Showing papers in "Journal for Healthcare Quality in 2006"
TL;DR: This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare.
Abstract: Healthcare, as with any other service operation, requires systematic innovation efforts to remain competitive, cost efficient, and up-to-date. This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare. Controlling healthcare cost increases, improving quality, and providing better healthcare are some of the benefits of this approach.
444 citations
TL;DR: The research base for the transitional care of older adults is described and recommendations to advance the science, translate best practices into home healthcare settings, and improve the transitions of high‐risk older adults to and from home healthcare are offered.
Abstract: Focusing on the critical transitions of patients and their caregivers across healthcare settings and among providers is a promising approach to enhancing care coordination and improving quality. This article describes the research base for the transitional care of older adults and offers recommendations to advance the science, translate best practices into home healthcare settings, and improve the transitions of high-risk older adults to and from home healthcare. Home healthcare is a component of the healthcare industry uniquely positioned to improve transitional care and outcomes for the growing population of older adults with continuous complex needs.
82 citations
TL;DR: Through the use of the PDMW, medication reconciliation has been dramatically improved and is found to greatly reduce adverse drug and medication events.
Abstract: Medication errors are among the most common type of patient-safety error and therefore are a priority for organizational performance-improvement efforts. Medication reconciliation has been found to greatly reduce adverse drug and medication events. At one facility, a computer-generated Physician Discharge Medication Worksheet (PDMW) was developed to aid medication reconciliation. Use of this tool led to a reduction in discrepancies in drug frequency and dose, as well as therapeutic duplication, at the time of discharge. Through the use of the PDMW, medication reconciliation has been dramatically improved.
39 citations
TL;DR: Preliminary outcomes of the program evaluated over a 4‐year period after implementation revealed improvements in aggregated rates of risk‐adjusted surgical complications and efficiency of care as evidenced by a substantial decrease in risk‐ adjusted average LOS for several surgical procedures.
Abstract: This article describes the structure, implementation, and early results of a performance-based hospital incentive program designed by a large nonprofit health plan. The Hospital Quality Service and Recognition program, developed by the Hawaii Medical Service Association, was launched in 2001 to reward high-quality medical care at the hospital level. This pay-for-performance program used administrative claims data, survey data, and hospital-reported information to assess hospital performance in risk-adjusted complications and risk-adjusted length of stay (LOS), patient satisfaction, and hospital processes of care measures. Financial incentives were provided to participating hospitals based on their performance on these measures. Preliminary outcomes of the program evaluated over a 4-year period after implementation revealed improvements in aggregated rates of risk-adjusted surgical complications and efficiency of care as evidenced by a substantial decrease in risk-adjusted average LOS for several surgical procedures. Quality improvement was demonstrated in several other program components including emergency department satisfaction. This quality incentive program offers an innovative approach for encouraging delivery of high-quality and service-oriented care in a statewide network of participating hospitals.
21 citations
TL;DR: Patients in this study reported that portable computers used at the bedside did not affect the clinician‐patient relationship and patients thought that the technology was a valuable tool and that it could foster an efficient hospital atmosphere and promote reliable and accurate medical documentation.
Abstract: Electronic patient records provide an opportunity for real-time access to patient information at the bedside, which has the potential to improve healthcare quality because it would increase efficiency and facilitate best practice. Patients in this study reported that portable computers used at the bedside did not affect the clinician-patient relationship. Many patients thought that the technology was a valuable tool and that it could foster an efficient hospital atmosphere and promote reliable and accurate medical documentation.
19 citations
TL;DR: A study that developed and implemented a multifaceted intervention to improve pain practices in nursing homes is reviewed and the implications of those study findings for the home healthcare setting are examined.
Abstract: Persistent pain affects at least half of all older adults. The negative consequences of persistent pain are numerous and include depression, anxiety, and lower overall quality of life: However, pain is often underrecognized, underreported, underassessed, and undertreated, and multiple barriers to optimal pain practices exist. Although a solid evidence base exists for optimal pain practices, little progress has been made. This article reviews a study that developed and implemented a multifaceted intervention to improve pain practices in nursing homes and then examines the implications of those study findings for the home healthcare setting.
15 citations
TL;DR: Examining how organizational climate has been defined and measured in health services research and identifies factors most important in home healthcare delivery finds standardization of climate measures will facilitate the ultimate goal of translating results into evidence‐based management practices to improve the quality of care delivery.
Abstract: Organizational climate generally refers to staff members' perceptions of organizational features like decision making, leadership, and norms. It is widely acknowledged that these perceptions influence patient, employee, and system outcomes. However, there has been little consensus on how best to measure these important relationships. This article examines how organizational climate has been defined and measured in health services research and identifies factors most important in home healthcare delivery. Standardization of climate measures will facilitate the ultimate goal of translating results into evidence-based management practices to improve the quality of care delivery.
