Care Quality (care + quality)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Care Quality

  • health care quality


  • Selected Abstracts


    Poster Sessions: Care Delivery/Quality of Life

    MOVEMENT DISORDERS, Issue S13 2006
    Article first published online: 19 JAN 200
    [source]


    Frequency of Seborrheic Keratosis Biopsies in the United States: A Benchmark of Skin Lesion Care Quality and Cost Effectiveness

    DERMATOLOGIC SURGERY, Issue 8 2003
    Maria I. Duque MD
    Background. Most seborrheic keratoses may be readily clinically differentiated from skin cancer, but occasional lesions resemble atypical melanocytic neoplasms. Objective. To evaluate the frequency, cost, and intensity of procedures performed that result in the removal and histopathologic evaluation of seborrheic keratoses. Methods. Episodes of surgical removal of lesions that were identified as seborrheic keratoses by histologic identification were determined using Medicare Current Beneficiary Survey data from 1998 to 1999. These episodes were defined by a histopathology procedure code that is associated with a diagnosis code for seborrheic keratosis. We then identified what procedure(s) generated the histopathology specimen. Biopsy and shave procedures were considered "low intensity," whereas excision and repair procedures were considered "high intensity." Results. Dermatologists managed 85% of all episodes of seborrheic keratoses. Dermatologists managed 89% of seborrheic keratosis episodes using low-intensity procedures compared with 51% by other specialties. For nondermatologists, 46% of the treatment cost ($9 million) to Medicare was generated from high-intensity management compared with 15% by dermatologists ($6 million). Conclusion. There is a significant difference in the management of suspicious pigmented lesions between dermatologists and other specialists. This affects both the cost and quality of care. [source]


    Managed Care Quality of Care and Plan Choice in New York SCHIP

    HEALTH SERVICES RESEARCH, Issue 3 2009
    Hangsheng Liu
    Objective. To examine whether low-income parents of children enrolled in the New York State Children's Health Insurance Program (SCHIP) choose managed care plans with better quality of care. Data Sources. 2001 New York SCHIP evaluation data; 2001 New York State Managed Care Plan Performance Report; 2000 New York State Managed Care Enrollment Report. Study Design. Each market was defined as a county. A final sample of 2,325 new enrollees was analyzed after excluding those in markets with only one SCHIP plan. Plan quality was measured using seven Consumer Assessment of Health Plans Survey (CAHPS) and three Health Plan Employer Data and Information Set (HEDIS) scores. A conditional logit model was applied with plan and individual/family characteristics as covariates. Principle Findings. There were 30 plans in the 45 defined markets. The choice probability increased 2.5 percentage points for each unit increase in the average CAHPS score, and the association was significantly larger in children with special health care needs. However, HEDIS did not show any statistically significant association with plan choice. Conclusions. Low-income parents do choose managed care plans with higher CAHPS scores for their newly enrolled children, suggesting that overall quality could improve over time because of the dynamics of enrollment. [source]


