Quality Indicators for Older Persons’ Transitions in Care: A Systematic Review and Delphi Process

2021 ◽  
pp. 1-15
Author(s):  
Kaitlyn Tate ◽  
Sarah Lee ◽  
Brian H Rowe ◽  
Garnet E Cummings ◽  
Jayna Holroyd-Leduc ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Older Persons ◽  
Steering Committee ◽  
Administrative Databases ◽  
Continuing Care ◽  
Free Text ◽  
Institute Of Medicine ◽  
Outcome Indicators ◽  
Transitions In Care ◽  
Documentation Systems

Abstract We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons’ transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked relevance, feasibility, and scientific soundness of QIs. A steering committee reviewed QIs for their feasible capture in Canadian administrative databases. Our search yielded 326 QIs from 53 sources. A final set of 38 feasible indicators to measure in current practice was included. The highest proportions of indicators were for the emergency department (47%) and the Institute of Medicine (IOM) quality domain of effectiveness (39.5%). Most feasible indicators were outcome indicators. Our work highlights a lack of standardized transition QI development in practice, and the limitations of current free-text documentation systems in capturing relevant and consistent data.

[P3-508]: EXPLORING QUALITY INDICATORS FOR OLDER PERSONS’ TRANSITIONS IN CARE: A SYSTEMATIC REVIEW AND DELPHI PROCESS

2017 ◽  
Vol 13 (7S_Part_24) ◽  
pp. P1171-P1172
Author(s):  
Greta G. Cummings ◽  
Kaitlyn Tate ◽  
Sarah Lee ◽  
Garnet Cummings ◽  
Jayna Holroyd-Leduc ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Indicators ◽  
Older Persons ◽  
Delphi Process ◽  
Transitions In Care

scholarly journals An Environmental Scan of Ambulatory Care Quality Indicators for Patients With Advanced Kidney Disease Currently Used in Canada

2021 ◽  
Vol 8 ◽  
pp. 205435812199109
Author(s):  
Jay Hingwala ◽  
Amber O. Molnar ◽  
Priyanka Mysore ◽  
Samuel A. Silver
Keyword(s):  
Kidney Disease ◽  
Ambulatory Care ◽  
Quality Indicators ◽  
Health Care Quality ◽  
Healthcare Research ◽  
Care Quality ◽  
Institute Of Medicine ◽  
Environmental Scan ◽  
Number Of Patients ◽  
Ambulatory Patients

Background: Quality indicators can be used to identify gaps in care and drive frontline improvement activities. These efforts are important to prevent adverse events in the increasing number of ambulatory patients with advanced kidney disease in Canada, but it is unclear what indicators exist and the components of health care quality they measure. Objective: We sought to identify, categorize, and evaluate quality indicators currently in use across Canada for ambulatory patients with advanced kidney disease. Design: Environmental scan of quality indicators currently being collected by various organizations. Setting: We assembled a 16-member group from across Canada with expertise in nephrology and quality improvement. Patients: Our scan included indicators relevant to patients with chronic kidney disease in ambulatory care clinics. Measurements: We categorized the identified quality indicators using the Institute of Medicine and Donabedian frameworks. Methods: A 4-member panel used a modified Delphi process to evaluate the indicators found during the environmental scan using the American College of Physicians/Agency for Healthcare Research and Quality criteria. The ratings were then shared with the full panel for further comments and approval. Results: The environmental scan found 28 quality indicators across 7 provinces, with 8 (29%) rated as “necessary” to distinguish high-quality from poor-quality care. Of these 8 indicators, 3 were measured by more than 1 province (% of patients on a statin, number of patients receiving a preemptive transplant, and estimated glomerular filtration rate at dialysis start); no indicator was used by more than 2 provinces. None of the indicators rated as necessary measured timely or equitable care, nor did we identify any measures that assessed the setting in which care occurs (ie, structure measures). Limitations: Our list cannot be considered as an exhaustive list of available quality indicators at hand in Canada. Our work focused on quality indicators for nephrology providers and programs, and not indicators that can be applied across primary and specialty providers. We also focused on indicator constructs and not the detailed definitions or their application. Last, our panel does not represent the views of other important stakeholders. Conclusions: Our environmental scan provides a snapshot of the scope of quality indicators for ambulatory patients with advanced kidney disease in Canada. This catalog should inform indicator selection and the development of new indicators based on the identified gaps, as well as motivate increased pan-Canadian collaboration on quality measurement and improvement. Trial registration: Not applicable as this article is not a systematic review, nor does it report results of a health intervention on human participants.

