Qual Manag Health Care [journal]
- Call for Reviewers. [Journal Article]
- Qual Manag Health Care 2016 Apr-Jun; 25(2):121.
- Call for Papers. [Journal Article]
- Qual Manag Health Care 2016 Apr-Jun; 25(2):121.
- Information for Authors. [Journal Article]
- Qual Manag Health Care 2016 Apr-Jun; 25(2):121.
- Advancing Payment Reform at the Community Level. [Journal Article]
- Qual Manag Health Care 2016 Apr-Jun; 25(2):111-20.
Multistakeholder alliances-groups of payers, purchasers, providers, and consumers that voluntarily work together to address local health goals-have increasingly been used to improve health care quality within their communities. Under the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) initiative, 16 multistakeholder alliances were charged with advancing payment reform as part of a larger effort to achieve dramatic and sustainable quality improvement.Drawing upon key informant interviews with alliance leaders and document reviews conducted from 2010 to 2014, we describe the payment reform projects undertaken by the AF4Q alliances and the roles that the alliances played to advance them.The most common types of projects pursued by alliances were those that introduced supplemental payments to fee-for-service reimbursement and built upon alliances' ongoing quality improvement initiatives. Alliances advanced payment reform through 4 roles: (1) educating and advocating, (2) designing payment reform projects, (3) recruiting participants, and (4) supporting the operation of projects. However, less than half of alliances' payment reform projects were operational by 2014.Quality improvement-focused multistakeholder alliances may play meaningful roles to advance payment reform, but they are not a panacea for overcoming well-documented barriers to reform.
- Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration. [Journal Article]
- Qual Manag Health Care 2016 Apr-Jun; 25(2):102-10.
The Veterans Health Administration piloted patient-centered care (PCC) innovations beginning in 2010 to improve patient and provider experience and environment in ambulatory care. We use secondary data to look at longitudinal trends, evaluate system redesign, and identify areas for further quality improvement.This was a retrospective, observational study using existing secondary data from multiple US Department of Veteran Affairs sources to evaluate changes in veteran and facility outcomes associated with PCC innovations at 2 innovation and matched comparison sites between FY 2008-2010 (pre-PCC innovations) and FY 2011-2012 (post-PCC innovations). Outcomes included access to primary care providers (PCPs); primary, specialty, and emergency care use; and clinical indicators for chronic disease.Longitudinal trends revealed a different story at each site. One site demonstrated better PCP access, decrease in emergency and primary care use, increase in specialty care use, and improvement in diabetic glucose control. The other site demonstrated a decrease in PCP access and primary care use, no change in specialty care use, and an increase in diastolic blood pressure in relation to the comparison site.Secondary data analysis can reveal longitudinal trends associated with system changes, thereby informing program evaluation and identifying opportunities for quality improvement.
- Building Systemwide Improvement Capability: Does an Organization's Strategy for Quality Improvement Matter? [Journal Article]
- Qual Manag Health Care 2016 Apr-Jun; 25(2):92-101.
Health care organizations have used different strategies to implement quality improvement (QI) programs but with only mixed success in implementing and spreading QI organization-wide. This suggests that certain organizational strategies may be more successful than others in developing an organization's improvement capability. To investigate this, our study examined how the primary focus of grant-funded QI efforts relates to (1) key measures of grant success and (2) organization-level measures of success in QI and organizational learning.Using a mixed-methods design, we conducted one-way analyses of variance to relate Veterans Affairs administrative survey data to data collected as part of a 3.5-year evaluation of 29 health care organization grant recipients. We then analyzed qualitative evidence from the evaluation to explain our results.We found that hospitals that focused on developing organizational infrastructure to support QI implementation compared with those that focused on training or conducting projects rated highest (at α = .05) on all 4 evaluation measures of grant success and all 3 systemwide survey measures of QI and organizational learning success.This study adds to the literature on developing organizational improvement capability and has practical implications for health care leaders. Focusing on either projects or staff training in isolation has limited value. Organizations are more likely to achieve systemwide transformation of improvement capability if their strategy emphasizes developing or strengthening organizational systems, structures, or processes to support direct improvement efforts.
- Involvement Drivers: A Study of Nurses and Physicians in Improvement Work. [Journal Article]
- Qual Manag Health Care 2016 Apr-Jun; 25(2):85-91.
