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Qual Manag Health Care [journal]
- Call for Reviewers. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 October/December; 23(4):287.
- Call for Papers. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 October/December; 23(4):287.
- Potentially Preventable Events: An Actionable Set of Measures for Linking Quality Improvement and Cost Savings. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 October/December; 23(4):280-286.
Rising health care costs will result in reduced payments to providers, but across-the-board provider payment reductions are not the answer. Instead, existing payment systems should be reformed to strengthen value for the dollars spent. This can be accomplished by increasing efficiency, improving quality and outcomes, and lowering costs. Payment system reforms must be practical, transparent, identify opportunities for care improvement, and demonstrate material cost savings. Most importantly, because the current growth in health care costs is unsustainable, these reforms must be able to be implemented today. A set of comprehensive measures is being used by state government and private payers in the United States to adjust payment, based on improved outcomes quality. This article details the use of this set of measures, referred to as potentially preventable events, and demonstrates how they are being applied to achieve health care value.
- Sampling Considerations for Health Care Improvement. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 October/December; 23(4):268-279.
Sampling in improvement work can pose challenges. How is it different from the sampling strategies many use with research, clinical trials, or regulatory programs? What should improvement teams consider when determining a useful approach to sampling and a useful sample size? The aim of this article is to introduce some of the concepts related to sampling for improvement. We give specific guidance related to determining a useful sample size to a wider health care audience so that it can be applied to improvement projects in hospitals and health systems.
- Organizational Coherence in Health Care Organizations: Conceptual Guidance to Facilitate Quality Improvement and Organizational Change. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 October/December; 23(4):254-267.
We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations.We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model.We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.
- The Use of Six Sigma in Health Care Management: Are We Using It to Its Full Potential? [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 October/December; 23(4):240-253.
Popular quality improvement tools such as Six Sigma (SS) claim to provide health care managers the opportunity to improve health care quality on the basis of sound methodology and data. However, it is unclear whether this quality improvement tool is being used correctly and improves health care quality. The authors conducted a comprehensive literature review to assess the correct use and implementation of SS and the empirical evidence demonstrating the relationship between SS and improved quality of care in health care organizations. The authors identified 310 articles on SS published in the last 15 years. However, only 55 were empirical peer-reviewed articles, 16 of which reported the correct use of SS. Only 7 of these articles included statistical analyses to test for significant changes in quality of care, and only 16 calculated defects per million opportunities or sigma level. This review demonstrates that there are significant gaps in the Six Sigma health care quality improvement literature and very weak evidence that Six Sigma is being used correctly to improve health care quality.
- Medical Home Interventions and Quality Outcomes for Older Adults: A Systematic Review. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 October/December; 23(4):226-239.
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.
- Reducing Hospital Readmissions Among Medicaid Patients: A Review of the Literature. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 October/December; 23(4):203-225.
Reducing hospital readmissions is a key approach to curbing health care costs and improving quality and patient experience in the United States. Despite the proliferation of strategies and tools to reduce readmissions in the general population and among Medicare beneficiaries, few resources exist to inform initiatives to reduce readmissions among Medicaid beneficiaries. Patients covered by Medicaid also experience readmissions and are likely to experience distinct challenges related to socioeconomic status. This review aims to identify factors related to readmissions that are unique to Medicaid populations to inform efforts to reduce Medicaid readmissions. Our search yielded 254 unique results, of which 37 satisfied all review criteria. Much of the Medicaid readmissions literature focuses on patients with mental health or substance abuse issues, who are often high utilizers of health care within the Medicaid population. Risk factors such as medication noncompliance, postdischarge care environments, and substance abuse comorbidities increase the risk of readmission among Medicaid patients.
- Frictions as Barriers to Perioperative Alignment: Results From a Latent Class Analysis. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 July/September; 23(3):188-200.
The quality of the relationship between the sterile processing department (SPD) and the operating room (OR) is an important determinant of OR safety and performance. In this article, the concept of "friction" refers to the SPD behaviors and attributes that can negatively affect OR performance. Panels of SPD professionals initially were asked to identify and operationally define different ways in which behaviors of a hospital's SPD could compromise OR performance. A national convenience sample of OR nurses (N = 291) rated 14 frictions in terms of their agreement or disagreement that each had a negative effect on OR performance in their hospital. Overall, more than 50% of the entire sample agreed that 2 frictions, "SPD does not communicate effectively with the OR" (55%) and "SPD inventories are insufficient for surgical volume" (52%), had negative effect on OR performance. However, a latent class analysis revealed 3 distinct classes of nurses who varied with respect to their level of agreement that SPD-OR frictions negatively affected OR performance. The observed heterogeneity in how different groups of nurses viewed different frictions suggests that effective efforts aimed at reducing performance-limiting frictions should be customized so that resources can be used where they are most needed.
- Assessing and Addressing Patient Satisfaction in a Longer-term Inpatient Psychiatric Hospital: Preliminary Findings on the Menninger Quality of Care Measure and Methodology. [JOURNAL ARTICLE]
- Qual Manag Health Care 2014 July/September; 23(3):178-187.
Patient satisfaction is increasingly used as an indicator of health care quality. Few measures are available to assess characteristics unique to inpatient psychiatric hospitals, especially those that provide longer-term care. Furthermore, there is limited guidance on how to utilize patient satisfaction data to guide quality improvement initiatives. The authors developed the 20-item, Menninger Quality of Care measure at The Menninger Clinic in Houston, Texas. Psychometric analyses were based on responses from 337 adult inpatients. The measure has excellent internal reliability (Cronbach α = 0.92) with adequate concurrent and construct validity. We present a methodology to identify targeted quality improvement efforts by (1) highlighting the perspective of patients who are generally satisfied but had at least some reservations regarding the care they received and (2) highlighting areas of concern that are most associated with overall quality of care. We discuss our findings in light of national health care quality trends.