The Joint Commission journal on quality improvement
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Jt Comm J Qual Improv · Jul 2001
Using outcome evaluations to assess interdisciplinary acute and chronic pain programs.
Outcome evaluations can be useful for reassuring patients that their time and effort are well spent on treatment and for providing staff with confidence in their treatment provision. Outcome evaluations were carried out in 1997 and 1999 to assess two initiatives for the treatment of patients within the Regina Health District (RHD), Saskatchewan, Canada-the Chronic Pain Team Evaluation and Management (CP TEAM) Service and the Acute Injury Management (AIM) Program. STUDY 1: The CP Team Service was an individualized interdisciplinary treatment program intended to serve patients with chronic pain. Of 47 eligible chronic pain patients, 36 participants completed treatment within 15 months, and 27 completed follow-up questionnaires on discharge; the comparison group was composed of the remaining 11 nontreated participants, 8 of whom responded to follow-up questionnaires. Only patients in the treatment group reported a decrease in pain and a decrease in interference in activities. Overall, satisfaction with treatment received was high. STUDY 2: The AIM Program was intended to aid employees with acute musculoskeletal injuries who could not perform regular job duties. Following injury, employees were contacted by an occupational health nurse and informed of the program. If the employee was interested, the AIM coordinator carried out an assessment and designed an individualized treatment package, including physical therapy, exercise therapy, and/or occupational therapy. Treatment was expected to continue until the employee returned to normal duties. Of 72 eligible employees, 43 employees participated and 29 opted not to participate-15 of whom agreed to participate as control participants for this study. Of the employees receiving AIM, 20 agreed to participate in this study. Of the employees not participating in AIM, 15 agreed to participate as control participants. Although pain and interference were greater among AIM participants before commencing treatment, by the end of treatment participants had improved more in level of pain severity and interference compared with controls. All participants reported improved job function over time. AIM participants, however, reported lower job function before treatment than control participants and similar job function after treatment- and indicated they were highly satisfied with the service they received. ⋯ Evaluations are not only used to assess program outcomes but are an important aspect of program validation and development. Data collection was incorporated, as much as possible, into routine treatment protocols and staff focused on obtaining essential information regarding patient outcomes rather than the whole scope of information.
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Jt Comm J Qual Improv · May 2001
Using an improvement model to reduce adverse drug events in VA facilities.
Adverse drug events cause significant morbidity and mortality in health care. Many adverse drug events are due to medication errors and are preventable. In 1999 and 2000 the Patient Safety Center of Inquiry collaborated with the Institute for Healthcare Improvement (IHI) to implement a quality improvement (QI) project designed to reduce medication errors within the Veterans Administration system. ⋯ The results suggest that gains made in organized QI efforts can be maintained for 6 months without additional external support or coaching if team structure and leadership support remain intact. Facilitators of QI efforts should focus on teams that are having difficulty learning new techniques. Finally, this effort appeared to generate cost savings.
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Jt Comm J Qual Improv · Apr 2001
Clinical TrialA Web-based diabetes care management support system.
Because of the often asymptomatic nature of diabetes and the long period between sustained hyperglycemia and observable complications, appropriate diabetes care relies on a long-term program of secondary prevention. Yet routine monitoring and screening among patients with diabetes is less than optimal. To support the provision of routine care to patients with diabetes, the Center for Health Services Research, Henry Ford Health System (Detroit), developed a Web-based Diabetes Care Management Support System (DCMSS). A nonrandomized, longitudinal study was conducted (January 1, 1998-October 31, 1999) with 13,325 health maintenance organization patients with diabetes who were aligned to 190 primary care providers practicing in 31 primary care clinics. ⋯ Computerized systems of clinical practice guidelines, patient registries, and performance feedback may help improve the rate of routine testing among patients with diabetes.
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Jt Comm J Qual Improv · Mar 2001
Developing indicators for emergency medical services (EMS) system evaluation and quality improvement: a statewide demonstration and planning project.
The state of California, like every other state, has no system for assessing the quality of prehospital emergency medical services (EMS) care. As part of a statewide project, a process was designed for the evaluation and quality improvement (QI) of EMS in California. Local EMS agency (LEMSA) representatives made a commitment to submit data from both the providers and the hospitals they work with. ⋯ Since the project's conclusion in June 2000, many regional and local EMS groups have begun to collect data on indicators. Many of the project's recommendations have been incorporated into the work plan of the state's System Review and Data Committee.
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Jt Comm J Qual Improv · Jan 2001
Ensuring safety of patients receiving sedation for procedures: evaluation of clinical practice guidelines.
In 1995 The Johns Hopkins Hospital in Baltimore convened an interdisciplinary task force to evaluate sedation practices, create a comprehensive set of sedation guidelines, and evaluate patient safety outcomes following guideline implementation. ⋯ Standardization of sedation practices is a complex and resource-intensive activity, requiring ongoing oversight and monitoring. Commitment from medical staff, nursing staff, and administration is essential to successful implementation of sedation guidelines.