American journal of medical quality : the official journal of the American College of Medical Quality
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Although approximately one of five people in the United States die in nursing homes (NHs), little has been written about their quality of dying, including the quality of terminal medical care. The purpose of this study is to review actual medical practices in NHs to suggest factors important for delivering good quality terminal care. Four NHs were surveyed for management of residents who died in 1992. ⋯ We conclude that physicians are able to recognize impending death and redirect the medical care of dying NH residents toward goals of terminal care management. This is more likely to occur in a NH environment that places greater emphasis upon total quality management. We suggest that another indicator in providing good NH terminal care is the physician's performance in predicting a short life expectancy.
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Comparative Study
Health care spending, delivery, and outcome in developed countries: a cross-national comparison.
This study examines the trend of health care spending, availability and use of medical services, and aggregate health outcome of the 24 industrialized member countries of the Organization for Economic Cooperation and Development (OECD). Major differences between the United States and other OECD countries are highlighted and discussed. ⋯ The United States needs to learn from the successful experience of other nations. Redesigning the system of health care delivery in the United States may be the only viable option to improve the quality of health care.
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One of the most important parameters that influence patient satisfaction with emergency department care is their perception of throughput time. It is defined in our department as the time from patient arrival to time of discharge. Measurement of throughput time is one objective measure of efficiency that is feasible in most emergency departments. ⋯ Analysis of variants through multiple regression was used to determine associations between the average daily throughput time and factors commonly assumed to have significant influence on patient throughput time. Our data analysis found that patient throughput was significantly affected by the number of inpatient admissions from the emergency department, daily census in the main emergency department, pediatric volume, and the number of ambulance arrivals. Several factors that were commonly assumed to affect patient throughput time, such as nursing hours worked and day of the week, were not significant.
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Recently the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) announced that it would integrate the use of clinical outcomes and other performance measures into the accreditation process through its new "ORYX" program. This JCAHO initiative represents a significant new development that will include more than 100 different performance measurement systems, most of which are available through commercial firms and outside organizations. ⋯ To illustrate some of the potential adverse effects that could result from using such data to compare health care providers and facilities, we discuss some common problems associated with several widely available performance measurement systems. We then suggest an alternative approach that could potentially avoid many of these problems in the future.
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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.