Quality Improvement at the Health System Level: Measurement, Risk Stratification, Disparity Populations, and Governance

2019 ◽  
pp. 388-398
Author(s):  
Gabrielle Betty Rocque ◽  
Inga T. Lennes ◽  
Kim Felder Rhoads ◽  
Peter Paul Yu
Keyword(s):  
Health Systems ◽  
Care Delivery ◽  
System Level ◽  
State Agencies ◽  
Public And Private ◽  
For Profit ◽  
Medical Centers ◽  
Level Measurement ◽  
Academic Medical ◽  
Integrated Delivery

Value-based health systems encompass a range of care-delivery models from small independent practices to large integrated delivery systems and academic medical centers. In addition, public and private payers, federal and state agencies, professional societies, and not-for-profit organizations collect and analyze data for quality and value improvement in health care–delivery outcomes. In this article, we review the multidimensional aspects of data collection, aggregation, analysis, and use for and by value-based health systems.

scholarly journals Sustaining Workforce Well-being: A Model for Supporting System Resilience During the COVID-19 Pandemic

2021 ◽  
Vol 10 ◽  
pp. 216495612199181
Author(s):  
Ellen Morrow ◽  
Megan Call ◽  
Mari Ransco ◽  
Kim Mahoney Hofmann ◽  
Amy Locke
Keyword(s):  
Health Care ◽  
Well Being ◽  
Academic Medical Centers ◽  
System Level ◽  
Health Care Teams ◽  
Medical Centers ◽  
Post Traumatic Growth ◽  
Academic Medical ◽  
Post Traumatic ◽  
System Resilience

Professional well-being in health care is critical to the success of academic medical centers inpatient care, educating trainees, serving communities, and pursuing research missions. The COVID-19 pandemic, caused by SARS-COV-2, has stretched health care teams and individuals in unique ways, leading to high levels of persistent stress with concern for longer term mental health implications. The pandemic is a catalyst to grow and strengthen support for those who work in health professions. Using one academic health center as a model, this paper reviews how professional well-being can be approached comprehensively at a system level while considering the needs of diverse employees during a time of increased need. This ramping up of services has the opportunity to build community and support a trajectory of post traumatic growth.

scholarly journals Broad Consent for Research on Biospecimens: The Views of Actual Donors at Four U.S. Medical Centers

2018 ◽  
Vol 13 (2) ◽  
pp. 115-124 ◽  
Author(s):  
Teddy D. Warner ◽  
Carol J. Weil ◽  
Christopher Andry ◽  
Howard B. Degenholtz ◽  
Lisa Parker ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Academic Medical Centers ◽  
Tissue Donation ◽  
Future Research ◽  
Sufficient Information ◽  
Broad Consent ◽  
For Profit ◽  
Medical Centers ◽  
Academic Medical ◽  
Wide Range

Commentators are concerned that broad consent may not provide biospecimen donors with sufficient information regarding possible future research uses of their tissue. We surveyed with interviews 302 cancer patients who had recently provided broad consent at four diverse academic medical centers. The majority of donors believed that the consent form provided them with sufficient information regarding future possible uses of their biospecimens. Donors expressed very positive views regarding tissue donation in general and endorsed the use of their biospecimens in future research across a wide range of contexts. Concerns regarding future uses were limited to for-profit research and research by investigators in other countries. These results support the use of broad consent to store and use biological samples in future research.

The Role of the Business Sector in Global Health Politics

2018 ◽  
pp. 385-408
Author(s):  
Kelley Lee ◽  
Julia Smith
Keyword(s):  
Collective Action ◽  
Global Health ◽  
Business Sector ◽  
Policy Debate ◽  
Public And Private ◽  
Health Politics ◽  
For Profit ◽  
Goods And Services ◽  
Private Interests ◽  
Health Related

The influence of for-profit businesses in collective action across countries to protect and promote population health dates from the first International Sanitary Conferences of the nineteenth century. The restructuring of the world economy since the late twentieth century and the growth of large transnational corporations have led the business sector to become a key feature of global health politics. The business sector has subsequently moved from being a commercial producer of health-related goods and services, contractor, and charitable donor, to being a major shaper of, and even participant in, global health policymaking bodies. This chapter discusses three sites where this has occurred: collective action to regulate health-harming industries, activities to provide for public interest needs, and participation in decision-making within global health institutions. These changing forms of engagement by the business sector have elicited scholarly and policy debate regarding the appropriate relationship between public and private interests in global health.

scholarly journals Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 94
Author(s):  
Carolyn Tarrant ◽  
Andrew M. Colman ◽  
David R. Jenkins ◽  
Edmund Chattoe-Brown ◽  
Nelun Perera ◽  
...  
Keyword(s):  
South Africa ◽  
Sri Lanka ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Low Income ◽  
System Level ◽  
Comparative Approach ◽  
Structured Interviews ◽  
Public And Private ◽  
The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

scholarly journals Multicenter point prevalence evaluation of the utilization and safety of drug therapies for COVID-19 at the onset of the pandemic timeline in the United States

