younger). We found that the ordering of tests and procedures for women was increased by exposure to the COOP Charts (52% vs. 35%; p < 0.01); the effect in men was not as significant (37% vs. 23%: p = 0.06). Although women reported no change in satisfaction with care, men claimed that the clinician helped in the management of pain (p = 0.02). We conclude that the use of health status measures during a single clinical encounter in an HMO changes clinician test ordering behaviour and may improve the help male patients receive for pain conditions. The long-term impact of these management changes is not known.

Episode of Care↗
PubMed1978

Direct and indirect measures of patient satisfaction with physicians' services.

This research examines alternative measures of patient satisfaction. Three measures were compared: (1) a direct measure to evaluate how the patient felt about his own personal physician, (2) an indirect measure that assessed attitudes about physicians in general, and (3) a measure designed to be intermediate between these two. Responses to the three measures were found to differ: the levels of satisfaction increased with the directness of the measure used; indirect evidence that this relationship could not be attributed solely to a patient's reluctance to criticize his own physician is also provided. The three measures were compared in terms of their association with other assessments of outcome and with indicators of the process of care. Although none of the associations was statistically significant, high scores on the intermediate measure tended to correspond with better outcomes and higher scores on the process of care. These findings are at least compatible with the contention than an intermediate measure provides the most valid assessment of patient satisfaction.

Adult↗
PubMed1992

Total quality management in a hospital.

The adaptation of the management philosophy and tools of total quality management (TQM) to the modern American hospital, its staff, and physicians is a major challenge facing health care today. The TQM "bandwagon" is one that hospitals both want to--and are required to--jump on, insofar as TQM is now part of the revised Joint Commission standards [Ed note: The standards encourage hospitals to adopt TQM, continuous quality improvement, or a similar approach to improve performance]. TQM holds out the promise of improving clinical quality while simultaneously reducing the "cost of poor quality." Although the actual realization of cost savings through TQM remains to be seen, the author provides an exceptionally clear overview of the issues involved in TQM implementation at the hospital level. This article is noteworthy in its practical and experienced approach to the necessary groundwork for a successful TQM program, including strategic commitment, human resource issues, and oversight of the TQM process as it unfolds. Quality review professionals may still wonder how to merge hospital and medical staff quality assurance efforts with TQM initiatives in the near future.

Consumer Behavior↗
PubMedDate not supplied

Modified orthodontic treatment goals in a patient with multiple complicating factors.

This paper reviews orthodontic care in patients who are in nontraditional categories. Specific orthodontic management of a patient who had severe hemophilia, seropositivity for anti-HIV Ab, and Hepatitis B surface antigen is reviewed. The importance of defining acceptable treatment goals in these patients is of paramount importance.

Adolescent↗
PubMed1992

Effectiveness of two palliative support teams.

The palliative care of 227 consecutive patients by two support teams was measured according to 17 key indicators in the Support Team Assessment Schedule (STAS), an instrument previously developed and validated for use in these settings. Mean time in care was 71 days (range 1-547); 56 per cent of patients died at home, 26 per cent in hospital, 18 per cent in a hospice. Totalled ratings (sum of 15 items, excluding two items owing to missed ratings) improved in 83 per cent of cases, remained unchanged in 3 per cent and deteriorated in 13 per cent. The main problems which the STAS identified at referral were family anxiety, symptom control, patient anxiety and communication between patient and family. Fifteen of the 17 items showed significant improvements (Wilcoxon Z ranged from -3.18 to -8.20, p less than 0.00005) between referral ratings and ratings for the last week of the patient's life; family anxiety and spiritual needs did not. Patient anxiety and symptom control, although improved, also remained relatively severe at death. These results demonstrate the value of measuring key indicators and indicate areas where improvement in palliative care is needed.

Adult↗
PubMed1990

Institutes of Quality: Prudential's approach to outcomes management for specialty procedures.

The Prudential Institutes of Quality program was developed to respond to the growing interest in the quality of care available to patients through both indemnity and managed medical plans and clients' concern about the continued escalation of health care costs. The program is based on the premise that high-quality care is the most efficient care that utilizes resources appropriately because of the experience of both the hospital and the physicians. Hospitals and physicians are selected through a questionnaire and site-visit process based on criteria developed from a literature review and outside expert counsel. Networks of facilities meeting the criteria serve the Prudential patient population. The history and results through the third quarter of 1989 and the implications of selective contracting for health care policy are presented.

Health Care Rationing↗
PubMed1991

Assessing quality of ambulatory care. A comparative analysis in rural versus tertiary general medical clinics.

The purpose of this study is to report the results and feasibility of a "multi-methods" assessment of ambulatory health care in both rural and tertiary care settings. Our method used an expert panel's assessment of patient health and satisfaction outcomes (measured by follow-up telephone interviews) and care processes (measured by chart review) for assessing complete episodes of care. Subjects consisted of a matched cohort of ambulatory adult patients from the above two settings. We identified and analyzed specific clinical errors to confirm the expert panel's judgment of inadequacy. Results indicate that in both settings unacceptable health outcomes were found, at least partially explained by serious care deficiencies for 1 out of 2 to 3 patients seen. The problems, which involved mostly laboratory and pharmaceutic management, are probably preventable using newer education and computer technologies. Our method, though dependent on adequate medical records, proved feasible in both the rural and tertiary ambulatory care settings studied.

Ambulatory Care↗
PubMedDate not supplied

Maintaining quality in a changing environment.

The turbulent health care environment has led to an increasing interest in assessment of quality of care, with a primary focus being outcomes analysis. The emphasis on organizational and clinical outcomes demands a total commitment to quality improvement and restructuring of the hospital environment.

Costs and Cost Analysis↗