scholarly journals Appropriateness of End-of-Life Care in People Dying With Dementia: Applying Quality Indicators on Linked Administrative Databases

2020 ◽  
Vol 21 (8) ◽  
pp. 1093-1101.e1
Author(s):  
Robrecht De Schreye ◽  
Tinne Smets ◽  
Luc Deliens ◽  
Lieven Annemans ◽  
Birgit Gielen ◽  
...  
Keyword(s):  
End Of Life ◽  
Quality Indicators ◽  
End Of Life Care ◽  
Administrative Databases ◽  
Life Care

scholarly journals Use of Electronic Administrative Databases to Measure Quality Indicators of Breast Cancer Care: Experience of Five Regional Oncology Networks in Italy

2020 ◽  
Vol 16 (2) ◽  
pp. e211-e220 ◽  
Author(s):  
Valentina Guarneri ◽  
Paolo Pronzato ◽  
Oscar Bertetto ◽  
Fausto Roila ◽  
Gianni Amunni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Indicators ◽  
Administrative Data ◽  
Population Level ◽  
Administrative Databases ◽  
Regional Variability ◽  
Care Experience ◽  
Italian Regions ◽  
Incident Cases

PURPOSE: Assuring quality of care, while maintaining sustainability, in complex conditions such as breast cancer (BC) is an important challenge for health systems. Here, we describe a methodology to define a set of quality indicators, assess their computability from administrative data, and apply them to a large cohort of BC cases. MATERIALS AND METHODS: Clinical professionals from the Italian Regional Oncology Networks identified 46 clinically relevant indicators of BC care; 22 were potentially computable using administrative data. Incident cases of BC diagnosed in 2016 in five Italian regions were identified using administrative databases from regional repositories. Each indicator was calculated through record linkage of anonymized individual data. RESULTS: A total of 15,342 incident BC cases were identified. Nine indicators were actually computable from administrative data (two structure and seven process indicators). Although most indicators were consistent with guidelines, for one indicator (blood tumor markers in the year after surgery, 44.2% to 64.5%; benchmark ≤ 20%), deviation was evident throughout the five regions, highlighting systematic overlooking of clinical recommendations. Two indicators (radiotherapy within 4 months after surgery if no adjuvant chemotherapy; 42% to 83.8%; benchmark ≥ 90%; and mammography 6 to 18 months after surgery, 55.1% to 72.6%; benchmark ≥ 90%) showed great regional variability and were lower than expected, possibly as result of an underestimation in indicator calculation by administrative data. CONCLUSION: Despite highlighting some limitations in the use of administrative data to measure health care performance, this study shows that evaluating the quality of BC care at a population level is possible and potentially useful for guiding quality improvement interventions.

scholarly journals Az endoszkópos regiszterek szerepe a minőségi betegellátásban. Az új magyar Endoszkópos Retrográd Cholangiopancreatographia (ERCP) Regiszter első eredményei

2018 ◽  
Vol 159 (37) ◽  
pp. 1506-1515 ◽  
Author(s):  
Dániel Pécsi ◽  
Péter Hegyi ◽  
Andrea Szentesi ◽  
Szilárd Gódi ◽  
Ferenc Pakodi ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Continuous Monitoring ◽  
Gastrointestinal Endoscopy ◽  
Late Complications ◽  
First Year ◽  
Free Text ◽  
Data Collecting ◽  
Clinically Significant ◽  
American Society ◽  
Collecting System

