The Joint Commission journal on quality improvement最新文献

{"title":"Improving Children’s Health Care: An Interview with Charles Homer","authors":"Steven Berman","doi":"10.1016/S1070-3241(02)28015-3","DOIUrl":"10.1016/S1070-3241(02)28015-3","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 3","pages":"Pages 139-147"},"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)28015-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461628","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":"Private Sector Unlikely to Follow Medicare Lead in Providing Health Plan Disenrollment Comparisons","authors":"Kristin L. Carman PhD (Senior Research Scientist),&nbsp;Sarah Daugherty MPH (doctoral student in epidemiology),&nbsp;Lauren D. Harris-Kojetin PhD (Senior Health and Policy Researcher),&nbsp;James S. Lubalin PhD (President)","doi":"10.1016/S1070-3241(02)28011-6","DOIUrl":"10.1016/S1070-3241(02)28011-6","url":null,"abstract":"<div><h3>Background</h3><p>There have been substantial efforts to improve the measurement and reporting of comparative quality information. A three-stage effort to develop comparative voluntary disenrollment measures for private health insurance plans is described. The literature on disenrollment and how key groups might use disenrollment information is reviewed; the development of a comparative survey of disenrollment is described; reasons employers, purchasing coalitions, and plans were ultimately unwilling or unable to sponsor the survey are delineated; and implications of these findings are discussed.</p></div><div><h3>Data and methods</h3><p>Methods used to develop the survey included review of existing literature on disenrollment, review of extant disenrollee surveys, cognitive testing, and expert review of the survey. Informal and formal interviews were conducted to assess the feasibility of different sponsors.</p></div><div><h3>Results</h3><p>A disenrollment survey instrument that covered areas of common interest to consumers, purchasers, and plans could be developed, but sponsors to test the collection and reporting of these data could not be recruited. This was due to four interrelated factors: technical challenges in developing appropriate samples, wide variation in resources and capabilities of purchasers and plans, the perception that the costs of the survey outweighed the benefits of comparative information on disenrollment to the different sponsors, and the absence of strong demand from purchasers, regulators, or consumers to motivate plans to collect or report comparative information on disenrollment.</p></div><div><h3>Implications</h3><p>Several major barriers must be overcome before disenrollment information can become a component of comparative health care quality measures for the privately insured.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 3","pages":"Pages 115-126"},"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)28011-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461571","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 Development and Demise of a Cataract Surgery Database","authors":"Flora Lum MD (Director, Quality and Clinical Care),&nbsp;Andrew P. Schachat MD (Karl Hagen Professor of Ophthalmology),&nbsp;Henry D. Jampel MD, MHS (Professor of Ophthalmology)","doi":"10.1016/S1070-3241(02)28010-4","DOIUrl":"10.1016/S1070-3241(02)28010-4","url":null,"abstract":"<div><h3>Background</h3><p>The American Academy of Ophthalmology (AAO; San Francisco) launched a national eye care outcomes initiative in 1996, in response to strong interest by third-party payers and managed care in performance measurement and outcomes. The AAO’s outcomes initiative NEON (National Eyecare Outcomes Network) began with the design and launch of a prospective observational registry of patients undergoing cataract surgery.</p></div><div><h3>Methods</h3><p>Participants submitted a common set of data regarding patients’ demographics, preoperative ophthalmologic history, physical exam, test results, functional status and symptoms, intraoperative procedures and events, and postoperative outcomes for all patients undergoing first or second eye cataract surgery.</p></div><div><h3>Results</h3><p>Between January 1, 1996, and March 30, 2001, a total of 249 ophthalmologists submitted data on 17,876 patients undergoing first or second eye surgery. All preoperative, intraoperative, and postoperative clinical data forms were submitted for 9,937 patients (55.7%). After surgery, 93% of patients achieved a best corrected visual acuity of 20/40, 89% improved their visual functioning, and 92% experienced fewer cataract-related symptoms.</p></div><div><h3>Discussion</h3><p>At the end of March 2001, NEON was discontinued because of a lack of participation and demand by members or third parties for this information. The momentum for accountability and performance measures never quite materialized into advantages for contracting for physicians or requirements by payers. In the future, more scientific evidence regarding the validity and meaning of outcome measures and differences in measurements, investment in health information technology infrastructure, use of technology to collect information at the point of care, and incentives favoring data collection and analysis will be needed to pave the way for renewed interest in outcomes.