Joint Commission journal on quality and patient safety / Joint Commission Resources
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Jt Comm J Qual Patient Saf · Jan 2011
Experiences of participants in a collaborative to develop performance measures for hospice care.
There has been increasing attention paid to quality assessment in hospice as the industry has grown and diversified. In response, policymakers have called for standardized approaches to monitoring hospice quality. The experiences of a set of hospices involved with the National Association for Home Care & Hospice (NAHC) Quality Assessment and Performance Improvement Collaborative, which was designed to test the use of a standardized patient symptom assessment tool as an exemplar of efforts to standardize symptom assessment in hospice, were examined. ⋯ The experiences of the participating hospices in the NAHC collaborative are intended to inform the design of future interorganizational learning efforts to promote quality assessment initiatives within hospice settings. Future hospice collaboratives should use multiple methods of communication to build a close participant network and be clear about collaborative goals and participant expectations and about the reciprocal relationship of the collaborative and the participants.
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Jt Comm J Qual Patient Saf · Jan 2011
Designing an abstraction instrument: lessons from efforts to validate the AHRQ patient safety indicators.
The U.S. Agency for Healthcare Research and Quality (AHRQ) and other organizations have developed quality indicators based on hospital administrative data. Characteristics of effective abstraction instruments were identified for determining both the positive predictive value (PPV) of Patient Safety Indicators (PSIs) and the extent to which hospitals and clinicians could have prevented adverse events. ⋯ Designing medical record abstraction instruments for quality improvement research involves several potential pitfalls. Understanding how we addressed these challenges might help both investigators and users of outcome indicators to appreciate the strengths and limitations of outcome-based quality indicators and tools designed to validate or investigate such indicators within provider organizations.
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Jt Comm J Qual Patient Saf · Jan 2011
Developing a policy for do not resuscitate orders within a framework of goals of care.
Discussions about DNR (do not resuscitate) orders or code status are common but can be difficult and may not lead to accurate understanding between clinicians and patients. These discussion are often isolated from the larger context of a patient's plan of care. Addressing patients goals of care, which provide a basic orientation for clinical and ethical decision making, may improve clinicians' understanding about patients' code-status preferences. ⋯ The DNR order policy represents an effort to translate conceptual analysis, empirical research, and clinical experience into hospital policy so that clinicians are encouraged to place code-status discussions within a larger, goal-oriented context. Using goals of care to guide decision making about DNR orders and other treatments should enhance the quality of patient care by improving the fit between the biomedical information we provide patients and the values our patients rely on to make their medical decisions.