Chapter 2: Quality Measurement Flashcards
After Florence Nightingale, who was the next leader in quality innovation?
Ernest Codman, 1914, Surgical outcomes measurement
After Ernest Codman, statistics were invented by?
Walter Shewhart, between World War I and World War II, who invented statistical process control.
In the late 20th century, who brought quality to healthcare, and how?
Batalden and Nelson brought scorecards and dashboards.
What are the three Donabedian elements?
Structure, process and outcome
According to the Donabedian model, what is a structural measure?
Equipment, training, supplies within the system
According to the Donabedian model, what is a process measure?
How often the right thing was done the right time. For example how often beta blockers were given to an acute MI patient.
According to the Donabedian model, what is an outcome measure?
The change in health status of the patient as result of your structure and process. This can include patient satisfaction as the outcome of the process.
What is a run chart, what does it measure?
Measures processes, structure, or outcomes over time. The central line, if used, indicates the median of the data.
What is the advantage of a run chart over a baseline data measurement?
Baseline data measurement only provides a snapshot in time. The second measurement later will show either improvement or worsening, even without intervention, just because of the discrete nature of the data set. A run chart is better at trending data over time.
In the setting of a run chart, what is a run? What is a trend?
Run: consecutive points below or above the central line, indicating a shift in the measure.
Trend: steady inclining or declining progression of data points representing a gradual change over time.
Remember, in a run chart, the central line is the median not the mean.
What is the difference between a control chart and a run chart?
For a control chart, the focus is on variation not trends. The centerline is the mean, and there are upper and lower control limits, typically representing three standard deviation from the mean.
In the setting of a statistical control chart, what is the PCL?
The PCL is the process control limit. It represents the threshold at which intensive evaluation or action is taken, because your process is considered to be in an unacceptable area.
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What is the advantage of a trigger tool?
Does not require self reporting. Can trigger automatically on Norco in the pain management area, or vitamin K administrations to patients receiving heparin.
Idea being that you catch or discover the process problems, even if they do not progress to patient harm.
What does IHI stand for?
Institute for healthcare improvement
What is the Appropriateness Model, advocated by the IHI?
This is an “all or none” approach to care. For example, if a pt with DM should have a laboratory test, an eye exam and a foot exam, failure to do ANY one of these would result in failure of the composite measure of preventive diabetes care.
The AHRQ has adopted the appropriateness model for score reporting.