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 3","pages":"Pages 108-114"},"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)28010-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461550","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":"A New Department—Field Notes","authors":"James Espinosa MD","doi":"10.1016/S1070-3241(02)28012-8","DOIUrl":"10.1016/S1070-3241(02)28012-8","url":null,"abstract":"","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 3","pages":"Page 107"},"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)28012-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461586","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 Comparison Charts to Assess Performance Measurement Data","authors":"Kwan Y. Lee PhD, SM (Project Director),&nbsp;Christine McGreevey RN, MS (Associate Project Director)","doi":"10.1016/S1070-3241(02)28014-1","DOIUrl":"10.1016/S1070-3241(02)28014-1","url":null,"abstract":"<div><h3>Background</h3><p>In 1997 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) announced the ORYX initiative, which integrates outcomes and other performance measurement data into the accreditation process. JCAHO uses control and comparison charts to identify performance trends and patterns that are provided to JCAHO surveyors in advance of a health care organization’s (HCO’s) survey. During the survey, the HCO is asked to explain its rationale for its selection of performance measures, how the ORYX data have been analyzed and used to improve performance, and the outcomes of these activities.</p></div><div><h3>Constructing comparison charts</h3><p>A comparison chart, a graphical summary of the comparison analysis, consists of actual (or observed) rates, expected rates, and expected ranges (upper and lower limits) for a given time frame. The expected range describes the degree of certainty that a given point is different from the average score (population).</p></div><div><h3>The use of comparison charts</h3><p>Comparison charts are primarily useful for telling an HCO whether one of its selected performance measures may be evidencing one of the three types of measurement outcomes: exemplary performance, average performance, or substandard performance (indicating an opportunity for improvement). The comparison charts compare an HCO’s outcomes to those of its comparison group or to its risk-adjusted data. The charts provide guidance to an HCO about whether it should continue to monitor a process so as to maintain its current level of performance or whether it should try to improve its current performance.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 3","pages":"Pages 129-138"},"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)28014-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461611","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 Evolution of Quality Management in State Medicaid Agencies: A National Survey of States with Comprehensive Managed Care Programs","authors":"Bruce E. Landon MD, MBA (Assistant Professor),&nbsp;Haiden A. Huskamp PhD (Assistant Professor),&nbsp;Carol Tobias MMHS (Director),&nbsp;Arnold M. Epstein MD, MA","doi":"10.1016/S1070-3241(02)28007-4","DOIUrl":"10.1016/S1070-3241(02)28007-4","url":null,"abstract":"<div><h3>Background</h3><p>Concern has been expressed about whether managed care health plans can successfully meet the special needs of Medicaid beneficiaries. A 1996 survey indicated that state Medicaid agencies had just begun conducting quality oversight and management. Since then the federal government has released guidelines under the Quality Improvement System for Managed Care (QISMC) program to assist states with quality management of managed care programs. In 1999 a follow-up telephone survey was conducted with representatives from 45 states to describe the current state of and changes in quality management activities by state Medicaid agencies for Medicaid beneficiaries enrolled in managed care.</p></div><div><h3>Results</h3><p>The 45 states represented a 50% increase between 1995 and 1999. The number of states enrolling the disabled had doubled (from 15 to 30). Most states collecting data on satisfaction and childhood immunizations fed it back to health plans, although feedback of other measures of access and quality occurred less frequently and fewer states provided information to beneficiaries choosing health plans. Fewer than 25% of states reported having even one health plan demonstrate improvement in individual measures of access and quality except for prenatal care (28%) and childhood immunizations (33%). Fewer than half of the states included contractual penalties in their contracts with health plans, and very few (three or fewer per penalty) had ever invoked such penalties.</p></div><div><h3>Conclusions</h3><p>State Medicaid agencies continue to adapt to their new roles as value-based purchasers of health care. Although increasing numbers of states collect data on satisfaction, access, and quality of care, few states have been able to document improved performance in the health plans they oversee.