Abstract P131: Utilization of a Clinical Registry to Drive Practice-Based Learning and Improvement Among Cardiology Fellows in Training: Observations From the American College of Cardiology's PINNACLE Registry™

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Melissa Frederick ◽  
Ramamanohara Pai ◽  
Vamshidhar Guduguntla ◽  
Howard Rosman ◽  
Katie Kehoe ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Data Collection ◽  
Care Delivery ◽  
Medical Center ◽  
Core Competencies ◽  
Initial Step ◽  
Clinical Registry ◽  
Therapeutic Decisions ◽  
Comparative Feedback

Background: The Accreditation Council for Graduate Medical Education (ACGME) has defined six core competencies that reflect changing needs of health care delivery. One of these competencies, practice-based learning and improvement (PBLI), is essential for improving processes and outcomes of care. As an initial step, incorporating a standardized method for data collection is required and helps physicians monitor the quality of their work, identify learning and QI needs and positively change practice behavior. Methods: The PINNACLE Registry is an outpatient practice-based QI program designed to optimize quality of care through the standardized collection and reporting of clinical data on CAD, atrial fibrillation, heart failure and hypertension. Twelve cardiac fellows participate in the PINNACLE Registry at St. John Hospital and Medical Center in Detroit. At each clinic encounter, a data collection form (DCF) which captures patient demographics, history/risk factors, and current therapies were recorded and transmitted to the ACC to generate comparative feedback reports about the quality of care delivered to patients. Use of the DCF was piloted from September 2009 through November 2009 and expanded to all patient encounters from December 1, 2009 through January 31, 2010. Impressions from the first 60 encounters are reported. Results: Fellows reported that the DCF improved their knowledge, though the initial process of collecting data impacted clinic workflow. Utilization of the DCF initially resulted in longer patient visits which decreased over time (average 7 minutes reduced to 4 minutes per patient). As a checklist connecting patient workflow to best cardiology evidence, residents reported that diagnostic and therapeutic decisions were not simply monitored, but guided by the DCF. Conclusions: The DCF was found be a useful tool for data collection and clinical decision support. Participation in the PINNACLE Registry has provided the opportunity to further the ACGME core competencies of patient care and practice-based learning and improvement in a cardiology fellow outpatient clinic.

Community oncology care delivery staffing model.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 87-87
Author(s):  
David C. Fryefield ◽  
Roberta Kafora ◽  
Lori Bradshaw-Hucko ◽  
Chris Tribble ◽  
Terry Jensen ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Six Sigma ◽  
Care Delivery ◽  
Core Competencies ◽  
Lean Six Sigma ◽  
Advisory Council ◽  
Physician Services ◽  
Staffing Model ◽  
Community Oncology

87 Background: In 2010, the US Oncology Network’s Clinical Advisory Council (CAC), a practice-based clinical leadership team, reviewed the care delivery process at 5 pilot community oncology clinics to determine how licensed and unlicensed clinical resources were used. The Lean Six Sigma methodology, which employs statistical analysis within a structured approach to problem-solving, was used to understand the required clinical activities of the practices within 3 primary areas. The objective of this pilot was to ensure patients receive timely, effective treatment from qualified personal in a cost-efficient model. Methods: A team led by a certified Master Black Belt studied tasks performed by licensed vs. non-licensed staff in the areas of physician services, treatment services and triage services at each practice. Based on the findings, tasks were realigned to maintain quality of care but to deliver care more efficiently. Results: Care Delivery processes comprised 95 tasks at baseline vs. 80 tasks in the redefined model. Within physician services, changes to workflow included rooming and clinic support (vitals, cleaning, and patient comfort) to be provided by Medical Assistants (MAs) instead of RN. RN duties were changed to MA supervision and tasks that require licensure. Changes to triage services included use of RNs to coordinate care and MAs for phone call screening, centralized triage (non-patient facing), and normal lab follow-up. Increased clarity of tasks and re-assignment of responsibilities reduced RN work load by 17% or 16.6 hours/day based on 120 patient visits. Each pilot site realized an annualized labor savings in excess of $100,000. This prospective, patient volume-based Care Delivery Staffing Model was adopted by the CAC as Network standard after completion of the pilot. Conclusions: Using Lean Six Sigma methods, the care delivery process was successfully re-designed such that clinical staff were re-aligned to better utilize each resource’s core competencies. Implementation of this care delivery model resulted in improved cost effectiveness while maintaining quality of care and also enabled prospective staff planning so that costs can be kept competitive in the future.

scholarly journals Clinical registry of cardiovascular surgeries in a university hospital

2019 ◽  
Vol 65 (1) ◽  
pp. 16-23
Author(s):  
Roberta Senger ◽  
Michelle Dornelles Santarem ◽  
Sílvia Goldmeier
Keyword(s):  
Quality Of Care ◽  
Data Collection ◽  
Cardiovascular Surgery ◽  
Measured Data ◽  
International Standards ◽  
University Hospital ◽  
Clinical Registry ◽  
Health Institutions

