scholarly journals The Medical Society’s Role in Assessing Physician’s Performance: An Analysis of Six Years of Grievances Considered by an Urban Medical Society

2006 ◽  
Vol 92 (4) ◽  
pp. 9-15
Author(s):  
Arthur Frank ◽  
Howard A. Hoffman ◽  
Edward H. Stolar
Keyword(s):  
Quality Of Care ◽  
Medical Records ◽  
Ethical Issues ◽  
Professional Standards ◽  
Medical Society ◽  
Legal Authority ◽  
Behavior Issues ◽  
Staff Behavior ◽  
Office Procedures

ABSTRACT Context Although they have no legal authority, medical organizations are frequently asked to assess physician conduct. These organizations have established a variety of procedures to review grievances brought for their consideration. Objective This analysis was conducted to assess the nature and the disposition of the complaints considered by the Professional Standards Committee (Committee) of an urban medical society. Design All cases considered by the Committee (193 complaints) during a six-year period were arbitrarily sorted into categories and the nature of how the case was resolved was tabulated. Results Of all the cases considered 108 (56 percent) were categorized as related to quality of care and physician/staff behavior issues. Of these, 39 (20 percent) dealt with the characteristics of the care provided, 28 (15 percent) with physician and staff behavior, 23 (12 percent) with physician and staff communications and 18 (nine percent) with ethical issues. An additional 85 cases (44 percent) were related to administrative issues and office procedures. Of these, 50 (26 percent) were related to billing, fees and charges, 23 (12 percent) concerned medical records, 10 (five percent) dealt with office practices and procedures and two (one percent) were related to worker’s compensation. Of 141 cases in which a judgment could be made, 48.2 percent were decided in the complainant’s favor and corrective recommendations were made. The grievance appeared to be inappropriate in 51.8 percent of the cases and the reason for this decision was explained to the complainant. In the remaining 22 percent of the cases irreconcilable descriptions of the circumstances made it impossible for the Committee to make a decision or recommendation about the grievance. Conclusion The mechanism of review by the Professional Standards Committee of a medical society does appear to offer a procedure by which there can be some resolution of these complaints. In cases in which a judgment could be made the complaint was decided in favor of the complainant as frequently as in favor of the physician.

scholarly journals Widespread gaps in the quality of care for primary biliary cholangitis in UK

2021 ◽  
pp. flgastro-2020-101713
Author(s):  
Mathuri Sivakumar ◽  
Akash Gandhi ◽  
Eathar Shakweh ◽  
Yu Meng Li ◽  
Niloufar Safinia ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Primary Biliary Cholangitis ◽  
Cholestatic Liver Disease ◽  
Patient Demographics ◽  
Risk Patients ◽  
Wide Scale ◽  
The Uk

ObjectivePrimary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines.DesignData were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ2 analysis for variation in performance between trusts.Results790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297).ConclusionOur findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit.

Electronic medical records: Assessment of recorded cancer stage in support of quality of care.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 129-129
Author(s):  
Gregory P. Hess
Keyword(s):  
Quality Of Care ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Positive Impact ◽  
Significant Proportion ◽  
Malignant Neoplasm ◽  
Cancer Stage ◽  
Underlying Assumption ◽  
Data Field