This article reports on the involvement of nurses and physicians in improvement work, with a special focus on the drivers. The purpose was to describe how the nurse and physician groups understand involvement drivers for improvement work and to explain the differences in how they understand involvement. The study was conducted at 2 Swedish hospitals, and a total of 20 nurses and 10 physicians were interviewed. The theoretical framework, developed by an interpretative approach, identifies and describes a number of involvement drivers. On clustering the drivers into larger involvement factors, the study shows clear differences and profiles in terms of the 2 groups' perception and understanding of the involvement-drivers. Each group's profile was then analyzed on the basis of concept of professional culture.
- Expanding Continuous Quality Improvement Capacity in the Medical Intensive Care Unit: Prehealth Volunteers as a Solution. [Journal Article]
- Qual Manag Health Care 2016 Apr-Jun; 25(2):79-84.
Health care delivery systems are challenged to support the increasing demands for improving patient safety, satisfaction, and outcomes. Limited resources and staffing are common barriers for making significant and sustained improvements. At Oregon Health & Science University, the medical intensive care unit (MICU) leadership team faced internal capacity limitations for conducting continuous quality improvement, specifically for the implementation and evaluation of the mobility portion of an evidence-based care bundle. The MICU team successfully addressed this capacity challenge using the person power of prehealth volunteers. In the first year of the project, 52 trained volunteers executed an evidence-based mobility intervention for 305 critically ill patients, conducting more than 200 000 exercise repetitions. The volunteers contributed to real-time evaluation of the project, with the collection of approximately 26 950 process measure data points. Prehealth volunteers are an untapped resource for effectively expanding internal continuous quality improvement capacity in the MICU and beyond.
- CLABSI Conversations: Lessons From Peer-to-Peer Assessments to Reduce Central Line-Associated Bloodstream Infections. [Journal Article]
- Qual Manag Health Care 2016 Apr-Jun; 25(2):67-78.
A national collaborative helped many hospitals dramatically reduce central line-associated bloodstream infections (CLABSIs), but some hospitals struggled to reduce infection rates. This article describes the development of a peer-to-peer assessment process (CLABSI Conversations) and the practical, actionable practices we discovered that helped intensive care unit teams achieve a CLABSI rate of less than 1 infection per 1000 catheter-days for at least 1 year. CLABSI Conversations was designed as a learning-oriented process, in which a team of peers visited hospitals to surface barriers to infection prevention and to share best practices and insights from successful intensive care units. Common practices led to 10 recommendations: executive and board leaders communicate the goal of zero CLABSI throughout the hospital; senior and unit-level leaders hold themselves accountable for CLABSI rates; unit physicians and nurse leaders own the problem; clinical leaders and infection preventionists build infection prevention training and simulation programs; infection preventionists participate in unit-based CLABSI reduction efforts; hospital managers make compliance with best practices easy; clinical leaders standardize the hospital's catheter insertion and maintenance practices and empower nurses to stop any potentially harmful acts; unit leaders and infection preventionists investigate CLABSIs to identify root causes; and unit nurses and staff audit catheter maintenance policies and practices.
- Educating Pharmacists in Quality (EPIQ): Recipient, Academy for Healthcare Improvement 2015 Duncan Neuhauser Award for Curricular Innovation. [Journal Article, Research Support, Non-U.S. Gov't]
- Qual Manag Health Care 2016 Jan-Mar; 25(1):61-5.
The Duncan Neuhauser Award for curriculum Innovation is presented annually at the Academy for Healthcare Improvement meeting. The award recognizes education providers that show innovation and improvement in advancing skills in health care. Duncan B. Neuhauser, PhD, a Senior Editor with the Quality Management in Health Care journal is a Professor of Health Services Research and the Charles Elton Blanchard Professor of Health Management at Case Western Reserve University. Dr Neuhauser has devoted his working life to the science of the improvement of health care and has served as a pioneer in the development of curriculum to promote health care improvement. The 2015 first place recipient was Educating Pharmacists in Quality (EPIQ) developed by the Pharmacy Quality Alliance. EPIQ was developed as a quality improvement education resource for use by pharmacy faculty and other professionals to teach students pharmacists, pharmacists, and other stakeholders about measuring, reporting, and improving quality in pharmacy practice. EPIQ has been integrated into more than 20 doctor of pharmacy curricula and has been used as part of employee training programs. Students and faculty members who have used the program have indicated via surveys that the program has a positive impact on awareness and knowledge of quality improvement in pharmacy.