Quality management in health care
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A national agenda for health care quality is unfolding but there is concern about inadequate progress on improving quality in hospitals. The 2003 Institute of Medicine report calls for transformational leadership in health care organizations to change systems and processes underlying quality. The key question is: Who will provide leadership in hospitals? A natural choice is the board of trustees on account of its legal responsibility for quality and its authority over medical staff and administration. ⋯ Barriers include trustee ignorance, trustee insecurity, board inattention, poor board-physician communication, fragmented information on quality, traditional medical staff structure, lack of professional management of quality, and lack of investment. Strategies for hospital board leadership should include preparing to lead, self-education, visible participation in quality activities, activism, role clarification, increased informal dialogue with physicians, medical staff reform, creation of a quality management department, instituting high-quality standards, and external quality audit. Boards face a historic opportunity to transform hospital quality backed by a strong legal mandate.
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The financing and organization of health care in the United States has been rapidly evolving in the last 30 years. Managed care and capitation have largely replaced fee-for-service as a way to pay providers. Cost-control initiatives were developed by payers. ⋯ These might be referred to as disease management that includes evidence-based medicine and outcomes measurement. It is proposed that a third revolution, patient empowerment, is just starting. The potential far-reaching consequences are described, discussed, and analyzed here, including their cost consequences.
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Qual Manag Health Care · Jan 2003
Application of attribute control charts to risk-adjusted data for monitoring and improving health care performance.
This article proposes a new class of control charts that may be used for monitoring and improving the quality of care. Unlike conventional control charts that rely on observed performance data, these charts use risk-adjusted data in addition to the observed data. The resulting time-ordered charts are capable of reducing time-to-time variation that may stem from uncontrollable changes in patient mix over time. ⋯ Risk-adjusted rates are obtained using multivariate logistic regression models. It was found that the risk-adjusted control charts could be effective in reducing biases that arise from variation in patient mix. These charts can potentially achieve higher sensitivity and specificity compared with ordinary control charts.
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Qual Manag Health Care · Jan 2003
Citizens' role in health services: satisfaction behavior: Kano's model, Part 2.
Kano's approach, besides providing a theoretical model for the behavior of consumer satisfaction, makes it possible to convert theory into practice by creating instruments (questionnaires) designed to study consumer preferences and to find out how a given service feature or attribute will behave in terms of consumer satisfaction. In the second part of this article (part 1 is also in this issue), we describe the technical aspects of developing and using this type of questionnaire and the implications of applying Kano's model.
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Qual Manag Health Care · Jan 2002
Comparative StudyStructural versus outcomes measures in hospitals: a comparison of Joint Commission and Medicare outcomes scores in hospitals.
Outcomes performance measures are increasingly important in health care. The Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) continues to rely on structure and process measures based on accepted good practice. One of the first tasks in moving to a more outcomes-oriented approach is to compare the two measurement approaches. ⋯ Joint Commission measures are generally not correlated with outcome measures. The few significant correlations that appear are often counterintuitive. We conclude that a potentially serious disjuncture exists between the outcomes measures and Joint Commission evaluations.