A multi-method quality improvement approach to systematically improve and promote the quality of national health and social care information

Safe and reliable healthcare depends on access to health information that is accurate, valid, reliable, timely, relevant, legible and complete. National data collections are repositories of health and social care data and play a crucial role in healthcare planning and clinical decision-making. We describe the development of an evidence-informed multi-method quality improvement program aimed to improve the quality of health and social care data in Ireland. Specific components involved: development of guidance to support implementation of health information standards; review program to assess compliance with standards; and educating health information stakeholders about health data and information quality. Observations from implementation of the program indicate enhanced health information stakeholder awareness of, and increased adoption of information management standards. The methodology used in the review program has proved to be a robust approach to identify areas of good practice and opportunities for improvement in information management practices. There has been positive adoption of the program among organisations reviewed and acceptance of the proposed recommendations. Early indications are that this multi-method approach will drive improvements in information management practices, leading to an improvement in health and social care data quality in Ireland. Aspects of this approach may be adapted to meet the needs of other countries.

Download Full-text

Exploring the role of the Care and Health Information Exchange (CHIE) in clinical decision-making: a realist evaluation

10.1101/2020.08.13.20174276 ◽

2020 ◽

Author(s):

Philip Scott ◽

Elisavet Andrikopoulou ◽

Haythem Nakkas ◽

Paul Roderick

Keyword(s):

Decision Making ◽

Health Information ◽

Information Exchange ◽

Healthcare Professionals ◽

Clinical Decision Making ◽

Social Care ◽

Health Information Exchange ◽

Clinical Decision ◽

Health And Social Care ◽

The Impact

Background: The overall evidence for the impact of electronic information systems on cost, quality and safety of healthcare remains contested. Whilst it seems intuitively obvious that having more data about a patient will improve care, the mechanisms by which information availability is translated into better decision-making are not well understood. Furthermore, there is the risk of data overload creating a negative outcome. There are situations where a key information summary can be more useful than a rich record. The Care and Health Information Exchange (CHIE) is a shared electronic health record for Hampshire and the Isle of Wight that combines key information from hospital, general practice, community care and social services. Its purpose is to provide clinical and care professionals with complete, accurate and up-to-date information when caring for patients. CHIE is used by GP out-of-hours services, acute hospital doctors, ambulance service, GPs and others in caring for patients. Research questions: The fundamental question was How does awareness of CHIE or usage of CHIE affect clinical decision-making? The secondary questions were What are the latent benefits of CHIE in frontline NHS operations? and What is the potential of CHIE to have an impact on major NHS cost pressures? The NHS funders decided to focus on acute medical inpatient admissions as the initial scope, given the high costs associated with hospital stays and the patient complexities (and therefore information requirements) often associated with unscheduled admissions. Methods: Semi-structured interviews with healthcare professionals to explore their experience about the utility of CHIE in their clinical scenario, whether and how it has affected their decision-making practices and the barriers and facilitators for their use of CHIE. The Framework Method was used for qualitative analysis, supported by the software tool Atlas.ti. Results: 21 healthcare professionals were interviewed. Three main functions were identified as useful: extensive medication prescribing history, information sharing between primary, secondary and social care and access to laboratory test results. We inferred two positive cognitive mechanisms: knowledge confidence and collaboration assurance, and three negative ones: consent anxiety, search anxiety and data mistrust. Conclusions: CHIE gives clinicians the bigger picture to understand the patient's health and social care history and circumstances so as to make confident and informed decisions. CHIE is very beneficial for medicines reconciliation on admission, especially for patients that are unable to speak or act for themselves or who cannot remember their precise medication or allergies. We found no clear evidence that CHIE has a significant impact on admission or discharge decisions. We propose the use of recommender systems to help clinicians navigate such large volumes of patient data, which will only grow as additional data is collected.

Download Full-text

Quality improvement through the paradigm of learning

Quality in Ageing and Older Adults ◽

10.1108/qaoa-02-2015-0009 ◽

2015 ◽

Vol 16 (4) ◽

pp. 195-207 ◽

Cited By ~ 6

Author(s):

Trish Hafford-Letchfield ◽

Peter Lavender

Keyword(s):

