The Joint Commission journal on quality improvement最新文献

{"title":"Assessing Performance Reports to Individual Providers in the Care of Acute Coronary Syndromes","authors":"Obli Mani MBBS,&nbsp;Rajendra H. Mehta MD (Clinical Assistant Professor),&nbsp;Thomas Tsai MD (House Officer),&nbsp;Sharon Van Riper RN (formerly Clinical Nurse Manager, Quality Improvement Coordinator),&nbsp;Jeanna V. Cooper MS (Research Associate),&nbsp;Eva Kline-Rogers MS, RN (Outcomes Research Coordinator),&nbsp;Elizabeth Nolan MS, RN, CS (Clinical Nurse Specialist),&nbsp;Gwen Kearly RN (Interim Clinical Nurse Manager),&nbsp;Steve Erickson MD (Assistant Professor),&nbsp;Kim A. Eagle MD (Chief of Clinical Cardiology)","doi":"10.1016/S1070-3241(02)28021-9","DOIUrl":"10.1016/S1070-3241(02)28021-9","url":null,"abstract":"<div><h3>Background</h3><p>As part of a quality improvement initiative in the management of acute coronary syndromes, performance reports on care of patients with acute myocardial infarction (MI) or unstable angina (UA) who were admitted to two cardiology services at the University of Michigan Medical Center in 1999 were disseminated to a range of providers.</p></div><div><h3>Methods</h3><p>In 1999, data were routinely collected by chart review on presentation, comorbidities, treatments, outcomes, and key process of care indicators for nearly 300 patients with AMI and a similar number of patients with acute UA. Key process of care indicators and outcomes were the focus of the report cards for AMI and UA.</p></div><div><h3>Results of survey on report cards</h3><p>The return rate for the provider survey—a simple one-page, nine-item question/answer sheet—was highest among faculty who received physician-specific reports (14 out of 17; 82%). Overall, 18 (60%) of 30 providers indicated that the report was useful, 18 responded favorably to the format, and only 3 (10%) indicated that the information was repetitive. Importantly, 24 (80%) indicated a desire to see future performance reports.</p></div><div><h3>Discussion</h3><p>Although hospitalwide or even statewide reports have become familiar, their overall impact on care within hospitals or health systems is unknown. Because so many different caregivers affect the care of a single patient, it is difficult to identify all of these and to consider which part of the care oversight should be ascribed to each provider. The care process itself must be reengineered to build in the systems and time required to accomplish continuous evaluation and improvement.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 5","pages":"Pages 220-232"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28021-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Collaboration is in the Eye of the Beholder","authors":"Joanne Disch PhD, RN","doi":"10.1016/S1070-3241(02)28022-0","DOIUrl":"https://doi.org/10.1016/S1070-3241(02)28022-0","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 5","pages":"Pages 233-234"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28022-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90002151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The New Paradigm of Crew Resource Management: Just What Is Needed to Reengage the Stalled Collaborative Movement?","authors":"Linda K. Kosnik RN, MSN, CS (Chief Nursing Officer)","doi":"10.1016/S1070-3241(02)28023-2","DOIUrl":"10.1016/S1070-3241(02)28023-2","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 5","pages":"Pages 235-241"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28023-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaboration is in the eye of the beholder.","authors":"J. Disch","doi":"10.1016/S1070-3241(02)28022-0","DOIUrl":"https://doi.org/10.1016/S1070-3241(02)28022-0","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 5 1","pages":"233-4"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28022-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Health Care Failure Mode and Effect Analysis™: The VA National Center for Patient Safety’s Prospective Risk Analysis System","authors":"Joseph DeRosier PE, CSP (Program Manager),&nbsp;Erik Stalhandske MPP, MHSA (Program Manager),&nbsp;James P. Bagian MD, PE (Director),&nbsp;Tina Nudell MS (Educational Specialist)","doi":"10.1016/S1070-3241(02)28025-6","DOIUrl":"10.1016/S1070-3241(02)28025-6","url":null,"abstract":"<div><h3>Background</h3><p>Most patient safety reporting systems concentrate on analyzing adverse events; injury has already occurred before any learning takes place. More progressive systems also concentrate on analyzing close calls, which affords the opportunity to learn from an event that did not result in a tragic outcome. Systems also exist that permit proactive evaluation of vulnerabilities before close calls occur. The engineering community has used the Failure Mode and Effect Analysis (FMEA) technique to accomplish this function, and the Department of Veterans Affairs (VA) National Center for Patient Safety has developed a hybrid prospective risk analysis system, Health Care Failure Mode and Effect Analysis (HFMEA™).