Joint Commission journal on quality and safety最新文献_第3页

Clinical Practice Guidelines and Performance Indicators as Related—But Often Misunderstood—Tools 临床实践指南和绩效指标作为相关但经常被误解的工具

Joint Commission journal on quality and safety Pub Date : 2004-12-01 DOI: 10.1016/S1549-3741(04)30109-7

Ann S. O’Malley M.D., M.P.H. (Assistant Professor), Carolyn Clancy M.D. (Director), Joe Thompson M.D., M.P.H. (Associate), Ravikiran Korabathina (Medical student), Gregg S. Meyer M.D., M.Sc.

{"title":"Clinical Practice Guidelines and Performance Indicators as Related—But Often Misunderstood—Tools","authors":"Ann S. O’Malley M.D., M.P.H. (Assistant Professor), Carolyn Clancy M.D. (Director), Joe Thompson M.D., M.P.H. (Associate), Ravikiran Korabathina (Medical student), Gregg S. Meyer M.D., M.Sc.","doi":"10.1016/S1549-3741(04)30109-7","DOIUrl":"https://doi.org/10.1016/S1549-3741(04)30109-7","url":null,"abstract":"<div><h3>Background</h3><p>Widespread variation in medical practice indicates that existing scientific evidence is often not translated into appropriate clinical care. Two tools have evolved that try to address this variation: clinical practice guidelines (CPGs) and performance indicators (PIs).</p></div><div><h3>Tensions Between CPGs and PIs</h3><p>CPGs present available evidence that is subsequently reviewed and frequently adopted by professional organizations, so that clinicians may judge whether specific management recommendations are appropriate for each patient. PIs are devised to measure and document performance to motivate organizations to improve through the use of common metrics.</p></div><div><h3>Implications of These Tensions</h3><p>The increasingly widespread use of PIs with CPGs (and clinicians’ confusion of them with CPGs) risks lowering the standards of clinical care. PIs are not intended to set optimal standards of care for any individual patient. Clinicians should not restrict their quality monitoring to a focus on PIs because they could miss important opportunities to learn and to improve the care they deliver to their individual patients.</p></div><div><h3>Conclusion</h3><p>Tensions between CPGs and PIs do not mean that these tools should be abandoned but rather that they need to be refined. Recognition of the imperfections of CPGs and PIs should not blind clinicians to the ultimate goals of these tools—to promote quality (through changes in practice and/or selection) and ensure that medical care is based on scientific evidence.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 ","pages":"Pages 48-56"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30109-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138357321","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}

引用次数: 0

What Do Collaborative Improvement Projects Do? Experience from Seven Countries 协作改进项目做什么?七个国家的经验

Joint Commission journal on quality and safety Pub Date : 2004-12-01 DOI: 10.1016/S1549-3741(04)30106-1

Tim Wilson M.D. (Director), Donald M. Berwick M.D., M.P.P. (CEO and President), Paul D. Cleary Ph.D. (Professor)

{"title":"What Do Collaborative Improvement Projects Do? Experience from Seven Countries","authors":"Tim Wilson M.D. (Director), Donald M. Berwick M.D., M.P.P. (CEO and President), Paul D. Cleary Ph.D. (Professor)","doi":"10.1016/S1549-3741(04)30106-1","DOIUrl":"https://doi.org/10.1016/S1549-3741(04)30106-1","url":null,"abstract":"<div><h3>Background</h3><p>Health care organizations are increasingly adopting multiorganizational collaborative approaches to quality improvement. Collaboratives have been conducted in many countries. There are large variations in the way collaboratives are structured and run, but there is no widely accepted framework for describing the components of collaboratives. Thus, it is difficult to study which approaches are most effective.</p></div><div><h3>Method</h3><p>The authors conducted semistructured interviews with 15 leaders of collaboratives to ascertain the common components of collaboratives and identify variations in the ways these components are implemented.</p></div><div><h3>Results</h3><p>The study identified seven features of collaboratives that the leaders interviewed thought were critical determinants of how effective the collaboratives were: sponsorship, topic, ideas for improvements, participants, senior leadership support, preliminary work and learning, and strategies for learning about and making improvements. For example, every interviewee mentioned that having participants collect data, perform audit work, or analyze the system they were in before the collaboration started was important to understanding their organization and the nature of the problems they had and to developing baseline data for later comparison. The authors describe variations in how these features have been implemented and possible functions of these features.</p></div><div><h3>Conclusion</h3><p>Systematically studying the impact of variations in the seven key features of collaboratives could yield important information about their role and impact.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 ","pages":"Pages 25-33"},"PeriodicalIF":0.0,"publicationDate":"2004-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30106-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138357329","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}

