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Qual Manag Health Care [journal]
- Call for papers. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):130.
- Letters. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):130.
- Making quality registers supporting improvements: a systematic review of the data visualization in 5 quality registries. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):119-28.
Traditionally, quality registries have been initiated, developed, and used by physicians essentially for research purposes. There is an unrealized opportunity to expand and strengthen the contribution of quality registries in health care quality improvement. This article aims to characterize quality registry annual reports regarding factors deemed important to process improvement. The 2012 annual reports of the 5 most highly developed Swedish quality registries were examined. Each of the 636 charts included was coded according to an abstraction form. Results show that league tables are highly prevalent, whereas funnel plots and control charts are rare. Health care quality is monitored over time on the basis of few and highly aggregated measurements, and it is usually measured using percentages. In conclusion, quality registry annual reports lack both the level of detail and the consideration of random variation necessary to being able to be systematically used in process improvement. Users of annual reports are recommended caution when discussing differences in quality, both over time and across health care providers, as they can be due to chance and insufficient guidance is provided on the reports in this regard. To better support process improvement, annual reports should thus be more detailed and give more consideration to random variation.
- Analysis and Improvement of Organizational Models for the Management of Patients With Type 2 Diabetes Mellitus: A Case Study in North-east Italy. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):99-118.
The study aimed to establish whether the organization for the management of type 2 diabetes mellitus at 9 diabetic units (DUs), in 5 neighboring local health authorities (LHAs), was able to (a) comply with the organizational model prescribed by specific regional standards; (b) ensure adequate clinical management of diabetic patients; (c) assess whether the relationship between primary care physicians (PCPs) and diabetologists (SDs) was instrumental to the needs of patients; (d) optimize specialist treatment at the DUs; (e) optimize drug management; and (f) check whether organizational changes led to variations in clinical results.This 6-stage study analyzed procedures, precoded actions, and recordable processes. Stage (1) Defining clinical and organizational endpoints; (2) Drafting flowcharts to describe the actions and work procedures implemented within each LHA; (3) Comparing the flowcharts with the data obtained from related literature; (4) Establishing a protocol shared with PCPs for the management and treatment of patients with type 2 diabetes; (5) Changing the procedures at the DUs; and (6) Evaluating the results. The data were assessed before and after establishing a shared protocol for SDs and PCPs (year 2009 vs 2011).The study shows inconsistencies in the organization of work in the 5 LHAs; however, collaboration with PCPs has guaranteed: (a) unchanged hemoglobin A1C values before and after applying the protocol; (b) a percentage increase in the number of patients with type 2 diabetes who were identified thanks to these protocols; (c) an increase in the use of biguanides compared to the preprotocol period; and (d) no change in the number of patients hospitalized because of acute complications from type 2 diabetes mellitus.This study confirms how adequate collaboration between SDs and PCPs keeps the risk of complications stable. Nevertheless, shared protocols and clearly defined roles are required.
- Implementing incentivized practice to improve patient care in developing countries. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):94-8.
Faculty awards provide an incentive to encourage higher standards of personal performance, which closely reflects the quality of health care. We report the development and implementation of the first medical faculty award program in the region.Anonymous preaward survey evaluated responses to understand the overall state of our institution. Five awards were celebrated. An anonymous postaward survey gathered responses to evaluate the effectiveness of the program.A total of 60% (307/509) of preaward survey responses were collected. Among those, 92% (283/307) felt that employee recognition was important and 78% (240/307) felt that performance should be the deciding criteria for employee recognition. A 24% (20/85) of the faculty received the decade of excellence award and 13% (11/85) received the compassionate physician award. Best service award was granted to 7% (6/85) of the nominees. Postaward survey showed 68% (170/250) agreed that the award ceremony incentivized them to increase quality of personal performance.In summary, we feel that this transparent, objective, and peer-nominated awards program could serve as an incentivized model for health care providers to elevate the standards of personal performance, which in turn will benefit the advancement of patient care.