    Primary Care Quality and Addiction Severity: A Prospective Cohort Study

    HEALTH SERVICES RESEARCH, Issue 2 2007
    Theresa W. Kim
    Background. Alcohol and drug use disorders are chronic diseases that require ongoing management of physical, psychiatric, and social consequences. While specific addiction-focused interventions in primary care are efficacious, the influence of overall primary care quality (PCQ) on addiction outcomes has not been studied. The aim of this study was to prospectively examine if higher PCQ is associated with lower addiction severity among patients with substance use disorders. Study Population. Subjects with alcohol, cocaine, and/or heroin use disorders who initiated primary care after being discharged from an urban residential detoxification program. Measurements. We used the Primary Care Assessment Survey (PCAS), a well-validated, patient-completed survey that measures defining attributes of primary care named by the Institute of Medicine. Nine summary scales cover two broad areas of PCQ: the patient,physician relationship (communication, interpersonal treatment, thoroughness of the physical exam, whole-person knowledge, preventive counseling, and trust) and structural/organizational features of care (organizational access, financial access, and visit-based continuity). Each of the three addiction outcomes (alcohol addiction severity (ASI-alc), drug addiction severity (ASI-drug), and any drug or heavy alcohol use) were derived from the Addiction Severity Index and assessed 6,18 months after PCAS administration. Separate longitudinal regression models included a single PCAS scale as the main predictor variable as well as variables known to be associated with addiction outcomes. Main Results. Eight of the nine PCAS scales were associated with lower alcohol addiction severity at follow-up (p,.05). Two measures of relationship quality (communication and whole- person knowledge of the patient) were associated with the largest decreases in ASI-alc (,0.06). More whole-person knowledge, organizational access, and visit-based continuity predicted lower drug addiction severity (ASI-drug: ,0.02). Two PCAS scales (trust and whole-person knowledge of the patient) were associated with lower likelihood of subsequent substance use (adjusted odds ratio, [AOR]=0.76, 95 percent confidence interval [95% CI]=0.60, 0.96 and AOR=0.66, 95 percent CI=0.52, 0.85, respectively). Conclusion. Core features of PCQ, particularly those reflecting the quality of the physician,patient relationship, were associated with positive addiction outcomes. Our findings suggest that the provision of patient-centered, comprehensive care from a primary care clinician may be an important treatment component for substance use disorders. [source]


    Patient Safety: A Curriculum for Teaching Patient Safety in Emergency Medicine

    ACADEMIC EMERGENCY MEDICINE, Issue 1 2003
    Karen S. Cosby MD
    Abstract The last decade has witnessed a growing awareness of medical error and the inadequacies of our health care delivery systems. The Harvard Practice Study and subsequent Institute of Medicine Reports brought national attention to long-overlooked problems with health care quality and patient safety. The Committee on Quality of Health Care in America challenged professional societies to develop curriculums on patient safety and adopt patient safety teaching into their training and certification requirements. The Patient Safety Task Force of the Society for Academic Emergency Medicine (SAEM) was charged with that mission. The curriculum presented here offers an approach to teaching patient safety in emergency medicine. [source]


    A national stroke quality register: 12 years experience from a participating hospital

    EUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2007
    P. Appelros
    Registration of all hospitalized stroke patients is practiced in Sweden in order to assess care quality. Data in this register, Riks-Stroke (RS), may be biased due to incomplete registration. The purpose of this paper was to report changes in stroke outcome in relation to fluctuations in registration. Patients registered in RS at a hospital during the period 1994,2005 were analyzed. Case fatality at 28 days, living conditions, and activities of daily living (ADL) performance at 3 months were correlated to the number of patients registered and follow-up frequency. A total of 4994 stroke cases were registered during the period. A high annual registration rate was significantly correlated to a high case fatality ratio. A low annual follow-up rate was associated with a low proportion of patients living in their own home without any need of help. Quality parameters are sensible for selection bias, which make them difficult to compare over time and between hospitals. We suggest that by weighing outcome data against stroke severity, safer conclusions may be drawn. Additionally, hospitals considering setting up quality registers should make every effort to attain complete case ascertainment at all times, including patients managed outside the hospital, in order to avoid selection bias. [source]


