History of Performance

Question 1

how do we improve performance and quality outside of science/research

Answer 1

focus on processes and systems at institutional level

Question 2

first hospital in 1700 becomes

Answer 2

Pennsylvania hospital, model for org and development of hospitals- collects metrics

Question 3

1960 NY begins practice of

Answer 3

medical licensure, NJ follows 10 yrs later

Question 4

what happened in medicine in 1800s

Answer 4

Mass GH set limits on clinical practice
disease/procedure index
medical licensures stopped
organize nursing training program
74-AMA encourage independent state license boards

Question 5

what happened in 1900s in medicine

Answer 5

03- nurse registration
10-flexner report - standardize med school curricula
17- standardization program
20 - college standards approved by med school body
46- Hill burton Act - funding for GH (free care expected)
52- joint commission of accreditation formed
80s- peer reviews
90s- Q improvement integrates into accreditation process

Question 6

florence nightingale

Answer 6

focused on infection control

Question 7

when Medicaid and Medicare formed

Answer 7

1965

Question 8

Flexner report

Answer 8

standardize med school curricula

Question 9

Hill burton act

Answer 9

funding for new or renovate GH, must provide certain level of free care

Question 10

when is CMS formed

Answer 10

2002

Question 11

national patient safety goals

Answer 11

apart of JC accreditation, must track outcomes of certain diagnoses

Question 12

tracer methodology

Answer 12

follow process of pt to measure quality and outcome of care

Question 13

DRGs- 08

Answer 13

group of everything used in a procedures that is included in a reimbursement

Question 14

Hitech 09

Answer 14

launching pad for EHR

Question 15

hippa-97

Answer 15

originally wanted to share info, then became about confidentiality/privacy

Question 16

ACA-10

Answer 16

coverage for everyone with preexisting conditions

Question 17

ICD 11 required further

Answer 17

documentation bc they can’t code for diagnosis if not specified in EHR

Question 18

problem with using different ICDs

Answer 18

not interoperable, limited in exchanging data

Question 19

callen

Answer 19

train midwives

Question 20

dr dickenson

Answer 20

standardized questionnaires for OBGYN pts

Question 21

dock

Answer 21

disaster training- nurses

Question 22

dr park

Answer 22

antiseptic principles-surgery

Question 23

dr pisacana

Answer 23

promote family practice

Question 24

dr boss

Answer 24

interdisciplinary core

Question 25

calderone

Answer 25

identify contraception methods

Question 26

pioneering GH

Answer 26

penn and mass - emphasized documentation

Question 27

minimum standard

Answer 27

reports certain things as part of accreditation

Question 28

medicare and medicaid implemented

Answer 28

quality assurance-report data
retrospective payment sys- pay afterwards
valued based purchasing
ACA

Question 29

metrics

Answer 29

specific variables that form the basis for assessing quality
ex: hours of nursing care per resident day

Question 30

benchmarks

Answer 30

quantitatively express the level the variable must reach, expectations

compare like to like
ex: at least four hours of nursing care per resident day

Question 31

dr codman

Answer 31

look at morbidity and mortality - outcome analysis

public admission of errors
early standards

Question 32

dr shewart

Answer 32

reduce variation in processes - control chart
2 types of variation- change and result of definable cause

Question 33

deming

Answer 33

process oriented rather than outcomes oriented

mistakes are not fault of individuals

Question 34

common variation

Answer 34

expected - by chance

Question 35

special variation

Answer 35

unexpected- assigned by cause

Question 36

juran

Answer 36

80/20 rules- focus on vital few that cause most problems

Pareto principle- quality in regard to customer satisfaction
juran trilogy
quality is expensive

Question 37

dr donabedian

Answer 37

published extensively on HC quality framework
three perspective measurements: structure, process, outcome

Question 38

structure

Answer 38

measures focus on static characteristics of those professionals that provide care

education, training

Question 39

process

Answer 39

interrelated activities, managerial support, clinical services during care

were the right actions taken and how well were they completed

Question 40

outcome

Answer 40

final results of care, consider factors of outcome- genetics, not under clinician control

Question 41

IOM crossing the quality

Answer 41

identified 6 aims for improvement- STEEEP, new framework for a redesign of US HC sys