15 citations
TL;DR: O Obstacles to implementing a customer service program in a multifaceted academic setting are highlighted, and the use of a novel tool, Q technique, to prioritize employee feedback is discussed.
Abstract: In the 21st-century healthcare environment, customer service remains critical to the fiscal viability of healthcare organizations. Continued competition for patients and diminishing reimbursements have necessitated the establishment of customer service programs to attract patients and retain outstanding employees. These programs should increase quality experiences for both internal customers (employees) and external customers (patients). This article describes a unique employee-driven customer service initiative titled Serving Together Achieving Results. Obstacles to implementing a customer service program in a multifaceted academic setting are highlighted, and the use of a novel tool, Q technique, to prioritize employee feedback is discussed.
14 citations
TL;DR: Key lessons from translation science are summarized and the implications for the organization and delivery of home healthcare are examined.
Abstract: Implementation of research evidence into clinical practice is a complex and dynamic process that has become the subject of investigation in the field of "translation science" or "knowledge utilization." Research shows how individuals, units, and organizations all influence the rate and extent of adoption of research evidence. Environmental factors also play an important role in this process. This article summarizes key lessons from translation science and examines the implications for the organization and delivery of home healthcare. The implementation of pain management guidelines is used as an example.
12 citations
TL;DR: The team used families' feedback to shape quality improvement initiatives and focused on questions with comparatively lower scores: physician communication, physician compassion, and family understanding of what to expect as their loved one approached the end of life.
Abstract: To enhance end-of-life care in a community hospital system, an interdisciplinary team designed and implemented a mail survey to obtain feedback from families of inpatients who died The 855 completed surveys (a 31% response rate) demonstrate that bereaved families are willing to give feedback on care received from nurses and physicians and attention paid to the personal needs of patients and families The team used families' feedback to shape quality improvement initiatives and focused on questions with comparatively lower scores: physician communication, physician compassion, and family understanding of what to expect as their loved one approached the end of life
11 citations
TL;DR: This article describes a study that investigated the viability of the EMR as a database for evaluating quality in a women's primary health clinic.
Abstract: Healthcare organizations are under increasing pressure to evaluate and report the level of quality in their health services. The electronic medical record (EMR) has been used in acute care settings to provide clinical data for quality evaluations. The implementation of the EMR in primary care settings is a more recent development, and as a result, the EMR has not been widely used to evaluate quality in primary care. Little research exists that uses the primary care medical record as a source of data. What remains to be seen is the extent to which EMRs contain the variables needed to address quality of primary care. This article describes a study that investigated the viability of the EMR as a database for evaluating quality in a women's primary health clinic.
TL;DR: Results indicate that antibiotic audit and educational interventions improve physicians' adherence to hospital guidelines for CAP.
Abstract: Community-acquired pneumonia (CAP) is the Leading cause of death from infection. In order to evaluate physicians' adherence to hospital guidelines for CAP, an observational prospective study during two consecutive winter periods at an Irish teaching hospital was performed. A series of educational sessions on management of CAP was provided for medical staff at the end of the first year. Comparison of results showed significant improvement in the rate of blood culture sampling (p < .01), sputum sampling (p < .05), and combined blood culture and sputum sampling (p < .01). Length of antibiotic treatment was more appropriate in the second study year. Results indicate that antibiotic audit and educational interventions improve physicians' adherence to hospital guidelines.
TL;DR: Two quality improvement initiatives undertaken by a palliative care program in Canada are discussed, demonstrating how the quality improvement process acted as a catalyst to enhance research readiness.
Abstract: Quality improvement is an essential feature of the ongoing development of palliative care programs. Little has been written, however, about using quality improvement as a strategy to introduce research concepts to staff and administrators for the purpose of enhancing research readiness in healthcare settings. This article describes such an endeavor. The authors discuss two quality improvement initiatives undertaken by a palliative care program in Canada. These two examples demonstrate how the quality improvement process acted as a catalyst to enhance research readiness.
TL;DR: Results suggest that if systems of care are redesigned, the payoff in patient and staff satisfaction and in improved functional and economic outcomes can be substantial.
Abstract: Since implementation of the Outcome and Assessment Information Set and publicly reported outcome indicators, a focus of home healthcare necessarily includes efforts to improve older patients' functional abilities. This article presents results from selected home-based research studies providing strategies for evidence-based practice to efficiently and effectively improve functional outcomes. Assessments and interventions are suggested, as well as administrative and clinical processes of care that have been found to successfully translate research into practice. Results suggest that if systems of care are redesigned, the payoff in patient and staff satisfaction and in improved functional and economic outcomes can be substantial.