2021 ◽  
Author(s):  
Nathaniel J Rhodes ◽  
Atheer Dairem ◽  
William J Moore ◽  
Anooj Shah ◽  
Michael J Postelnick ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Drug Therapy ◽  
Supportive Care ◽  
The United States ◽  
Primary Objective ◽  
Point Prevalence ◽  
Medical Centers ◽  
Academic Medical ◽  
History Of ◽  
Secondary Objective

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose There are currently no FDA-approved medications for the treatment of coronavirus disease 2019 (COVID-19). At the onset of the pandemic, off-label medication use was supported by limited or no clinical data. We sought to characterize experimental COVID-19 therapies and identify safety signals during this period. Methods We conducted a non-interventional, multicenter, point prevalence study of patients hospitalized with suspected/confirmed COVID-19. Clinical and treatment characteristics within a 24-hour window were evaluated in a random sample of up to 30 patients per site. The primary objective was to describe COVID-19–targeted therapies. The secondary objective was to describe adverse drug reactions (ADRs). Results A total of 352 patients treated for COVID-19 at 15 US hospitals From April 18 to May 8, 2020, were included in the study. Most patients were treated at academic medical centers (53.4%) or community hospitals (42.6%). Sixty-seven patients (19%) were receiving drug therapy in addition to supportive care. Drug therapies used included hydroxychloroquine (69%), remdesivir (10%), and interleukin-6 antagonists (9%). Five patients (7.5%) were receiving combination therapy. The rate of use of COVID-19–directed drug therapy was higher in patients with vs patients without a history of asthma (14.9% vs 7%, P = 0.037) and in patients enrolled in clinical trials (26.9% vs 3.2%, P < 0.001). Among those receiving drug therapy, 8 patients (12%) experienced an ADR, and ADRs were recognized at a higher rate in patients enrolled in clinical trials (62.5% vs 22%; odds ratio, 5.9; P = 0.028). Conclusion While we observed high rates of supportive care for patients with COVID-19, we also found that ADRs were common among patients receiving drug therapy, including those enrolled in clinical trials. Comprehensive systems are needed to identify and mitigate ADRs associated with experimental COVID-19 treatments.

Stiffen the sinews, summon up the blood, and strain upon the start: enfranchising the medical profession for clinically proximate advocacy of improved healthcare

2021 ◽  
pp. 103985622110250
Author(s):  
Jeffrey C L Looi ◽  
Stephen Allison ◽  
Stephen R Kisely ◽  
Tarun Bastiampillai
Keyword(s):  
Resource Allocation ◽  
Health Systems ◽  
Medical Profession ◽  
Continuing Professional Development ◽  
Health Advocacy ◽  
Public And Private ◽  
Medical Practitioners ◽  
The Public ◽  
Team Activity

Objective: To discuss and reflect upon the role of medical practitioners, including psychiatrists, as health advocates on behalf of patients, carers and staff. Conclusions: Health advocacy is a key professional competency of medical practitioners, and is part of the RANZCP framework for training and continuing professional development. Since advocacy is often a team activity, there is much that is gained experientially from volunteering and working with other more experienced health advocates within structurally and financially independent (of health systems and governments) representative groups (RANZCP, AMA, unions). Doctors may begin with clinically proximate advocacy for improved healthcare in health systems, across the public and private sectors. Health advocacy requires skill and courage, but can ultimately influence systemic outcomes, sway policy decisions, and improve resource allocation.

scholarly journals Quality in crisis: a systematic review of the quality of health systems in humanitarian settings

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Keely Jordan ◽  
Todd P. Lewis ◽  
Bayard Roberts
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Health Systems ◽  
Point Of Care ◽  
System Level ◽  
System Quality ◽  
High Quality ◽  
Humanitarian Settings ◽  
Quality Health

Abstract Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings.

Hospital Volume is Not a Predictor of Outcomes after Gastrectomy for Neoplasm

2009 ◽  
Vol 75 (10) ◽  
pp. 932-936 ◽  
Author(s):  
Kevin M. Reavis ◽  
Marcelo W. Hinojosa ◽  
Brian R. Smith ◽  
James B. Wooldridge ◽  
Sindhu Krishnan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Gastric Surgery ◽  
National Database ◽  
Medical Centers ◽  
Outcome Relationship ◽  
Academic Medical ◽  
Low Volume ◽  
Poor Outcomes ◽  
The University

Studies have shown conflicting data with regard to the volume and outcome relationship for gastrectomy. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of gastrectomy on outcomes at academic centers between 2004 and 2008. Outcome measures, including length of stay, 30-day readmission, morbidity, and in-hospital mortality, were compared among high- (13 or greater), medium- (6 to 12), and low-volume (five or less) hospitals. There were 10 high- (n = 593 cases), 36 medium- (n = 1076 cases), and 75 low-volume (n = 500 cases) hospitals. There were no significant differences between high- and low-volume hospitals with regard to length of stay, overall complications, 30-day readmission rate, and in-hospital mortality (2.4 vs 4.4%, respectively, P = 0.06). Despite the small number of gastrectomies performed at the low-volume hospitals, these same hospitals performed a large number of other types of gastric surgery such as gastric bypass for the treatment of morbid obesity (102 cases/year). Within the context of academic medical centers, lower annual volume of gastrectomy for neoplasm is not a predictor of poor outcomes which may be explained by the gastric operative experience derived from other types of gastric surgery.

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