Joint Commission journal on quality and safety最新文献_第7页

Physician-Perceived Barriers to Adopting a Critical Pathway for Community-Acquired Pneumonia 医生认为采用社区获得性肺炎关键途径的障碍

Joint Commission journal on quality and safety Pub Date : 2004-07-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30044-4

Sumit R. Majumdar M.D., M.P.H. (Assistant Professor), Scot H. Simpson Pharm.D., M.Sc. (Research Associate), Thomas J. Marrie M.D. (Professor and Chairman)

{"title":"Physician-Perceived Barriers to Adopting a Critical Pathway for Community-Acquired Pneumonia","authors":"Sumit R. Majumdar M.D., M.P.H. (Assistant Professor), Scot H. Simpson Pharm.D., M.Sc. (Research Associate), Thomas J. Marrie M.D. (Professor and Chairman)","doi":"10.1016/S1549-3741(04)30044-4","DOIUrl":"10.1016/S1549-3741(04)30044-4","url":null,"abstract":"<div><h3>Background</h3><p>A proven efficacious and evidence-based critical pathway for community-acquired pneumonia (CAP) was implemented in six hospitals across a health service region (Edmonton, Canada). After one year (November 2000–November 2001), the pathway had reduced average length of stay by 1 day (from 10.8 to 9.8 days, <em>p</em> < .001). However, great variation was observed in physician adherence to the pathway.</p></div><div><h3>Methods</h3><p>Physician-perceived barriers to adoption of the CAP pathway were identified through in-depth interviews. Data saturation was reached after 10 physicians, representing a convenience sample of those willing to participate, were interviewed.</p></div><div><h3>Results</h3><p>Self-reported adherence to the CAP pathway was 75% (range 50%–100%). Qualitative analysis of the interview data indicated that comments could be grouped into five themes: (1) limited applicability, (2) lack of flexibility to accommodate atypical clinical presentations, (3) perception of insufficient evidence to support recommendations, (4) local organizational barriers, and (5) need for local adaptation. For example, one physician remarked that his community hospital had insufficient staff to support collection of lab samples for all patients.</p></div><div><h3>Discussion</h3><p>Interventions to increase pathway adoption and further improve quality of CAP care should address the identified barriers. For example, local audit and feedback of outcomes data to persuade physicians of the benefits of CAP pathways will need to be instituted.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 7","pages":"Pages 387-395"},"PeriodicalIF":0.0,"publicationDate":"2004-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30044-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40875005","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

The North Carolina Experience with the Diabetes Health Disparities Collaboratives 北卡罗莱纳与糖尿病健康差异合作的经验

Joint Commission journal on quality and safety Pub Date : 2004-07-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30045-6

Anthea Wang M.D., M.P.H., Marti Wolf R.N., M.P.H., Randy Carlyle M.T., M.P.A. (Director of Patient Services), Janice Wilkerson R.N., C.P.H.Q., Deborah Porterfield M.D., M.P.H. (Consultant), Janet Reaves R.N., M.P.H. (Head)

{"title":"The North Carolina Experience with the Diabetes Health Disparities Collaboratives","authors":"Anthea Wang M.D., M.P.H., Marti Wolf R.N., M.P.H., Randy Carlyle M.T., M.P.A. (Director of Patient Services), Janice Wilkerson R.N., C.P.H.Q., Deborah Porterfield M.D., M.P.H. (Consultant), Janet Reaves R.N., M.P.H. (Head)","doi":"10.1016/S1549-3741(04)30045-6","DOIUrl":"10.1016/S1549-3741(04)30045-6","url":null,"abstract":"<div><h3>Background</h3><p>The Bureau of Primary Health Care (BPHC) adopted a collaborative approach that used the Chronic Care Model and quality improvement methods. The North Carolina Diabetes Prevention and Control Branch has partnered with the 12 participating community health centers since early 2000.</p></div><div><h3>Methods</h3><p>Team leaders of the first four centers that participated in the collaboratives were interviewed. Information obtained included previous diabetes efforts, benefits of the collaborative, success factors, and barriers to sustainability.</p></div><div><h3>Case Study</h3><p>In one of two case studies, a nonprofit community health center made Chronic Care Model-based changes to the organization of health care, clinical information systems, and delivery system design.</p></div><div><h3>Results</h3><p>Centers tracked used the electronic registry to establish a baseline, trend key process and outcome measures, and raise the standard of care. Success factors included senior leadership support, physician champions, multidisciplinary teams, and priority of collaborative activities. Barriers included staff turnover and low priority in strategic planning. Glycohemoglobin (A1C) values from aggregated reports demonstrated improvement.</p></div><div><h3>Discussion</h3><p>Useful strategies for future collaboratives may include providing provider-specific data, imparting vision to new team members, ensuring that leadership provides collaborative structure and resources, and pairing veteran and new participating sites.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 7","pages":"Pages 396-404"},"PeriodicalIF":0.0,"publicationDate":"2004-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30045-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40875006","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: 42

