CHSRF Knowledge Transfer: Public Reporting: One Piece of the Quality Improvement Puzzle

Introduction.Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs.Objective.To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts.Design.A multiphase modified Delphi technique.Setting.Paper-based survey supplemented with a 1-day consensus meeting.Participants.A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts.Results.There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting.Conclusion.We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

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Public Reporting and Pay for Performance in Hospital Quality Improvement

Neurosurgery ◽

10.1227/01.neu.0000309485.81103.12 ◽

2007 ◽

Keyword(s):

Quality Improvement ◽

Pay For Performance ◽

Public Reporting ◽

Hospital Quality

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Public Reporting, Patient Safety, and Quality Improvement

JONA The Journal of Nursing Administration ◽

10.1097/00005110-200504000-00004 ◽

2005 ◽

Vol 35 (4) ◽

pp. 161???162 ◽

Cited By ~ 2

Author(s):

Linda D. Hofler

Keyword(s):

Patient Safety ◽

Quality Improvement ◽

Public Reporting

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A decade of commitment to hospital quality of care: overview of and perceptions on multicomponent quality improvement policies involving accreditation, public reporting, inspection and pay-for-performance

BMC Health Services Research ◽

10.1186/s12913-021-07007-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Astrid Van Wilder ◽

Jonas Brouwers ◽

Bianca Cox ◽

Luk Bruyneel ◽

Dirk De Ridder ◽

...

Keyword(s):

Quality Improvement ◽

Quality Of Care ◽

Acute Care ◽

Government Policy ◽

Online Survey ◽

Pay For Performance ◽

Acute Care Hospitals ◽

Public Reporting ◽

Hospital Quality

Abstract Background Quality improvement (QI) initiatives such as accreditation, public reporting, inspection and pay-for-performance are increasingly being implemented globally. In Flanders, Belgium, a government policy for acute-care hospitals incorporates aforementioned initiatives. Currently, questions are raised on the sustainability of the present policy. Objective First, to summarise the various initiatives hospitals have adopted under government encouragement between 2008 and 2019. Second, to study the perspectives of healthcare stakeholders on current government policy. Methods In this multi-method study, we collected data on QI initiative implementation from governmental and institutional sources and through an online survey among hospital quality managers. We compiled an overview of QI initiative implementation for all Flemish acute-care hospitals between 2008 (n = 62) and 2019 (n = 53 after hospital mergers). Stakeholder perspectives were assessed via a second survey available to all healthcare employees and a focus group with healthcare policy experts was consulted. Variation between professions was assessed. Results QI initiatives have been increasingly implemented, especially from 2016 onwards, with the majority (87%) of hospitals having obtained a first accreditation label and all hospitals publicly reporting performance indicators, receiving regular inspections and having entered the pay-for-performance initiative. On the topic of external international accreditation, overall attitudes within the survey were predominantly neutral (36.2%), while 34.5% expressed positive and 29.3% negative views towards accreditation. In examining specific professional groups in-depth, we learned 58% of doctors regarded accreditation negatively, while doctors were judged to be the largest contributors to quality according to the majority of respondents. Conclusions Hospitals have demonstrated increased efforts into QI, especially since 2016, while perceptions on currently implemented QI initiatives among healthcare stakeholders are heterogeneous. To assure quality of care remains a top-priority for acute-care hospitals, we recommend a revision of the current multicomponent quality policy where the adoption of all initiatives is streamlined and co-created bottom-up.

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Two Decades of Nursing Home Compare: What Have We Learned?

Medical Care Research and Review ◽

10.1177/1077558720931652 ◽

2020 ◽

pp. 107755872093165

Author(s):

R. Tamara Konetzka ◽

Kevin Yan ◽

Rachel M. Werner

Keyword(s):

Systematic Review ◽

Quality Improvement ◽

Nursing Home ◽

Quality Of Care ◽

Nursing Homes ◽

Risk Adjustment ◽

Public Reporting ◽

Review Of The Literature ◽

Nursing Home Compare

Approximately two decades ago, federally mandated public reporting began for U.S. nursing homes through a system now known as Nursing Home Compare. The goals were to provide information to enable consumers to choose higher quality nursing homes and to incent providers to improve the quality of care delivered. We conduct a systematic review of the literature on responses to Nursing Home Compare and its effectiveness in meeting these goals. We find evidence of modest but meaningful response by both consumers and providers. However, we also find evidence that some improvement in scores does not reflect true quality improvement, that disparities by race and income have increased, that risk-adjustment of the measures is likely inadequate, and that several key domains of quality are not represented. Our results support moderate success of Nursing Home Compare in achieving intended goals but also reveal the need for continued refinement.

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