    Primary Care Quality and Addiction Severity: A Prospective Cohort Study

    HEALTH SERVICES RESEARCH, Issue 2 2007
    Theresa W. Kim
    Background. Alcohol and drug use disorders are chronic diseases that require ongoing management of physical, psychiatric, and social consequences. While specific addiction-focused interventions in primary care are efficacious, the influence of overall primary care quality (PCQ) on addiction outcomes has not been studied. The aim of this study was to prospectively examine if higher PCQ is associated with lower addiction severity among patients with substance use disorders. Study Population. Subjects with alcohol, cocaine, and/or heroin use disorders who initiated primary care after being discharged from an urban residential detoxification program. Measurements. We used the Primary Care Assessment Survey (PCAS), a well-validated, patient-completed survey that measures defining attributes of primary care named by the Institute of Medicine. Nine summary scales cover two broad areas of PCQ: the patient,physician relationship (communication, interpersonal treatment, thoroughness of the physical exam, whole-person knowledge, preventive counseling, and trust) and structural/organizational features of care (organizational access, financial access, and visit-based continuity). Each of the three addiction outcomes (alcohol addiction severity (ASI-alc), drug addiction severity (ASI-drug), and any drug or heavy alcohol use) were derived from the Addiction Severity Index and assessed 6,18 months after PCAS administration. Separate longitudinal regression models included a single PCAS scale as the main predictor variable as well as variables known to be associated with addiction outcomes. Main Results. Eight of the nine PCAS scales were associated with lower alcohol addiction severity at follow-up (p,.05). Two measures of relationship quality (communication and whole- person knowledge of the patient) were associated with the largest decreases in ASI-alc (,0.06). More whole-person knowledge, organizational access, and visit-based continuity predicted lower drug addiction severity (ASI-drug: ,0.02). Two PCAS scales (trust and whole-person knowledge of the patient) were associated with lower likelihood of subsequent substance use (adjusted odds ratio, [AOR]=0.76, 95 percent confidence interval [95% CI]=0.60, 0.96 and AOR=0.66, 95 percent CI=0.52, 0.85, respectively). Conclusion. Core features of PCQ, particularly those reflecting the quality of the physician,patient relationship, were associated with positive addiction outcomes. Our findings suggest that the provision of patient-centered, comprehensive care from a primary care clinician may be an important treatment component for substance use disorders. [source]


    Improving child care quality in Early Head Start programs: A partnership model

    INFANT MENTAL HEALTH JOURNAL, Issue 1-2 2002
    Lenna L. Ontai
    Many Early Head Start (EHS) programs do not provide child care directly but instead contract with existing community child care agencies to provide services. Such arrangements challenge EHS programs to create unique ways to ensure quality in the child care component of the program. The current research project reports on the efforts of a partnership between an EHS program and community child care agency to improve child care quality. The goal was to systematically identify changes in quality made within the EHS program as the result of a system of monitoring and assessment carried out under the partnership. The current study utilized ITERS and Arnett scales to assess the quality of the community center-based infant child care at the beginning of the EHS program and nine months later. The results indicate a significant improvement in some areas of child care whereas other areas appeared to be more difficult to enhance with the current method. Additionally, differential areas of improvement were found between infant and toddler classrooms. The discussion focuses on aspects of the partnership that most likely contributed to quality improvements. ©2002 Michigan Association for Infant Mental Health. [source]


    Proposing indicators for the development of nursing care quality in Iran

    INTERNATIONAL NURSING REVIEW, Issue 4 2008
    M. Pazargadi phd
    Background:, Nursing has come a long way in developing frameworks for the delivery of high-quality care; however, it is still grappling with identifying key performance indicators and defining the patient outcomes that are directly or indirectly affected by nurses. Objective:, The study aimed to determine performance quality indicators in nursing care based on the healthcare system in Iran. Methods:, A descriptive exploratory study was conducted and 220 nurses from seven provinces in Iran were selected by quota sampling. A questionnaire including 97 indicators in seven categories was developed to collect data and respondents were asked to rate each indicator for importance, scientific acceptability and feasibility of implementation. Results:, Of the initial 220 distributed questionnaires, 74% (n = 119) nurse managers and 26% (n = 42) expert nurses (total: n = 161) returned questionnaires (73% response rate). The mean scores for all categories showed that the most of the indicators were important and scientifically acceptable (mean > 2.40), but difficult to implement in hospitals (mean < 2.15). An analysis using ANOVA showed that there were no significant differences between seven categories for the ,importance' aspect, but there were significant differences between ,time and quality of care' and ,job satisfaction', for ,scientific acceptability' (P = 0.004) and significant differences between most of categories for ,feasibility of implication'(P = 0.000). Conclusion:, The researchers have proposed the most significant nursing quality indicators for the clinical setting in Iran. These indicators would be useful for nurse managers as a first step to assess the quality of nursing care in hospitals. [source]