TL;DR: This article explores one community hospital's success in bringing a research focus into its performance improvement initiatives.
Abstract: Lack of research expertise and participation in the nonacademic setting hinders evidence-based performance improvement in community hospitals Research opportunities are Limited in small hospitals, and staff nurses often are unfamiliar with research terminology and practice This article explores one community hospital's success in bringing a research focus into its performance improvement initiatives
TL;DR: A self‐administered medical staff satisfaction survey was developed and validated to develop and validate a reliable and valid method to assess physician satisfaction in order to identify potential areas of discontent.
Abstract: Hospitals continuously look for ways to improve patient care and retain high-quality physicians. Previous research indicates that physicians' satisfaction with where they practice is a crucial part of addressing these issues. A reliable and valid method to assess physician satisfaction is needed in order to identify potential areas of discontent. The purpose of the present study was to develop and validate a self-administered medical staff satisfaction survey. The survey contains 13 Likert-type items divided into three reliable subscales: Quality of Patient Care (alpha = .84), Ease of Practice (alpha = .76), and Relationship with Leadership (alpha = .92). Results from both exploratory and confirmatory factor analyses supported the survey's structure and robustness across three independent samples.
TL;DR: The article highlights the value of collecting and analyzing formative data on the process and offers specific recommendations to other QI professionals contemplating the use of claims data for performance feedback.
Abstract: Performance feedback is a common quality improvement (QI) intervention strategy in the outpatient setting. This article describes the use by one quality improvement organization (QIO) of performance feedback to primary-care physicians with claims-based measures relating to diabetes, adult vaccinations, and mammography screening. Feedback from the physicians identified themes relating to data accuracy, methodology of the feedback reports, reasons for low performance rates, and suggestions on how the QIO could improve its intervention strategy. The article highlights the value of collecting and analyzing formative data on the process and offers specific recommendations to other QI professionals contemplating the use of claims data for performance feedback.
TL;DR: It is indeed possible for rural hospitals to meet and exceed the unique needs of patients and physicians, to achieve healthy profit margins, and to be the rural hospital of choice that employees are proud to work for.
Abstract: This article describes the emerging trend of using metrics in rural hospitals to achieve world-class performance. This trend is a response to the fact that rural hospitals have small patient volumes yet must maintain a profit margin in order to fulfill their mission to the community. The conceptual idea for this article is based largely on Robert Kaplan and David Norton's Balanced Scorecard articles in the Harvard Business Review. The ideas also come from the experiences of the 60-plus rural hospitals that are using the Balanced Scorecard and their implementation of metrics to influence performance and behavior. It is indeed possible for rural hospitals to meet and exceed the unique needs of patients and physicians (customers), to achieve healthy profit margins, and to be the rural hospital of choice that employees are proud to work for.
TL;DR: A technology tool was developed that calculates medication dosage requirements during emergency situations and a simple low‐cost technological solution for improving patient safety and care‐provider assurance is described.
Abstract: To prevent adverse drug events for pediatric patients, increase care provider efficiency, and reduce stress for care providers, a technology tool was developed that calculates medication dosage requirements during emergency situations. This article describes a simple low-cost technological solution for improving patient safety and care-provider assurance. Follow-up studies provide validation of the technology tool.
TL;DR: The concept of autcorrelation is discussed and the negative impact of autocorrelation on traditional SPC methods is demonstrated, with a specific focus on the use of SPC charts to detect unusual events.
Abstract: Statistical process control (SPC) charts have become widely implemented tools for quality monitoring and assurance in healthcare settings across the United States. SPC methods have been successfully used in industrial settings to track the quality of products manufactured by machines and to detect deviations from acceptable levels of product quality. However, problems may arise when SPC methods are used to evaluate human behavior. Specifically, when human behavior is tracked over time, the data stream generated usually exhibits periodicity and gradualism with respect to behavioral changes over time. These tendencies can be quantified and are recognized in the statistical field as autocorrelation. When autocorrelation is present, conventional SPC methods too often identify events as “unusual” when they really should be understood as products of random fluctuation. This article discusses the concept of autocorrelation and demonstrates the negative impact of autocorrelation on traditional SPC methods, with a specific focus on the use of SPC charts to detect unusual events.
TL;DR: It is suggested that within the next five years, the number of children born with Down's syndrome in Northern Ireland will more than double from the current number of births in the region, which is thought to be around 5,000.
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TL;DR: Patient safety indicators can be a valuable reporting tool to incorporate into patient safety plans to monitor performance and identify areas that warrant further investigation.