Do All Components of the Chronic Care Model Contribute Equally to Quality Improvement? 慢性护理模式的所有组成部分对质量改善的贡献相同吗?

Joint Commission journal on quality and safety Pub Date : 2004-06-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30034-1

JoAnn M. Sperl-Hillen M.D. (Investigator), Leif I. Solberg M.D. (Associate Medical Director), Mary C. Hroscikoski M.D. (Research Associate), A. Lauren Crain Ph.D. (Statistician), Karen I. Engebretson (Programmer Analyst), Patrick J. O’Connor M.D., M.P.H. (Senior Clinical Investigator)

{"title":"Do All Components of the Chronic Care Model Contribute Equally to Quality Improvement?","authors":"JoAnn M. Sperl-Hillen M.D. (Investigator), Leif I. Solberg M.D. (Associate Medical Director), Mary C. Hroscikoski M.D. (Research Associate), A. Lauren Crain Ph.D. (Statistician), Karen I. Engebretson (Programmer Analyst), Patrick J. O’Connor M.D., M.P.H. (Senior Clinical Investigator)","doi":"10.1016/S1549-3741(04)30034-1","DOIUrl":"10.1016/S1549-3741(04)30034-1","url":null,"abstract":"<div><h3>Background</h3><p>The Chronic Care Model (CCM) is a widely used conceptual model for improving chronic illness care, but there is limited evidence to support the validity of this model. Seventeen clinics in a single medical group used the CCM in a diabetes improvement initiative, and the study tested which CCM components at the clinic level were associated with improved glycohemoglobin (A1C) and low-density (LDL) outcomes for patients with diabetes.</p></div><div><h3>Design</h3><p>Three leaders from each of 17 clinics completed a survey in 2002 that assessed the presence of CCM components in their clinics. Clinic scores from this survey were correlated with change in clinic-level measures of the quality of care for their diabetes patients (A1C and LDL outcomes) during the preceding year.</p></div><div><h3>Results</h3><p>Delivery system design (DSD) scores were positively correlated with improvements in A1C and lipid test rates and levels at these clinics (<em>r</em> = 0.49-0.57, <em>p</em><span> < .05). Self-management support and clinical information systems demonstrated associations that may have substantive significance but did not reach </span><em>p</em> < 05.</p></div><div><h3>Conclusions</h3><p>These data suggest that delivery system design is associated with improved A1C and LDL outcomes for people with diabetes. Additional studies are necessary to determine the association of other CCM components with improved outcomes.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 6","pages":"Pages 303-309"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30034-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24574854","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: 80

Editorial Advisory Board 编辑顾问委员会

Joint Commission journal on quality and safety Pub Date : 2004-06-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30091-2

引用次数: 0

A Staffing-Effectiveness Methodology for Analyzing Human Resource and Clinical/Service Screening Indicator Data 分析人力资源和临床/服务筛选指标数据的人员效能方法

Joint Commission journal on quality and safety Pub Date : 2004-06-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30036-5

Jacqueline Sullivan Ph.D., R.N., Peter Brust M.S.N., R.N., C.C.R.N., Patricia J. Wren (Chief Human Resources Officer), Victoria Rich Ph.D, R.N. (Chief Nursing Officer)

