Quality improvement and audits in clinical practice

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

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Connecting funds with quality outcomes in health care: a blueprint for a Clinical Practice Improvement Payment

Australian Health Review ◽

10.1071/ah070s54 ◽

2007 ◽

Vol 31 (5) ◽

pp. 54 ◽

Cited By ~ 7

Author(s):

Michael Ward ◽

Sandra A Daniels ◽

Gary J Walker ◽

Stephen Duckett

Keyword(s):

Health Care ◽

Quality Improvement ◽

Quality Of Care ◽

Clinical Practice ◽

Quality Of Health Care ◽

Geographic Variations ◽

Quality Outcomes ◽

Practice Improvement ◽

Global Problem

There are significant geographic variations in the quality of health care, often with substantial gaps between what is known to be achievable and what is actually achieved in practice. This is a global problem that has persisted for many years despite a variety of conventional quality improvement initiatives. Attention has therefore recently turned to realignment of funding with specified levels of desired quality of care as an alternative. This paper outlines one approach that will be introduced as a pilot in Queensland.

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

10.2310/ps.1047 ◽

2021 ◽

Author(s):

Sonali P. Desai ◽

Allen Kachalia

Keyword(s):

Quality Improvement ◽

Quality Of Care ◽

Clinical Practice ◽

Performance Measurement ◽

Care Performance

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Competence in Clinical Practice, Quality of Care, and the Burden of Mental Illness

PsycEXTRA Dataset ◽

10.1037/e504412011-006 ◽

2010 ◽

Author(s):

Alan E. Kazdin

Keyword(s):

Mental Illness ◽

Quality Of Care ◽

Clinical Practice

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Nurses’ Perceptions of a Care Plan Information Technology Solution With Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study (Preprint)

10.2196/preprints.11846 ◽

2018 ◽

Author(s):

Azizeh Khaled Sowan ◽

Meghan Leibas ◽

Albert Tarriela ◽

Charles Reed

Keyword(s):

Intensive Care ◽

Quality Of Care ◽

Clinical Practice ◽

Nursing Care ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Care Plan ◽

System Use ◽

Nurses Perceptions

BACKGROUND The integration of clinical practice guidelines (CPGs) into the nursing care plan and documentation systems aims to translate evidence into practice, improve safety and quality of care, and standardize care processes. OBJECTIVE This study aimed to evaluate nurses’ perceptions of the usability of a nursing care plan solution that includes 234 CPGs. METHODS A total of 100 nurses from 4 adult intensive care units (ICUs) responded to a survey measuring nurses’ perceptions of system usability. The survey included 37 rated items and 3 open-ended questions. RESULTS Nurses’ perceptions were favorable with more than 60.0% (60/100) in agreement on 12 features of the system and negative to moderate with 20.0% (20/100), to 59.0% (59/100) in agreement on 19 features. The majority of the nurses (80/100, 80.0% to 90/100, 90.0%) agreed on 4 missing safety features within the system. More than half of the nurses believed they would benefit from refresher classes on system use. Overall satisfaction with the system was just above average (54/100, 54.0%). Common positive themes from the narrative data were related to the system serving as a reminder for complete documentation and individualizing patient care. Common negative aspects were related to duplicate charting, difficulty locating CPGs, missing unit-specific CPGs, irrelevancy of information, and lack of perceived system value on patient outcomes. No relationship was found between years of system use or ICU experience and satisfaction with the system (P=.10 to P=.25). CONCLUSIONS Care plan systems in ICUs should be easy to navigate; support efficient documentation; present relevant, unit-specific, and easy-to-find information; endorse interdisciplinary communication; and improve safety and quality of care.

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Improving nursing documentation for surgical patients in a referral hospital in Freetown, Sierra Leone: protocol for assessing feasibility of a pilot multifaceted quality improvement hybrid type project

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00768-5 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Nataliya Brima ◽

Nick Sevdalis ◽

K. Daoh ◽

B. Deen ◽

T. B. Kamara ◽

...

Keyword(s):

Quality Improvement ◽

Quality Of Care ◽

Sierra Leone ◽

Referral Hospital ◽

Audit And Feedback ◽

Health System Strengthening ◽

Theory Of Change ◽

Improve Quality ◽

Nursing Documentation

Abstract Background There is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently, there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings. To address this gap, we have developed a multifaceted quality improvement intervention to improve nursing documentation in a low-income country hospital setting. The aim of this pilot project is to test the intervention within the surgical department of a national referral hospital in Freetown, Sierra Leone. Methods This project was co-developed and co-designed by in-country stakeholders and UK-based researchers, after a multiple-methodology assessment of needs (qualitative, quantitative), guided by a participatory ‘Theory of Change’ process. It has a mixed-method, quasi-experimental evaluation design underpinned by implementation and improvement science theoretical approaches. It consists of three distinct phases—(1) pre-implementation(project set up and review of hospital relevant policies and forms), (2) intervention implementation (awareness drive, training package, audit and feedback), and (3) evaluation of (a) the feasibility of delivering the intervention and capturing implementation and process outcomes, (b) the impact of implementation strategies on the adoption, integration, and uptake of the intervention using implementation outcomes, (c) the intervention’s effectiveness For improving nursing in this pilot setting. Discussion We seek to test whether it is possible to deliver and assess a set of theory-driven interventions to improve the quality of nursing documentation using quality improvement and implementation science methods and frameworks in a single facility in Sierra Leone. The results of this study will inform the design of a large-scale effectiveness-implementation study for improving nursing documentation practices for patients throughout hospitals in Sierra Leone. Trial registration Protocol version number 6, date: 24.12.2020, recruitment is planned to begin: January 2021, recruitment will be completed: December 2021.

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CQI: Meeting the Mandate for Quality

Otolaryngology ◽

10.1016/s0194-5998(05)80278-5 ◽

1995 ◽

Vol 112 (5) ◽

pp. P111-P111

Author(s):

Carl A. Patow

Keyword(s):

Quality Improvement ◽

Patient Satisfaction ◽

Quality Of Care ◽

Continuous Quality Improvement ◽

Educational Objectives ◽

Continuous Quality

Educational objectives: To understand the principles of continuous quality improvement and to use these principles to enhance patient satisfaction through increased efficiency and improved quality of care.

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Value-based dentistry: Putting the patient first

Faculty Dental Journal ◽

10.1308/rcsfdj.2016.126 ◽

2016 ◽

Vol 7 (3) ◽

pp. 126-129 ◽

Cited By ~ 2

Author(s):

Sreenivas Koka ◽

Galya Raz

Keyword(s):

Risk Management ◽

Quality Improvement ◽

Quality Of Care ◽

Dental Care ◽

Time Cost ◽

Safety Risk ◽

The Cost ◽

Over Time

What does ‘value’ mean? In the context of dental care, it can be defined as the quality of care received by a patient divided by the cost to the patient of receiving that care. In other words: V =Q/C, where Q equals the quality improvement over time, which most patients view in the context of the outcome, the service provided and safety/risk management, and C equals the financial, biological and time cost to the patient. Here, the need for, and implications of, value-based density for clinicians and patients alike are explored.

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