Quality management in health care
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Qual Manag Health Care · Jan 2011
International medical travelers, length of stay, and the continuum of care: inquiry and comparison.
In this study, we assess whether length of stay (LOS) is associated with patient geographic origin and whether payment source for international patients explains differences in LOS. ⋯ The most complex international patients coming to US AMCs have substantially longer LOS than the most complex domestic patients, even after controlling for demographic characteristics, and type of condition. More research is needed to understand the underlying drivers of these differences.
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Qual Manag Health Care · Jul 2010
Risk-adjusted indices for measuring the quality of inpatient care.
This article describes a risk-adjustment method for profiling hospitals and physicians on key measures of clinical quality using readily available administrative data. By comparing actual and expected rates of mortality, complications, readmissions, and patient safety events, this method enables providers to identify both favorable and adverse outcomes performance.
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Qual Manag Health Care · Jul 2010
Applying Lean Six Sigma methodologies to improve efficiency, timeliness of care, and quality of care in an internal medicine residency clinic.
Patients' connectedness to their providers has been shown to influence the success of preventive health and disease management programs. Lean Six Sigma methodologies were employed to study workflow processes, patient-physician familiarity, and appointment compliance to improve continuity of care in an internal medicine residency clinic. ⋯ This study shows that incremental changes in workflow processes in a residency clinic can have a significant impact on practice efficiency and adherence to scheduled visits for preventive health care and chronic disease management. This project used a structured "Plan-Do-Study-Act" approach.
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Qual Manag Health Care · Jul 2010
Retracted PublicationUsing in situ simulation to identify and resolve latent environmental threats to patient safety: case study involving operational changes in a labor and delivery ward.
Since the publication of "To Err Is Human" in 1999, health care professionals have looked to high-reliability industries such as aviation for guidance on improving system safety. One of the most widely adopted aviation-derived approaches is simulation-based team training, also known as crew resource management training. In the health care domain, crew resource management training often takes place in custom-built simulation laboratories that are designed to replicate operating rooms or labor and delivery rooms. ⋯ In this article, we present the results from 1 such simulation: a patient who experienced a difficult labor that resulted in an emergency caesarian section and hysterectomy. During the simulation, a number of latent environmental threats to safety were identified. This article presents the latent threats and the steps that the hospital has taken to remedy them.
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Qual Manag Health Care · Jan 2010
Historical ArticleChange in MS-DRG assignment and hospital reimbursement as a result of Centers for Medicare & Medicaid changes in payment for hospital-acquired conditions: is it coding or quality?
In October 2008, the Centers for Medicare & Medicaid Services reduced payments to hospitals for a group of hospital-acquired conditions (HACs) not documented as present on admission (POA). It is unknown what proportion of Medicare severity diagnosis related group (MS-DRG) assignments will change when the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code for the HAC is not taken into account even before considering the POA status. ⋯ Removing HACs from MS-DRG assignment may result in significant cost savings for the Centers for Medicare & Medicaid Services through reduced payment to hospitals. As more conditions are added, the negative impact on hospital reimbursement may become greater. However, it is possible that variation in coding practice may affect cost savings and not reflect true differences in quality of care.