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 2","pages":"Pages 72-82"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28007-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461511","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 Control Charts to Assess Performance Measurement Data","authors":"Kwan Lee PhD, SM (Project Director),&nbsp;Christine McGreevey RN, MS (Associate Project Director)","doi":"10.1016/S1070-3241(02)28009-8","DOIUrl":"10.1016/S1070-3241(02)28009-8","url":null,"abstract":"<div><h3>Background</h3><p>In 1997 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) announced the ORYX initiative, which integrates outcomes and other performance measurement data into the accreditation process. JCAHO uses control and comparison charts to identify performance trends and patterns that are provided to JCAHO surveyors in advance of the organization’s survey. During its survey, the health care organization (HCO) is asked to explain its rationale for its selection of performance measures, how the ORYX data have been analyzed and used to improve performance, and the outcomes of these activities.</p></div><div><h3>What do control charts do?</h3><p>Control charts indicate whether an HCO’s process is in statistical control (that is, stable insofar as only common cause variation exists) or out of statistical control (that is, unstable insofar as special cause variation exists). With the presence of special cause variation, the HCO should not make any change in its processes until the special cause is identified and eliminated.</p></div><div><h3>Choosing the correct control chart</h3><p>An HCO can use many different control charts. Selecting the correct control chart type for the type of data collected makes interpretation more sensitive for detecting special cause variation. The ORYX measures are calculated as proportions (rates), ratios, and means (continuous variables data, such as average length of stay), and this information forms the basis for selecting the correct type of control chart. In addition, the average rate (especially for rare event measures) and the average number of cases need to be considered when selecting the control chart type for small population measures.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 2","pages":"Pages 90-101"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28009-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461535","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":"Coaching and Leadership for the Diffusion of Innovation in Health Care: A Different Type of Multi-Organization Improvement Collaborative","authors":"Paul L. Green MS, RN, CPHQ (Director),&nbsp;Paul E. Plsek MS","doi":"10.1016/S1070-3241(02)28006-2","DOIUrl":"10.1016/S1070-3241(02)28006-2","url":null,"abstract":"<div><h3>Background</h3><p>Health care organizations have suffered a steady decrease in operating margins in recent years while facing increased competition and pressure to provide ever-higher levels of customer service, quality of care, and innovation in delivery methodologies. The ability to rapidly find and implement changes that will lead to strategic improvement is critical. To assist member organizations in dealing with these issues, VHA Upper Midwest launched the Coaching and Leadership Initiative (VHA-CLI) in January 1999. The initiative was intended to develop new methods of collaborating for organizational learning of best practices, with a focus on generalizable change and deliberate leadership supports for deployment, diffusion, and sustainability. The emphasis was on the spread of ideas for improvement into all relevant corners of the organization.</p></div><div><h3>Structure and process of the collaborative</h3><p>The structure of the VHA-CLI collaborative involved four waves of demonstration teams during 2 years. Each meeting of the collaborative included an executive session, team learning sessions (concepts applied to their improvement projects), and planning for the 6-month action period following the meeting. An important feature of the collaborative is the way in which teams in the various waves overlapped. For example, the Wave 1 team for a given organization came to a learning session in January 1999. At the second collaborative meeting in June 1999, the Wave 1 teams reported on the progress in their pilot sites. This meeting was also the kick-off session for the Wave 2 teams, which could learn about organizational culture and the improvement model from the efforts of their colleagues on Wave 1. Wave 1 teams also learned about and planned for spreading their efforts to other sites beyond the pilot. The pattern of multiple teams stretching across two waves of activity was repeated at every meeting of the collaborative.</p></div><div><h3>Success</h3><p>Each organization in the collaborative has achieved improved outcomes around its selected clinical topics. In total, 26 teams have made significant improvement in 17 different topic areas. In addition, each organization has been able to successfully spread tested improvements to other individuals, teams, or locations, and the improvement work has become easier and more rapid with each successive cycle.</p></div><div><h3>Conclusions</h3><p>The learning process initiated by this project will continue for at least another year in the VHA Upper Midwest region and will be expanded as participating organizations in other regions enroll in the VHA’s national effort.