Quality Improvement ◽

Older People ◽

Social Care ◽

Care Home ◽

Care Homes ◽

Project Staff ◽

Content Type ◽

Health And Social Care ◽

Learning Interventions

Purpose – Achieving meaningful participation and co-production for older people in care requires radical approaches. The purpose of this paper is to explore an innovation where learning interventions were introduced into care settings and older people matched to community-based learning mentors to develop partnerships. The authors explore how the concept of learning might be used as a paradigm to raise the quality of care in institutionalised settings using a co-productive and relationship-based approach to promote wellbeing. Design/methodology/approach – A structured evaluation drew on qualitative data captured from interviews with older people (n=25) and learning mentors (n=22) to reflect on the potential benefits and challenges involved when introducing learning interventions in care settings. This was contextualised alongside data captured from stakeholders (n=10) including a care home manager, social care and education commissioners, trustees and project staff to assess the interdisciplinary contribution of lifelong learning to quality improvement. Findings – Introducing learning interventions to older people within care settings promoted participation, advocacy and relationship-based care which in turn helped to create a positive culture. Given the current challenges to improve quality in care services, drawing on a paradigm of learning may encourage older people to retain their independence as care homes strive towards a person-centred approach. Promoting social activities and leisure using learning was found to foster closer working relationships between older people and the wider community. These had a levelling effect through reciprocity, using an asset based approach. There were benefits for the care provider as the partnerships formed enabled people to raise both individual and collective concerns about care and support. Originality/value – Raising and sustaining the quality of support for older people requires input from the wider public sector beyond health and social care. Purposeful engagement with other disciplines such as learning and leisure offers the potential to realise a more sustainable model of user choice, person-centred support and user involvement. Being engaged through learning can nourish membership in the community for marginalised populations such as older people living in care homes.

Download Full-text

Advances in E-Health

Life ◽

10.3390/life11060468 ◽

2021 ◽

Vol 11 (6) ◽

pp. 468

Author(s):

Vivian Vimarlund ◽

Sabine Koch ◽

Christian Nøhr

Keyword(s):

Health Information ◽

Social Care ◽

Self Management ◽

Health And Social Care

E-health offers new ways to access health information, to deliver health and social care and to perform self-management [...]

Download Full-text

Baseline Quality-of-Care Data From a Quality-Improvement Program Implemented by a Network of Diabetes Outpatient Clinics

Diabetes Care ◽

10.2337/dc08-0469 ◽

2008 ◽

Vol 31 (11) ◽

pp. 2166-2168 ◽

Cited By ~ 43

Author(s):

M. C.E. Rossi ◽

A. Nicolucci ◽

A. Arcangeli ◽

A. Cimino ◽

G. De Bigontina ◽

...

Keyword(s):

Quality Improvement ◽

Quality Of Care ◽

Quality Improvement Program ◽

Outpatient Clinics ◽

Improvement Program

Download Full-text

Regulating the quality of health and social care services in England: lessons for Australia: Keynote address at the 2015 Australasian Society for Intellectual Disability National Conference

Research and Practice in Intellectual and Developmental Disabilities ◽

10.1080/23297018.2016.1180260 ◽

2016 ◽

Vol 3 (2) ◽

pp. 145-155 ◽

Cited By ~ 5

Author(s):

David Behan ◽

Jonathan Beebee ◽

Ian Dodds

Keyword(s):

Intellectual Disability ◽

Social Care ◽

Keynote Address ◽

National Conference ◽

Care Services ◽

Health And Social Care

Download Full-text

Could health information systems enhance the quality of Aboriginal health promotion? A retrospective audit of Aboriginal health programs in the Northern Territory of Australia

10.21203/rs.2.17217/v4 ◽

2020 ◽

Author(s):

Nikki Ann Percival ◽

Priscilla Boucher ◽

Kathleen Conte ◽

Kate Robertson ◽

Julie Cook

Keyword(s):

Health Promotion ◽

Quality Improvement ◽

Information Systems ◽

Health Information ◽

Aboriginal Health ◽

Health Information Systems ◽

Online System ◽

Retrospective Audit ◽

Potential Benefits

Abstract Background: In Australia, health services are seeking innovative ways to utilize data stored in health information systems to report on, and improve, health care quality and health system performance for Aboriginal Australians. However, there is little research about the use of health information systems in the context of Aboriginal health promotion. In 2008, the Northern Territory’s publicly funded healthcare system introduced the Quality Improvement Program Planning System (QIPPS) as the centralized online system for recording information about health promotion programs. The purpose of this study was to explore the potential for utilizing data stored in QIPPS to report on quality of Aboriginal health promotion, using chronic disease prevention programs as exemplars. We identify the potential benefits and limitations of health information systems for enhancing Aboriginal health promotion. Methods: A retrospective audit was undertaken on a sample of health promotion projects delivered between 2013 and 2016. A validated, paper-based audit tool was used to extract information stored in the QIPPS online system and report on Aboriginal health promotion quality. Simple frequency counts were calculated for dichotomous and categorical items. Text was extracted and thematically analyzed to describe community participation processes and strategies used in Aboriginal health promotion. Results: 39 Aboriginal health promotion projects were included in the analysis. 34/39 projects recorded information pertaining to the health promotion planning phases, such as statements of project goals, ‘needs assessment’ findings, and processes for consulting Aboriginal people in the community. Evaluation findings were reported in approximately one third of projects and mostly limited to a recording of numbers of participants. For almost half of the projects analyzed, community participation strategies were not recorded. Conclusion: This is the first Australian study to shed light on the feasibility of utilizing data stored in a purposefully designed health promotion information system. Data availability and quality were limiting factors for reporting on Aboriginal health promotion quality. Based on our learnings of QIPPS, strategies to improve the quality and accuracy of data entry together with the use of quality improvement approaches are needed to reap the potential benefits of future health promotion information systems.