129 Background: Electronic medical records (EMRs) are being increasingly adopted in part driven by reports of their positive impact on patient’s quality of care. An underlying assumption is that data recorded will be relatively complete. As a field of primary importance, this study assessed the frequency with which cancer stage was recorded within an EMR data field during a historical and recent 12-month period. A random sample of records with missing stage was assessed to identify at a qualitative level reasons that stage may be omitted. Methods: Two datasets were constructed. The first comprised of oncology EMRs from 77 practices covering 476 sites of care across 34 states from 1/1/2000-12/31/2010. The second dataset from 58 practices covering 391 sites of care across 37 states. Inclusion criteria required patients to have a valid visit (i.e., not simply ‘scheduled’) and ≥ 1 diagnosis of a primary, malignant, neoplasm (except brain or spine). All data fields utilized to record stage (stage I, II, etc.) or from which stage could be reliably derived (T, M, N fields) were defined as "recorded." Practices were not required to exist in each dataset. Recorded stage by age, gender, state, and payer type was also assessed. Results: Reasons reported for absent stage within the data field included: consult visit only, written in the progress notes, text present in a scanned report, stage X (insufficient information), continuing treatment initiated elsewhere, and missing entry error. Conclusions: A significant proportion of cancer patients may not have stage recorded in the designated, searchable, data field within an EMR. The frequency of recorded stage is increasing over time. Reasons for unpopulated stage field(s) include use of nonsearchable text entries, scanned reports, and short episodes of care. Further research is needed to validate the observations in this study, determine root causes, and employ appropriate solutions. [Table: see text]

Lung cancer quality of care in Uruguay: First experience in a public hospital.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 231-231
Author(s):  
Maria Clara Rodriguez Palleiro ◽  
Virginia Rodriguez ◽  
Viviana Dominguez ◽  
Siul Salisbury ◽  
Alonzo Rodriguez ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Quality Of Care ◽  
Cancer Care ◽  
Medical Records ◽  
Adherence Rate ◽  
Pathology Report ◽  
Histologic Subtype ◽  
Starting Point ◽  
The Impact

231 Background: Improvement in quality of cancer care is a strategic health objective for the Ministry of Health in Uruguay. Lung cancer is the first cancer in mortality in men and the third in women in our country, there are few reports from Latino America about quality of cancer care, in our knowledge this is the first in lung cancer. Methods: We audit a public reference center in oncology that receive about 8 percent of new cases in the country, our objective was to perform a first study in quality of cancer care in non-small cell lung cancer. We reviewed the compliance with a group of 14 indicators (six general and eight NSCLC specific) selected from literature and used in different quality programs. We performed a retrospective analysis of medical records from 408 new patients seen between January 2011 and July 2016. Results: The median age was 62 years, 72,8% were male and 27,2% females, 76,6% were stage III-IV and 23,6% were stage I-II. The median adherence rate to core indicators were 84,2 (69% to 100%). PS was recorded in 76% of cases. Pathology report was present in 71,8% and stage in 97% of medical records. NSCLC indicators had a lower adherence rate 29,8% (5% to 56,3%). 60% receive adjuvant therapy based in platins but only in 5% of patients receive cisplatin. Histologic subtype was informed in 42% of pathology samples and EGFR mutation test were performed in 56% of patient with non-squamous lung cancer. Patients were treated with chemotherapy or radiotherapy as first treatment in 65,4%, stage IV patients receive as first line platin based chemotherapy in 42,7% of cases . Time between diagnosis and first treatment initiation was 28 days and the time to symptoms initiation to diagnosis was 3 months. Conclusions: This auditory identify a high rate of compliance in general indicators, compliance with lung cancer specific quality indicators is heterogeneous. Time to diagnosis need special attention. This study identify a room to improve in lung cancer quality of care and establish a starting point to evaluate the impact of future improvement efforts.

Anticancer therapy within the last 30 days of life: Results of an audit and re-audit cycle from a regional cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18260-e18260
Author(s):  
Mike Nguyen ◽  
Alysson Wann ◽  
Babak Tamjid ◽  
Arvind Sahu ◽  
Javier Torres
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Retrospective Review ◽  
Medical Records ◽  
Quality Improvement Intervention ◽  
Separate Analysis ◽  
Number Of Patients ◽  
Audit Period ◽  
Improvement Intervention