Abstract: Patient safety indicators (PSIs) can be a valuable reporting tool to incorporate into patient safety plans to monitor performance and identify areas that warrant further investigation. The Agency for Healthcare Research and Quality (AHRQ) developed PSIs as a low-cost tool to enable hospitals to monitor safety patterns within specific patient populations. Screening performance and evaluating it against empirical rates provided by AHRQ are the cornerstones of the PSI system.
TL;DR: In this article, the authors examined automated DUR for home healthcare patients with diabetes or hypertension, and found that 60% of patients and 50.7% of hypertension triggered severe, moderate, or duplicative alerts.
Abstract: Computerized drug utilization review (DUR) can potentially reduce adverse drug events. We examined automated DUR for home healthcare patients with diabetes or hypertension. Sixty-eight percent of diabetes patients and 50.7% of hypertension patients triggered severe, moderate, or duplicative alerts. Among diabetes patients, 74.3% of duplicative alerts were trivial or inappropriate, compared with 3.9% among hypertension patients. Experts judged that 40.5% of high-risk diabetes patients and 53.6% of hypertension patients had alerts requiring nurse follow-up. Adequate follow-up was significantly lower for the former. The relationship between inappropriate alerts and poorer follow-up reinforces the need for more specific alert systems to focus clinicians' attention on clinically important alerts.
TL;DR: The preliminary results support the idea that the TQManager Feedback Instrument has potential for application in healthcare organizations trying to close the quality chasm.
Abstract: The focus of this article is secondary analysis of data to establish the psychometric properties of the TQManager Feedback Instrument. The TQManager Feedback Instrument was developed by Schmidt and Finnegan in 1993 to assess five key managerial competencies related to creating work environments where quality management can thrive. The overall instrument reliability measured by Cronbach's alpha was 0.97. Construct validity assessment using principal components analysis with varimax rotation did not empirically support the thesis that more than one dimension exists on the instrument. Further psychometric testing is needed. The preliminary results support the idea that the TQManager Feedback Instrument has potential for application in healthcare organizations trying to close the quality chasm.
TL;DR: The trend in the rate of avoidable hospitalizations and the rapid growth of the beneficiary population indicate that new enrollees had a higher health status and perhaps better access to outpatient care.
Abstract: Most research shows a lower rate of avoidable hospitalizations associated with better access to outpatient care. Such findings have important implications for the Veterans Health Administration (VHA), with its change from delivering mainly inpatient services to emphasizing quality ambulatory care. From 1999 to 2004 the number of avoidable hospitalizations at the VHA increased while the rate per 10,000 enrollees declined. The trend in the rate of avoidable hospitalizations and the rapid growth of the beneficiary population indicate that new enrollees had a higher health status and perhaps better access to outpatient care.
TL;DR: MaineHealth leveraged knowledge, resources, and data through collaboration to help providers improve care and outcomes for asthma, heart failure, diabetes, and depression, and it can help influence improvement efforts in other small and medium‐sized rural communities.
Abstract: Small and rural communities face unique challenges in improving healthcare quality. To address these challenges, MaineHealth, an integrated health system serving small and rural communities, leveraged knowledge, resources, and data through collaboration to help providers improve care and outcomes for asthma, heart failure, diabetes, and depression. The programs emphasized patient self-care, used uniform clinical standards, and supported population-based data collection. This collaborative approach provided an effective way to achieve improved outcomes across a geographically and structurally diverse system, and it can help influence improvement efforts in other small and medium-sized rural communities.
TL;DR: The process by which a payer and provider were able to transform a contentious relationship into a collaborative patient‐centered program is described, which demonstrates that through the sharing of retrospective utilization data, improved clinical and financial outcomes can be achieved.
Abstract: The current relationship between payers and providers is often adversarial. The growth of managed care has fostered very little cooperation between the payer and provider, even though both are working toward improved patient outcomes. This article describes the process by which a payer and provider were able to transform a contentious relationship into a collaborative patient-centered program. The program demonstrates that through the sharing of retrospective utilization data, improved clinical and financial outcomes can be achieved.
TL;DR: Differences in clinical practice for 30 clinical indicators suggest potential targets for healthcare quality improvements and patients seeing physicians who treated a high volume of patients generally received better care.
Abstract: This article examines variations in clinical practice for 30 clinical indicators. Patients' age, gender, and morbidity and certain characteristics of their physicians affected whether they received recommended care. Recommended care increased with patient age for 13 significant clinical indicators and decreased with age for 7 others. Males received recommended care more often for 12 of 13 clinical indicators. Recommended care varied by physician specialties for health screenings, disease management, and medication use. Patients seeing physicians who treated a high volume of patients generally received better care. The variations in recommended care suggest potential targets for healthcare quality improvements.