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"Quality of Health Care"
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Researching quality in care transitions : international perspectives
\"This book is concerned with the complexities of achieving quality in care transitions. The organization and accomplishment of high quality care transitions relies upon the coordination of multiple professionals, working within and across multiple care processes, settings and organizations, each with their own distinct ways of working, profile of resources, and modes of organizing. In short, care transitions might easily be regarded as complex activities that take place within complex systems, which can make accomplishing high quality care challenging. As a subject of enquiry, care transitions are approached from many research, improvement and policy perspectives: from group psychology and human factors to social and political theory; from applied process re-engineering projects to exploratory ethnographic studies; from large-scale policy innovations to local improvements initiatives. This collection will provide a unique cross-disciplinary and multi-level analysis, where each chapter presents a particular depth of insight and analysis, and together offer a holistic and detail understand of care transitions.\"-- Provided by publisher.
Book
Systematic Review: Comparison of the Quality of Medical Care in Veterans Affairs and Non-Veterans Affairs Settings
Background: The Veterans Health Administration, the nation's largest integrated delivery system, launched an organizational transformation in the mid 1990s to improve the quality of its care. Purpose: To synthesize the evidence comparing the quality of medical and other nonsurgical care in Veterans Affairs (VA) and non-VA settings. Data Sources: MEDLINE database and bibliographies of retrieved studies. Study Selection: Studies comparing the technical quality of nonsurgical care in VA and US non-VA settings published between 1990 and August 2009. Data Extraction: Two physicians independently reviewed 175 unique studies identified using the search strategy and abstracted data related to 6 domains of study quality. Data Synthesis: Thirty-six studies met the inclusion criteria. All 9 general comparative studies showed greater adherence to accepted processes of care or better health outcomes in the VA compared with care delivered outside the VA. Five studies of mortality following an acute coronary event found no clear survival differences between VA and non-VA settings. Three studies of care processes after an acute myocardial infarction found greater rates of evidence-based drug therapy in VA, and 1 found lower use of clinically-appropriate angiography in the VA. Three studies of diabetes care processes demonstrated a performance advantage for the VA. Studies of hospital mortality found similar risk-adjusted mortality rates in VA and non-VA hospitals. Limitations: Most studies used decade-old data, assessed self-reported service use, or included only a few VA or non-VA sites. Conclusions: Studies that assessed recommended processes of care almost always demonstrated that the VA performed better than non-VA comparison groups. Studies that assessed risk-adjusted mortality generally found similar rates for patients in VA and non-VA settings.
Journal Article
Measuring, Reporting, and Rewarding Quality of Care in 5 Nations: 5 Policy Levers to Enhance Hospital Quality Accountability
Context: Studies have documented wide quality variation among hospitals within and across countries. Increasing quality-of-care accountability for hospitals, especially for patients and the general public, is an important policy objective, but no study has yet systematically and comprehensively compared leading countries' initiatives in this regard. Methods: Based on expert interviews and an extensive literature review, we investigate hospital quality accountability in England, Germany, the Netherlands, Sweden, and the United States. The underlying framework includes 3 elements: measuring quality, reporting quality, and rewarding quality. Each element is subdivided into 2 dimensions, with measuring composed of indicator type and data source, reporting composed of degree of reporting centralization and data accessibility, and rewarding composed of extent of application and type of quality-related payments. Findings: The results show a wide spectrum of approaches and progress levels. Measuring strategies are more similar across countries, while quality reporting and financial rewards are more dissimilar. Reporting of process indicators is more prevalent than reporting of outcomes. Most countries have introduced some quality-related payment schemes, with the United States having the most comprehensive approach. Based on the cross-country assessment, 5 policy levers to enhance quality transparency are identified and illustrated through country-specific examples: (1) the government should take a central role in establishing standards and incentives for quality transparency and health IT system integration; (2) system centralization and decentralization need to be balanced to ensure both national comparability and local innovation; (3) health systems need to focus more on outcome transparency and less on process measures; (4) health systems need to engage providers as proponents of quality transparency; and (5) reporting should focus on hospital and condition levels to ensure comparability and enable meaningful patient choice. Conclusions: The findings facilitate cross-country learning and best-practice adoption by assessing hospital quality accountability strategies in 5 countries in a structured and comparative manner. The identified policy levers are relevant for enhancing breadth, depth, and value of quality accountability.
Journal Article
The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement
BackgroundQuality improvement (QI) efforts have become widespread in healthcare, however there is significant variability in their success. Differences in context are thought to be responsible for some of the variability seen.ObjectiveTo develop a conceptual model that can be used by organisations and QI researchers to understand and optimise contextual factors affecting the success of a QI project.Methods10 QI experts were provided with the results of a systematic literature review and then participated in two rounds of opinion gathering to identify and define important contextual factors. The experts subsequently met in person to identify relationships among factors and to begin to build the model.ResultsThe Model for Understanding Success in Quality (MUSIQ) is organised based on the level of the healthcare system and identifies 25 contextual factors likely to influence QI success. Contextual factors within microsystems and those related to the QI team are hypothesised to directly shape QI success, whereas factors within the organisation and external environment are believed to influence success indirectly.ConclusionsThe MUSIQ framework has the potential to guide the application of QI methods in healthcare and focus research. The specificity of MUSIQ and the explicit delineation of relationships among factors allows a deeper understanding of the mechanism of action by which context influences QI success. MUSIQ also provides a foundation to support further studies to test and refine the theory and advance the field of QI science.
Journal Article
When the patient is the expert: measuring patient experience and satisfaction with care
In 2018, three independent reports were published, emphasizing the need for attention to, and improvements in, quality of care to achieve effective universal health coverage. A key aspect of high quality health care and health systems is that they are person-centred, a characteristic that is at the same time intrinsically important (all individuals have the right to be treated with dignity and respect) and instrumentally important (person-centred care is associated with improved health-care utilization and health outcomes). Following calls to make 2019 a year of action, we provide guidance to policy-makers, researchers and implementers on how they can take on the task of measuring person-centred care. Theoretically, measures of person-centred care allow quality improvement efforts to be evaluated and ensure that health systems are accountable to those they aim to serve. However, in practice, the utility of these measures is limited by lack of clarity and precision in designing and by using measures for different aspects of person-centeredness. We discuss the distinction between two broad categories of measures of patient-centred care: patient experience and patient satisfaction. We frame our discussion of these measures around three key questions: (i) how will the results of this measure be used?; (ii) how will patient subjectivity be accounted for?; and (iii) is this measure validated or tested? By addressing these issues during the design phase, researchers will increase the usability of their measures.
Journal Article
Donabedian’s Lasting Framework for Health Care Quality
In a landmark article published 50 years ago, Avedis Donabedian proposed using the triad of structure, process, and outcome to evaluate the quality of health care. That triad, along with his eventual seven pillars of quality, continues to inform efforts to improve care.
Though historians are often hesitant to declare any event a “first,” one might safely claim that the contemporary health care quality movement had its “founding moment” in October 1965. Less than 3 months after the Medicare and Medicaid programs were enacted, the newly created Health Services Research Section of the U.S. Public Health Service convened a meeting in Chicago of leaders from many health-related fields. These leaders considered the influence of social and economic research on public health, the organization of community health agencies, and the quality of health services.
One of these experts, Avedis Donabedian, a professor of medical . . .
Journal Article