    Patient expectation and satisfaction with nursing care in Turkey: a literature review

    INTERNATIONAL NURSING REVIEW, Issue 3 2007
    S. A. Özsoy phd
    Background:, Patient satisfaction is used as an important indicator of care quality and is frequently included in healthcare planning and evaluation. This study presents a review of research on patient expectation and satisfaction with nursing care in Turkey. Aim:, To review the national literature on patient expectations and satisfaction with nursing care. Methods:, The researchers reviewed 3089 articles of which 27 were discussed in detail. Of these 3089 articles, 1812 were from all issues of 14 Turkish nursing journals which have been published in the last 50 years, and 1277 articles were from 24 nursing congress and symposium books. Results:, The results of this study are divided into two categories: expectations concerning ,nursing care', and ,satisfaction with nursing care'. The findings show that there exist conceptual and philosophic deficiencies in the approaches to patient satisfaction and that there is a need to use standardized instruments to study and assess patient satisfaction in the future. Conclusion:, Over the last 20 years, studies of patient expectation and satisfaction with nursing care have been gaining high importance, but it is also noticed that in a national and philosophical approach the studies are not based on clearly defined concepts. Moreover, it has been concluded that there is a need for valid and reliable tools in the evaluation of satisfaction. [source]


    International field test results of the Observable Indicators of Nursing Home Care Quality instrument

    INTERNATIONAL NURSING REVIEW, Issue 4 2002
    FAAN , M. Rantz RN
    Abstract Researchers at the University of Missouri-Columbia developed the Observable Indicators of Nursing Home Care Quality instrument to measure the dimensions of nursing home care quality during a brief on-site visit to a nursing home. The instrument has been translated for use in Iceland and used in Canada. Results of the validity and reliability studies using the instrument in 12 nursing homes in Reykjavik, in a large Veterans Home in Ontario with 14 units tested separately, and in 20 nursing homes in Missouri, are promising. High-content validity was observed in all countries, together with excellent inter-rater reliability and coefficient alpha. Test,retest reliabilities in Iceland and Missouri were good. Results of the international field test of the Observable Indicators of Nursing Home Care Quality instrument points to the usefulness of such an instrument in measuring nursing home care quality following a quick on-site observation in a nursing facility. The instrument should be used as a facility-wide assessment of quality, rather than for individual units within a facility. We strongly recommend its use by practising nurses in nursing homes to assess quality of care and guide efforts to improve care. We recommend its use by researchers and consumers and further testing of the use of the instrument with regulators. [source]


    The Co-Occurrence of Chronic Diseases and Geriatric Syndromes: The Health and Retirement Study

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2009
    Pearl G. Lee MD
    OBJECTIVES: To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality. DESIGN: Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS). SETTING: Nationally representative health interview survey. PARTICIPANTS: Respondents in the 2004 wave of the HRS aged 65 and older. MEASUREMENTS: Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education). RESULTS: Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58% were female, 8% were African American, and 4% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P<.001). Fifty-six percent had at least one of the five index conditions, and 23% had two or more. Of respondents with one condition, 20% to 55% (depending on the index condition) had two or more additional conditions. CONCLUSION: Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes. [source]


    Nursing care quality and adverse events in US hospitals

    JOURNAL OF CLINICAL NURSING, Issue 15-16 2010
    Robert J Lucero
    Aim., To examine the association between nurses' reports of unmet nursing care needs and their reports of patients' receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals. Background., Because nursing activities are often difficult to measure, and data are typically not collected by health care organisations, there are few studies that have addressed the association between nursing activities and patient outcomes. Design., Secondary analysis of cross-sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US. Methods., Multivariate linear regression models estimated the effect of unmet nursing care needs on adverse events given the influence of patient factors and the care environment. Results., The proportion of necessary nursing care left undone ranged from 26% for preparing patients and families for discharge to as high as 74% for developing or updating nursing care plans. A majority of nurses reported that patients received the wrong medication or dose, acquired nosocomial infections, or had a fall with injury infrequently. However, nurses who reported that these adverse events occurred frequently varied considerably [i.e. medication errors (15%), patient falls with injury (20%), nosocomial infection (31%)]. After adjusting for patient factors and the care environment, there remained a significant association between unmet nursing care needs and each adverse event. Conclusion., The findings suggest that attention to optimising patient care delivery could result in a reduction in the occurrence of adverse events in hospitals. Relevance to clinical practice., The occurrence of adverse events may be mitigated when nurses complete care activities that require them to spend time with their patients. Hospitals should engage staff nurses in the creation of policies that influence human resources management to enhance their awareness of the care environment and patient care delivery. [source]


