scholarly journals An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis

2020 ◽  
Vol 7 ◽  
pp. 205435812097531
Author(s):  
Daniel Blum ◽  
Alison Thomas ◽  
Claire Harris ◽  
Jay Hingwala ◽  
William Beaubien-Souligny ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Indicators ◽  
Quality Metrics ◽  
Care Quality ◽  
Environmental Scan ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Effective Care ◽  
Starting Point

Background: Quality metrics or indicators help guide quality improvement work by reporting on measurable aspects of health care upon which improvement efforts can focus. For recipients of in-center hemodialysis (ICHD) in Canada, it is unclear what ICHD quality indicators exist and whether they adequately cover different domains of health care quality. Objectives: To identify and evaluate current Canadian ICHD quality metrics to document a starting point for future collaborations and standardization of quality improvement in Canada. Design: Environmental scan of quality metrics in ICHD, and subsequent indicator evaluation using a modified Delphi approach. Setting: Canadian ICHD units. Participants: Sixteen-member pan-Canadian working group with expertise in ICHD and quality improvement. Measurements: We classified the existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods: Each metric was rated by a 5-person subcommittee using a modified Delphi approach based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for additional comments. Results: We identified 27 metrics that are tracked across 8 provinces, with only 9 (33%) tracked by multiple provinces (ie, more than 1 province). We rated 9 metrics (33%) as “necessary” to distinguish high-quality from low-quality care, of which only 2 were tracked by multiple provinces (proportion of patients by primary access and rate of vascular access-related bloodstream infections). Most (16/27, 59%) indicators assessed the IOM domains of safe or effective care, and none of the “necessary” indicators measured the IOM domains of timely, patient-centered, or equitable care. Limitations: The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals, with more representation from academic sites. Conclusions: Quality indicators in Canada mainly focus on safe and effective care, with little provincial overlap. These results highlight current gaps in quality of care measurement for ICHD, and this initial work should provide programs with a starting point to combine highly rated indicators with newly developed indicators into a concise balanced scorecard that supports quality improvement initiatives across all aspects of ICHD care. Trial Registration: not applicable.

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 An Environmental Scan and Evaluation of Home Dialysis Quality Indicators Currently Used in Canada

2020 ◽  
Vol 7 ◽  
pp. 205435812097739
Author(s):  
Lisa Dubrofsky ◽  
Ali Ibrahim ◽  
Karthik Tennankore ◽  
Krishna Poinen ◽  
Sachin Shah ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Peritoneal Dialysis ◽  
Quality Indicators ◽  
Patient Centered ◽  
High Quality ◽  
Home Dialysis ◽  
Environmental Scan ◽  
Starting Point

Background: Quality indicators are important tools to measure and ultimately improve the quality of care provided. Performance measurement may be particularly helpful to grow disciplines that are underutilized and cost-effective, such as home dialysis (peritoneal dialysis and home hemodialysis). Objective: To identify and catalog home dialysis quality indicators currently used in Canada, as well as to evaluate these indicators as a starting point for future collaboration and standardization of quality indicators across Canada. Design: An environmental scan of quality indicators from provincial organizations, quality organizations, and stakeholders. Setting: Sixteen-member pan-Canadian panel with expertise in both nephrology and quality improvement. Patients: Our environmental scan included indicators relevant to patients on home dialysis. Measurements: We classified existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods: To evaluate the indicators, a 6-person subcommittee conducted a modified version of the Delphi consensus technique based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for further examination. We rated items from 1 to 9 on 6 domains (1-3 does not meet criteria to 7-9 meets criteria) as well as a global final rating (1-3 unnecessary to 7-9 necessary) to distinguish high-quality from low-quality indicators. Results: Overall, we identified 40 quality indicators across 7 provinces, with 22 (55%) rated as “necessary” to distinguish high quality from poor quality care. Ten indicators were measured by more than 1 province, and 5 of these indicators were rated as necessary (home dialysis prevalence, home dialysis incidence, anemia target achievement, rates of peritonitis associated with peritoneal dialysis, and home dialysis attrition). None of these indicators captured the IOM domains of timely, patient-centered, or equitable care. Limitations: The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals. Conclusions: These results provide Canadian home dialysis programs with a starting point on how to measure quality of care along with the current gaps. This work is an initial and necessary step toward future collaboration and standardization of quality indicators across Canada, so that home dialysis programs can access a smaller number of highly rated balanced indicators to motivate and support patient-centered quality improvement initiatives.

scholarly journals Quality indicators for Palliative Day Services: A modified Delphi study

2018 ◽  
Vol 33 (2) ◽  
pp. 197-205 ◽  
Author(s):  
Noleen K McCorry ◽  
Sean O’Connor ◽  
Kathleen Leemans ◽  
Joanna Coast ◽  
Michael Donnelly ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Indicators ◽  
Delphi Study ◽  
Service Providers ◽  
Panel Discussion ◽  
Unmet Need ◽  
Modified Delphi ◽  
Starting Point ◽  
Day Services

