American journal of medical quality : the official journal of the American College of Medical Quality
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This study reports lessons learned from a project to develop a flexible, generalizable, and valid method for corporate buyers of hospital care that would permit them to use available secondary data to rate the outcomes quality of all hospitals in a local market area. As hospitalization insurance has moved from coverage that applied equally to all licensed hospitals to arrangements which selected a certain preferred hospital or hospitals and rejected others, the need to determine the quality of different hospitals (as well as what they would cost the insurer or buyer) has become apparent. The product of this project was the development and demonstration of a set of rating methods that build on the strengths available in large hospital discharge data bases, such as (but by no means limited to) that of the Pennsylvania Health Care Cost Containment Council (PHC4). These measures, or others developed using these methods, deal with uncertainty in the data--its diagnosis and treatment--in a conceptually valid and practically useful way, illustrate a process that might be used in the general development of quality measures, and provide a useful critique of some other measures.
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This article describes information useful for consumers and purchasers in making choices about health care services. Two types of information are described, patient satisfaction surveys and public reports about the price and outcomes of health care services such as those published by the Pennsylvania Health Care Cost Containment Council. ⋯ The goal of patient satisfaction reporting is to incorporate the patient's perspective to improve care. Public reports about the price and outcome of hospital and physician services not only facilitate consumer and purchaser choice, they also encourage continuous quality improvement by providers.
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A multidisciplinary group was formed to develop strategies to reduce ventilator-associated lower respiratory tract infections (LRI) in an intensive care unit (ICU) of a 540-bed acute care teaching medical center. The group process was facilitated by the Infection Director and the quality management specialist. The group was made of medical, nursing, and respiratory therapy staff. ⋯ The results of the evaluation were used as feedback to measure protocol implementation. This was found to improve compliance with the protocol. Both the process (care of ventilated patients) and the outcome (number of LRI) have been improved through use of continuous quality improvement concepts and transdisciplinary interventions.