Quality Improvement Methods in Clinical Medicine

PEDIATRICS ◽  
1999 ◽  
Vol 103 (Supplement_E1) ◽  
pp. 203-214 ◽  
Author(s):  
Paul E. Plsek
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Clinical Practice ◽  
Control Charts ◽  
Health Care Organizations ◽  
Clinical Medicine ◽  
Lessons Learned ◽  
Small Scale ◽  
Gap Measurement ◽  
Practice Of Medicine

This article surveys the methods and tools of quality improvement used today in health care. Specifically, we describe how clinicians can use these methods to impact the clinical practice of medicine. Improvement teams from a variety of health care organizations have reported the successful use of basic methods such as group work, flowcharting, data collection, and graphical data analysis. In addition to these incremental, problem-solving methods borrowed from the industrial practice of improvement, we have also seen the use of specific process design methods in health care applications such as care path development. The pace of change in health care has also led to the practical development of newer methods for rapid cycle improvement. We will review the basic approach behind these methods and illustrate key elements such as the ideas of change concepts and small-scale tests of change. Unfortunately, whereas these methods have been very successful and highly appealing to improvement practitioners, they may also have inadvertently widened a gulf between these practitioners and traditional health-services and clinical researchers. We offer an assessment of this issue and suggest ways to narrow the communication gap. Measurement has also traditionally been a part of the thinking about quality assurance and improvement in health care. We review the new philosophy of measurement that has emerged from recent improvement thinking and describe the use of control charts in clinical improvement. Benchmarking and multiorganizational collaboratives are more recent innovations in the ways we approach improvement in health care. These efforts go beyond simple measurement and explore the why and how associated with the widespread variation in performance in health care. We explore a variety of health care examples to illustrate these methods and the lessons learned in their use. We conclude the article with an overview of four habits that we believe are essential for health care organizations and individual clinicians to adopt to bring about real improvement in the clinical practice of medicine. These are the habits for: 1) viewing clinical practice as a process; 2) evidence-based practice; 3) collaborative learning; and 4) change.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2021 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Performance Measurement ◽  
Clinical Performance ◽  
The United States ◽  
Performance Measure ◽  
Care Performance

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This review contains 1 figure, 3 tables, and 56 references Keywords: Quality of care, performance measure, quality improvement, clinical practice, sigma six, transparency

scholarly journals Lessons learned from implementing a responsive quality assessment of clinical ethics support

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Eva M. Van Baarle ◽  
Marieke C. Potma ◽  
Maria E. C. van Hoek ◽  
Laura A. Hartman ◽  
Bert A. C. Molewijk ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Assessment ◽  
Learning Process ◽  
Clinical Ethics ◽  
Health Care Organizations ◽  
Lessons Learned ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Dutch Health

Abstract Background Various forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other’s health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project. Methods CES practitioners’ experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions. Results The main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices. Conclusions The evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that “servant leadership” and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA.

scholarly journals Why Health Care Professionals Belong to an Intensive Care Virtual Community: Qualitative Study (Preprint)

2019 ◽  
Author(s):  
Kaye Denise Rolls ◽  
Margaret Mary Hansen ◽  
Debra Jackson ◽  
Doug Elliott
Keyword(s):  
Health Care ◽  
Social Media ◽  
Intensive Care ◽  
Clinical Practice ◽  
Focus Groups ◽  
Health Care Professionals ◽  
Health Care Organizations ◽  
Knowledge Exchange ◽  
Virtual Community ◽  
Practice Variation

BACKGROUND Clinical practice variation that results in poor patient outcomes remains a pressing problem for health care organizations. Some evidence suggests that a key factor may be ineffective internal and professional networks that limit knowledge exchange among health care professionals. Virtual communities have the potential to overcome professional and organizational barriers and facilitate knowledge flow. OBJECTIVE This study aimed to explore why health care professionals belong to an exemplar virtual community, ICUConnect. The specific research objectives were to (1) understand why members join a virtual community and remain a member, (2) identify what purpose the virtual community serves in their professional lives, (3) identify how a member uses the virtual community, and (4) identify how members used the knowledge or resources shared on the virtual community. METHODS A qualitative design, underpinned by pragmatism, was used to collect data from 3 asynchronous online focus groups and 4 key informant interviews, with participants allocated to a group based on their posting behaviors during the previous two years—between September 1, 2012, and August 31, 2014: (1) frequent (>5 times), (2) low (≤5 times), and (3) nonposters. A novel approach to focus group moderation, based on the principles of traditional focus groups, and e-moderating was developed. Thematic analysis was undertaken, applying the Diffusion of Innovation theory as the theoretical lens. NCapture (QRS International) was used to extract data from the focus groups, and NVivo was used to manage all data. A research diary and audit trail were maintained. RESULTS There were 27 participants: 7 frequent posters, 13 low posters, and 7 nonposters. All participants displayed an external orientation, with the majority using other social media; however, listservs were perceived to be superior in terms of professional compatibility and complexity. The main theme was as follows: “Intensive care professionals are members of ICUConnect because by being a member of a broader community they have access to credible best-practice knowledge.” The virtual community facilitated access to all professionals caring for the critically ill and was characterized by a positive and collegial online culture. The knowledge found was credible because it was extensive and because the virtual community was moderated and sponsored by a government agency. This enabled members to benchmark and improve their unit practices and keep up to date. CONCLUSIONS This group of health care professionals made a strategic decision to be members of ICUConnect, as they understood that to provide up-to-date clinical practices, they needed to network with colleagues in other facilities. This demonstrated that a closed specialty-specific virtual community can create a broad heterogeneous professional network, overcoming current ineffective networks that may adversely impact knowledge exchange and creation in local practice settings. To address clinical practice variation, health care organizations can leverage low-cost social media technologies to improve interprofessional and interorganizational networks.