{"title":"A Staffing-Effectiveness Methodology for Analyzing Human Resource and Clinical/Service Screening Indicator Data","authors":"Jacqueline Sullivan Ph.D., R.N., Peter Brust M.S.N., R.N., C.C.R.N., Patricia J. Wren (Chief Human Resources Officer), Victoria Rich Ph.D, R.N. (Chief Nursing Officer)","doi":"10.1016/S1549-3741(04)30036-5","DOIUrl":"10.1016/S1549-3741(04)30036-5","url":null,"abstract":"<div><h3>Background</h3><p>The Hospital of the University of Pennsylvania (Philadelphia), a university-affiliated academic health center, developed and pilot tested a method for analyzing staffing effectiveness.</p></div><div><h3>Screening Indicators</h3><p>Human resource screening indicators chosen for analysis included direct caregiver indicators (based on nursing and allied health resource data), such as registered nurse (R.N.) turnover rate, and indirect caregiver indicators (based on overall health care organization resource data), such as overall hospital turnover rate. Clinical/service screening indicators consisted of five nursing-sensitive outcome variables.</p></div><div><h3>Data Collection</h3><p>Patient unit-based data collection at the hospital was institutionally aggregated on a quarterly basis for all human resource and clinical service indicators. Initial methodological development and pilot testing focused on statistical process control chart (SPCC) methodology for longitudinal measurements and the use of spider diagrams for examination of potential relationships within and among all variables, with all variables considered simultaneously in an interrelational analytical process.</p></div><div><h3>Discussion</h3><p>The design, development, and pilot-testing of the staffing-effectiveness methodology led to recommendations for clinical and operational interventions.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 6","pages":"Pages 322-330"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30036-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24574856","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: 6

Take a Second Glance: A Novel Approach to Inpatient Fall Prevention 再看一眼:预防住院病人跌倒的新方法

Joint Commission journal on quality and safety Pub Date : 2004-06-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30033-X

Sally Szumlas R.N., M.S.(C), C.P.H.Q. (Director), Jennifer Groszek R.N., M.J. (Research Nurse Coordinator), Stephanie Kitt R.N., M.S.N. (Director, Quality and Clinical Decision Support), Carol Payson R.N., M.S.N. (Clinical Nurse Manager), Kristine Stack R.N., B.S.N. (Medicine Nursing Resource Coordinator)

{"title":"Take a Second Glance: A Novel Approach to Inpatient Fall Prevention","authors":"Sally Szumlas R.N., M.S.(C), C.P.H.Q. (Director), Jennifer Groszek R.N., M.J. (Research Nurse Coordinator), Stephanie Kitt R.N., M.S.N. (Director, Quality and Clinical Decision Support), Carol Payson R.N., M.S.N. (Clinical Nurse Manager), Kristine Stack R.N., B.S.N. (Medicine Nursing Resource Coordinator)","doi":"10.1016/S1549-3741(04)30033-X","DOIUrl":"10.1016/S1549-3741(04)30033-X","url":null,"abstract":"<div><h3>Background</h3><p>An approach to fall prevention was conducted under the assumption that all inpatients are at risk for falls and that all employees within the hospital setting have a role in fall prevention.</p></div><div><h3>Fall Prevention Programs</h3><p>Northwestern Memorial Hospital (Chicago), a 725-bed tertiary care academic medical center, recently updated a longstanding fall prevention program, “Take a Glance,” to standardize and simplify its approach to fall prevention. In the “Take a Second Glance” program, all patients were screened for higher-than-standard fall risk on admission and at least every 24hours. Standard interventions were recommended and integrated into practice for all patients. The training session for managers provided information, materials, and job aids for staff to facilitate implementation. A reduced number (36 to 13) of interventions were prescribed for fall prevention, and important safety measures were to be incorporated into the patient’s plan of care.</p></div><div><h3>Results</h3><p>A 20% reduction in total falls (<em>p</em> < 0.0001), a 15% reduction in the average hospital fall rate (<em>p</em> < 0.0001), and a more than doubling of the average days between falls with injuries were found when comparing 11 months of data to the previous year.</p></div><div><h3>Discussion</h3><p>The fall prevention program is now in the control phase after program implementation. Data are monitored closely for variation, and discussions regarding continued rigorous goal setting for further improvements are planned.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 6","pages":"Pages 295-302"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30033-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24574853","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: 20

Using Medical Record Reminders to Improve Pneumococcal Vaccination Rates 使用病历提醒提高肺炎球菌接种率

Joint Commission journal on quality and safety Pub Date : 2004-06-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30037-7

Elizabeth A. Warner M.D., Mitchel J. Seleznick M.D. (Associate Professor)