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 2","pages":"Pages 55-71"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28006-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461494","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 the Internet to Teach Consumers about Quality Care","authors":"Marilyn H. Oermann PhD, RN, FAAN (Professor),&nbsp;Marsha Lesley BSN, MLIS (Doctoral Student/Research Assistant),&nbsp;Susan Frances Kuefler MSN (Staff Nurse)","doi":"10.1016/S1070-3241(02)28008-6","DOIUrl":"10.1016/S1070-3241(02)28008-6","url":null,"abstract":"<div><h3>Background</h3><p>The Internet is an important source of health information for consumers. Patients can learn about their diagnoses, review treatments and medications, and locate other health information for themselves and their families. Information about quality care can also be found on the Internet. Few consumers, though, use these Web sites for learning about quality care.</p></div><div><h3>Search for Web sites on quality care</h3><p>In 2000 the investigators searched the Internet and generated a list of approximately 90 relevant Internet documents under the broad heading of quality health care. They then pared the list to 34, by using the Health Information Technology Institute (HITI) criteria.</p></div><div><h3>Testing of Internet documents by consumers</h3><p>In the second phase of the project, 5 of the 34 Internet documents were tested by a convenience sample of 32 consumers. Most of the participants had experience in using the Internet, although generally not in the area of quality care. They found the Web sites easy to use and indicated that the Internet resources would help them assess the quality of care they receive from physicians, nurses, and others.</p></div><div><h3>Discussion</h3><p>Web sites need to be evaluated to ensure that the information they provide is accurate and current, among other criteria. All patients should understand their health benefits and the importance of making informed decisions about their health care, as well as how quality care is measured, how to use quality reports, how to choose providers and hospitals, how to assess the quality of their own care and be more involved in it, and what they should do when faced with new diagnoses.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 2","pages":"Pages 83-89"},"PeriodicalIF":0.0,"publicationDate":"2002-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28008-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461522","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":"Taking the National Guideline for Care of Acute Myocardial Infarction to the Bedside: Developing the Guideline Applied in Practice (GAP) Initiative in southeast Michigan","authors":"Kim A. Eagle MD (Chief of Clinical Cardiology),&nbsp;Meg Gallogly (Project Manager),&nbsp;Rajendra H. Mehta MD (Clinical Assistant Professor of Internal Medicine),&nbsp;Patricia L. Baker RN, MS, CPHQ (Project Manager),&nbsp;Angela Blount MPH (Data Analyst),&nbsp;Marge Freundl RN, MSN, CS (Director),&nbsp;Michele J. Orza ScD (Director),&nbsp;Robert Parrish (Senior Vice President),&nbsp;Arthur L. Riba MD (Director),&nbsp;Cecelia Kucyk Montoye RN, MSN, CPHQ","doi":"10.1016/S1070-3241(02)28002-5","DOIUrl":"10.1016/S1070-3241(02)28002-5","url":null,"abstract":"<div><h3>Background</h3><p>The Guideline Applied in Practice (GAP) program was developed in 2000 to improve the quality of care by improving adherence to clinical practice guidelines. For the first GAP project, the American College of Cardiology (ACC) partnered with the Southeast Michigan Quality Forum Cardiovascular Subgroup and the Michigan Peer Review Organization (MPRO) to develop interventions that might facilitate the use of the ACC/AHA Acute Myocardial Infarction (AMI) guideline in the practice setting. Ten Michigan hospitals participated in implementing the project, which began in March 2000.</p></div><div><h3>Designing the project</h3><p>The project developed a multifaceted intervention aimed at key players in the care delivery triangle: the physician, nurse, and patient. Intervention components included a project kick-off presentation and dinner, creation and implementation of a customized tool kit, identification and assignment of local nurse and physician opinion leaders, grand rounds site visits, and measurement before and after the intervention.</p></div><div><h3>Implementing the project</h3><p>The GAP project experience suggests that hospitals are enthusiastic about partnering with ACC to improve quality of care; partners can work together to develop a program for guideline implementation; rapid-cycle implementation is possible with the GAP model; guidelines and quality indicators for AMI are well accepted; and hospitals can adapt the national guideline for care into usable tools focused on physicians, nurses, and patients.</p></div><div><h3>Discussion</h3><p>Important structure and process changes—both of which are required for successful QI efforts—have been demonstrated in this project. Ultimately, the failure or success of this initiative will depend on an indication that the demonstrated improvement in the quality indicators is sustained over time.</p></div>","PeriodicalId":79382,"journal":{"name":"The Joint Commission journal on quality improvement","volume":"28 1","pages":"Pages 5-19"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1070-3241(02)28002-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56461436","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}