Joint Commission journal on quality and patient safety / Joint Commission Resources
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Jt Comm J Qual Patient Saf · Oct 2006
Multicenter StudyA trigger tool to identify adverse events in the intensive care unit.
The Institute for Healthcare Improvement has tested and taught use of a variety of trigger tools, including those for adverse medication events, neonatal intensive care events, and a global trigger tool for measuring all event categories in a hospital. The trigger tools have evolved as a complimentary adjunct to voluntary reporting. The Trigger Tool technique was used to identify the rate of occurrence of adverse events in the intensive care unit (ICU), and a subset of ICUs described those events in detail. ⋯ The Trigger Tool methodology is a practical approach to enhance detection of adverse events in ICU patients. Evaluation of these adverse events can be used to direct resource use for improvement work. The measurement of these sampled chart reviews can also be used to follow the impact of the change strategies on the occurrence of adverse events within a local ICU.
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Jt Comm J Qual Patient Saf · Sep 2006
Pay for performance for antibiotic timing in pneumonia: caveat emptor.
Health care practitioners and hospital administrators have focused on a performance measure regarding antibiotic timing for patients with community-acquired pneumonia in anticipation of a pay-for-performance program through the Centers for Medicare & Medicaid Services (CMS) and private payers. ⋯ Attempts to address the performance measure are probably dependent on how well the emergency department functions and the level of crowding. Patients with a suspected pneumonia may be empirically covered with antibiotics before radiographic diagnosis, which should increase the rate of antibiotic administration for antibiotic-nonresponsive conditions and contribute to antibiotic resistance. The answer is to find measures of system throughput and/or work flow that are associated with improved patient care outcomes.
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Jt Comm J Qual Patient Saf · Aug 2006
Paying physicians for quality: evidence and themes from the field.
Health plans, self-insured employers, health plans, and provider organizations are currently introducing financial incentives that reward physicians for delivering high-quality medical care. Yet a review of existing research reveals virtually no empirical studies of the effect of direct, internal quality incentives on physician performance. Key-informant interviews with leaders of provider organizations should shed new light on evolving quality incentives within organizations. ⋯ These findings have implications for the acceptability and structure of financial incentives for quality directed to health care provider organizations. A set of considerations for the design and implementation of quality incentives relate to the incentives' scope, controllability, transparency, size, and orientation (individual or team), as well as the relationship between the extrinsic financial incentives and professionals' intrinsic motivation.
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Jt Comm J Qual Patient Saf · Jul 2006
Improving health care quality and safety for people with disabilities: an interview with Lisa Iezzoni. Interview by Steven Berman.
Dr. Iezzoni addresses issues in the quality and safety of health care for people with disabilities, who may be especially likely to experience problems in care.