{"title":"Using Medical Record Reminders to Improve Pneumococcal Vaccination Rates","authors":"Elizabeth A. Warner M.D., Mitchel J. Seleznick M.D. (Associate Professor)","doi":"10.1016/S1549-3741(04)30037-7","DOIUrl":"10.1016/S1549-3741(04)30037-7","url":null,"abstract":"<div><h3>Background</h3><p>Despite widespread recommendations, the pneumococcal vaccination rate of patients 65 years of age or older is below target goals. A reminder system was instituted at the time of the scheduled primary care visit as a pilot quality improvement project.</p></div><div><h3>Methods</h3><p>Medical records staff used clinic schedules to identify patients 65 years of age or older, stamping that day’s progress note with a reminder about pneumococcal vaccination. The physician could note previous vaccination or could order vaccination at the visit. If the patient was previously vaccinated or received a vaccine during that visit, an indicator was placed on the front of the chart. Staff at both clinics received an educational session on the indications and benefits of pneumococcal vaccination.</p></div><div><h3>Results</h3><p>Before implementing the reminder intervention, the pneumococcal immunization recording was comparable at the reminder clinic and at a second clinic that did not use reminders (x<sup>2</sup> = 0.324, NS). At 6 months, 95/112 (85%) and 75/115 (65%) patients at the reminder and the second clinic had documentation of pneumococcal vaccination (x<sup>2</sup> = 12.66, <em>p</em> < .005); at 12 months, 76% and 58% had such documentation. At the reminder clinic, the reminder stamp was found in 158/205 (77%) of the charts reviewed, with documentation of pneumococcal vaccination in 140/158 (89%) of these charts.</p></div><div><h3>Discussion</h3><p>The simple and inexpensive method of placing selective reminders in charts for elderly patients eligible for pneumococcal vaccination was highly effective in increasing the pneumococcal vaccination rate.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 6","pages":"Pages 331-334"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30037-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24574857","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: 8

Miscoding as a Cause of Elevated Simple Pneumonia Mortality 错误编码是单纯性肺炎死亡率升高的原因

Joint Commission journal on quality and safety Pub Date : 2004-06-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30038-9

Hewitt Goodpasture M.D. (Medical Director), Chau-Thuong Nguyen-Dang M.D., Tony H. Lee M.D., Paula G. Ghazarian R.N., B.S.N., C.I.C. (Infection Control Coordinator), Mary A. Fulton R.N., B.S.N., C.I.C. (Infection Control Coordinator)

{"title":"Miscoding as a Cause of Elevated Simple Pneumonia Mortality","authors":"Hewitt Goodpasture M.D. (Medical Director), Chau-Thuong Nguyen-Dang M.D., Tony H. Lee M.D., Paula G. Ghazarian R.N., B.S.N., C.I.C. (Infection Control Coordinator), Mary A. Fulton R.N., B.S.N., C.I.C. (Infection Control Coordinator)","doi":"10.1016/S1549-3741(04)30038-9","DOIUrl":"10.1016/S1549-3741(04)30038-9","url":null,"abstract":"<div><h3>Background</h3><p>An independent health care evaluating organization reported on the Internet that the 1996–1998 mortality rate for simple pneumonia (one of the diagnoses in diagnosis-related group [DRG] 89) was 11.06% (expected rate, 7.69%)—a rate much higher than suggested by the medical center’s prospective quality surveillance. Chart review was undertaken to explain this reported higher mortality rate.</p></div><div><h3>Methods</h3><p>Two-hundred forty-six charts of patients (123 expired, and 123 alive at discharge) were reviewed; each chart concluded with a principal diagnosis. The differences between the originally coded principal diagnosis and the recoded principal diagnoses were examined.</p></div><div><h3>Results</h3><p>Application of <em>Coding Clinic</em> guidelines revealed that a principal diagnosis of simple pneumonia should have been coded in only 85 (34.6%) of the charts. The remaining charts should have been coded as respiratory failure (13.8%), congestive heart failure (11.4%), respiratory infections and inflammations (7.7%), and other diagnoses (32.5%). Coding occurred prior to discharge summary dictation in 48.4% of the cases. On the basis of the findings, the actual calculated mortality rate of simple pneumonia was 6.6%.</p></div><div><h3>Discussion</h3><p>Coding in advance of discharge summary completion and nonexplicit documentation of the principal diagnoses occurred frequently. Reasons for miscoding included failure to distinguish between principal and final diagnoses, delay in discharge summary dictation, and inadequate documentation.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 6","pages":"Pages 335-341"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30038-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24576477","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: 7

Developing a National Continuous Quality Improvement System for Neuromodulation Treatment in the Netherlands 在荷兰发展神经调节治疗的国家持续质量改进系统

Joint Commission journal on quality and safety Pub Date : 2004-06-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30035-3

