Using Quality Improvement Curriculum To Improve Adherence To Children's Asthma Care Measure National Hospital Inpatient Quality Measures In A University Health System

2012 ◽  
Author(s):  
Yuan-Jiun N. Chao ◽  
Ruth McDonald
Keyword(s):  
Quality Improvement ◽  
Health System ◽  
Quality Measures ◽  
Hospital Inpatient ◽  
Asthma Care ◽  
National Hospital ◽  
Care Measure

Expanding patient engagement in quality improvement and health system redesign

2016 ◽  
Vol 29 (5) ◽  
pp. 176-182 ◽  
Author(s):  
G. Ross Baker ◽  
Carol Fancott ◽  
Maria Judd ◽  
Patricia O’Connor
Keyword(s):  
Quality Improvement ◽  
Health System ◽  
Patient Engagement ◽  
Health System Redesign

scholarly journals Quality indicators of dental health care in Serbia

2019 ◽  
Vol 66 (1) ◽  
pp. 36-42
Author(s):  
Svetlana Jovanović ◽  
Maja Milošević ◽  
Irena Aleksić-Hajduković ◽  
Jelena Mandić
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health System ◽  
Quality Indicators ◽  
Health Care Quality ◽  
Care Quality ◽  
System Quality ◽  
Quality Health Care ◽  
Quality Health

Summary Health care has witnessed considerable progresses toward quality improvement over the past two decades. More precisely, there have been global efforts aimed to improve this aspect of health care along with experts and decision-makers reaching the consensus that quality is one of the most significant dimensions and features of health system. Quality health care implies highly efficient resource use in order to meet patient’s needs in terms of prevention and treatment. Quality health care is provided in a safe way while meeting patients’ expectations and avoiding unnecessary losses. The mission of continuous improvement in quality of care is to achieve safe and reliable health care through mutual efforts of all the key supporters of health system to protect patients’ interests. A systematic approach to measuring the process of care through quality indicators (QIs) poses the greatest challenge to continuous quality improvement in health care. Quality indicators are quantitative indicators used for monitoring and evaluating quality of patient care and treatment, continuous professional development (CPD), maintaining waiting lists, patients and staff satisfaction, and patient safety.

scholarly journals Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism

2017 ◽  
Vol 1 (21;1) ◽  
pp. E1-E12 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Quality Improvement ◽  
Resource Use ◽  
Quality Measures ◽  
Payment System ◽  
Sustainable Growth ◽  
Composite Score ◽  
Care Providers ◽  
Incentive Payment ◽  
Final Rule ◽  
Care Information

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula – a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, “The Merit-Based Incentive Payment System, or MIPS.” The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), valuebased payment (VBP) system were merged with the addition of Clinical Improvement Activity category. The proposed rule also changed the name of MU to Advancing Care Information, or ACI. ACI contributes to 25% of composite score of the four programs, PQRS contributes 50% of the composite score, while VBP system, which deals with resource use or cost, contributes to 10% of the composite score. The newest category, Improvement Activities or IA, contributes 15% to the composite score. The proposed rule also created what it called a design incentive that drives movement to delivery system reform principles with the inclusion of Advanced Alternative Payment Models (APMs). Following the release of the proposed rule, the medical community, as well as Congress, provided substantial input to Centers for Medicare and Medicaid Services (CMS),expressing their concern. American Society of Interventional Pain Physicians (ASIPP) focused on 3 important aspects: delay the implementation, provide a 3-month performance period, and provide ability to submit meaningful quality measures in a timely and economic manner. The final rule accepted many of the comments from various organizations, including several of those specifically emphasized by ASIPP, with acceptance of 3-month reporting period, as well as the ability to submit non-MIPS measures to improve real quality and make the system meaningful. CMS also provided a mechanism for physicians to avoid penalties for non-reporting with reporting of just a single patient. In summary, CMS has provided substantial flexibility with mechanisms to avoid penalties, reporting for 90 continuous days, increasing the low volume threshold, changing the reporting burden and data thresholds and, finally, coordination between performance categories. The final rule has made MIPS more meaningful with bonuses for exceptional performance, the ability to report for 90 days, and to report on 50% of the patients in 2017 and 60% of the patients in 2018. The final rule also reduced the quality measures to 6, including only one outcome or high priority measure with elimination of cross cutting measure requirement. In addition, the final rule reduced the burden of ACI, improved the coordination of performance, reduced improvement activities burden from 60 points to 40 points, and finally improved coordination between performance categories. Multiple concerns remain regarding the reduction in scoring for quality improvement in future years, increase in proportion of MIPS scoring for resource use utilizing flawed, claims based methodology and the continuation of the disproportionate importance of ACI, an expensive program that can be onerous for providers which in many ways has not lived up to its promise. Key words: Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, improvement activities, advancing care information performance category

Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis

2021 ◽  
pp. bmjqs-2021-013110
Author(s):  
Sanjay Mahant ◽  
Jun Guan ◽  
Jessie Zhang ◽  
Sima Gandhi ◽  
Evan Jon Propst ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Health System ◽  
Interrupted Time Series ◽  
Improve Quality ◽  
Interrupted Time Series Analysis ◽  
Quality Improvement Programme ◽  
Improvement Programme

BackgroundTonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care pathway. We determined the association of this payment and quality improvement programme with tonsillectomy quality of care.MethodsInterrupted time series analysis of children undergoing elective tonsillectomy at community and children’s hospitals in Ontario in the QBP period (1 April 2014 to 31 December 2018) and the pre-QBP period (1 January 2009 to 31 January 2014) using health administrative data. We compared the age-standardised and sex-standardised rates for all-cause tonsillectomy-related revisits within 30 days, opioid prescription fills within 30 days and index tonsillectomy inpatient admission.Results111 411 children underwent tonsillectomy: 51 967 in the QBP period and 59 444 in the pre-QBP period (annual median number of hospitals, 86 (range 77–93)). Following QBP programme implementation, revisit rates decreased for all-cause tonsillectomy-related revisits (0.48 to −0.18 revisits per 1000 tonsillectomies per month; difference −0.66 revisits per 1000 tonsillectomies per month (95% CI −0.97 to −0.34); p<0.0001). Codeine prescription fill rate continued to decrease but at a slower rate (−4.81 to −0.11 prescriptions per 1000 tonsillectomies per month; difference 4.69 (95% CI 3.60 to 5.79) prescriptions per 1000 tonsillectomies per month; p<0.0001). The index tonsillectomy inpatient admission rate decreased (1.12 to 0.23 admissions per 1000 tonsillectomies per month; difference −0.89 (95% CI −1.33 to −0.44) admissions per 1000 tonsillectomies per month; p<0.0001).ConclusionsThe payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures.

scholarly journals Association Between Delivery System Structure and Intensity of End-of-Life Cancer Care

2020 ◽  
Vol 16 (7) ◽  
pp. e590-e600
Author(s):  
Lindsey A. Herrel ◽  
Ziwei Zhu ◽  
Jennifer J. Griggs ◽  
Deborah R. Kaye ◽  
James M. Dupree ◽  
...  
Keyword(s):  
Health System ◽  
End Of Life ◽  
Delivery System ◽  
End Of Life Care ◽  
Life Quality ◽  
Quality Measures ◽  
System Structure ◽  
Cancer Center ◽  
Life Care ◽  
Intensity Of Care

PURPOSE: To determine whether the type of delivery system is associated with intensity of care at the end of life for Medicare beneficiaries with cancer. PATIENTS AND METHODS: We used SEER registry data linked with Medicare claims to evaluate intensity of end-of-life care for patients who died of one of ten common cancers diagnosed from 2009 through 2014. Patients were categorized as receiving the majority of their care in an integrated delivery system, designated cancer center, health system that was both integrated and a certified cancer center, or health system that was neither. We evaluated adherence to seven nationally endorsed end-of-life quality measures using generalized linear models across four delivery system types. RESULTS: Among 100,549 beneficiaries who died of cancer during the study interval, we identified only modest differences in intensity of end-of-life care across delivery system structures. Health systems with no cancer center or integrated affiliation demonstrated higher proportions of patients with multiple hospitalizations in the last 30 days of life (11.3%), death in an acute care setting (25.9%), and lack of hospice use in the last year of life (31.6%; all P < .001). Patients enrolled in hospice had lower intensity care across multiple end-of-life quality measures. CONCLUSION: Intensity of care at the end of life for patients with cancer was higher at delivery systems with no integration or cancer focus. Maximal supportive care delivered through hospice may be one avenue to reduce high-intensity care at the end of life and may impact quality of care for patients dying from cancer.

