History of Performance Flashcards
how do we improve performance and quality outside of science/research
focus on processes and systems at institutional level
first hospital in 1700 becomes
Pennsylvania hospital, model for org and development of hospitals- collects metrics
1960 NY begins practice of
medical licensure, NJ follows 10 yrs later
what happened in medicine in 1800s
Mass GH set limits on clinical practice
disease/procedure index
medical licensures stopped
organize nursing training program
74-AMA encourage independent state license boards
what happened in 1900s in medicine
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
florence nightingale
focused on infection control
when Medicaid and Medicare formed
1965
Flexner report
standardize med school curricula
Hill burton act
funding for new or renovate GH, must provide certain level of free care
when is CMS formed
2002
national patient safety goals
apart of JC accreditation, must track outcomes of certain diagnoses
tracer methodology
follow process of pt to measure quality and outcome of care
DRGs- 08
group of everything used in a procedures that is included in a reimbursement
Hitech 09
launching pad for EHR
hippa-97
originally wanted to share info, then became about confidentiality/privacy
ACA-10
coverage for everyone with preexisting conditions
ICD 11 required further
documentation bc they can’t code for diagnosis if not specified in EHR
problem with using different ICDs
not interoperable, limited in exchanging data
callen
train midwives
dr dickenson
standardized questionnaires for OBGYN pts
dock
disaster training- nurses
dr park
antiseptic principles-surgery
dr pisacana
promote family practice
dr boss
interdisciplinary core
calderone
identify contraception methods
pioneering GH
penn and mass - emphasized documentation
minimum standard
reports certain things as part of accreditation
medicare and medicaid implemented
quality assurance-report data
retrospective payment sys- pay afterwards
valued based purchasing
ACA
metrics
specific variables that form the basis for assessing quality
ex: hours of nursing care per resident day
benchmarks
quantitatively express the level the variable must reach, expectations
compare like to like
ex: at least four hours of nursing care per resident day
dr codman
look at morbidity and mortality - outcome analysis
public admission of errors
early standards
dr shewart
reduce variation in processes - control chart
2 types of variation- change and result of definable cause
deming
process oriented rather than outcomes oriented
mistakes are not fault of individuals
common variation
expected - by chance
special variation
unexpected- assigned by cause
juran
80/20 rules- focus on vital few that cause most problems
Pareto principle- quality in regard to customer satisfaction
juran trilogy
quality is expensive
dr donabedian
published extensively on HC quality framework
three perspective measurements: structure, process, outcome
structure
measures focus on static characteristics of those professionals that provide care
education, training
process
interrelated activities, managerial support, clinical services during care
were the right actions taken and how well were they completed
outcome
final results of care, consider factors of outcome- genetics, not under clinician control
IOM crossing the quality
identified 6 aims for improvement- STEEEP, new framework for a redesign of US HC sys