Background: The goal of Palliative Day Services is to provide holistic care that contributes to the quality of life of people with life-threatening illness and their families. Quality indicators provide a means by which to describe, monitor and evaluate the quality of Palliative Day Services provision and act as a starting point for quality improvement. However, currently, there are no published quality indicators for Palliative Day Services. Aim: To develop and provide the first set of quality indicators that describe and evaluate the quality of Palliative Day Services. Design and setting: A modified Delphi technique was used to combine best available research evidence derived from a systematic scoping review with multidisciplinary expert appraisal of the appropriateness and feasibility of candidate indicators. The resulting indicators were compiled into ‘toolkit’ and tested in five UK Palliative Day Service settings. Results: A panel of experts independently reviewed evidence summaries for 182 candidate indicators and provided ratings on appropriateness, followed by a panel discussion and further independent ratings of appropriateness, feasibility and necessity. This exercise resulted in the identification of 30 indicators which were used in practice testing. The final indicator set comprised 7 structural indicators, 21 process indicators and 2 outcome indicators. Conclusion: The indicators fulfil a previously unmet need among Palliative Day Service providers by delivering an appropriate and feasible means to assess, review, and communicate the quality of care, and to identify areas for quality improvement.

scholarly journals Ambulatory and Hospital-based Quality Improvement Methods in Israel

2014 ◽  
Vol 7 ◽  
pp. HSI.S11027
Author(s):  
Nava Blum ◽  
Dafna Halperin ◽  
Youssef Masharawi
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Indicators ◽  
Health Care Quality ◽  
Economic Cooperation ◽  
Care Quality ◽  
Review Article ◽  
National Program

This review article compares ambulatory and hospital-based quality improvement methods in Israel. Data were collected from: reports of the National Program for Quality Indicators in community, the National Program for Quality Indicators in Hospitals, and from the Organization for Economic Cooperation and Development (OECD) Reviews of Health Care Quality.

Patient-Centered, Integrated Health Care Quality Measures Could Improve Health Literacy, Language Access, and Cultural Competence

2019 ◽  
Author(s):  
Ignatius Bau ◽  
Robert A. Logan ◽  
Christopher Dezii ◽  
Bernard Rosof ◽  
Alicia Fernandez ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Literacy ◽  
Cultural Competence ◽  
Health Care Quality ◽  
Care Quality ◽  
National Committee ◽  
Patient Centered ◽  
Organizational System ◽  
Language Access

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.

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.

What initiatives do healthcare leaders agree are needed for healthcare system improvement? Results of a modified-Delphi study

2018 ◽  
Vol 32 (8) ◽  
pp. 1002-1012
Author(s):  
Stuart Barson ◽  
Robin Gauld ◽  
Jonathon Gray ◽  
Goran Henriks ◽  
Christina Krause ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Healthcare System ◽  
Professional Training ◽  
Delphi Process ◽  
Content Type ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Health And Social Care ◽  
System Leaders ◽  
Practical Implications

Purpose The purpose of this paper is to identify five quality improvement initiatives for healthcare system leaders, produced by such leaders themselves, and to provide some guidance on how these could be implemented. Design/methodology/approach A multi-stage modified-Delphi process was used, blending the Delphi approach of iterative information collection, analysis and feedback, with the option for participants to revise their judgments. Findings The process reached consensus on five initiatives: change information privacy laws; overhaul professional training and work in the workplace; use co-design methods; contract for value and outcomes across health and social care; and use data from across the public and private sectors to improve equity for vulnerable populations and the sickest people. Research limitations/implications Information could not be gathered from all participants at each stage of the modified-Delphi process, and the participants did not include patients and families, potentially limiting the scope and nature of input. Practical implications The practical implications are a set of findings based on what leaders would bring to a decision-making table in an ideal world if given broad scope and capacity to make policy and organisational changes to improve healthcare systems. Originality/value This study adds to the literature a suite of recommendations for healthcare quality improvement, produced by a group of experienced healthcare system leaders from a range of contexts.

The essence, content and characteristics of medical services’ quality

2021 ◽  
pp. 40-43
Author(s):  
Constantin Etco ◽  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care System ◽  
Health Care Quality ◽  
Services Quality ◽  
Care Quality ◽  
Medical Services ◽  
Total Quality ◽  
Care System

One of the priorities of the health care system in Moldova is the medical services’ quality improvement. Th is article presents various defi nitions for health care quality and the principles connected with quality improvement. An important part in this article is allocated to the structure and main principles of total quality management in the health care system. Th is part reveals the problems of the commissions that are studying the quality of medical services in healthcare establishments.

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