Download Full-text

Collaborating across health and social care: joint funding an adult protection Coordinator post in Caerphilly, UK

The Journal of Adult Protection ◽

10.1108/jap-06-2014-0020 ◽

2015 ◽

Vol 17 (2) ◽

pp. 139-147

Author(s):

Andrea Giordano ◽

Alison Neville

Keyword(s):

Social Services ◽

Social Care ◽

Service Improvement ◽

Health Board ◽

Content Type ◽

Health And Social Care ◽

Abuse And Neglect ◽

Vulnerable Adults ◽

Adult Protection

Purpose – The purpose of the paper is to improve the consistency and quality of the response to vulnerable adults who experience abuse and neglect within NHS, independent healthcare and social care settings is noted by practitioners, agencies and patients. Health and social care policy frameworks promote principles of service improvement and consistency, along with a focus on outcomes and resource effectiveness and interagency collaboration. The Protection of Vulnerable Adults (POVA) coordinator role carries the responsibility of coordinating a response to individual referrals of abuse and neglect as described as part of the Designated Lead Manager role in the Wales Interim POVA Policy and Procedures for the POVA from abuse (Wales Adult Protection Coordinators Group, 2013). Design/methodology/approach – This paper will explore the benefits realised through a registered nurse being seconded from the Aneurin Bevan University Health Board into a newly created joint adult protection Health Coordinator post within the Caerphilly County Borough Council social services department POVA team. Findings – This is the first example of such partnership working in adult protection in Wales and has provided a number of benefits in relation to: providing adult protection advice; coordinating the response to referrals of vulnerable adult abuse and neglect within health and social care settings; carrying out or buddying others to complete adult protection investigations; facilitating the two day non-criminal POVA investigation training course and, awareness raising within the local Health Board. The development of a student nurse placement in the social services POVA team cements the multiagency collaborative approach that this development sought to achieve. Originality/value – The need to improve the consistency and quality of the response to vulnerable adults who experience abuse and neglect within NHS, independent healthcare and social care settings is noted by practitioners, agencies and patients.

Download Full-text

Good practice in health and social care provision for LGBT older people in the UK

LGBT health inequalities ◽

10.2307/j.ctt1t89jh6.16 ◽

2017 ◽

pp. 145-158

Author(s):

Sue Westwood ◽

Andrew King ◽

Kathryn Almack ◽

Yiu-Tung Suen ◽

Louis Bailey

Keyword(s):

Older People ◽

Social Care ◽

Good Practice ◽

Care Provision ◽

Health And Social Care ◽

The Uk

Download Full-text

Understanding health information management practices in public hospitals in Kuwait

Health Information Management Journal ◽

10.1177/1833358319837247 ◽

2019 ◽

Vol 49 (2-3) ◽

pp. 127-136

Author(s):

Dari Alhuwail

Keyword(s):

Health Information ◽

Information Management ◽

Healthcare Reform ◽

Management Practices ◽

Digital Health ◽

Developed Countries ◽

Health Information Management ◽

Public Hospitals ◽

Health It ◽

Management Standard

Background: Health information technology (IT) solutions can aid healthcare reform efforts, but without proper information management, these efforts are futile. In this study, we used Kuwait as an example of a high per-capita gross domestic product country that faces information management challenges to draw insights that can be generalised to other developed countries. Objective: (i) to uncover the status quo of information management practices in public hospitals and (ii) to offer recommendations to improve them. Method: This study analysed qualitative and quantitative accreditation-related data pertaining to the compliance with the information management standard at all secondary care public hospitals over two accreditation cycles. Results: Overall, public hospitals had made positive progress in their compliance with the information management standard. However, issues still existed with (i) developing and implementing an information management plan, (ii) involving the appropriate stakeholders in selecting health IT solutions and (iii) access to the Internet by staff and patients. Conclusion: Evidence underscored the importance of proper information management driven by clear centralised strategic plans. Implications: With the rapid adoption of digital health systems, the role of health information management leaders should not be undervalued. Embracing health IT solutions with strong information management practices can aid healthcare reform efforts.

Download Full-text