e18260 Background: The therapeutic landscape in medical oncology continues to expand significantly. Newer therapies, especially immunotherapy, offer the hope of profound and durable responses with more tolerable side effect profiles. Integrating this information into the decision making process is challenging for patients and oncologists. Systemic anticancer treatment within the last thirty days of life is a key quality of care indicator and is one parameter used in the assessment of aggressiveness of care. Methods: A retrospective review of medical records of all patients previously treated at Goulburn Valley Health oncology department who died between 1 January 2015 and 30 June 2018 was conducted. Information collected related to patient demographics, diagnosis, treatment, and hospital care within the last 30 days of life. These results were presented to a hospital meeting and a quality improvement intervention program instituted. A second retrospective review of medical records of all patients who died between 1 July 2018 and 31 December 2018 was conducted in order to measure the effect of this intervention. Results: The initial audit period comprised 440 patients. 120 patients (27%) received treatment within the last 30 days of life. The re-audit period comprised 75 patients. 19 patients (25%) received treatment within the last 30 days of life. Treatment rates of chemotherapy reduced after the intervention in contrast to treatment rates of immunotherapy which increased. A separate analysis calculated the rate of mortality within 30 days of chemotherapy from the total number of patients who received chemotherapy was initially 8% and 2% in the re-audit period. Treatment within the last 30 days of life was associated with higher use of aggressive care such as emergency department presentation, hospitalisation, ICU admission and late hospice referral. Palliative care referral rates improved after the intervention. Conclusions: This audit demonstrated that a quality improvement intervention can impact quality of care indicators with reductions in the use of chemotherapy within the last 30 days of life. However, immunotherapy use increased which may be explained by increased access and perceived better tolerability.

scholarly journals Real-world data: how they can help to improve quality of care

2021 ◽  
Vol 8 ◽  
pp. 134-139
Author(s):  
Giovanni Corrao ◽  
Giovanni Alquati ◽  
Giovanni Apolone ◽  
Andrea Ardizzoni ◽  
Giuliano Buzzetti ◽  
...  
Keyword(s):  
Public Health ◽  
Quality Of Care ◽  
Real World ◽  
Ethical Issues ◽  
Data Availability ◽  
Quality Data ◽  
Real World Data ◽  
World Data ◽  
Critical Issues

The current COVID pandemic crisis made it even clearer that the solutions to several questions that public health must face require the access to good quality data. Several issues of the value and potential of health data and the current critical issues that hinder access are discussed in this paper. In particular, the paper (i) focuses on “real-world data” definition; (ii) proposes a review of the real-world data availability in our country; (iii) discusses its potential, with particular focus on the possibility of improving knowledge on the quality of care provided by the health system; (iv) emphasizes that the availability of data alone is not sufficient to increase our knowledge, underlining the need that innovative analysis methods (e.g., artificial intelligence techniques) must be framed in the paradigm of clinical research; and (v) addresses some ethical issues related to their use. The proposal is to realize an alliance between organizations interested in promoting research aimed at collecting scientifically solid evidence to support the clinical governance of public health.

Abstract 242: Can Belief Enhance Relief? A Multicenter Study

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Abbas Alshami ◽  
America Avila ◽  
Carlos Romero ◽  
Raphael Villarreal ◽  
Sharon Einav ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Patient Care ◽  
Ethical Issues ◽  
Belief Systems ◽  
Statistical Significance ◽  
Healthcare Providers ◽  
Well Being ◽  
Physical Symptoms ◽  
Personal Beliefs

Purpose: While caring for patients, it is important to recognize more than just the apparent physical symptoms. Their emotional well-being, level of comfort, and spiritual concerns are relevant and should be taken into consideration. We aimed to identify if a greater commitment to spiritual belief systems by healthcare providers could have an effect on the patient care they provided. Methods: The Ethics in Intensive Care Study (ETHICS) was conducted in multiple centers all over the world utilizing a confidential survey. Questions were related to personal opinions on ethical issues, including personal beliefs, and patient care. We hypothesized that the personal beliefs of the healthcare providers should not affect the quality of care provided. Pearson’s correlation was used to ascertain statistical significance. Results: A total of 9,720 healthcare providers rated their level of spirituality from 1 (least) to 10 (greatest), and answered whether their beliefs affected their patient care. The majority of the people surveyed (65.6%; n=6,378) assessed themselves between 5 and 8 out of 10. In each individual level, most physicians felt patient care was not affected. However, on closer inspection and analysis, an interesting trend emerged. Only 11.4% (n=45) of those who rated themselves in level 1 of spirituality (n=394) stated their patient care was affected by their personal beliefs. Of people in level 5 (n=1,300), 13.3% (n=173) felt their beliefs affect the quality of care provided, and surprisingly, that number increased to 21.4% (n=193) among those healthcare provider rated in level 10 (n=899) [ p <0.001, Pearson’s R correlation 0.94]. Conclusions: A significant number of physicians identify themselves as religious, whether by belief in God, or based on a level of spirituality. We found a strong correlation between the level of spirituality a provider feels and the perception of how much his/her patient care is affected. We are not aware if this translates into real differences in patient care.