    Monitoring indicators of health care quality by means of a hospital register of tumours

    JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2008
    Maximino Redondo MD PhD
    Abstract Rationale, Hospital registers of tumours provide, on a continuous basis, information on differences in patterns of neoplasias and the results of the treatment strategies employed. Objective, In view of the scant publications on measures of health care quality in hospital tumour registers, the aim of our paper is to present the outcome of a study to monitor the results related to health care quality in oncology. Methods, Data are presented for cases recorded at the Hospital Costa del Sol over a period of 8 years. The sources of information are fundamentally the patient's medical record and the database of the Pathology Department. Results, A high proportion of patients (mean 50%, range 45,68%) were admitted to the hospital by the Emergency Department; there was a notably long delay between the appearance of the first symptoms and the occasion of the first hospital visit (median 65 days; range 60,75 days). Particularly striking was the corresponding delay for breast cancer patients, in most cases superior to 3 months. As was the case for the percentage of admissions by the Emergency Department, most of the indicators evaluated in this study present a significant improvement compared with the initial years of the Hospital Register of Tumours. Thus, non anatomic-pathological diagnoses represented around 7% (range 3,13%), while 43% of patients (range 28,57%) were given adjuvant treatment in the form of radiation therapy or chemotherapy. In 40% of cases (range 20,50%), the tumour stage was included in the clinical record by the doctor who was treating the patient (in the remaining cases, these data were recorded by the Tumour Registry); the date of appearance of the first symptoms was included in the medical record in 65% of cases (range 54,80%). According to the stage classification, the following 5-year survival rates were recorded: (I) 98%, (II) 94%, (III) 69% and (IV) 39% for breast cancer; (I) 93%, (II) 83%, (III) 68% and (IV) 12% for cancer of the colon; and (I) 100%, (II) 94%, (III) 79% and (IV) 53% for prostate cancer. Conclusion, The high percentage of patients admitted by the Emergency Department and the long delay between the appearance of the first symptoms reflect the deficient attention paid to this problem by patients and by primary health care services. Our results suggest that the Hospital Register of Tumours could constitute an excellent tool for monitoring the quality of health care systems for oncological patients. [source]


    Curriculum development: The venous thromboembolism quality improvement resource room

    JOURNAL OF HOSPITAL MEDICINE, Issue 2 2006
    Sylvia McKean MD
    Abstract BACKGROUND The role of the hospitalist has evolved over the last decade, with hospitalists increasingly being asked to lead systems-based initiatives to improve the quality of inpatient care. The educational strategy of the Society of Hospital Medicine (SHM) includes development of practice-based resources to support hospitalist-led improvement in clinically important measures of hospital care quality. OBJECTIVE To develop a resource at the SHM Web site to present quality improvement (QI) principles for systems-based care in the hospital and to help individual hospitalists improve specific patient outcomes. DESIGN The SHM defined the role of the hospitalist in QI, performed an assessment of the educational needs of hospitalists, and executed a Web-based educational strategy to address these needs. The organization identified the most common cause of preventable inpatient deaths, hospital-acquired venous thromboembolism (VTE), and prioritized the need to improve prophylaxis. RESULTS This new resource at the SHM Web site presents principles for conducting QI in the hospital. To enable learning that is practice based, the VTE Quality Improvement Resource Room (QI RR) features Ask the Expert, an interactive discussion community, and an original Improvement Workbook, a downloadable project outline and tutorial that hospitalists can use to guide and document steps in an effort aimed at reducing hospital-acquired VTE. CONCLUSIONS This QI resource serves as a template for the development of subsequent hospital-based resources. User feedback will refine the QI RR and its format so that similar offerings can target other significant inpatient problems. Additional research is needed to evaluate learning and the clinical impact of this quality improvement resource on hospital performance measures and patient outcomes. Journal of Hospital Medicine 2006;1:124,132. © 2006 Society of Hospital Medicine. [source]