引用次数: 0

Self-Management Support in a Web-Based Medical Record: A Pilot Randomized Controlled Trial 基于网络的医疗记录中的自我管理支持:一项随机对照试验

Joint Commission journal on quality and safety Pub Date : 2004-11-01 DOI: 10.1016/S1549-3741(04)30074-2

Harold I. Goldberg M.D., Daniel S. Lessler M.D., M.H.A. (Associate Professor of Medicine), Kathleen Mertens R.N., M.N., M.P.H. (Manager of Patient Education/Outcomes Tracking), Ted A. Eytan M.D., M.P.H. (Associate Medical Director of Clinical Informatics), Allen D. Cheadle Ph.D. (Research Professor of Health Services)

引用次数: 15

Editorial Advisory Board 编辑顾问委员会

Joint Commission journal on quality and safety Pub Date : 2004-11-01 DOI: 10.1016/S1549-3741(04)30096-1

引用次数: 0

How to Design Computerized Alerts to Ensure Safe Prescribing Practices 如何设计计算机警报以确保安全的处方操作

Joint Commission journal on quality and safety Pub Date : 2004-11-01 DOI: 10.1016/S1549-3741(04)30071-7

Adrianne Feldstein M.D., M.S. (Adjunct Investigator), Steven R. Simon M.D. (Assistant Professor), Jennifer Schneider M.P.H. (Research Associate), Michael Krall M.D., M.S. (Physician), Dan Laferriere R.N., M.S.N. (Clinic Coordinator), David H. Smith R.Ph., M.H.A., Ph.D. (Investigator), Dean F. Sittig Ph.D. (Director), Stephen B. Soumerai Sc.D. (Professor of Ambulatory Care and Prevention)

{"title":"How to Design Computerized Alerts to Ensure Safe Prescribing Practices","authors":"Adrianne Feldstein M.D., M.S. (Adjunct Investigator), Steven R. Simon M.D. (Assistant Professor), Jennifer Schneider M.P.H. (Research Associate), Michael Krall M.D., M.S. (Physician), Dan Laferriere R.N., M.S.N. (Clinic Coordinator), David H. Smith R.Ph., M.H.A., Ph.D. (Investigator), Dean F. Sittig Ph.D. (Director), Stephen B. Soumerai Sc.D. (Professor of Ambulatory Care and Prevention)","doi":"10.1016/S1549-3741(04)30071-7","DOIUrl":"10.1016/S1549-3741(04)30071-7","url":null,"abstract":"<div><h3>Background</h3><p>Medication errors and preventable adverse drug events are common, and about half of medication errors occur during medication ordering. This study was designed to develop and evaluate medication safety alerts and processes for educating prescribers about the alerts.</p></div><div><h3>Methods</h3><p>At Kaiser Permanente Northwest, a group-model health maintenance organization where prescribers have used computerized order entry since 1996, qualitative interviews were conducted with 20 primary care prescribers.</p></div><div><h3>Results</h3><p>Prescribers considered alerts helpful for providing prescribing and preventive health information. More than half the interviewees stated that it would be unwise to let clinicians control or avoid safety alerts. Common frustrations were (1) being delayed by the alert, (2) having difficulty interpreting the alert, and (3) receiving the same alert repeatedly. Most prescribers preferred small-group educational sessions tied to existing meetings and having local physicians conduct education sessions.</p></div><div><h3>Discussion</h3><p>The findings were used to design a strategy for introducing and promoting the interventions, modifying the alert text and tools, and focusing the education on how clinicians could use the alerts effectively.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 11","pages":"Pages 602-613"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30071-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24832857","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}

引用次数: 78

Using Variance Analysis to Detect Hazards in a Bar-Code–Assisted Medication Preparation Process 用方差分析检测条形码辅助药物制备过程中的危害

Joint Commission journal on quality and safety Pub Date : 2004-11-01 DOI: 10.1016/S1549-3741(04)30073-0

Kamisha Hamilton Escoto M.S.I.E. (Doctoral student), Melissa Hallock M.S.I.E. (Master’s student), Jennifer Wagner M.S.I.E. (Doctoral student), Ben-Tzion Karsh Ph.D. (Assistant Professor)