SUMMARY OBJECTIVES To create and implement a computerized clinical registry to verify in the short-, medium- and long-term the mortality and the incidence of significant surgical outcomes in adult patients submitted to cardiovascular surgeries. METHODS This is a prospective, observational registry-based study aimed at documenting the characteristics of patients undergoing cardiovascular surgery. RESULTS Variables were standardized according to international references from the Society of Thoracic Surgeons (STS), American College of Cardiology (ACC), Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS) and the Department of Informatics of SUS (DATASUS). The standardization was performed in English with an interface in Portuguese to make the data collection easier in the institution. Quality of care indicators, surgical procedure characteristics, in addition to significant cardiovascular outcomes will be measured. Data were collected during the hospitalization until hospital discharge or at the seventh day, in thirty days, six months, twelve months and annually until completing five years. CONCLUSION The importance of a database maintenance with international standards that can be reproducible was evidenced, allowing the evaluation of techniques and assistance and the integration of data among health institutions.

scholarly journals Humanização da assistência de enfermagem em uma unidade de internação obstétrica

2013 ◽  
Vol 4 (2) ◽  
pp. 88 ◽  
Author(s):  
Natália Chantal Magalhães Da Silva ◽  
Ludmila De Oliveira Ruela ◽  
Zélia Marilda Rodrigues Resck ◽  
Maria Betânia Tinti De Andrade ◽  
Eliana Peres Rocha Carvalho Leite ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Data Collection ◽  
Nursing Care ◽  
Nursing Staff ◽  
Prospective Data ◽  
Hospital Unit ◽  
Strategic Actions ◽  
Normal Birth ◽  
Quantitative Descriptive

Resumo: O estudo objetivou verificar o atendimento prestado pela equipe de enfermagem durante o trabalho de parto e parto. Optou-se pelo método quantitativo, descritivo, transversal e prospectivo. A coleta de dados foi realizada no período de maio a junho de 2011, abrangendo uma amostra de 30 puérperas de parto normal. Os resultados evidenciam que algumas atividades ainda estão em discordância com o que é recomendado pelo Programa de Humanização. É necessário o desenvolvimento de ações estratégicas, buscando a melhoria da qualidade da assistência que ainda se encontra aquém das expectativas.Palavras-chave: Enfermagem; Humanização da assistência; Parto.Humanization Nursing Care in a Hospital Unit ObstetricalAbstrat:The study aimed to verify the care provided by nursing staff during labor and birth. We chose the method quantitative, descriptive, crosssectional and prospective. Data collection was conducted from May to June 2011, covering a sample of 30 mothers of normal birth. The results show that some activities are still in disagreement with what is recommended by the Humanization Program. It requires the development of strategic actions, seeking to improve the quality of care that is still below expectations.Keywords: Nursing; Humanization of assistance; Childbirth.Humanización de la Atención de Enfermería en una Unidad Hospitalaria ObstétricaResumen: El estudio tuvo como objetivo verificar la atención recibida por el personal de enfermería durante el parto y el nacimiento. Elegimos el método cuantitativo, descriptivo, transversal y prospectivo. La recolección de datos se llevó a cabo entre mayo y junio de 2011, que abarcó una muestra de 30 madres de nacimiento normal. Los resultados muestran que algunas actividades aún están en desacuerdo con lo que es recomendado por lo Programa de Humanización. Se requiere el desarrollo de acciones estratégicas, que buscan mejorar la calidad de la atención que todavía está debajo de las expectativas.Palabras clave: Enfermería; Humanización de la asistencia; Parto.

scholarly journals Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar

2020 ◽  
Author(s):  
Bénédicte Razafinjato ◽  
Luc Rakotonirina ◽  
Jafeta Benony Andriantahina ◽  
Laura F. Cordier ◽  
Randrianambinina Andriamihaja ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Community Health ◽  
Access To Health Care ◽  
Care Delivery ◽  
Local Level ◽  
Scale Up ◽  
P Value ◽  
The Impact

AbstractDespite the widespread global adoption of community health (CH) systems, there are evidence gaps in how to best deliver community-based care aligned with global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. PIVOT partnered with the Ministry of Public Health to pilot a new two-pronged approach for care delivery in rural Madagascar: one CHW provided care at a stationary CH site while 2-5 additional CHWs provided care via proactive household visits. The pilot included professionalization of the CHW workforce (i.e. recruitment, training, financial incentive) and twice monthly supervision of CHWs. We evaluated the impact of the CH pilot on utilization and quality of integrated community case management (iCCM) in the first six months of implementation (October 2019-March 2020).We compared utilization and proxy measures of quality of care (defined as adherence to the iCCM protocol for diagnosis, classification of disease severity, treatment) in the intervention commune and five comparison communes, using a quasi-experimental study design and relying on routinely collected programmatic data. Average per capita monthly under-five visits were 0.28 in the intervention commune and 0.22 in the comparison communes. In the intervention commune, 40.0% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 77.8% of observed visits in the intervention commune (vs 49.5% in the comparison communes, p-value=<0.001). A two-pronged approach to CH delivery and professionalization of the CHW workforce increased utilization and demonstrated satisfactory quality of care. National stakeholders and program managers should evaluate program re-design at a local level prior to national or district-wide scale-up.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2017 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This chapter contains 56 references.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2015 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This chapter contains 56 references.