    A model for developing high-reliability teams

    JOURNAL OF NURSING MANAGEMENT, Issue 5 2010
    WILLIAM RILEY PhD
    riley w., davis s.e., miller k.k. & mccullough m. (2010) Journal of Nursing Management18, 556,563 A model for developing high-reliability teams Aim, To develop a model for high reliability in health care quality and patient safety. Background, A high-reliability health organization (HRO) has measurable near perfect performance in quality and safety. High reliability is necessary in health care where the consequences of error are high and the frequency is low. Key issues, Despite a decade of intense focus on quality and safety since a series of reports from the Institute of Medicine (IOM), health care is not a completely safe industry and quality is not what it should be to ensure high reliability for patients. Conclusions, A model for high reliability is presented that includes the individual skills necessary to assure high-reliability teams on a patient care unit. High-reliability teams (HRT) form an essential core of a HRO. These teams and their organizations value a culture of safety every day with every patient encounter. Implications for nursing management, Nurse managers can lead in creating a HRO by first developing HRTs on their patient care unit. [source]


    The clinical nurse leader: a catalyst for improving quality and patient safety

    JOURNAL OF NURSING MANAGEMENT, Issue 5 2008
    FAAN, JOAN M. STANLEY PhD
    Aim, The clinical nurse leader (CNL®) is a new nursing role introduced by the American Association of Colleges of Nursing (AACN). This paper describes its potential impact in practice. Background, Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources. Method, A naturalistic approach is used to evaluate the impact the CNL has had on outcomes of care. Case studies describe the CNL implementation experiences at three different practice settings within the same geographic region. Results, Cost savings, including improvement on Centers for Medicare and Medicaid Services (CMS) core measures, are realized quickly in settings where the CNL role has been integrated into the care delivery model. Conclusions, With the growing calls for improved outcomes and more cost-effective care, the CNL role provides an opportunity for nursing to lead innovation by maximizing health care quality while minimizing costs. Implications for nursing management, Nursing is in a unique position to address problems that plague the nation's health system. The CNL represents an exciting and promising opportunity for nursing to take a leadership role, in collaboration with multiple practice partners, and implement quality improvement and patient safety initiatives across all health care settings. [source]


    Working conditions and the possibility of providing good care

    JOURNAL OF NURSING MANAGEMENT, Issue 4 2002
    Gunvor Lövgren RN
    Background,An open and tolerant climate characterized by joy in work where the personnel can mature as people and develop their professional competence was postulated as essential to working conditions under which good care can be provided in line with a care policy accepted for healthcare in a northern Swedish county. Aim, This study aimed to examine working conditions before and 3 years after the implementation of the care policy. Method, All personnel working on four hospital wards in the county described their experiences in questionnaires in a baseline measure in 1995 (n = 119) and a follow-up measure in 1998 (n = 106). Findings, Lower ratings for working conditions were found in many respects in the follow-up measure. Fewer respondents from three wards expressed satisfaction with their current work situation. More respondents in one of these wards expressed, in addition, an inability to keep up with their work and fewer also evaluated their immediate superiors as good leaders. More of the respondents from one ward expressed the intention of looking for alternative employment and wanted to have another job. More respondents in two wards reached scores indicating burnout risk or burnout, and lower means were seen in two to 10 work climate dimensions per ward, out of 10 possible, in the follow-up measure compared with the baseline. Conclusion, The working conditions seen as requisite for the possibility of providing good care seem to have deteriorated in a number of respects on the wards studied over a three-year period and improvements are needed if the care offered is to be in line with the stated care policy. A concurrent study investigating patient satisfaction of the care quality in the same county showed a deterioration in their assessments between measurements carried through with a three-year interval, implying a relationship between the working conditions of the personnel and the patients' experiences of care. [source]


