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Qual Manag Health Care [journal]
- Medical home interventions and quality outcomes for older adults: a systematic review. [Journal Article]
- Qual Manag Health Care 2013 Oct-Dec; 22(4):327-40.
Medical home care has been identified as a model for improving primary care delivery and population-specific quality and safety outcomes. Questions remain how this model affects older adult quality. This systematic review addresses 2 important questions: Are quality and safety outcomes associated with medical home and patient-centered interventions, and how is quality studied in older adult primary care research?The authors searched MEDLINE for articles that examined interventions that were associated with medical home principles. Each article was evaluated using a standardized data abstraction form. Studies were categorized according to how interventions influenced specific quality and safety outcomes-improved clinical and treatment measures and care delivery processes-for older adults.Thirteen research studies were identified by the authors. A great deal of variety exists in both research design and how quality and safety outcomes for older adults are operationalized in primary care. In general, studies indicate potentially beneficial relationships between 3 types of medical home interventions targeting health care utilization, disease management, and patient-provider communication to improved quality outcomes.It would be advantageous for practices looking to align with patient-centered medical home quality and safety goals to consider the needs of older adults when redesigning care delivery.
- An exploratory analysis of the correlation of pain scores, patient satisfaction with relief from pain, and a new measure of pain control on the total dose of opioids in pain care. [Journal Article, Research Support, U.S. Gov't, P.H.S.]
- Qual Manag Health Care 2013 Oct-Dec; 22(4):322-6.
We explored the associations between opioid dose and multiple measures of pain.Thirty-two consecutive patients admitted solely for an acute exacerbation of cancer-related pain or for surgery were followed for their entire hospital stay (115 days of pain). For each hospital day, we collected pain scores, the number of pain scores, trends in pain scores, the percentage of time patients had 100% acceptable relief from pain, and the number of times patients were asked about acceptable pain relief. Finally, we asked those who had 100% relief of pain whether they could have used more pain medicine. Linear regression models were fit to estimate the amount of variation explained (R) in dose of medication, by each pain measurement variable.Nineteen patients with cancer (74 days of pain) and 13 patients undergoing surgery (41 days of pain) were evaluated. Pain scores, the number of pain scores, trends in pain scores, and 100% acceptable relief scores poorly correlated with the use of medication in the linear regression models (R for all models ≤0.2). A question about needing more pain medicine explained the greatest amount of variation in opioid dose.Pain and acceptable relief scores do not adequately reflect the use of medication. A prospective study is needed to further assess the value of additional measures of the adequacy of pain care.
- The structure of service quality perceptions for multiple-encounter services. [Journal Article]
- Qual Manag Health Care 2013 Oct-Dec; 22(4):306-21.
The objective of this study was to examine a complex service environment-hospitals-to suggest how service quality could be reframed and measured for multiple-encounter service situations more effectively.In this cross-sectional study, a sample of 371 patients completed the survey instrument. Service quality measures were guided by the literature but allowed to flow from the respondents at the preliminary stage.Confirmatory factor analysis, along with structural equation modeling, was used to test the hypothesized relationships among key actors' performance metrics (KAPMs).Patient satisfaction is significantly influenced by perceived service quality based on KAPMs. For multiple-encounter services, service quality dimensions and measures ought to be tied to KAPMs.Primary actors-ie, doctors-need knowledge and skills about patient psychology, negotiation, handling difficult patients, and, importantly, "putting the customer first." Sensitivity training on such matters should be provided. The secondary actors are the nurses who have more frequent contact with the patients. Nurses need to be perceived as "patient advocates." Effective advocacy begins with prompt and caring services to build trust. The tertiary actors in their support role also ought to be integrated into becoming vital part of the service provided.
- Improving patient access in nuclear medicine: a case study of PET scanner scheduling. [Journal Article]
- Qual Manag Health Care 2013 Oct-Dec; 22(4):293-305.
We used the systems engineering technique of discrete event simulation modeling to assist in increasing patient access to positron emission tomographic examinations in the Department of Nuclear Medicine at Mayo Clinic, Rochester. The model was used to determine the best universal slot length to address the specific access challenges of a destination medical center such as Mayo Clinic. On the basis of the modeling, a new schedule was implemented in April 2012 and our before and after data analysis shows an increase of 2.4 scans per day. This was achieved without requiring additional resources or negatively affecting patient waiting, staff satisfaction (as evaluated by day length), or examination quality.
- Motivators and hygiene factors among physicians responding to explicit incentives to improve the value of care. [Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.]
- Qual Manag Health Care 2013 Oct-Dec; 22(4):276-92.