TECHNOLOGY

PEDIATRICS ◽  
1978 ◽  
Vol 61 (1) ◽  
pp. 4-4
Author(s):  
Jerry Avorn ◽  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Care Delivery ◽  
Healing Process ◽  
Economic Changes ◽  
Profit Margins ◽  
Technological Imperative ◽  
The Social ◽  
Social Uses

We must not assume, as we so often have, that any problem can be solved merely by the application of more technology, and more hardware. In the case of medicine, far-reaching cultural and economic changes will have to take place before we can develop an optional health care system—changes which need have nothing whatever to do with machines or automation. A computer, or a "patient's assistant," can improve the quality of care or render it mediocre; it can be a means of freeing medical talent for larger questions, or just larger incomes; it can increase the dignity of healing or it can cheapen and degrade the experience. These are outcomes that are relatively independent of the technology itself; as we have learned so often and so painfully, it is the social uses to which we put these capabilities that are crucial. If we don't allow a blind technological imperative to squeeze all that is human out of the healing process, if we don't let lust for maximized profit margins contaminate even more of medicine, these tools may play a role in ending the crisis of health care delivery we now face. But if we choose to approach these problems as we have approached so many others in this century, even pulling out all the plugs won't help.

Telepsychiatry Use in Rural Areas in the United States

2020 ◽  
Vol 13 (4) ◽  
pp. 1-13
Author(s):  
Alberto Coustasse ◽  
Morgan Ruley ◽  
Tonnie C. Mike ◽  
Briana M. Washington ◽  
Anna Robinson
Keyword(s):  
Mental Health ◽  
United States ◽  
Quality Of Care ◽  
Rural Areas ◽  
Care Delivery ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
The United States ◽  
Access And Quality

Rural areas have experienced a higher than average shortage of healthcare professionals. Numerous challenges have limited access to mental health services. Some of these barriers have included transportation, number of providers, poverty, and lack of insurance. Recently, the utilization of telepsychiatry has increased in rural areas. The purpose of this review was to identify and coalesce the benefits of telepsychiatry for adults living in rural communities in the United States to determine if telepsychiatry has improved access and quality of care. The methodology for this study was a literature review that followed a systematic approach. References and sources were written in English and were taken from studies in the United States between 2004 and 2018 to keep this review current. Fifty-nine references were selected from five databases. It was found that several studies supported that telepsychiatry has improved access and quality of care available in rural environments. At the same time, telepsychiatry in mental healthcare has not been utilized as it should in rural adult populations due to lack of access, an overall shortage of providers, and poor distribution of psychiatrists. There are numerous benefits to implementing telepsychiatry in rural areas. While there are still barriers that prevent widespread utilization, telepsychiatry can improve mental health outcomes by linking rural patients to high-quality mental healthcare services that follow evidence-based care and best practices. Telepsychiatry utilization in rural areas in the United States has demonstrated to have a significant ability to transform mental health care delivery and clinician productivity. As technology continues to advance access, telepsychiatry will also advance, making access more readily available.

scholarly journals FACILITATING CARE: A NARRATIVE APPROACH TO ASSESS EXPERIENCED QUALITY OF CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S73-S73
Author(s):  
Katya Sion ◽  
Hilde Verbeek ◽  
Gaby Odekerken-Schröder ◽  
Sandra Zwakhalen ◽  
Jos Schols ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Nursing Homes ◽  
Data Collection ◽  
Needs Assessment ◽  
Family Members ◽  
Added Value ◽  
Narrative Approach ◽  
Individual Conversations ◽  
Three Phases

Abstract This study aimed to develop a method to assess experienced quality of care (QoC) in nursing homes from the resident’s perspective. A narrative approach “Facilitating Care” (FC) was developed based on the INDEXQUAL framework of experienced QoC and a needs assessment. FC assesses experienced QoC by training care professionals to perform individual conversations with residents, their family and their professional caregivers (triads) in another organization than where they are employed. FC consists of three phases: 1) training, 2) data collection and registration, and 3) analysis and reporting of the results. In 2018, 16 care professionals were trained and performed 148 conversations (47 residents, 44 family members, 57 professional caregivers) in 8 different nursing homes. Evaluation showed that FC teaches helpful conversation techniques and provides valuable insights into residents’ experienced QoC. Whilst the process was considered time consuming, all participants emphasized the added value of taking time for FC conversations.

Inpatient Rehabilitation Quality of Care From the Patient’s Perspective: Effect of Data Collection Timing and Patient Characteristics

2019 ◽  
Vol 100 (6) ◽  
pp. 1032-1041 ◽  
Author(s):  
Anne Deutsch ◽  
Allen W. Heinemann ◽  
Karon F. Cook ◽  
Linda Foster ◽  
Ana Miskovic ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Data Collection ◽  
Inpatient Rehabilitation ◽  
Patient Characteristics ◽  
Patient’S Perspective ◽  
Perspective Effect
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