Abstract: Introduction: The continuous monitoring of quality indicators in gastrointestinal endoscopy has become an essential requirement nowadays. Most of these data cannot be extracted from the currently used free text reports, therefore a structured web-based data-collecting system was developed to record the indicators of pancreatobiliary endoscopy. Aim: A structured data-collecting system, the ERCP Registry, was initiated to monitor endoscopic retrograde cholangiopancreatography (ERCP) examinations prospectively, and to verify its usability. Method: From January 2017, all ERCPs performed at the First Department of Medicine, University of Pécs, have been registered in the database. In the first year, the detailed data of 595 examinations were entered into the registry. After processing these data, the testing period of the registry is now finished. Results: On 447 patients, 595 ERCPs were performed. The success rate of cannulation is 93.8% if all cases are considered. Difficult biliary access was noted in 32.1% of patients with native papilla, and successful cannulation was achieved in 81.0% of these cases during the first procedure. Post-ERCP pancreatitis was observed in 13 cases (2.2%), clinically significant post-papillotomy bleeding was registered in 2 cases (0.3%), while 27 patients (4.5%) developed temporary hypoxia during the procedure. 30-day follow-up was successful in 75.5% of the cases to detect late complications. All of the quality indicators determined by the American Society of Gastrointestinal Endoscopy (ASGE) were possible to monitor with the help of the registry. Our center already complies with most of these criteria. Conclusions: Continuous monitoring of the quality indicators of endoscopic interventions are not supported by the current hospital information system but it became possible with our registry. The ERCP Registry is a suitable tool to detect the quality of patient care and also useful for clinical research. Several endoscopy units have joined already this initiative and it is open for further centres through our web page ( https://tm-centre.org/hu/regiszterek/ercp-regiszter/ ). Orv Hetil. 2018; 159(37): 1506–1515.

scholarly journals The Older Persons’ Transitions in Care (OPTIC) study: pilot testing of the transition tracking tool

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Robert Colin Reid ◽  
Garnet E Cummings ◽  
Sarah L Cooper ◽  
Stephanie L Abel ◽  
Laura J Bissell ◽  
...  
Keyword(s):  
Older Persons ◽  
Pilot Testing ◽  
Transitions In Care

A description of the free text word choices physicians use to describe prognosis in over 50,000 electronic treatment plans.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 219-219
Author(s):  
Lalan S. Wilfong ◽  
Mark Ferencik ◽  
Marcus A. Neubauer
Keyword(s):  
Treatment Plan ◽  
Management Plan ◽  
Response To Therapy ◽  
Care Plan ◽  
Current Status ◽  
Free Text ◽  
Institute Of Medicine ◽  
Word Count ◽  
Data Set ◽  
Treatment Plans

219 Background: Fourteen practices within the US Oncology Network are participating in the Center for Medicare and Medicaid Innovation’s (CMMI) Oncology Care Model. To meet the requirement of documenting a care plan that contains the 13 components in the Institute of Medicine Care Management Plan, an electronic treatment plan was developed which incorporates core elements from our EMR, IKnowMed, supplemented by additional physician documentation. Physicians must document in their own words the prognosis section of the care plan. Methods: To better understand the word choices physicians use for prognosis, we evaluated the word choices used in over 50,000 treatment plans. Using an excel based word count macro, all contents of the free text entry “prognosis” field were sorted based on frequency of the same answer and were then ranked from most common use to least common. A word count method was applied to determine and rank the most commonly used words across all answers. The “current status of disease” field in the treatment plan was used to divide the prognosis answers into those that mentioned “Metastatic” and “Not Metastatic” so that prognosis wording trends could be compared using pivot tables and data filters. Results: 70% of prognosis word choices were single words: “excellent, good, fair, poor, or guarded” were the most common. 20% of phrases were multi-word that appeared repeatedly such as “will depend on the response to therapy.” Only 10% of answers were uniquely worded per treatment plan and felt to be personal to the patient’s situation. Additionally, the number of words did not differ between metastatic and non-metastatic disease. Conclusions: To our knowledge, this is the largest cohort of treatment plans where the word choices used by physicians are described to document prognosis to patients. The results indicate that single words or short phrases are commonly used to describe prognosis when the treatment plan is shared with patients. The data set has high potential for further study to better understand the role and impact of written treatment plans (including downstream events) to help physicians refine this documentation for better patient understanding of this important topic.

scholarly journals Lessons from the past: A window on the future

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Alan Katz ◽  
Marni Brownell ◽  
Mark Smith
Keyword(s):  
Data Sharing ◽  
Linked Data ◽  
Ethical Issues ◽  
Interdisciplinary Collaboration ◽  
Critical Role ◽  
Relationship Building ◽  
Administrative Databases ◽  
Free Text ◽  
The Past ◽  
The Future

