The group care quality standards assessment: A framework for assessment, quality improvement, and effectiveness

The authors of this paper recommend the integration of health care quality improvement measures for health literacy, language access, and cultural competence. The paper also notes the importance of patient-centered and equity-based institutional performance assessments or monitoring systems. The authors support the continued use of specific measures such as assessing organizational system responses to health literacy or the actual availability of needed language access services such as qualified interpreters as part of overall efforts to maintain quality and accountability. Moreover, this paper is informed by previous recommendations from a commissioned paper provided by the National Committee for Quality Assurance (NCQA) to the Roundtable on Health Literacy of the National Academies of Sciences, Engineering, and Medicine. In the commissioned paper, NCQA explained that health literacy, language access, and cultural competence measures are siloed and need to generate results that enhance patient care improvements. The authors suggest that the integration of health literacy, language access, and cultural competence measures will provide for institutional assessment across multiple dimensions of patient vulnerabilities. With such integration, health care organizations and providers will be able to cultivate the tools needed to identify opportunities for quality improvement as well as adapt care to meet diverse patients’ complex needs. Similarly, this paper reinforces the importance of providing more “measures that matter” within clinical settings.

Download Full-text

Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization

Physical Therapy ◽

10.2522/ptj.20130541 ◽

2015 ◽

Vol 95 (4) ◽

pp. 588-599 ◽

Cited By ~ 8

Author(s):

Joel M. Stevans ◽

Christopher G. Bise ◽

John C. McGee ◽

Debora L. Miller ◽

Paul Rockar ◽

...

Keyword(s):

Quality Improvement ◽

Case Report ◽

Physical Therapy ◽

Care Quality ◽

Routine Practice ◽

Evidence Based ◽

Implementation Barriers ◽

Improvement Program ◽

Improvement Project ◽

Systems Perspective

Background and Purpose Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap. Case Description The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making. Outcomes The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers. Discussion Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians.

Download Full-text

Changes in the Rates of Reported Pressure Ulcers in Response to a Regional Critical Care Quality Improvement Project

Journal of the Intensive Care Society ◽

10.1177/175114371401500308 ◽

2014 ◽

Vol 15 (3) ◽

pp. 216-221 ◽

Cited By ~ 1

Author(s):

Antony N Thomas ◽

Robert J Taylor ◽

Andrea Berry

Keyword(s):

Critical Care ◽

Quality Improvement ◽

Pressure Ulcers ◽

Care Quality ◽

Quality Improvement Project ◽

Improvement Project

Download Full-text

Effect of angiotensin-converting inhibitor or angiotensin receptor blocker on one-year survival in patients ≥65 years hospitalized with a left ventricular ejection fraction ≥50%**The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The investigator assumes full responsibility for the accuracy and completeness of the ideas presented. This study is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare & Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the investigator concerning experience in engaging with issues presented are welcomed.

The American Journal of Cardiology ◽

10.1016/s0002-9149(02)03173-9 ◽

2003 ◽

Vol 91 (3) ◽

pp. 363-365 ◽

Cited By ~ 14

Author(s):

Carla A Sueta ◽

Allison Russo ◽

Anna Schenck ◽

David W Brown ◽

Ross J Simpson

Keyword(s):

Quality Improvement ◽

Health Care Quality ◽

Left Ventricular ◽

Care Quality ◽

Left Ventricular Ejection ◽

Direct Result ◽

Improvement Program ◽

Ventricular Ejection Fraction ◽

Us Government ◽

Health Care Quality Improvement

Download Full-text

Development of Potentially Better Practices for the Neonatal Intensive Care Unit as a Culture of Collaboration: Communication, Accountability, Respect, and Empowerment

PEDIATRICS ◽

10.1542/peds.111.se1.e471 ◽

2003 ◽

Vol 111 (Supplement_E1) ◽

pp. e471-e481

Author(s):

Judy Ohlinger ◽

Mark S. Brown ◽

Sue Laudert ◽

Sue Swanson ◽

Ona Fofah ◽

...

