Quality Management in Health Care最新文献

Background and objectives: Slovenia lags behind international recommendations for reporting and learning from patient safety incidents and risk management in health care. To counter this, the country established the SenSys project, which receives technical support from the European Commission's Structural Reform Support Service, in cooperation with the Danish Patient Safety Authority, and pertains to an initiative to improve health care. A subproject of the SenSys project works to adapt and implement the International Classification for Patient Safety of the World Health Organization (ICPS-WHO). This article presents a case study of the national research process to identify the necessary Slovenian national adaptation and upgrade of the ICPS-WHO, the ICPS-SL, particularly regarding types of patient safety incidents. Our aim was to reflect on how we used the insights from different research elements and learned from different aspects of our project/system development.

Methods: We used the SQUIRE 2.0 (Standards of Quality Improvement Reporting Excellence) to present our case study. The methods used to collect information on the necessary adaptations to establish an optimal ICPS-SL included a literature review, qualitative analysis of national consultation meetings, and a 2-cycle Delphi study. This process took place between January 2018 and August 2019, and we found 18 useful articles. Participants such as providers, users, and national bodies from national consultation meetings were all key stakeholders.

Results: The relevant stakeholders agreed upon changes to the ICPS-WHO to implement in the ICPS-SL as an integrated part of a Slovenia's incident reporting and learning system. Notably, they implemented changes in terminology in the translation of some English terms. They also added or hierarchically reordered some patient safety incident types: for example, they added the nation-specific point "treatment of pain" as a type of patient safety incident. The stakeholders will also partially integrate the following indicators: monitoring systems, vigilance systems, and complaint systems.

Conclusion: Different research elements contributed to the ICPS-SL's new knowledge and more reliable development. We emphasized a cooperative process with a consensus-building approach while linking the knowledge, experience, and needs of various stakeholders. All interested parties adopted this process, aiming to establish conditions for national learning from patient safety incidents and better preventive action for health care quality and safety. Vertical and horizontal multidisciplinary teamwork was a focal point as well. Technical assistance proved especially useful. It is now necessary to clinically test the ICPS-SL classification framework as Slovenia's internationally harmonized standard, and have the Health Council adopt it for use both online and in practice.

The number of publicly available hospital quality rating systems has substantially increased over the past 2 decades. These rating systems are meant to provide patients, clinicians, and payers with relevant information to select and pay differentially for better quality of care. However, there is evidence of inconsistency, unreliability, and bias in current hospital quality rating systems. Financial ratings are similarly intended to enable investors to identify stronger companies (as investment targets), and these rating systems could provide insight into strategies to improve hospital quality ratings. We evaluate the credit rating methodologies of Standard & Poor's, Moody's, and Fitch Group and propose principles to improve hospital quality rating systems through better standardized measures and the use of external audits of source data. Emulating key features of credit rating systems may advance the delivery of meaningful hospital quality ratings.

Background: There exists an array of quality performance measures for nursing homes. They can confuse consumers, administrators, and government regulators. Our methodology provides a unified multidimensional evaluation.

Objective: To present a methodology to perform a multidimensional assessment of each nursing home within any specified group of nursing homes to aid policy makers, administrators, and consumers with a clear, easy-to-interpret evaluation of a nursing home quality performance.

Methods: We use data envelopment analysis (DEA) to integrate several quality measures into a comprehensive benchmarking model. We present statewide results comparing DEA performance scores with the Five-Star rating using data from New York State (NYS) Department of Health.

Results: In total, 212 of the 526 nursing homes performed as well as possible. Public nursing homes are most likely to lie on the frontier and have the highest average performance scores. The relationship between the DEA-based performance scores and the NYS Five-Star quality ratings is very weak.

Conclusion: DEA is a comprehensive methodology for measuring nursing home quality. The DEA factor performance scores provide detailed information for individual nursing homes, enabling administrators to benchmark their facility's quality performance and to focus quality improvement efforts more effectively.

Background and objectives: Patient experience measures tend to have notable ceiling effects that make it difficult to learn from gradations of satisfaction to improve care. This study tested 2 different iterative satisfaction measures after a musculoskeletal specialty care visit in the hope that they might have less ceiling effect. We measured floor effects, ceilings effects, skewness, and kurtosis of both questionnaires. We also assessed patient factors independently associated with the questionnaires and the top 2 possible scores.

