Health-Care Justice, Health Inequalities, and U.S. Health System Reform

2016 ◽  
Author(s):  
Carla C. Keirns
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Financial Incentives ◽  
System Reform ◽  
Value System ◽  
Health System Financing ◽  
Care Models ◽  
Access And Quality ◽  
Health Care Justice

Changes in health system financing and delivery have the potential to save thousands of lives and billions of dollars. The overarching value system embedded in these new models for payment is a rough utilitarianism with origins in economic analysis. These models use financial incentives to change the behavior of physicians, hospitals, and patients. In addition, many of these policy approaches are also based in other normative approaches to medical care with links to liberal economic theory. While these utilitarian-based innovations in insurance and payment policy have often proven to improve access and quality of care in the aggregate, they have frequently been shown to have less benefit or even cause harm to vulnerable populations. This chapter demonstrates how improvements in quality of care frequently have the unintended consequence of widening disparities, either because the populations who had the worst outcomes to start with are more difficult to reach with improved-care models, or because the mechanisms designed to increase access and quality actually destabilize institutions that have long served the poor. As health reforms are implemented, attention to their impact on poor patients and the institutions that serve them will be essential.

scholarly journals Comparison of two Dutch follow-up care models for spinal cord-injured patients and their impact on health problems, re-admissions and quality of care

2007 ◽  
Vol 21 (11) ◽  
pp. 997-1006 ◽  
Author(s):  
J.H.A. Bloemen-Vrencken ◽  
L.P. de Witte ◽  
M.W.M. Post ◽  
C. Pons ◽  
F.W.A. van Asbeck ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Quality Of Care ◽  
Health Problems ◽  
Follow Up Care ◽  
Care Models ◽  
Injured Patients ◽  
Spinal Cord Injured

Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis

2021 ◽  
pp. bmjqs-2021-013110
Author(s):  
Sanjay Mahant ◽  
Jun Guan ◽  
Jessie Zhang ◽  
Sima Gandhi ◽  
Evan Jon Propst ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Health System ◽  
Interrupted Time Series ◽  
Improve Quality ◽  
Interrupted Time Series Analysis ◽  
Quality Improvement Programme ◽  
Improvement Programme

BackgroundTonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care pathway. We determined the association of this payment and quality improvement programme with tonsillectomy quality of care.MethodsInterrupted time series analysis of children undergoing elective tonsillectomy at community and children’s hospitals in Ontario in the QBP period (1 April 2014 to 31 December 2018) and the pre-QBP period (1 January 2009 to 31 January 2014) using health administrative data. We compared the age-standardised and sex-standardised rates for all-cause tonsillectomy-related revisits within 30 days, opioid prescription fills within 30 days and index tonsillectomy inpatient admission.Results111 411 children underwent tonsillectomy: 51 967 in the QBP period and 59 444 in the pre-QBP period (annual median number of hospitals, 86 (range 77–93)). Following QBP programme implementation, revisit rates decreased for all-cause tonsillectomy-related revisits (0.48 to −0.18 revisits per 1000 tonsillectomies per month; difference −0.66 revisits per 1000 tonsillectomies per month (95% CI −0.97 to −0.34); p<0.0001). Codeine prescription fill rate continued to decrease but at a slower rate (−4.81 to −0.11 prescriptions per 1000 tonsillectomies per month; difference 4.69 (95% CI 3.60 to 5.79) prescriptions per 1000 tonsillectomies per month; p<0.0001). The index tonsillectomy inpatient admission rate decreased (1.12 to 0.23 admissions per 1000 tonsillectomies per month; difference −0.89 (95% CI −1.33 to −0.44) admissions per 1000 tonsillectomies per month; p<0.0001).ConclusionsThe payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures.

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

2017 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

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 chapter contains 56 references.

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

2015 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

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 chapter contains 56 references.

Telepsychiatry Use in Rural Areas in the United States

2020 ◽  
Vol 13 (4) ◽  
pp. 1-13
Author(s):  
Alberto Coustasse ◽  
Morgan Ruley ◽  
Tonnie C. Mike ◽  
Briana M. Washington ◽  
Anna Robinson
Keyword(s):  
Mental Health ◽  
United States ◽  
Quality Of Care ◽  
Rural Areas ◽  
Care Delivery ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
The United States ◽  
Access And Quality

Rural areas have experienced a higher than average shortage of healthcare professionals. Numerous challenges have limited access to mental health services. Some of these barriers have included transportation, number of providers, poverty, and lack of insurance. Recently, the utilization of telepsychiatry has increased in rural areas. The purpose of this review was to identify and coalesce the benefits of telepsychiatry for adults living in rural communities in the United States to determine if telepsychiatry has improved access and quality of care. The methodology for this study was a literature review that followed a systematic approach. References and sources were written in English and were taken from studies in the United States between 2004 and 2018 to keep this review current. Fifty-nine references were selected from five databases. It was found that several studies supported that telepsychiatry has improved access and quality of care available in rural environments. At the same time, telepsychiatry in mental healthcare has not been utilized as it should in rural adult populations due to lack of access, an overall shortage of providers, and poor distribution of psychiatrists. There are numerous benefits to implementing telepsychiatry in rural areas. While there are still barriers that prevent widespread utilization, telepsychiatry can improve mental health outcomes by linking rural patients to high-quality mental healthcare services that follow evidence-based care and best practices. Telepsychiatry utilization in rural areas in the United States has demonstrated to have a significant ability to transform mental health care delivery and clinician productivity. As technology continues to advance access, telepsychiatry will also advance, making access more readily available.

‘It makes you someone who changes with the times’: health worker and client perspectives on a smartphone-based counselling application deployed in rural Tanzania

2019 ◽  
Vol 34 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kristy Hackett ◽  
Mina Kazemi ◽  
Curtis Lafleur ◽  
Peter Nyella ◽  
Lawelu Godfrey ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Data Management ◽  
Low Income ◽  
Community Intervention ◽  
Health Workers ◽  
Low Income Countries ◽  
Maternal And Newborn Health ◽  
Pregnancy And Childbirth

AbstractMobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients’ perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.

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