Best practices and benchmarking in healthcare : a practical journal for clinical and management application最新文献

The editors are providing this Executive Summary by the University HealthSystem Consortium of their Emergency Department Benchmarking Project. The report has been reviewed by the participating members listed at the end of the summary. The summary report provides both an interesting account of how a benchmarking project of considerable magnitude can be accomplished but also indicates how important comparative data can be used to improve individual programs.

The editors are providing this Executive Summary by the University HealthSystem Consortium of their Adult ICU Benchmarking Project. The report has been reviewed by the participating members listed at the end of the summary. The summary report provides both an interesting account of how a benchmarking project of considerable magnitude can be accomplished but also indicates how important comparative data can be used to improve individual programs.

An individual program's viewpoint on the overall benchmarking process for critical care medicine and how this process can provide a conceptual understanding of how benchmarking can be beneficial.

Background: The total expense associated with acute myocardial infarction in the United States is substantial because of the combination of high volume and high cost per case. The aim of this study was to identify potential cost-saving strategies for the management of acute myocardial infarction.

Methods: Information was gathered through professional interviews combined with an extensive literature review.

Results: Numerous opportunities for cost savings were identified and classified into six categories: pharmaceuticals, changing the work within steps, corporate philosophy and clinical decision making, continuous physician education and involvement, preventive measures and systems of care, and additional resources.

Conclusions: Although there are many possible areas healthcare providers could consider for cost saving in acute myocardial infarction, the situation at each site will need to be considered carefully before areas are selected. It is of vital importance that the quality of care not be compromised in the effort to reduce cost.

There is a significant but different role for hospital staff nurses within a managed care environment. This article describes the role and reviews major areas where the staff nurse is critical in achieving positive patient outcomes that are cost-effective and efficient.

Making the decision to retire from active practice is a complex process with very strong psychological overtones. Successful retirement demands preplanning, and financial preplanning must begin very early in the career to achieve the time value of money. Psychological preparation requires recognition that retirement is inevitable, and an avenue of change for yourself and your spouse should be identified, anticipated, and refined over time.

A growing concern about the deterioration of the clinical skills of physicians has stimulated a renewed interest in the teaching and assessment of these skills. Standardized patients can be an effective means to teach or assess a physician's competence in clinical skills, such as history taking, physical examination, and patient-physician interaction skills. This article will describe this new method and delineate its emerging role in medical school education, residency training, and its potential role in continuing education and quality assurance for practicing physicians within a managed care setting.

The Highmark Blue Cross/Blue Shield Pegasus Project was created in the fall of 1996 to benchmark best practices at health plans around the United States through extensive interviews, literature searches, and other measures. Characteristics of highly successful health plans across a number of major categories are summarized in the final recommendations presented by this report.

Background: A small urban hospital identified angina pectoris (DRG 140) as a high-cost and low-reimbursement DRG. Variation in the process of care for patients with cardiac chest pain was related to the timing of decisions on stress tests and whether inpatient GI workups were performed. Underutilization of aspirin was identified as a quality of care issue. In collaboration with Texas Medical Foundation (TMF), the Quality Improvement Organization (QIO) for Texas, this became the initial Health Care Quality Improvement Program (HCQIP) project and the first effort by the hospital at pathway development.

Intervention: A team effort lead by physicians, including other healthcare groups at the hospital, identified elements considered essential to providing ideal care for patients with cardiac chest pain, formulating these elements into a clinical pathway.

Results: Emergency room physicians, an essential stakeholder group, had not been included in the initial pathway development, which proved to be a critical factor to effective implementation. Pathway implementation was associated with increased administration of aspirin by 45.7% (p < 0.001), reduced length of stay by 1.0 days (p = 0.064), and reduced total charges by an average of $1710.20 (p = 0.039).

Discussion: These results suggest that process of care improvement, i.e., clinical pathway implementation, in collaboration with a QIO, contributed to reduced variation in the process of care. Participation by all stakeholders from the beginning in process of care improvement is essential.