</p></div><div><h3>Key aspects of the HFMEA™ process</h3><p>HFMEA™ is a 5-step process that uses an interdisciplinary team to proactively evaluate a health care process. The team uses process flow diagramming, a Hazard Scoring Matrix™, and the HFMEA Decision Tree™ to identify and assess potential vulnerabilities. The HFMEA™ Worksheet is used to record the team’s assessment, proposed actions, and outcome measures. HFMEA™ includes testing to ensure that the system functions effectively and new vulnerabilities have not been introduced elsewhere in the system.</p></div><div><h3>The VA rollout</h3><p>HFMEA™ was successfully introduced to the VA system through a series of video-conferences in August 2001. These broadcasts included a prepared training video and interactive question-and-answer sessions. To ensure a successful first year of the program, all VA facilities will focus on the same topic, with support materials from the NCPS office; the topic is a review of the contingency system for distribution of medications in the event of failure of the bar code medication administration process.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 5","pages":"Pages 248-267"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28025-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Based Management: Using Serial Firm Trials to Improve Diabetes Care Quality","authors":"Harold I. Goldberg MD (Associate Professor of Medicine),&nbsp;William E. Neighbor MD (Associate Professor of Family Medicine),&nbsp;Irl B. Hirsch MD (Professor of Medicine),&nbsp;Allen D. Cheadle PhD (Research Professor of Health Services),&nbsp;Scott D. Ramsey MD, PhD (Associate Professor),&nbsp;Ed Gore PhD (Senior Computer Specialist)","doi":"10.1016/S1070-3241(02)28016-5","DOIUrl":"10.1016/S1070-3241(02)28016-5","url":null,"abstract":"<div><h3>Background</h3><p>The design of delivery systems that can truly conduct continuous quality improvement (CQI) as a routine part of clinical care provision remains a vexing problem. The effectiveness of the “computerized firm system” approach to chronic disease CQI was examined, with diabetes as the focus of a 5-year case study.</p></div><div><h3>Methods</h3><p>A large family medical center had been divided into two parallel group practices for reasons of efficiency. These frontline structures (also known as primary care “firms”) were supported to serially adapt and evaluate selected CQI interventions by first introducing process changes on one firm but not the other and comparing the groups. Because all the required longitudinal data were contained in a computerized repository, it was possible to conduct these controlled “firm trials” in a matter of months at low cost.</p></div><div><h3>Results</h3><p>During a 3-year period, implementation of point-of-service reminders and a pharmacist outreach program increased recommended glycohemoglobin (HbA1c) testing by 50% (<em>p</em> = 0.02) and reduced the number of diabetic patients inadequately controlled by 43% (<em>p</em> &lt; 0.01). Following this outcome improvement, patients exhibited a 16% reduction in ambulatory visit rates (<em>p</em> = 0.04). The observed outcome improvement, however, was reversed during the subsequent 2 years, when staffing austerities forced by unrelated declines in clinic revenue caused the withdrawal of trial interventions.</p></div><div><h3>Conclusions</h3><p>The processes and outcomes of diabetes care were improved, demonstrating that CQI and controlled trials are not mutually exclusive in moving toward the practice of evidence-based management. Health care systems can, by conducting serial firm trials, become learning organizations. CQI programs of all kinds will likely never flourish, however, until quality improvement and reimbursement mechanisms have become better aligned.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 4","pages":"Pages 155-166"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28016-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporting Outcomes and Other Issues in Patient Safety: An Interview with Albert Wu","authors":"Steven Berman","doi":"10.1016/S1070-3241(02)28019-0","DOIUrl":"10.1016/S1070-3241(02)28019-0","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 4","pages":"Pages 197-204"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28019-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Quality Measurement Tool and Reporting Format for Long Term Care","authors":"Elizabeth D. Moxey MPH (Project Director),&nbsp;John P. O’Connor PhD (formerly Project Director),&nbsp;Elizabeth White MD (Medical Director),&nbsp;Barbara Turk RN, MSN (Director),&nbsp;David B. Nash MD, MBA (Director)","doi":"10.1016/S1070-3241(02)28018-9","DOIUrl":"10.1016/S1070-3241(02)28018-9","url":null,"abstract":"<div><h3>Background</h3><p>Quality measurement in long term care (LTC) presents many challenges: the lack of a uniform definition of quality, the existence of multiple domains for measurement, a multitude of potential perspectives, and regulatory influences that emphasize measurement only of poor quality. Research efforts have yet to solve the issues of measurement; however, operators of long term care facilities must use the current state of the art in quality measurement as the basis for their quality improvement efforts.