Methods: In this cross-sectional study, 186 patients completed questionnaires while seeing 1 of 11 participating orthopedic surgeons in July and August 2019; the questionnaire measured: (1) demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit on 2 iterative satisfaction scales. Bivariate and multivariable analyses sought associations of the explanatory variable with the satisfaction scales.

Results: There is a small correlation between the 2 scales ( r = 0.27; P < .001). Neither scale had a floor effect and both had a ceiling effect of 45%. There is a very small correlation between greater health anxiety and lower satisfaction measured with one of the scales ( r = -0.16; P = .05).

Conclusion: An iterative satisfaction questionnaire created some spread in patient experience data, but could not limit ceiling effects. Additional strategies are needed to remove ceiling effects from satisfaction measures.

Background and objectives: Treatment of chronic, noninfectious ocular inflammation includes corticosteroids, disease-modifying antirheumatic medications, and biologics. To mitigate adverse effects associated with the use of these medications, routine laboratory test monitoring is recommended throughout treatment. We evaluated the effectiveness of an alert added to the electronic medical record (EMR) to aid in laboratory test monitoring for patients prescribed these high-risk medications.

Methods: A prospective, interventional study assessed the effect of the alert within the EMR on laboratory test ordering at the Division of Ocular Immunology at the Wilmer Eye Institute. The primary outcome measure was the change in number of ordered laboratory tests at 3, 6, and 12 months after the alert activation compared with pre-intervention levels and overall through the study period. The laboratory tests that were monitored included complete blood count, comprehensive metabolic panel, dual-energy x-ray absorptiometry (DXA) scanning, fasting lipid panel, and interferon gamma release assays.

Results: The laboratory test orders for 153 patients on high risk medications were analyzed. Only the frequency of ordering the DXA and interferon gamma release assays increased significantly, compared with baseline, throughout the study. Conversely, there was a significant decrease in the frequency of ordering of fasting lipid profiles and hemoglobin A 1c at each time point and for complete blood count and comprehensive metabolic panel at the 6-month time point.

Conclusion: An EMR alert results in increased laboratory test ordering initially for tests drawn on a yearly basis, but the effect on more frequently ordered tests wanes with time if the alert can be silenced by the provider. Nonetheless, it provides a novel mechanism to increase laboratory ordering in patients on high-risk medications that can be adapted for use in other EMR software. Future studies are needed to assess whether physician laboratory test ordering behavior is altered throughout the study period with the use of a non-silencable alert.

Background and objectives: While the priority of caregivers in any health care establishment is patient care, they are often constrained by time and cannot fully devote themselves to projects aiming at improving the quality and safety of care. Although the culture of quality is widespread in health care establishments, the quality and safety department team must continue to improve existing procedures and develop new ones, in order to reinforce the take-home message that safety is of paramount importance. Since good communication is a key factor in the success of quality plans, the quality and safety team in our establishment is placing special emphasis on "out of the ordinary" activities that take professional carers out of their daily routines, arouse their curiosity, and increase their adherence to quality procedures.

Methods: The issues addressed during these activities are based on the year-round continuous assessment of in-house procedures. Only those that have been deemed essential for safe care are focused upon. Most of the activities that are implemented have already been tried and tested in the fields of industry and aviation, and they all have a fun, collaborative, and creative component. Their impact and effect are assessed by carrying out the same assessments as those used at the beginning on the project.

Results: These innovative activities, which have received strong support from the staff, have had a positive effect on interdepartmental cooperation, on the adherence to the new methods presented, and on ensuring that information is made available to the greatest number of professionals. They have allowed the staff to acquire and consolidate new professional knowledge and have promoted good practice.

Conclusion: This new program of activities has considerably improved the safety culture within our establishment. While the relationship between the skills of professionals and patient safety is clear to all, the message needs to be delivered in an original way that makes a lasting impression, in addition to using "standard" communication methods such as plenary meetings. The bottom line is to get as many professionals as possible fully adherent to the culture of quality, since quality is everyone's business and health care procedures are constantly evolving. Based on our experience, we provide a set of activities that can be improved and adapted according to the setting in which it is used.