The Joint Commission journal on quality improvement
-
Jt Comm J Qual Improv · Apr 1999
Case Reports Comparative StudyUsing statistical process control charts for the continual improvement of asthma care.
Home monitoring of lung function using simple, inexpensive tools to measure peak expiratory flow rate (PEFR) has been possible since the 1970s. Yet although current national and international guidelines recommend monitoring of PEFRs via traditional run charts, their use by both patients and physicians remains low. The role of statistical process control (SPC) theory and charts in the serial monitoring of lung function at home were explored and applied to the direct care of patients with asthma. The method represents an integration of collective professional and improvement knowledge with the related disciplines of continual improvement, SPC, system thinking/system dynamics, paradigms, and the learning community/organization. ⋯ The PEFR control chart employs an interesting statistical platform that enables the integration of knowledge of serial measurements and knowledge of the variation between those measurements into a tool with which to better assess the asthma care process being followed. This tool provides clinical insights, practical knowledge, and opportunities unavailable to patients and physicians via traditional PEFR charting.
-
Jt Comm J Qual Improv · Mar 1999
The accuracy of hospital reports of organ donation eligibility, requests, and consent: a cross-validation study.
Many states require hospitals to complete a form for each patient who dies, reporting the patient's organ and tissue donation eligibility status, whether a request was made, and the outcome of the request. A study was conducted to determine the accuracy of state-required forms in documenting organ eligibility and procurement activities. ⋯ Basing the evaluation of hospital or statewide organ procurement performance on summary information provided by these forms would lead to an inaccurate picture of organ procurement activities in the state.
-
Jt Comm J Qual Improv · Feb 1999
AMA Clinical Quality Improvement Forum ties it all together: from guidelines to measurement to analysis and back to guidelines.
In Chicago October 15, 1998, the American Medical Association (AMA) Department of Clinical Quality Improvement introduced a broadened scope for its Practice Parameters Forum, now retitled the Clinical Quality Improvement Forum. The Forum will now focus on integrating all the components of what the AMA has identified as the quality continuum-clinical practice guidelines, performance measurement, and process and outcomes analysis. ⋯ CLINICAL OUTCOMES MEASUREMENT: If outcomes can be associated with specific processes of care, clinical practice guidelines can be refined. However, outcomes are dependent on factors outside physicians' behavior and control, such as patient compliance, comorbidities, and other risk factors, and consequently consideration of these variables is essential to appropriately interpreting the data.
-
Jt Comm J Qual Improv · Feb 1999
Integrating clinical performance improvement across physician organizations: the PhyCor experience.
There is a paucity of literature describing the implementation of clinical performance improvement (CPI) efforts across geographically dispersed multispecialty group practices and independent practice associations. PhyCor, a physician management company based in Nashville, Tennessee, has integrated CPI initiatives into its operating infrastructure. PhyCor CPI INITIATIVES: The strategic framework guiding PhyCor's CPI initiatives is built around a physician-driven, patient-centered model. Physician/administrator leadership teams develop and implement a clinical and financial strategic plan for performance improvement; adopt local clinical and operational performance indicators; and agree on and gain consensus with local physician champions to engage in CPI initiatives. The area/regional leadership councils integrate and coordinate regional medical management and CPI initiatives among local groups and independent practice associations. In addition to these councils and a national leadership council, condition-specific care management councils have also been established. These councils develop condition-specific protocols and outcome measures and lead the implementation of CPI initiatives at their own clinics. ⋯ Physician leadership and strategic vision, CPI-oriented organizational infrastructure, broad-based physician involvement in CPI, providing access to performance data, parallel incentives, and creating a sense of urgency for accelerated change are all critical success factors to the implementation of CPI strategies at the local, regional, and national levels.
-
Jt Comm J Qual Improv · Aug 1998
Measuring the quality of performance in the management of waiting lists: using cataract surgery as an example.
Quality of care committees monitor waiting lists to ensure that patient care is not compromised. Frequently, waiting lists are determined by individual physicians, and no explicit criteria determine who is first in the queue. The quality of ophthalmologists' decisions for managing waiting lists of cataract patients, a high-volume elective patient group, was examined in a study of patients undergoing cataract surgery in 1997 in the Regina Health District, Saskatchewan, Canada. ⋯ Waiting lists can be well managed by using individual physician decision making, although explicit formal decision-making rules would be helpful. A variety of methodologies and analyses can be used to evaluate the management of waiting lists and to assist in identifying criteria for assigning priority to patients.