P.S.R.O., Quality of Care, and Research

1980 ◽  
Vol 3 (4) ◽  
pp. 461-472
Author(s):  
Richard Goldstein
Keyword(s):  
Quality Of Care ◽  
Medical Care ◽  
Peer Review ◽  
Evaluation System ◽  
Public Law ◽  
Professional Standards ◽  
Necessary Condition ◽  
Quality Of Medical Care

A necessary condition for achieving the legislative goals of Public Law 92-603, which created the Professional Standards Review Organizations, is the proper evaluation of the system of providing medical care. Peer review as currently constituted does not provide a proper evaluation. This article shows why present practices are not satisfactory, presents an outline of a minimally satisfactory evaluation system, and concludes by showing that many of the criticisms made of P.S.R.O.s are deficient, and that peer review has the potential for resulting in some improvement in the quality of medical care.

scholarly journals Validation study of German inpatient administrative health data for epidemiological surveillance and measurement of quality of care for sepsis: the OPTIMISE study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e035763
Author(s):  
Daniel Schwarzkopf ◽  
Carolin Fleischmann-Struzek ◽  
Peter Schlattmann ◽  
Heike Dorow ◽  
Dominique Ouart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Of Care ◽  
Gold Standard ◽  
Medical Records ◽  
Risk Model ◽  
Predictive Accuracy ◽  
Health Data ◽  
Epidemiological Surveillance ◽  
Administrative Health Data

IntroductionSepsis is a major cause of preventable deaths in hospitals. This study aims to investigate if sepsis incidence and quality of care can be assessed using inpatient administrative health data (IAHD).Methods and analysisDesign: Retrospective observational validation study using routine data to assess the diagnostic accuracy of sepsis coding in IAHD regarding sepsis diagnosis based on medical record review. Procedure: A stratified sample of 10 000 patients with an age ≥15 years treated in between 2015 and 2017 in 10 German hospitals is investigated. All available information of medical records is screened by trained physicians to identify true sepsis cases (‘gold standard’) both according to current (‘sepsis-1’) definitions and new (‘sepsis-3’) definitions. Data from medical records are linked to IAHD on patient level using a pseudonym. Analyses: Proportions of cases with sepsis according to sepsis-1 and sepsis-3 definitions are calculated and compared with estimates from coding of sepsis in IAHD. Predictive accuracy (sensitivity, specificity) of different coding abstraction strategies regarding the gold standard is estimated. Predictive accuracy of mortality risk factors obtained from IAHD regarding the respective risk factors obtained from medical records is calculated. An IAHD-based risk model for hospital mortality is compared with a record-based risk model regarding model-fit and predicted risk of death. Analyses adjust for sampling weights. The obtained estimates of sensitivity and specificity for sepsis coding in IAHD are used to estimate adjusted incidence proportions of sepsis based on German national IAHD.Ethics and disseminationThe study has been approved by the ethics commission of the Jena University Hospital (No. 2018-1065-Daten). The results of the study will be discussed in an expert panel to write a memorandum on improving the utility of IAHD for epidemiological surveillance and quality management of sepsis care.Trial registration numberDRKS00017775; Pre-results.

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