IntroductionThe Manitoba Centre for Health Policy has provided international leadership in organizing and accessing administrative databases, linking and analyzing data and translating the findings of research into policy for three decades. During this period, MCHP has addressed numerous challenges in each of these areas. Objectives and ApproachLinked data research is expanding rapidly in terms of access to new data sources, different types of data, sharing of data across jurisdictions, and advances in data analytics. Technical advances such as computing power and artificial intelligence support these developments while governance structures and ethical issues challenge them. This presentation will describe some of the challenges MCHP has met with a view to gaining insight into how solutions evolved and how experience can guide the future of linked data research. ResultsThe scaling up of linked data research will need to address specific challenges including de-identification of free text, accessing and linking data from private enterprise such as wearables, and interdisciplinary collaboration to incorporate new techniques developed by computer scientists. Cross-jurisdictional data analysis presents challenges in addressing differences in data architecture. Inter-jurisdictional and international data sharing create ethical and governance challenges. Experience has demonstrated the critical role that relationship building plays in addressing each of these. These relationships are different depending on the partners. They are all based on the development of common use of language, understanding the motivation and concerns of each party, clearly articulating the benefits of the relationship and data use and attention to the cultural and political environment. Conclusion/ImplicationsLessons from the past can guide us in addressing challenges posed by the exciting opportunities available to us all. While many of these challenges will be solved with technical solutions, we should not overlook the importance of human relationships in building a culture of trust and collaboration as we move

scholarly journals Effectiveness of an Electronic Communication Tool on Transitions in Care From the Intensive Care Unit: Protocol for a Cluster-Specific Pre-Post Trial (Preprint)

2020 ◽  
Author(s):  
Jeanna Parsons Leigh ◽  
Rebecca Brundin-Mather ◽  
Liam Whalen-Browne ◽  
Devika Kashyap ◽  
Khara Sauro ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
Health Care Providers ◽  
Primary Outcome ◽  
Audit And Feedback ◽  
Free Text ◽  
Care Providers ◽  
Transitions In Care ◽  
Post Trial ◽  
The Impact

BACKGROUND Transitions in care are vulnerable periods in health care that can expose patients to preventable errors due to incomplete or delayed communication between health care providers. Transitioning critically ill patients from intensive care units (ICUs) to other patient care units (PCUs) is particularly risky, due to the high acuity of the patients and the diversity of health care providers involved in their care. Instituting structured documentation to standardize written communication between health care providers during transitions has been identified as a promising means to reduce communication breakdowns. We developed an evidence-informed, computer-enabled, ICU-specific structured tool—an electronic transfer (e-transfer) tool—to facilitate and standardize the composition of written transfer summaries in the ICUs of one Canadian city. The tool consisted of 10 primary sections with a user interface combination of structured, automated, and free-text fields. OBJECTIVE Our overarching goal is to evaluate whether implementation of our e-transfer tool will improve the completeness and timeliness of transfer summaries and streamline communications between health care providers during high-risk transitions. METHODS This study is a cluster-specific pre-post trial, with randomized and staggered implementation of the e-transfer tool in four hospitals in Calgary, Alberta. Hospitals (ie, clusters) were allocated randomly to cross over every 2 months from control (ie, dictation only) to intervention (ie, e-transfer tool). Implementation at each site was facilitated with user education, point-of-care support, and audit and feedback. We will compare transfer summaries randomly sampled over 6 months postimplementation to summaries randomly sampled over 6 months preimplementation. The primary outcome will be a binary composite measure of the timeliness and completeness of transfer summaries. Secondary measures will include overall completeness, timeliness, and provider ratings of transfer summaries; hospital and ICU lengths of stay; and post-ICU patient outcomes, including ICU readmission, adverse events, cardiac arrest, rapid response team activation, and mortality. We will use descriptive statistics (ie, medians and means) to describe demographic characteristics. The primary outcome will be compared within each hospital pre- and postimplementation using separate logistic regression models for each hospital, with adjustment for patient characteristics. RESULTS Participating hospitals were cluster randomized to the intervention between July 2018 and January 2019. Preliminary extraction of ICU patient admission lists was completed in September 2019. We anticipate that evaluation data collection will be completed by early 2021, with first results ready for publication in spring or summer 2021. CONCLUSIONS This study will report the impact of implementing an evidence-informed, computer-enabled, ICU-specific structured transfer tool on communication and preventable medical errors among patients transferred from the ICU to other hospital care units. CLINICALTRIAL ClinicalTrials.gov NCT03590002; https://www.clinicaltrials.gov/ct2/show/NCT03590002 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18675

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