Quality Improvement Using Automated Data Sources: The Anesthesia Quality Institute

ABSTRACT Many institutions are seeking ways to enhance their surgical trainees' quality improvement (QI) skills.Background To educate trainees about the importance of lifelong performance improvement, chief residents at New York Presbyterian Hospital–Weill Cornell Medicine are members of a multidisciplinary QI team tasked with improving surgical outcomes. We describe the process and the results of this effort.Objective Our analysis used 2 data sources to assess complication rates: the National Surgical Quality Improvement Program (NSQIP) and ECOMP, our own internal complication database. Chief residents met with a multidisciplinary QI team to review complication rates from both data sources. Chief residents performed a case-by-case analysis of complications and a literature search in areas requiring improvement. Based on this information, chief residents met with the multidisciplinary team to select interventions for implementation, and delivered QI-focused grand rounds summarizing the QI process and new interventions.Methods Since 2009, chief residents have presented 16 QI-focused grand rounds. Urinary tract infections (UTIs) and surgical site infections (SSIs) were the most frequently discussed. Interventions to improve UTIs and SSIs were introduced to the department of surgery through these reports in 2011 and 2012. During this time we saw improvement in outcomes as measured by NSQIP odds ratio.Results Departmental grand rounds are a suitable forum to review NSQIP data and our internal, resident-collected data as a means to engage chief residents in QI improvement, and can serve as a model for other institutions to engage surgery residents in QI projects.Conclusions

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Registry and health insurance claims data in vascular research and quality improvement

VASA ◽

10.1024/0301-1526/a000589 ◽

2017 ◽

Vol 46 (1) ◽

pp. 11-15 ◽

Cited By ~ 23

Author(s):

Christian-Alexander Behrendt ◽

Franziska Heidemann ◽

Henrik Christian Rieß ◽

Konstanze Stoberock ◽

Sebastian Eike Debus

Keyword(s):

Quality Improvement ◽

Health Insurance ◽

Administrative Data ◽

Claims Data ◽

Data Sources ◽

Insurance Claims ◽

Advantages And Disadvantages ◽

Insurance Claims Data ◽

Health Insurance Claims Data ◽

Health Insurance Claims

Abstract. The expansion of procedures in multidisciplinary vascular medicine has sparked a controversy regarding measures of quality improvement. In addition to primary registries, the use of health insurance claims data is becoming of increasing importance. However, due to the fact that health insurance claims data are not collected for scientific evaluation but rather for reimbursement purposes, meticulous validation is necessary before and during usage in research and quality improvement matters. This review highlights the advantages and disadvantages of such data sources. A recent comprehensive expert opinion panel examined the use of health insurance claims data and other administrative data sources in medicine. Results from several studies concerning the validity of administrative data varied significantly. Validity of these data sources depends on the clinical relevance of the diagnoses considered. The rate of implausible information was 0.04 %, while the validity of the considered diagnoses varied between 80 and 97 % across multiple validation studies. A matching study between health insurance claims data of the third-largest German health insurance provider, DAK-Gesundheit, and a prospective primary registry of the German Society for Vascular Surgery demonstrated a good level of validity regarding the mortality of endovascular and open surgical treatment of abdominal aortic aneurysm in German hospitals. In addition, a large-scale international comparison of administrative data for the same disorder presented important results in treatment reality, which differed from those from earlier randomized controlled trials. The importance of administrative data for research and quality improvement will continue to increase in the future. When discussing the internal and external validity of this data source, one has to distinguish not only between its intended usage (research vs. quality improvement), but also between the included diseases and/or treatment procedures. Linkage between primary registry data and administrative data could be a reasonable solution to some current major issues of validity. 

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Variations in Institutional Review Board Approval in the Implementation of an Improvement Research Study

Nursing Research and Practice ◽

10.1155/2013/548591 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Darpan I. Patel ◽

Kathleen R. Stevens ◽

Frank Puga

Keyword(s):

Quality Improvement ◽

Research Study ◽

Science Research ◽

Institutional Review Board ◽

Data Sources ◽

Research Network ◽

Board Meeting ◽

Improvement Science ◽

Institutional Review Board Approval ◽

Institutional Review

The purpose of this paper is to report the variance in institutional review board (IRB) reviews as part of the implementation of a multisite, quality improvement study through the Improvement Science Research Network (ISRN) and recommend strategies successful in procuring timely IRB approval. Using correspondence documents as data sources, the level of review was identified and time to submission, time to approval, and time to study start were analyzed. Thirteen of the 14 IRBs conducted independent reviews of the project. Twelve IRBs approved the study through expedited review while two IRBs reviewed the project at a full board meeting. Lastly, 11 of the 14 sites required documented consent. The greatest delay in approval was seen early on in the IRB process with site PIs averaging 45.1 ± 31.8 days to submit the study to the IRB. IRB approvals were relatively quick with an average of 14 ± 5.7 days to approval. The delay in study submission may be attributed to a lack of clear definitions and differing interpretations of the regulations that challenge researchers.

