Clinical performance and quality health care
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Clin Perform Qual Health Care · Apr 1996
Proportion of mortality caused by severe hospital-acquired infection in open-heart surgery.
To investigate severe hospital-acquired infection as an independent risk factor for in-hospital mortality and the proportion of mortality caused by severe hospital-acquired infections in patients under going open-heart surgery. ⋯ Severe hospital-acquired infection is a principal factor in in-hospital mortality. One third of all deaths are caused by infection. Major efforts should be devoted to the prevention and control of severe nosocomial infections in open-heart surgery patients to prevent mortality.
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Clin Perform Qual Health Care · Jul 1995
Randomized Controlled Trial Clinical TrialCan a house call by a public health nurse improve the quality of the discharge process for geriatric patients?
To determine whether there was any benefit from a single house call by a health visitor (a public health nurse) to an elderly person after discharge home from a geriatric hospital. ⋯ A house call by a health visitor to elderly patients after discharge from geriatric wards does not measurably improve the quality of the discharge.
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Clin Perform Qual Health Care · Oct 1993
Using patient reports to measure health care system performance.
We developed a self-administered patient questionnaire that asks for data concerning the time to receive services (access to care), communication between providers (coordination of care), and follow up after tests and treatment (continuity of care). From these data, we construct rates of performance about the clinical management systems that support provision of these services. Rates of system performance are calculated for indicators using patients' responses to survey questions. ⋯ The sensitivity and specificity of patient reports are being evaluated for all indicators classified as gold standards for medical records. Indicators considered gold standard items for patient reports are matched for agreement with any information contained in the medical record. Also, patient characteristics associated with accurate reporting is to be assessed using multivariate logistic regression models.
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Clin Perform Qual Health Care · Jul 1993
Review Historical ArticleQuality in anesthesia care: lessons from industry and a proposal for valid measurement and improvement.
Quality anesthetic care is a goal fundamental to our tradition and our training, but defining and measuring quality in anesthesia presents special challenges. Industrial models of quality, especially those so fundamental to the re-emergence of post-war Japan, deserve careful study and are discussed at some length, but they clearly have limitations in understanding quality in anesthesiology. We suggest that most current quality efforts are inherently flawed. ⋯ Third, and perhaps most important, anesthetic processes and outcomes must be reported on a national level. Fundamental to future quality efforts in our specialty, we believe, is the establishment of a protected National Anesthesia Outcome Registry. This article reviews the industrial and medical history of quality, its measurement and improvement, and attempts to apply principles learned over many decades to anesthesiology.
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Clin Perform Qual Health Care · Apr 1993
Hospital-based continuous quality improvement: a realistic appraisal.
To evaluate the impact of a continuous quality improvement (CQI) multidisciplinary team process on emergency department admission times. ⋯ Although CQI is a promising approach to certain quality problems, a number of issues remain to be explored before full-scale implementation in academic centers can be endorsed.