International journal for quality in health care : journal of the International Society for Quality in Health Care
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Int J Qual Health Care · Dec 2003
Improving patient safety across a large integrated health care delivery system.
Patient safety is moving up the list of priorities for hospitals and health care delivery systems, but improving safety across a large organization is challenging. We sought to create a common patient safety strategy for the Partners HealthCare system, a large, integrated, non-profit health care delivery system in the United States. ⋯ This loosely integrated delivery system represents a daunting landscape for the development and institution of patient safety concepts. Many projects aimed at different components of patient safety must occur at the same time for significant change, yet culture and care-related beliefs vary substantially within the system, and measurement is especially challenging. Moreover, with many potential interventions, and limited resources, prioritization and selection is difficult. Nonetheless, consensus about some issues has been reached, in particular because of a well delineated patient safety structure. We believe the net result will be substantial improvement in patient safety.
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Int J Qual Health Care · Dec 2003
ReviewThe US Agency for Healthcare Research and Quality's activities in patient safety research.
To update the international community on the US Agency for Healthcare Research and Quality's (AHRQ) recent and current activities in improving patient safety. ⋯ The patient safety research field has undergone a period of rapid evolution. It is now incumbent upon the international health care quality improvement community to translate the future results of this research investment into improved safety for patients.
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Int J Qual Health Care · Dec 2003
Validity and reliability of guidelines for neck pain treatment in primary health care. A nationwide empirical analysis in Spain.
To assess the reliability and validity of existing clinical guidelines on neck-pain physiotherapy treatment and follow-up in Spain. ⋯ The results question the guidelines' reliability and validity, and their usefulness in ensuring quality. We conclude that guidelines should be reviewed and re-designed with greater scientific rigour.
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Int J Qual Health Care · Dec 2003
Improving medication safety: the measurement conundrum and where to start.
The use of medication remains the most common intervention in health care. The complexity of both medication use and the medication management process, especially in the in-patient setting, create a significant risk for hospitalized patients. Despite the widespread recognition of the hazards that medication use poses to patients, there are no widely accepted or standardized methods to measure the safety of medication use. ⋯ Medication safety is a complex process and measurement of it needs to be a core component throughout the whole process. With the introduction of computerized analysis of patient information, measurement becomes much easier and potentially more powerful and achievable than either incident reporting or chart reviews for purposes of accountability, prevention, and ongoing improvement of both process and clinical practice. This paper reviews approaches to measuring medication safety from the perspective of both harm and error, and outlines a strategy that combines both approaches in the electronic era.
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Int J Qual Health Care · Dec 2003
'Emerge': Benchmarking of clinical performance and patients' experiences with emergency care in Switzerland.
To assess the effects of uniform indicator measurement and group benchmarking followed by hospital-specific activities on clinical performance measures and patients' experiences with emergency care in Switzerland. ⋯ Undertaken in a real-world setting, small but significant improvements in performance measures and patients' perceptions of emergency care could be achieved. Hospitals accomplished these improvements mainly by averting strong outliers, and were most successful in preventing series of negative events. Uniform outcomes measurement, group benchmarking, and data-driven hospital-specific strategies for change are suggested as valuable tools for continuous improvement. Several hospitals have already implemented the developed measures in their internal quality systems and subsequent measurements are projected.