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Multiple data sources fusion for enterprise quality improvement by a multilevel latent response model

IIE Transactions ◽

10.1080/0740817x.2013.849829 ◽

2014 ◽

Vol 46 (5) ◽

pp. 512-525 ◽

Cited By ~ 1

Author(s):

Shuai Huang ◽

Jing Li ◽

Gerri Lamb ◽

Madeline H. Schmitt ◽

John Fowler

Keyword(s):

Quality Improvement ◽

Data Sources ◽

Response Model ◽

Multiple Data Sources ◽

Multiple Data

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Narrative review of European healthcare benchmarking experiences: shared goals, different focuses and formats (Preprint)

10.2196/preprints.28642 ◽

2021 ◽

Author(s):

Anna García-Altés ◽

Cristina Adroher ◽

Viky Morón ◽

Boi Ruiz

Keyword(s):

Quality Improvement ◽

Health System ◽

Patient Experience ◽

Healthcare Quality ◽

European Countries ◽

Data Sources ◽

Web Based ◽

European Healthcare ◽

System Review ◽

Conflicting Goals

BACKGROUND Benchmarking experiences have been flourishing in Europe during the last years with the idea of improving healthcare quality. OBJECTIVE This paper aims to review the European benchmarking experiences, analysing their main characteristics and highlighting common and differential ones. METHODS The identification of benchmarking experiences was based on the list of European countries for which there exists an electronic “HiT health system review”. Predefined variables were identified, mainly data sources, formats, topics, and target audiences. RESULTS 14 benchmarking experiences were identified. Most of them are governmental. All of them are web-based. The easiness to navigate through the websites and materials and to understand them varies among experiences. Most common data sources are registries. Few experiences include patient experience indicators. None of them explicitly mentions if they use results as the basis to start quality improvement efforts. CONCLUSIONS Benchmarking is essential for transparency and accountability, and to support improvement. To do this effectively it must reconcile important and potentially conflicting goals: meaningful accountability, requiring real consequences from underperformance, and an environment that encourages open and honest reporting. Enhancing reporting websites is needed.

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Should Caregivers Attempt to Assist Falling Patients?

Innovation in Aging ◽

10.1093/geroni/igaa057.765 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 237-237

Author(s):

Tatjana Bulat ◽

Yvonne Friedman ◽

Blake Barrett ◽

Jason Lind ◽

Margeaux Chavez ◽

...

Keyword(s):

Computer Simulation ◽

Quality Improvement ◽

Environmental Factors ◽

Data Collection ◽

Field Data ◽

Data Sources ◽

Primary Data ◽

Improvement Project ◽

Key Variables ◽

Initial Results

Abstract This quality improvement project seeks to provide guidance on whether caregivers should attempt to “assist” fallers, and if so, the safest way to minimize injury to themselves and the faller. Primary aims were to: 1) Identify common characteristics of documented assisted falls, 2) Identify cases where injuries to patients and/or staff occur, and 3) Provide guidance to the clinical field. Data sources for this project includes secondary databases of assisted falls events as well as primary data collection using computer simulation. Initial results for 2 VA quality tracking databases of assisted falls over a 9-year period are presented. Qualitative matrix analyses were conducted for both assisted falls datasets, which separately examined patient and employee injuries related to assisted falls. Two trained qualitative experts analyzed 195 fall narratives from the datasets to develop insights about the most common fall scenarios that result in injury. The most commonly reported assisted falls scenarios included 1) related to toileting, 2) while ambulating, and 3) while transferring from wheelchair. Findings of these analyses indicate current documentation does not capture the nuance of assisted falls. Additional variables such as 1) the direction of the fall; 2) the fall scenario; 3) how staff sought to assist; 4) staff injury description and 5) and other key variables (patient symptoms, environmental factors) that could improve fall documentation and understanding of assisted falls. Preliminary efforts are providing information for development of a computer simulation using a virtual environment to repeatedly test common fall scenarios and influences of caregiver assistance.

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