Nicoline Beersen M.Sc. (Research Fellow), J.H. Bart de Bruijn M.D., Ph.D. (Associate professor), Monique A. Dekkers R.N. (Research Nurse), Pieter ten Have M.D. (Staff Member), Gideon B. Hekster Ph.D. (Clinical Psychologist), W. Ken Redekop Ph.D. (Assistant Professor), Geert H.J.J. Spincemaille M.D., Ph.D., Peter J. Theuvenet M.D., Marc Berg M.D., Ph.D. (Professor of Social Medical Sciences), Niek S. Klazinga M.D., Ph.D. (Professor of Social Medicine)

{"title":"Developing a National Continuous Quality Improvement System for Neuromodulation Treatment in the Netherlands","authors":"Nicoline Beersen M.Sc. (Research Fellow), J.H. Bart de Bruijn M.D., Ph.D. (Associate professor), Monique A. Dekkers R.N. (Research Nurse), Pieter ten Have M.D. (Staff Member), Gideon B. Hekster Ph.D. (Clinical Psychologist), W. Ken Redekop Ph.D. (Assistant Professor), Geert H.J.J. Spincemaille M.D., Ph.D., Peter J. Theuvenet M.D., Marc Berg M.D., Ph.D. (Professor of Social Medical Sciences), Niek S. Klazinga M.D., Ph.D. (Professor of Social Medicine)","doi":"10.1016/S1549-3741(04)30035-3","DOIUrl":"10.1016/S1549-3741(04)30035-3","url":null,"abstract":"<div><h3>Background</h3><p>Because neuromodulation was not included in the national health insurance system, the Dutch Neuromodulation Group (DNG) developed national standards and a continuous quality improvement (CQI) system for consistency in application of neuromodulation techniques and in the quality of outcomes.</p></div><div><h3>Developing the National Quality Improvement System</h3><p>A stepwise approach was used in which the following ten steps were taken: (1) selected participating medical specialists and their centers, (2) described the treatment protocol, (3) collected data in a national database, (4) organized feedback sessions for the DNG, (5) formulated quality indicators, (6) adjusted the process of treatment, (7) formalized the structure of the DNG, (8) definined responsibilities, (9) established procedures for future development, and (10) made agreements with payers.</p></div><div><h3>Discussion</h3><p>Making reimbursement for expensive health care interventions contingent on a national CQI system created a powerful financial incentive to continuously provide effective care in an efficient manner.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 6","pages":"Pages 310-321"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30035-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24574855","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

Why Not Give Consumers A Framework for Understanding Quality? 为什么不给消费者一个理解质量的框架?

Joint Commission journal on quality and safety Pub Date : 2004-06-01 Epub Date: 2016-11-17 DOI: 10.1016/S1549-3741(04)30040-7

Judith Hibbard Dr.PH. (Professor), L. Gregory Pawlson M.D., M.P.H. (Executive Vice President)

{"title":"Why Not Give Consumers A Framework for Understanding Quality?","authors":"Judith Hibbard Dr.PH. (Professor), L. Gregory Pawlson M.D., M.P.H. (Executive Vice President)","doi":"10.1016/S1549-3741(04)30040-7","DOIUrl":"10.1016/S1549-3741(04)30040-7","url":null,"abstract":"<div><h3>Background</h3><p>Consumers care about the quality of medical care but do not pay attention to currently available quality information or use it to make more informed health care choices. According to the theory of constructed preferences, when people are in a situation that is both complex and unfamiliar, they likely do not have fixed ideas about what is important to them. This theory seems to describe the situation of consumers and comparative quality information. The alternative would be to help consumers understand the overall concept of quality and the different elements that make up quality of care. The Institute of Medicine (IOM) report <em>Crossing the Quality Chasm</em> provides a framework for understanding, measuring, and evaluating the quality of medical care.</p></div><div><h3>Impact of Providing a Framework for Understanding Quality</h3><p>Focus groups were conducted in 2001 to determine what performance information they would like to see to help them select a physician. The findings indicated that consumers’ understanding of health care quality information was expanded to include a broader array of factors when a cogent framework was used to present quality information.</p></div><div><h3>Using the IOM Framework for All Public Reporting on Quality</h3><p>The IOM framework or a modified version should be used for all public reporting on health care quality. The consistent use of some or all of the six IOM categories of performance reporting will reinforce the message that this is what constitutes high-quality care and it is what the public should expect to know when they make health care choices.</p></div>","PeriodicalId":84970,"journal":{"name":"Joint Commission journal on quality and safety","volume":"30 6","pages":"Pages 347-351"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1549-3741(04)30040-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24576479","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: 30