Health care quality assurance: Difference between revisions

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A [[systematic review]] found that "publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain".<ref name="pmid18195336">{{cite journal |author=Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG |title=Systematic review: the evidence that publishing patient care performance data improves quality of care |journal=Ann. Intern. Med. |volume=148 |issue=2 |pages=111–23 |year=2008 |pmid=18195336 |doi=}}</ref> However, a comparative study found concerns with the quality of data that is publically available.<ref>{{Cite journal | doi = 10.1377/hlthaff.27.6.1680 | volume = 27 | issue = 6 | pages = 1680-1687 | last = Rothberg | first = Michael B.
A [[systematic review]] found that "publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain".<ref name="pmid18195336">{{cite journal |author=Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG |title=Systematic review: the evidence that publishing patient care performance data improves quality of care |journal=Ann. Intern. Med. |volume=148 |issue=2 |pages=111–23 |year=2008 |pmid=18195336 |doi=}}</ref> However, a comparative study found concerns with the quality of data that is publically available.<ref>{{Cite journal | doi = 10.1377/hlthaff.27.6.1680 | volume = 27 | issue = 6 | pages = 1680-1687 | last = Rothberg | first = Michael B.
| coauthors = Elizabeth Morsi, Evan M. Benjamin, Penelope S. Pekow, Peter K. Lindenauer | title = Choosing The Best Hospital: The Limitations Of Public Quality Reporting | journal = Health Aff | accessdate = 2008-11-10 | date = 2008-11-01 | url = http://content.healthaffairs.org/cgi/content/abstract/27/6/1680
| coauthors = Elizabeth Morsi, Evan M. Benjamin, Penelope S. Pekow, Peter K. Lindenauer | title = Choosing The Best Hospital: The Limitations Of Public Quality Reporting | journal = Health Aff | accessdate = 2008-11-10 | date = 2008-11-01 | url = http://content.healthaffairs.org/cgi/content/abstract/27/6/1680
}}</ref> A subsequent cluster [[randomized controlled trial]] reported no benefit.<ref>{{Cite journal
| doi = 10.1001/jama.2009.1731
| pages = 2009.1731
| last = Tu
| first = Jack V.
| coauthors = Linda R. Donovan, Douglas S. Lee, Julie T. Wang, Peter C. Austin, David A. Alter, Dennis T. Ko
| title = Effectiveness of Public Report Cards for Improving the Quality of Cardiac Care: The EFFECT Study: A Randomized Trial
| journal = JAMA
| accessdate = 2009-11-18
| date = 2009-11-18
| url = http://jama.ama-assn.org/cgi/content/abstract/2009.1731v1
}}</ref>
}}</ref>


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Health care quality assurance is "activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps."[1]

Health care quality assurance addresses topics such as medical error, cross infections, evidence-based medicine, and patient satisfaction.

Creating quality measures

Creating quality measures from clinical practice guidelines can be problematic.[2][3]

Conflict of interest may influence the creation of measures. The National Committee for Quality Assurance recieves money from groups who have financial interests in the components of measures.[4]

Measuring quality

Chart abstraction may underestimate quality.[5]

Improving quality

More experience, as measured by volume of care, is associated with better quality of care.[6]

Process control charts can be used to identify specific problems that need improvement.[7][8][9] Examples are assessing methods to obtain blood cultures[10], the impact of screening for methicillin resistant Staphylococcus aureus[11] and comparing mortality in surgical units[12].

Surprisingly, hospitals reporting more compliance with the Leapfrog safe practices do not report reduced mortality than other hospitals.[13]

Cultures of quality

The highest quality takes place when all involved constantly reinforce "lessons learned" to one another, in a learning process. The institution performing this research was a United States Air Force hospital at which aviation safety techniques were well known.[14]

Considerable insight from aviation safety appears applicable to health care. [15]

Audit and feedback

Audit and feedback has been systematically reviewed by the Cochrane Collaboration who concluded its "effects are generally small to moderate."[16]

More recently, a factorial, cluster randomized controlled trial of audit and feedback concluded "enhanced feedback of requesting rates and brief educational reminder messages, alone and in combination, are effective strategies ."[17] The feedback in this trial was enhanced with an educational message.

Public reporting of quality measures

A systematic review found that "publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain".[18] However, a comparative study found concerns with the quality of data that is publically available.[19] A subsequent cluster randomized controlled trial reported no benefit.[20]

Research on quality improvement

Guidelines exist for the reporting of studies on quality improvement (http://www.squire-statement.org/).[21][22][23]