    Integrating education into primary care quality and cost improvement at an academic medical center

    THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2006
    R. Van Harrison PhD
    Abstract Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical clinical guidelines for common medical conditions; measure and provide feedback on physicians' performance; and facilitate systemic changes to support appropriate care. Various methods are used to improve care, including evidence reviews, formal education, informal clinical "opinion leaders," feedback, reminders, and procedure changes. Twenty-four common medical conditions have been addressed through this process. More than 30 measures of clinical performance have been developed and reported. Methods: This case study describes a systematic, multifaceted program to improve the quality and cost-effectiveness of primary care. Results: Illustrative results for clinical performance are presented for 2 measures of chronic care, 2 measures of preventive care, and 2 measures of acute care. All 6 measures show general improvement in performance across years, with performance near or above the National Committee for Quality Assurance's 90th percentile for Health Plan Employer Data and Information Set measures. Discussion: A systematic approach involving all relevant components of a health system integrates the synthesis of information, education about the information and how to implement it, and addressing operational barriers. Benefits include a curriculum that is shared across faculty, residents, and medical students and more uniform quality of care that faculty model for physicians-in-training. [source]


    Leadership and management in the aged care sector: A narrative synthesis

    AUSTRALASIAN JOURNAL ON AGEING, Issue 2 2010
    Yun-Hee Jeon
    The aim of this study is to examine the issues and the progress being made in leadership and management with relevance for the residential aged care workforce. A systematic review was conducted using scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts. After a seven-tiered culling process, we conducted a detailed review of 153 papers relevant to leadership and management development in aged care. Strong, effective leadership and management promotes staff job satisfaction and retention, high care quality and the well-being of care recipients, and reduces associated costs. Good leadership and effective management also play a key role in bringing about a successful change to a positive workplace culture through innovative programs and research projects. Organisational investment in improving leadership and management skills and capabilities can only improve outcomes for staff stability and productivity, care quality and budgets, and better prepare the aged care sector. [source]


    Using Patient Care Quality Measures to Assess Educational Outcomes

    ACADEMIC EMERGENCY MEDICINE, Issue 5 2007
    Susan R. Swing PhD
    ObjectivesTo report the results of a project designed to develop and implement a prototype methodology for identifying candidate patient care quality measures for potential use in assessing the outcomes and effectiveness of graduate medical education in emergency medicine. MethodsA workgroup composed of experts in emergency medicine residency education and patient care quality measurement was convened. Workgroup members performed a modified Delphi process that included iterative review of potential measures; individual expert rating of the measures on four dimensions, including measures quality of care and educational effectiveness; development of consensus on measures to be retained; external stakeholder rating of measures followed by a final workgroup review; and a post hoc stratification of measures. The workgroup completed a structured exercise to examine the linkage of patient care process and outcome measures to educational effectiveness. ResultsThe workgroup selected 62 measures for inclusion in its final set, including 43 measures for 21 clinical conditions, eight medication measures, seven measures for procedures, and four measures for department efficiency. Twenty-six measures met the more stringent criteria applied post hoc to further stratify and prioritize measures for development. Nineteen of these measures received high ratings from 75% of the workgroup and external stakeholder raters on importance for care in the ED, measures quality of care, and measures educational effectiveness; the majority of the raters considered these indicators feasible to measure. The workgroup utilized a simple framework for exploring the relationship of residency program educational activities, competencies from the six Accreditation Council for Graduate Medical Education general competency domains, patient care quality measures, and external factors that could intervene to affect care quality. ConclusionsNumerous patient care quality measures have potential for use in assessing the educational effectiveness and performance of graduate medical education programs in emergency medicine. The measures identified in this report can be used as a starter set for further development, implementation, and study. Implementation of the measures, especially for high-stakes use, will require resolution of significant measurement issues. [source]