scholarly journals Patient Outcomes and Cost-Effectiveness of a Sepsis Care Quality Improvement Program in a Health System*

2019 ◽  
Vol 47 (10) ◽  
pp. 1371-1379 ◽  
Author(s):  
Majid Afshar ◽  
Erum Arain ◽  
Chen Ye ◽  
Emily Gilbert ◽  
Meng Xie ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cost Effectiveness ◽  
Health System ◽  
Patient Outcomes ◽  
Care Quality ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Sepsis Care

Comparative Evaluation of Two Asthma Care Quality Measures Among Medicaid Beneficiaries

CHEST Journal ◽  
2009 ◽  
Vol 135 (5) ◽  
pp. 1193-1196 ◽  
Author(s):  
Mihail Samnaliev ◽  
Jeffrey D. Baxter ◽  
Robin E. Clark
Keyword(s):  
Comparative Evaluation ◽  
Quality Measures ◽  
Care Quality ◽  
Asthma Care ◽  
Medicaid Beneficiaries

scholarly journals Inpatient Asthma Care and Future Morbidity: A Role for Quality Improvement

PEDIATRICS ◽  
2018 ◽  
Vol 141 (5) ◽  
pp. e20180420
Author(s):  
Elizabeth D. Allen ◽  
Richard J. Brilli
Keyword(s):  
Quality Improvement ◽  
Asthma Care

scholarly journals Facilitators of interdepartmental quality improvement: a mixed-methods analysis of a collaborative to improve pediatric community-acquired pneumonia management

2018 ◽  
Vol 28 (3) ◽  
pp. 215-222 ◽  
Author(s):  
JoAnna K Leyenaar ◽  
Christine B Andrews ◽  
Emily R Tyksinski ◽  
Eric Biondi ◽  
Kavita Parikh ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Clinical Care ◽  
Quality Measures ◽  
Community Acquired Pneumonia ◽  
Categorical Variables ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
Narrow Spectrum ◽  
Clinical Departments

BackgroundEmergency medicine and paediatric hospital medicine physicians each provide a portion of the initial clinical care for the majority of hospitalised children in the USA. While these disciplines share goals to increase quality of care, there are scant data describing their collaboration. Our national, multihospital learning collaborative, which aimed to increase narrow-spectrum antibiotic prescribing for paediatric community-acquired pneumonia, provided an opportunity to examine factors influencing the success of quality improvement efforts across these two clinical departments.ObjectiveTo identify barriers to and facilitators of interdepartmental quality improvement implementation, with a particular focus on increasing narrow-spectrum antibiotic use in the emergency department and inpatient settings for children hospitalised with pneumonia.MethodsWe used a mixed-methods design, analysing interviews, written reports and quality measures. To describe hospital characteristics and quality measures, we calculated medians/IQRs for continuous variables, frequencies for categorical variables and Pearson correlation coefficients. We conducted in-depth, semistructured interviews by phone with collaborative site leaders; interviews were transcribed verbatim and, with progress reports, analysed using a general inductive approach.Results47 US-based hospitals were included in this analysis. Qualitative analysis of 35 interview transcripts and 142 written reports yielded eight inter-related domains that facilitated successful interdepartmental quality improvement: (1) hospital leadership and support, (2) quality improvement champions, (3) evidence supporting the intervention, (4) national health system influences, (5) collaborative culture, (6) departments’ structure and resources, (7) quality improvement implementation strategies and (8) interdepartmental relationships.ConclusionsThe conceptual framework presented here may be used to identify hospitals’ strengths and potential barriers to successful implementation of quality improvement efforts across clinical departments.

Sign in / Sign up

Export Citation Format

Share Document