Physician's dissatisfaction is reported to be increasing, especially in primary care. The transition from fee-for-service to outcome-based reimbursements may make matters worse.To investigate influences of provider attitudes and practice settings on job satisfaction/dissatisfaction during transition to quality-based payment models, we assessed self-reported satisfaction/dissatisfaction with practice in a Rochester (New York)-area physician practice association in the process of implementing pay-for-performance.We linked cross-sectional data for 215 survey respondents on satisfaction ratings and behavioral attitudes with medical record data on their clinical behavior and practices, and census data on their catchment population. Factors associated with the odds of being satisfied or dissatisfied were determined via predictive multivariable logistic regression modeling.Dissatisfied physicians were more likely to have larger-than-average patient panels, lower autonomy and/or control, and beliefs that quality incentives were hindering patient care. Satisfied physicians were more likely to have a higher sense of autonomy and control, smaller patient volumes, and a less complex patient mix. Efforts to maintain or improve satisfaction among physicians should focus on encouraging professional autonomy during transitions from volume-based to quality/outcomes-based payment systems. An optimum balance between accountability and autonomy/control might maximize both health care quality and job satisfaction.
- Effect of modest pay-for-performance financial incentive on time-to-discharge summary dictation among medical residents. [Journal Article]
- Qual Manag Health Care 2013 Oct-Dec; 22(4):272-5.
Evaluate the effect of a modest financial incentive on time-to-discharge summary dictation among medicine residents.Pay-for-performance incentives are used in a number of health care settings. Studies are lacking on their use with medical residents and other trainees. Timely completion of discharge summaries is necessary for effective follow-up after hospitalization, and residents perform the majority of discharge summary dictations in academic medical centers.Medicine residents with the lowest average discharge-to-dictation time during their 1-month inpatient medicine ward rotation were rewarded with a $50 gift card. Discharge data were captured using an autopopulating electronic database.The average discharge-to-dictation time was reduced from 7.44 to 1.84 days, representing a 75.3% decrease. Almost 90% of discharge summary dictations were performed on the day of discharge.A modest financial incentive resulted in a marked improvement in the time-to-discharge summary dictation by medicine residents. Pay-for-performance programs may be an effective strategy for improving the quality and efficiency of patient care in academic medical centers.
- From the editor. [Editorial]
- Qual Manag Health Care 2013 Oct-Dec; 22(4):271.
- Care bundle methodology reporting must be rigorous. [Comment, Letter]
- Qual Manag Health Care 2013 Jul-Sep; 22(3):267.
- Home enteral feeding: analysis and improvement of organizational models. [Journal Article]
- Qual Manag Health Care 2013 Jul-Sep; 22(3):248-66.
The purpose of this study was to analyze the organizational models of home enteral feeding used in 5 local health authorities (LHAs) in the Veneto region (Italy). By comparing these models with the main guidelines, the authors have attempted to determine the "minimum standards" to be adopted at an organizational level.This 3-stage study analyzes procedures, precoded actions, and recordable processes. Stage 1: objectives were defined, work methods selected, and reference guidelines chosen. Stage 2: flowcharts were drafted to show the actions and work paths taken for the 5 LHAs. Stage 3: flowcharts were compared with data from the literature.The study shows that very different organizational models exist. For instance, by comparing organizational processes with the procedures prescribed by the guidelines, it can be seen that the mean percentages of actions taken by the 5 LHAs, for patients in both rest homes and nursing homes, rarely exceeds the threshold of 50% (on a scale from 0% to 100%).This study shows that home enteral feeding is neither optimized nor uniform in the 5 LHAs and that standardized methods are not used for clinical monitoring.
- The governance of quality management in dutch health care: new developments and strategic challenges. [Journal Article]
- Qual Manag Health Care 2013 Jul-Sep; 22(3):236-47.
This article gives a brief sketch of quality management in Dutch health care. Our focus is upon the governance of guideline development and quality measurement. Governance is conceptualized as the structure and process of steering of quality management. The governance structure of guideline development in the Netherlands can be conceptualized as a network without central coordination. Much depends upon the self-initiative of stakeholders. A similar picture can be found in quality measurement. Special attention is given to the development of care standards for chronic disease. Care standards have a broader scope than guidelines and take an explicit patient perspective. They not only contain evidence-based and up-to-date guidelines for the care pathway but also contain standards for self-management. Furthermore, they comprise a set of indicators for measuring the quality of care of the entire pathway covered by the standard. The final part of the article discusses the mission, tasks and strategic challenges of the newly established National Health Care Institute (Zorginstituut Nederland), which is scheduled to be operative in 2013.