Quality management in health care
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Qual Manag Health Care · Jan 2002
Building and assessing competence: the potential for evidence-based graduate medical education.
The Accreditation Council for Graduate Medical Education (ACGME) has recently begun to use educational outcome measures as an accreditation tool. This long-term initiative offers the potential for building knowledge about effective educational interventions and ultimately for using time-variable educational models. ⋯ Skill sets and accountability proceed along a continuum that is outlined. Crucial is the development of a community committed to discerning and obeying the truth about the effectiveness of educational interventions.
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Qual Manag Health Care · Jan 2002
Enhancing VHA's mission to improve veteran health: synopsis of VHA's Malcolm Baldrige award application.
The Veterans Health Administration (VHA) provides health care value to an aging veteran population in the midst of rising health care costs and the necessity to demonstrate improvements in the quality of care. The Malcolm Baldrige framework offers a comprehensive assessment of the organization's management system, performance improvements, and the promise to enhance health outcomes, including quality and patient satisfaction. This article will describe the development, current status, and future plans within VHA for the Malcolm Baldrige Award for Healthcare.
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Qual Manag Health Care · Jan 2002
A model of medical error based on a model of disease: interactions between adverse events, failures, and their errors.
This article discusses Rush-Presbyterian-St. Luke's Medical Center's approach to assessing and preventing errors in care and promoting patient safety. The word error is applied to all kinds of events, including adverse occurrences, negligence, and malpractice. ⋯ A patient safety committee standardized the definition of medical error and developed a taxonomy for error as a prelude to efforts at error reduction. It identified three levels or layers that can represent a train of events culminating in an undesired outcome: error, treatment failure, and adverse event. This discussion is offered in the interest of clarifying some of the issues.
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Qual Manag Health Care · Jan 2001
Case Reports Comparative StudySame patients, same critical events--different systems of care, different outcomes: description of a human factors approach aimed at improving the efficacy and safety of sedation/analgesia care.
The practice of sedating pediatric patients undergoing diagnostic and therapeutic procedures represents an ideal model for evaluating systems of health care delivery. We present detailed evidence of how different systems acting on the same patient under similar conditions result in very different outcomes. ⋯ We conclude with a demonstration of how a patient simulator can be used to quantify responses to sedation emergencies. These data constitute the basis for innovating novel sedation care systems and strategies that will optimize safety and efficacy.
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Qual Manag Health Care · Jan 2000
Opinions and use of advance directives by physicians at a tertiary care hospital.
The physician-patient relationship is an essential part of end-of-life planning, including discussions of advance directives (AD). Physicians likely to encounter AD issues with their patients were identified and queried as to their knowledge, opinion, and experience with ADs. Though most physicians felt ADs were helpful to both physicians and patients, considerably less were familiar with hospital policies and the different types of ADs. Formal education in the use and function of ADs also appears to be lacking, suggesting a need to improve the way in which ADs are addressed during medical training.