- Factors influencing the length of hospital stay in patients with acute exacerbations of chronic obstructive pulmonary disease admitted to intensive care units. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):86-93.
The cost of hospital admissions for acute exacerbations of COPD (AECOPD) accounts for 70% of total costs for the treatment of COPD patients. We wanted to identify clinical parameters associated with a longer length of stay (LOS) in these patients.We reviewed electronic medical records of patients with AECOPD admitted between January 1, 2006, and December 31, 2010. The inclusion criteria were age 45 years or older, the diagnosis of AECOPD by GOLD (Global Initiative for Chronic Obstructive Lung Disease) guideline criteria, and admission to an intensive care unit. We compared the quartile with the longest LOS group with the other 3 quartiles using routine clinical data.217 patients met inclusion criteria. The mean age was 67.4 ± 10.9 years, 47% were male, the mean FEV1s (forced expiratory volume in 1 second) was 42.4% ± 17.4% of predicted, and the mean LOS was 9.0 ± 6.0 days. Univariate analysis demonstrated that nursing home status, low albumins, the presence of pleural effusions, intubation, and high APACHE II scores were associated with increased LOS (P < .05 for each factor). Multivariate logistic regression demonstrated that the need for intubation (P < .001) predicted an increased LOS.Our study demonstrates that intubation for mechanical ventilation increased the LOS in patients with AECOPD. More intensive interventions in these patients might decrease the LOS and improve outcomes.
- Relational continuity or rapid accessibility in primary care?: a mixed-methods study of veteran preferences. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):76-85.
To examine preferences for relational continuity and rapid accessibility for telephone care.A mixed-methods sequential explanatory design was utilized. Structured telephone interviews were conducted with 448 Veterans receiving primary care from Veterans Affairs facilities, who rated the importance of relational continuity and rapid accessibility. Seventeen focus groups were conducted with 123 Veterans to examine preferences for continuity versus accessibility and factors affecting these preferences.Higher proportions of interview patients rated talking with a nurse from their own primary care team (69%) and talking with a nurse with whom they have previous primary care contact (60%) as very important, compared with talking to any nurse as soon as possible (53%) and receiving advice immediately (50%). Focus group participants preferred a familiar provider within 24 hours over immediate contact with an unfamiliar provider, particularly for routine needs. Rapid accessibility was more frequently preferred for urgent questions/concerns. Preference for relational continuity was mitigated by patient age, and access to electronic medical records in larger, but not smaller, facilities.Health care systems supplementing in-person care with telephone care need to ensure that this care aligns with patient preferences and provide opportunities for both relational continuity and rapid accessibility where possible.
- Tools to expedite the development of treatment plans. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):70-5.
Quality improvement strategies can be used to modify existing health care processes to reduce patient wait times. We undertook a quality improvement project to reduce the time between new patients' initial visits and the finalization of their treatment plans. Initiation of treatment of new patients at the MD Anderson Sarcoma Medical Oncology Clinic can take up to 2 weeks from their initial consultation. Treatment delays result in increased costs and anxiety for the patient, adversely affecting the quality of care provided. We performed detailed process mapping and a cause-and-effect analysis to identify and prioritize opportunities for improvement. Process improvements addressed 2 key causes of delay to develop a finalized treatment plan: (1) insufficient data for decision making at the time of new patient visit and (2) delays in obtaining diagnostic imaging. After implementing our process improvements, the median time to develop a treatment plan decreased by 89% from 70.5 to 7.6 hours. Our process changes involved minimal additional work and had the secondary outcome of resulting in time savings for the clinic team.
- From the editor. [Journal Article]
- Qual Manag Health Care 2014 Apr-Jun; 23(2):69.
- Letter to the editor. [Comment, Letter]
- Qual Manag Health Care 2014 Jan-Mar; 23(1):64-5.