Quality Improvement Basics: A Crash Course for Pediatric Cardiac Care

2019 ◽  
Vol 10 (6) ◽  
pp. 733-741 ◽  
Author(s):  
Katherine E. Bates ◽  
Jean Connor ◽  
Nikhil K. Chanani ◽  
Mary C. McLellan ◽  
Andrea McCormick ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Control Charts ◽  
Diagnostic Tools ◽  
Cardiac Care ◽  
Statistical Process ◽  
Sustained Improvement ◽  
Key Driver ◽  
Cardiac Intensive Care

Background: Lack of knowledge of quality improvement (QI) methodology and change management principles can explain many of the difficulties encountered when trying to develop effective QI initiatives in health care. Methods: An interactive QI workshop at the 14th Annual Meeting of the Pediatric Cardiac Intensive Care Society provided an overview of the role of QI in health care, basic QI frameworks and tools, and leadership and organizational culture pitfalls. The top five QI projects submitted to the meeting were later presented to an expert QI panel in a separate session to illustrate examples of QI principles. Results: Workshop presenters introduced two major QI methodologies used to design QI projects. Important first steps include identifying a problem, forming a multidisciplinary team, and developing an aim statement. Key driver diagrams were highlighted as an important tool to develop a project’s framework. Several diagnostic tools used to understand the problem were discussed, including the “5 Why’s,” cause-and-effect charts, and process flowcharts. The importance of outcome, process, and balancing measures was emphasized. Identification of interventions, the value of plan-do-study-act cycles to fuel continuous QI, and use of statistical process control, including run charts or control charts, were reviewed. The importance of stakeholder engagement, transparency, and sustainability was discussed. Later, the top five QI projects presented highlighted multiple “QI done well” practices discussed during the preconference QI workshop. Conclusions: Understanding QI methodology and appropriately applying basic QI tools are pivotal steps to realizing meaningful and sustained improvement.

Improving pediatric experience of pain during vaccinations: a quality improvement project

2019 ◽  
Vol 32 (6) ◽  
pp. 1034-1040
Author(s):  
Terri MacDougall ◽  
Shawna Cunningham ◽  
Leeann Whitney ◽  
Monakshi Sawhney
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Pain Management ◽  
Practice Guidelines ◽  
Pediatric Population ◽  
Lessons Learned ◽  
Pediatric Pain ◽  
Topical Anesthetic ◽  
Content Type ◽  
Pain Scores

Purpose The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC). Design/methodology/approach The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project. Findings Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form. Research limitations/implications This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide. Practical implications Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice. Originality/value This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.

Cost of Cancer Care: Issues and Implications

2007 ◽  
Vol 25 (2) ◽  
pp. 180-186 ◽  
Author(s):  
Neal J. Meropol ◽  
Kevin A. Schulman
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Clinical Practice ◽  
Cancer Care ◽  
Medical Technology ◽  
Clinical Medicine ◽  
Scientific Progress ◽  
Medical Spending ◽  
Cost Of Health Care

Medical technology is increasingly costly in most fields of clinical medicine. Oncology has not been spared from issues related to cost, in part resulting from the tremendous scientific progress that has lead to new tools for diagnosis, treatment, and follow-up of our patients. The increasing cost of health care in general (and cancer care in particular) raises complex questions related to its effects on our economy and the citizens of our society. This article reviews the macroeconomic principles and individual behaviors that govern medical spending, and examines how cost disproportionately affects various populations. Our overall goal is to frame debate about health policy concerns that influence the clinical practice of oncology.

scholarly journals Chronic Kidney Disease Testing Among Primary Care Patients With Type 2 Diabetes Across 24 U.S. Health Care Organizations

2021 ◽  
Author(s):  
Nikita Stempniewicz ◽  
Joseph A. Vassalotti ◽  
John K. Cuddeback ◽  
Elizabeth Ciemins ◽  
Amy Storfer-Isser ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Health Care ◽  
Chronic Kidney Disease ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Health Care Organizations ◽  
The United States ◽  
Testing Rate

<b>Objective: </b>Clinical guidelines for people with diabetes recommend chronic kidney disease (CKD) testing at least annually using estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR). We aimed to understand CKD testing among people with type 2 diabetes in the United States. <p><b>Research Design and Methods:</b> Electronic health record data were analyzed from 513,165 adults with type 2 diabetes, receiving primary care from 24 health care organizations and 1,164 clinical practice sites. We assessed the percentage of patients with both ≥1 eGFR and ≥1 uACR, <a></a><a>and each test</a> individually, in the 1, 2, and 3 years ending September 2019, by health care organization and clinical practice site. Elevated albuminuria was defined by uACR ≥30 mg/g.</p> <p><strong>Results:</strong> The 1-year median testing rate across organizations was 51.6% for both uACR and eGFR, 89.5% for eGFR, and 52.9% for uACR. uACR testing varied (10<sup>th</sup>–90<sup>th</sup> percentile) from 44.7% to 63.3% across organizations and from 13.3% to 75.4% across sites. Over 3 years, the median testing rate for uACR across organizations was 73.7%. Overall, the prevalence of detected elevated albuminuria was 15%. The average prevalence of detected elevated albuminuria increased linearly with uACR testing rates at sites, with estimated prevalence of 6%, 15%, and 30%, at uACR testing rates of 20%, 50%, and 100%. </p> <p><strong>Conclusions:</strong> While eGFR testing rates are uniformly high among people with type 2 diabetes, testing rates for uACR are suboptimal and highly variable across and within the organizations examined. Guideline-recommended uACR testing should increase detection of CKD.</p>

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