References

  1. ↑ Anonymous (2024), Health care quality assurance (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Walter LC, Davidowitz NP, Heineken PA, Covinsky KE (2004). "Pitfalls of converting practice guidelines into quality measures: lessons learned from a VA performance measure". JAMA 291 (20): 2466–70. DOI:10.1001/jama.291.20.2466. PMID 15161897. Research Blogging.
  3. ↑ Fonarow GC, Abraham WT, Albert NM, et al (January 2007). "Association between performance measures and clinical outcomes for patients hospitalized with heart failure". JAMA 297 (1): 61–70. DOI:10.1001/jama.297.1.61. PMID 17200476. Research Blogging.
  4. ↑ Meier, Barry (August 17, 2009). Diabetes Case Shows Pitfalls of Treatment Rules. The New York Times. Retrieved on 2009-08-18. “the National Committee for Quality Assurance, received about $3 million, or 10 percent of its revenue, last year from drug and medical device makers”
  5. ↑ How well does chart abstraction measure quality? A...[Am J Med. 2000 - PubMed Result]. Retrieved on 2008-02-12.
  6. ↑ Lin HC, Xirasagar S, Lin HC, Hwang YT (2008). "Does physicians' case volume impact inpatient care costs for pneumonia cases?". J Gen Intern Med 23 (3): 304-9. DOI:10.1007/s11606-007-0462-3. PMID 18043982. Research Blogging.
  7. ↑ Nelson EC, Splaine ME, Batalden PB, Plume SK (March 1998). "Building measurement and data collection into medical practice". Ann. Intern. Med. 128 (6): 460–6. PMID 9499330. [e]
  8. ↑ Lloyd, Robert M.; Carey, Raymond G. (1995). Measuring quality improvement in healthcare: a guide to statistical process control applications. White Plains, N.Y: Quality Resources. ISBN 0-527-76293-8. 
  9. ↑ Staker, Larry V.; Carey, Raymond G. (2002). Improving Healthcare with Control Charts: Basic and Advanced SPC Methods and Case Studies. Milwaukee, Wis: ASQ Quality Press. ISBN 0-87389-562-2. 
  10. ↑ Norberg A, Christopher NC, Ramundo ML, Bower JR, Berman SA (February 2003). "Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter". JAMA 289 (6): 726–9. PMID 12585951. [e]
  11. ↑ Harbarth S, Fankhauser C, Schrenzel J, et al (March 2008). "Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients". JAMA 299 (10): 1149–57. DOI:10.1001/jama.299.10.1149. PMID 18334690. Research Blogging.
  12. ↑ Tekkis PP, McCulloch P, Steger AC, Benjamin IS, Poloniecki JD (April 2003). "Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data". BMJ 326 (7393): 786–8. DOI:10.1136/bmj.326.7393.786. PMID 12689973. Research Blogging.
  13. ↑ Kernisan, Leslie P.; Sei J. Lee, W. John Boscardin, C. Seth Landefeld, R. Adams Dudley (2009-04-01). "Association Between Hospital-Reported Leapfrog Safe Practices Scores and Inpatient Mortality". JAMA 301 (13): 1341-1348. DOI:10.1001/jama.2009.422. Retrieved on 2009-04-01. Research Blogging.
  14. ↑ {{citation | title = Advances in Patient Safety: From Research to Implementation Volume 1. Research Findings | contribution = Implementing Safety Cultures in Medicine: What We Learn by Watching Physicians | author = Timothy J. Hoff, Henry Pohl, Joel Bartfield | url = http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=aps.section.65 | publisher = National Center for Biotechnology Information, [[National Library of Medicine}}
  15. ↑ Robert L Helmreich (2000 March 18), British Medical Journal title = On error management: lessons from aviation 320(7237): 781–785.
  16. ↑ Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD (2006). "Audit and feedback: effects on professional practice and health care outcomes". Cochrane Database Syst Rev (2): CD000259. DOI:10.1002/14651858.CD000259.pub2. PMID 16625533. Research Blogging.
  17. ↑ Thomas RE, Croal BL, Ramsay C, Eccles M, Grimshaw J (June 2006). "Effect of enhanced feedback and brief educational reminder messages on laboratory test requesting in primary care: a cluster randomised trial". Lancet 367 (9527): 1990–6. DOI:10.1016/S0140-6736(06)68888-0. PMID 16782489. Research Blogging.
  18. ↑ Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG (2008). "Systematic review: the evidence that publishing patient care performance data improves quality of care". Ann. Intern. Med. 148 (2): 111–23. PMID 18195336. [e]
  19. ↑ Rothberg, Michael B.; Elizabeth Morsi, Evan M. Benjamin, Penelope S. Pekow, Peter K. Lindenauer (2008-11-01). "Choosing The Best Hospital: The Limitations Of Public Quality Reporting". Health Aff 27 (6): 1680-1687. DOI:10.1377/hlthaff.27.6.1680. Retrieved on 2008-11-10. Research Blogging.
  20. ↑ Tu, Jack V.; Linda R. Donovan, Douglas S. Lee, Julie T. Wang, Peter C. Austin, David A. Alter, Dennis T. Ko (2009-11-18). "Effectiveness of Public Report Cards for Improving the Quality of Cardiac Care: The EFFECT Study: A Randomized Trial". JAMA: 2009.1731. DOI:10.1001/jama.2009.1731. Retrieved on 2009-11-18. Research Blogging.
  21. ↑ Davidoff, Frank; Paul Batalden, David Stevens, Greg Ogrinc, Susan Mooney, for the SQUIRE development group (2008-12-01). "Publication Guidelines for Quality Improvement Studies in Health Care: Evolution of the SQUIRE Project". Journal of General Internal Medicine 23 (12): 2125-2130. DOI:10.1007/s11606-008-0797-4. Retrieved on 2008-12-18. Research Blogging.
  22. ↑ Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S (November 2008). "Publication guidelines for improvement studies in health care: evolution of the SQUIRE Project". Ann. Intern. Med. 149 (9): 670–6. PMID 18981488. [e]
  23. ↑ Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney SE (2009). "Publication guidelines for quality improvement studies in health care: evolution of the SQUIRE project". BMJ 338: a3152. PMID 19153129. [e]

External links

Quality measures

Measuring quality improvement

Reporting studies of quality improvement

  1. ↑ Iglehart JK (1996). "The National Committee for Quality Assurance". N. Engl. J. Med. 335 (13): 995-9. PMID 8786789. [e]
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