Keyword(s):

Intensive Care ◽

Quality Improvement ◽

Neonatal Intensive Care ◽

Care Quality ◽

Care Group ◽

Team Members ◽

Leadership Management ◽

Standards Of Conduct ◽

Year 2000 ◽

Multidisciplinary Teamwork

Objective. The Vermont Oxford Network (VON) CARE Group was formed in response to the need to create organizational cultures supportive of change and quality improvement. Methods. The CARE Group consisted of team members from 4 participating neonatal intensive care units (NICUs). All CARE Group members chose to work on multidisciplinary teamwork for the duration of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000. A questionnaire was developed by the CARE Group and administered to the 4 focus group NICUs. The survey focused on 6 domains of the organization: unit coordination, working in the NICU, leadership, management of disagreements, authority, and unit culture. Benchmarking visits were completed to supplement the information found in the survey and the literature. Results. Seven potentially better practices (PBPs) were developed on the basis of the surveys, benchmark visits, and literature reviews. The PBPs include 1) a clear, shared NICU purpose, goals, and values; 2) effective communication among and between teams and team members; 3) leaders lead by example; 4) nurture a collaborative NICU environment with trust and respect; 5) live principled standards of conduct and standards of excellence; 6) nurture competent and committed teams and team members; and 7) commit to effective and positive conflict management. Conclusions. The CARE Group successfully used quality improvement methods and collaboration to delineate principles and practices of multidisciplinary teamwork.

Download Full-text

A disease-based evaluation of lung cancer care quality in a community healthcare system.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.251 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 251-251

Author(s):

Meghan Brooke Taylor ◽

Meredith Ray ◽

Nicholas Faris ◽

Matthew Smeltzer ◽

Carrie Fehnel ◽

...

Keyword(s):

Lung Cancer ◽

Quality Improvement ◽

Surgical Treatment ◽

Healthcare System ◽

Cancer Care ◽

Care Quality ◽

Nodal Points ◽

Diagnostic Biopsy ◽

Pre Treatment ◽

Non Surgical Treatment

251 Background: Lung cancer care is complex, but, for quality improvement, can be simplified into five ‘nodal points’: lesion detection, diagnostic biopsy, radiologic staging, invasive staging, and treatment. We previously demonstrated great heterogeneity in passage through these nodal points in patients who received surgical resection for lung cancer in our healthcare system. However, examining only surgical patients may underestimate the enormity of the opportunity for quality improvement. With the aim of identifying quality gaps in pre-treatment evaluation for lung cancer, we evaluated the flow of care through these nodal points within a community-based healthcare system. Methods: We classified lung cancer care procedures received by all suspected lung cancer patients treated within the Multidisciplinary Thoracic Oncology Program at Baptist Cancer Center, Memphis TN between 2014 and 2019, into five nodal points. We compared the frequency of, and time intervals between, nodal points among patients receiving surgical, nonsurgical (chemotherapy/radiation), or no definitive treatment, using Chi-square or Kruskal Wallis tests, where appropriate. Results: Of 1304 eligible patients: 11% had no pre-treatment diagnostic procedure, 20% no PET/CT, and 39% no invasive staging. 39% of patients underwent surgical resection, 51% received non-surgical treatment, and 10% received no treatment. Patients who had surgery were less likely than those who had non-surgical treatment to get a diagnostic test, radiologic staging, and invasive staging (Table). Patients who had non-surgical treatment were more likely to pass through all five nodal points (50% v 68%, p<0.0001). The median (IQR) duration from initial lesion identification to treatment (n=1126) was 77 days (45-190); 27 days (10-90) from lesion identification to diagnostic biopsy (n=1115); and 38 days (26-63) from diagnostic biopsy to treatment (n=1041). Patients who had surgery received less timely care than those who had non-surgical or no treatment: median 122 v 66 v 68 days from lesion identification to treatment; 40 v 21 v 29 days from lesion identification to diagnostic biopsy; 46 v 38 v 31 days from diagnostic biopsy to treatment (p<0.0001 all comparisons). Conclusions: Quality improvement initiatives within our healthcare system, such as the establishment of a coordinated multidisciplinary program, enhanced care quality over previous benchmarks. Despite improvements, lung cancer patients who had surgery received less frequent and less timely pre-treatment evaluation than those without surgery. Implementing a standardized cancer care pathway from diagnosis to surgery could help to reduce variations in optimal care delivery.[Table: see text]

Download Full-text