American journal of medical quality : the official journal of the American College of Medical Quality
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This article identifies empirically supported techniques for improving medical practice patterns by relying on both The Delta Group's professional change management experience and a thorough review of the literature relating to the essential characteristics of successful change management programs in health care. The purpose of this article is to provide health care professionals with an overview of the various change management techniques that have been widely regarded as having the greatest impact on the clinical and financial success of improvement programs before health care professionals initiate change management activities within their own organization.
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Provider knowledge is a potential barrier to adherence to clinical guidelines. The purpose of this study is to assess the impact of organizational, provider, and guideline factors on provider knowledge of a congestive heart failure (CHF) clinical practice guideline (CPG) in the Veterans Health Administration (VHA) health care system. We developed a survey to investigate institution-level factors influencing the effectiveness of guideline implementation, including characteristics of the guideline, providers, hospital culture and structure, and regional network. ⋯ Specific variables within these categories that were related to greater knowledge included physician belief that guidelines were applicable to their practice, distribution of guideline summaries, use of guideline storyboards in clinic areas, the use of technology (eg, electronic patient records) in CPG implementation, and establishment of implementation checkpoints and deadlines. Provider knowledge of guidelines is affected by factors at various organizational levels: dissemination approaches, use of technology, and hospital culture. Guideline implementation efforts that target multiple organizational levels may increase provider knowledge.
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It is widely acknowledged that the measurement of outcomes of care and the comparison of outcomes over time within health care providers and risk-adjusted comparisons among providers are important parts of improving quality and cost-effectiveness of care. However, few studies have assessed the costs of measuring outcomes of care. We sought to evaluate the personnel and financial resources spent for a prospective assessment of outcomes of acute hospital care by health professionals in internal medicine. ⋯ We estimated that the total cost for each hospital to assess outcomes of care for accreditation (10 tracer diagnoses over 6 months) would be 9700 Euros and that continuous monitoring of outcomes (5 tracer diagnoses) would cost 12,400 Euros per year. This study suggests that outcomes of acute hospital care can be assessed with limited resources and that standardized training programs would reduce variability in overall costs. This study should help hospital decision makers to estimate the necessary funding for outcomes measurement initiatives.
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Randomized Controlled Trial Clinical Trial
Controlled trial of a patient-completed history questionnaire: effects on quality of documentation and patient and physician satisfaction.
The purpose of this work was to study the impact of a patient-self-completed history questionnaire upon the quality of the information in the medical record, resource utilization, patient satisfaction, and physician satisfaction. A controlled trial was performed in a primary care clinic of a public supported, urban, university hospital. The patients were mainly poor, minority, urban individuals visiting the clinic for their first primary care visit. ⋯ Of the patients who received the questionnaire, all who were asked felt that all their issues were addressed, compared with only 83% in the control group (P = .015). No increases in physician time or in utilization of medical resources were found. The implementation of a self-administered history questionnaire in an urban primary care clinic resulted in improved chart quality and improved satisfaction of physicians and patients.
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Comparative Study
A comparison of predictive outcomes of APACHE II and SAPS II in a surgical intensive care unit.
The Acute Physiologic Score and Chronic Health Evaluation (APACHE) II and the Simplified Acute Physiologic Scale (SAPS) II are two of the more commonly employed predictors of outcome and performance in the intensive care unit setting. However, controversy persists about whether the scores generated by these systems have similar predictive value. This study compared the predicted mortalities derived from APACHE II and SAPS II and contrasted them to the actual mortality in a surgical intensive care unit (SICU). ⋯ We conclude that although disparities between APACHE II and SAPS II predicted mortalities in individual patients may be significant, APACHE II and SAPS II have similar predictive value in a large SICU patient population. However, both APACHE II and SAPS II systems overestimate mortality in SICU patients. Based on our results, we conclude that either system can be used to measure quality of care in the SICU; however, neither system can be reliably applied to a single patient.