{"title":"Using Variance Analysis to Detect Hazards in a Bar-Code–Assisted Medication Preparation Process","authors":"Kamisha Hamilton Escoto M.S.I.E. (Doctoral student), Melissa Hallock M.S.I.E. (Master’s student), Jennifer Wagner M.S.I.E. (Doctoral student), Ben-Tzion Karsh Ph.D. (Assistant Professor)","doi":"10.1016/S1549-3741(04)30073-0","DOIUrl":"10.1016/S1549-3741(04)30073-0","url":null,"abstract":"<div><h3>Background</h3><p>Medication errors have received significant attention, with studies pinpointing problems in the physician ordering, pharmacy dispensing, and nurse administering processes. Yet, the nursing process for preparing medications, which typically occurs in a medication room on the unit, has not received much attention. This process is deceptively complex, and without proper design, it could break down at numerous points.</p></div><div><h3>Human Factors Engineering Analysis</h3><p>Prospective hazard analysis methods allow the detection of potential hazards during the planning, assessment, and design phases of a process or technology. A specific technique—variance analysis—is used within one type of prospective hazard analysis, the sociotechnical systems analysis (STSA). STSA provides guidance to (1) analyze existing or planned systems to understand the social, technical, and environmental system components; (2) collect and analyze the system data; and (3) use the analysis to design or redesign the system.</p></div><div><h3>Discussion</h3><p>The STSA variance analysis is an additional tool that health care clinicians, administrators, and risk managers can use to proactively identify hazards for control. Although this larger analysis is more time consuming, it forces the analysts to conduct a true systems analysis before implementing technical, social, environmental, or organizational changes.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 11","pages":"Pages 622-628"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30073-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24832859","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}

引用次数: 14

Barriers to First-Week Follow-up of Newborns: Findings from Parent and Clinician Focus Groups 新生儿第一周随访的障碍:来自家长和临床医生焦点小组的发现

Joint Commission journal on quality and safety Pub Date : 2004-11-01 DOI: 10.1016/S1549-3741(04)30070-5

Susanne Salem-Schatz Sc.D. (Principal), Laura E. Peterson B.S.N., S.M. (Visiting Lecturer), R. Heather Palmer M.B., B.Ch., S.M. (Professor), Mark Clanton M.D., M.P.H., Sudhakar Ezhuthachan M.D., D.C.H. (Division Head), Richard C. Luttrell B.BA., M.A (Senior Manager), Chris Newman M.S., R.N.C., C.N.N.P. (Neonatal Nurse Practitioner), Roinell Westbury R.N. (Disease Management Supervisor)

{"title":"Barriers to First-Week Follow-up of Newborns: Findings from Parent and Clinician Focus Groups","authors":"Susanne Salem-Schatz Sc.D. (Principal), Laura E. Peterson B.S.N., S.M. (Visiting Lecturer), R. Heather Palmer M.B., B.Ch., S.M. (Professor), Mark Clanton M.D., M.P.H., Sudhakar Ezhuthachan M.D., D.C.H. (Division Head), Richard C. Luttrell B.BA., M.A (Senior Manager), Chris Newman M.S., R.N.C., C.N.N.P. (Neonatal Nurse Practitioner), Roinell Westbury R.N. (Disease Management Supervisor)","doi":"10.1016/S1549-3741(04)30070-5","DOIUrl":"10.1016/S1549-3741(04)30070-5","url":null,"abstract":"<div><h3>Background</h3><p>Monitoring newborns within the first week is critical to assess the adequacy of feeding and weight gain and to identify instances of hyperbilirubinemia. As systems of maternal and newborn care have become increasingly fragmented, infants are at increased risk of poor outcomes because of poor follow-up. Structured focus groups were conducted in June–July 2001 to provide information about the barriers to timely newborn follow-up and strategies to address them.</p></div><div><h3>Methods</h3><p>One focus group for physicians and one for nurses were held at the Henry Ford Health System, Detroit, and two focus groups of parents were recruited by Blue Cross Blue Shield of Texas, Dallas.</p></div><div><h3>Results</h3><p>Barriers were identified in communication and information, systems and processes of care, and parental knowledge and education. Concerns raised by clinicians and parents were consistent and complementary. Some organizations have begun implementing some of the suggested strategies to achieve timely follow-up.</p></div><div><h3>Discussion</h3><p>Implementing the AAP guideline and improving safe care in the first week of newborn life will require attention to linkages and transitions between these various microsystems.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 11","pages":"Pages 593-601"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30070-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24832854","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}

引用次数: 16

Editorial: Microsystems, Macrosystems, and Kernicterus 社论:微系统、宏系统和内核

Joint Commission journal on quality and safety Pub Date : 2004-11-01 DOI: 10.1016/S1549-3741(04)30069-9

Paul M. Schyve M.D. (Senior Vice President)

引用次数: 5

Fixing Broken Bones and Broken Homes: Domestic Violence as a Patient Safety Issue 修复骨折和破碎的家庭:作为病人安全问题的家庭暴力

Joint Commission journal on quality and safety Pub Date : 2004-11-01 DOI: 10.1016/S1549-3741(04)30075-4