</p><p>A project was commissioned by management of a large integrated delivery system with a robust network of LTC facilities who wished to implement a continuous quality improvement process on the basis of a measurement tool that provides a comprehensive resident-centered assessment of quality. The objectives of this project, therefore, were to identify domains of quality, to select and adapt validated instruments for measurement within each domain, to pilot test a data collection process, and to develop an operational quality profiling report format for LTC facilities.</p></div><div><h3>Design and methods</h3><p>Using an expert panel and the LTC research literature, an operational measurement tool was developed, consisting of four domains of quality: organizational, clinical, environmental, and social.</p></div><div><h3>Discussion</h3><p>A pilot study conducted in two nursing facilities demonstrated that the data collection process could be operationalized within tight resource and budgetary constraints. The development of an operational quality assessment tool enables management to take a consistent view of diverse institutions, focusing in detail on quality of care as it is perceived by residents. The tool allows evaluation of trends over time and comparison to external norms.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 4","pages":"Pages 180-196"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28018-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Clinical Pathways Use in a Community Hospital: It Depends on What “Use” Means","authors":"Nancy Hoffart PhD, RN (Associate Professor),&nbsp;Ann Kuckelman Cobb PhD, RN","doi":"10.1016/S1070-3241(02)28017-7","DOIUrl":"10.1016/S1070-3241(02)28017-7","url":null,"abstract":"<div><h3>Background</h3><p>Many benefits have been associated with the use of clinical pathways, yet developing them can be costly, and implementing them is not always successful. A 300-bed Midwestern community hospital began a clinical pathways program in 1995, and by fall 1998, 15 pathways were in various stages of implementation, with 3 under development. Many challenges had been encountered, but hospital leaders were eager to find ways to increase pathway use.</p></div><div><h3>Methods</h3><p>A qualitative case study design was used to investigate four clinical pathways, two perceived as being “used” and two that were perceived as “not used.” Each pathway was analyzed as a separate case, followed by cross-case analysis. Qualitative data were collected in 65 semistructured interviews with administrators, physicians, physicians’ office staff, nurses, and allied health professionals at the hospital. Data were also collected through observation and document analysis.</p></div><div><h3>Results</h3><p>The two used pathways had been introduced as part of a larger change in care, whereas the two pathways not used had been introduced as standalone innovations. Confusing and inadequately developed aspects of the hospital’s clinical pathways program included its purposes, the definition of pathway use, pathway procedures, accountability, education, and incentives. A new case management department, ongoing administrative support, and a sophisticated medical information system were viewed as supports for continued growth in the program.</p></div><div><h3>Conclusions</h3><p>Implementation of clinical pathways was delayed and complicated by the varied perceptions of the program among stakeholders. Lack of clarity and consistency in how information about the program was communicated made it difficult for clinicians to develop a shared understanding of clinical pathways.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 4","pages":"Pages 167-179"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28017-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Rapid Cycle: A One-Day Safety Summit Tool to Prevent Mislabeled Laboratory Specimens","authors":"Tina Maund MS, RN (Director),&nbsp;James Espinosa MD,&nbsp;Linda Kosnik MSN, RN (Chief Nursing Officer)","doi":"10.1016/S1070-3241(02)28013-X","DOIUrl":"10.1016/S1070-3241(02)28013-X","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 3","pages":"Pages 127-128"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28013-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}