Felicia Cohn Ph.D. (Director of Medical Ethics), William J. Rudman Ph.D. (Professor)

{"title":"Fixing Broken Bones and Broken Homes: Domestic Violence as a Patient Safety Issue","authors":"Felicia Cohn Ph.D. (Director of Medical Ethics), William J. Rudman Ph.D. (Professor)","doi":"10.1016/S1549-3741(04)30075-4","DOIUrl":"10.1016/S1549-3741(04)30075-4","url":null,"abstract":"<div><h3>Background</h3><p>Domestic violence (DV) is a significant problem in terms of both patient harm and cost. To better address this problem, the diagnosis and treatment of DV are considered within the emerging model of patient safety and medical error reduction. The case of a female patient who presents in the clinical setting following an incident of DV shows how medical errors can be analyzed as they are in medical cases not involving DV, such as when a person with abdominal pain is sent away from the emergency department with instructions to take an acid reducer and later suffers a burst appendix.</p></div><div><h3>Root Cause Analysis</h3><p>A number of factors inhibit the correct diagnosis and treatment of DV victims seeking additional treatment. Physicians often fail to screen for DV, misidentify symptoms, or deny the possibility of underlying DV, and patients often hide the symptoms and refuse to admit the problem. However, human factor errors related to knowledge, cultural norms, and individual biases; organizational factors, including lack of training and reimbursement; and technology factors related to information accessibility appear to play significant roles.</p></div><div><h3>Conclusion</h3><p>Failure to diagnose or adequately address DV can be interpreted as medical errors. Addressing DV requires a systemic response, which might begin with integrating education and training about DV into the clinical setting, ensuring the use of existing screening tools, and providing adequate and appropriate reimbursement levels.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 11","pages":"Pages 636-646"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30075-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24832861","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}

引用次数: 5

Assessing Return on Investment of Defined-Population Disease Management Interventions 评估特定人群疾病管理干预措施的投资回报

Joint Commission journal on quality and safety Pub Date : 2004-11-01 DOI: 10.1016/S1549-3741(04)30072-9

Thomas W. Wilson Ph.D., M.P.H., Dr.PH. (Independent strategic epidemiologist), Jeff Gruen M.D., M.B.A. (Senior Medical Director), William Thar M.D., M.P.H. (Chief Medical Officer), Donald Fetterolf M.D., M.B.A. (Chief Medical Officer), Minalkumar Patel M.D., M.P.H. (Executive Medical Director), Richard G. Popiel M.D. (Vice President, Chief Medical Officer), Al Lewis Esq. (Executive Director), David B. Nash M.D., M.B.A. (Director)

{"title":"Assessing Return on Investment of Defined-Population Disease Management Interventions","authors":"Thomas W. Wilson Ph.D., M.P.H., Dr.PH. (Independent strategic epidemiologist), Jeff Gruen M.D., M.B.A. (Senior Medical Director), William Thar M.D., M.P.H. (Chief Medical Officer), Donald Fetterolf M.D., M.B.A. (Chief Medical Officer), Minalkumar Patel M.D., M.P.H. (Executive Medical Director), Richard G. Popiel M.D. (Vice President, Chief Medical Officer), Al Lewis Esq. (Executive Director), David B. Nash M.D., M.B.A. (Director)","doi":"10.1016/S1549-3741(04)30072-9","DOIUrl":"10.1016/S1549-3741(04)30072-9","url":null,"abstract":"<div><h3>Background</h3><p>Strategies to reduce health expenditures through the improvement of health and quality of care are in high demand. A group of experts formed a nonpartisan, independent work group, under the sponsorship of the National Managed Health Care Congress. Its goal was to establish a list of easy-to-understand, actionable, and usable recommendations to enable disease management program advocates to conduct basic-level evaluations.</p></div><div><h3>Recommendations</h3><p>The work group made recommendations concerning identification of reference and intervention population, population definitions, quantitative methods and data quality, confounding and bias, and stakeholder agreements/contracting.</p></div><div><h3>Case Study</h3><p>A case study was created to quantitatively illustrate some of the major issues raised by the work group. Five typical errors were simulated by applying different rules to the intervention population than to the reference population: differential inclusion (high versus low risk), differential exclusion (high versus low risk) and differential claims run-out. Compared with the true impact, four of the five errors resulted in a bias toward “intervention effect,” while one (differential inclusion of high-risk patients) was biased against the “intervention effect.” The direction and magnitude of the bias in natural settings will not necessarily follow this pattern.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 11","pages":"Pages 614-621"},"PeriodicalIF":0.0,"publicationDate":"2004-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30072-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24832858","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}

引用次数: 14