Key Terms Flashcards
1
Q
Outcome Research
A
Systematic measurement of patient or service results
2
Q
Data Collector
A
An individual PT who has regular contact with patients and who documents process of service delivery.
3
Q
Documentation
A
Process or products of recording the status, clinical decision-making, and the provision of health services.
4
Q
Cohort Data
A
Measurements taken from a group of patients with similar characteristics
5
Q
Retrospective Chart Review
A
Process of harvesting selected data from patient charts or files after patient has discontinued services
6
Q
Healthcare Outcomes
A
Results of patient of health delivery.
7
Q
Therapeutic Indicators
A
Observations of patient characteristics; used by clinicians to determine the impact of interventions
8
Q
Episode of Intervention
A
Services provided without interruption for a patient condition or problem, generally marked by an initial evaluation at the start and discharge summary at the end
9
Q
Patient Outcomes
A
Changes in the consequences of illness or injury that occur as a result of intervention and that are meaningful to the patient
10
Q
Outcomes Measures
A
Wide variety of objective processes or tools used to measure patient status over time
11
Q
Fix-it Approach
A
A stereotype of practice in which the focus of care is on curing, alleviating, or modifying patient problems and using normal health as the standard for comparison
12
Q
Meaningful Result
A
Relevance to at least two people or parties
13
Q
Evaluate-and-Treat Approach
A
Approach to patient care that is oriented toward the identification of impairments and/or deviations from normal function and the linking of these deviations to interventions that can address them
14
Q
Intervention
A
Any process or activity that occurs to or on behalf of a patient; may include direct or hands-on treatment, patient education, adaptation of the environment or of equipment
15
Q
Outcome Approach
A
Approach to patient care in which meaningful goals are identified and resources and interventions are selected to manage the patient toward those goals
16
Q
Predict and Manage
A
Result of care or the outcome is predicted before the intervention begins, and the clinician manages the available resources and interventions toward achieving the goal
17
Q
Reflective Practitioner
A
Someone who continually evaluates his or her effectiveness as a PT
18
Q
Theory
A
Description of the relationships among concepts, structures, or phenomena
19
Q
Model
A
Graphic or physical representation of a theory
20
Q
Impairments
A
Loss or abnormality at the tissue or organ level resulting in changes such as limited ROM, decreases in strength or endurance, and postural malalignment
21
Q
Functional Limitations
A
Loss of the ability to perform tasks or activities
22
Q
Disability
A
Lost ability to perform a skill in an environment
23
Q
Handicap
A
Term from 1980 used in reference to the activities and roles a person could not perform
24
Q
Social/Role Limitations
A
Loss of ability to fulfill personal and societal roles
25
Participation
Ability to fulfill personal and societal roles
26
Inputs
Characteristics or variables that define a particular service setting
27
Processes
Activities/services that patients or providers participate in
28
Outcomes
Meaningful results following an episode of intervention
29
Model
Graphic or physical representation of a theory
30
Functional outcomes
Measure of the patient’s ability to perform the tasks of everyday living following an episode of intervention.
31
Provider outcomes
Results of service delivery activities, whether the provider is an individual or a group, that are meaningful for the providing clinicians. Include service consistency, intervention effectiveness, percent of patient satisfaction, knowledge and impairment changes.
32
Service outcomes
Results of the delivery of services within an institution, among similar institutions, or across larger heatlh-care systems. Include overall patient satisfaction, utilization, variability in care, service costs, profits per diagnosis, staff retention and access, reimbursement patterns, referral rates, accreditation status, comparisons of similar variables with other types of healthcare systems.
33
Quality of life
A person’s assessment of satisfaction with life. Includes work, health, social life, community comfort, academic success and financial status.
34
Health related quality of life
Multidimensional assessment of life satisfaction as it relates to the person’s state of health and the societal expectations of people who do or do not have disabilities. Items asked differ based on diagnostic grouping, age of patients, societal and cultural expectations.
35
Medical effectiveness
Extent to which a medical intervention is able to cure a disease or condition.
36
Patient satisfaction
Patient’s perceptions of the care he/she has received.
37
Service satisfaction
A patient’s perceptions of satisfaction derived from interacting with a service provider. Cannot be separated from the place it occurs or the person who provides the service.
38
Technical satisfaction
Patient’s perceptions that the provider is knowledgeable and able to perform the necessary examination, evaluation, and treatment procedures in a comfortable and efficient way. This is a type of service satisfaction.
39
Humaneness satisfaction
Patient’s perception of the provider’s warmth, caring, willingness to listen, appropriateness of nonverbal and verbal behaviors, and respect for the patient.
40
Good Satisfaction
Satisfaction with a product or item that can be used regardless of where it is produced. Easier to access goods satisfaction > service satisfaction.
41
Access satisfaction
Perceptions of the convenience with which services are scheduled, the hours of service, the distance to service, and perceived availability.
42
Atmospherics
Perceptions of the environment in which services are delivered. Issues may include organization, crowding, perceptions of how an office is supposed to look, and how expensive the furnishings look.
43
Mortality
Rate of death
44
Morbidity
Ratio of sick to well in a community or to the frequency of complications that follows a medical intervention.
45
Cost effectiveness
Comparison of the cost to produce the same outcome by similar providers or service delivery systems. The provider that costs the least to achieve the same outcome is the most cost-effective.
46
Cost benefit
Positive benefits of providing services relative to the cost or negative aspects of providing the service.
47
Cost utility
Estimates of patient preferences for different health states relative to the length and quality of life and available interventions.
48
Unit cost
Cost to produce or deliver one unit or a product or service; incorporates both direct and indirect costs of production
49
Normative standard
Observations or measurements that reflect the normal distribution of a characteristic in the general population. Compare the patient to a gold standard or a healthy, age-matched cohort.
50
Relative standard
Observations or measurements that reflect changes based on initial measurements and where the starting or ending points may be different for each person. Use the patient as their own measure of success. Clinician compares the patient’s perception of what is acceptable/desirable with the patient’s current status.
51
Criterion reference
Observations or measurements that reflect the patient’s performance of an activity as compared with a task analysis of that activity.
52
QALY
Assessment of duration of life weighed against the quality of that life. Do this by plotting HRQOL vs. time.
53
Q-Twist
Quality-adjusted Time Without Symptoms and Toxicities; a quality-adjusted survival analysis. Estimated survival time is adjusted according to the QOL experienced.
54
Patient
Consumer of rehabilitation outcome data. Participate in determining meaningful outcomes for intervention.
55
Clinical settings
The business structure that provides healthcare services.
56
Family
The people who interact daily with a patient and who may be providers of physical, emotional or financial support.
57
What do Health care agencies rely on outcome data for?
Government agencies and private insurance programs rely heavily on outcome data (or their absence) to make management policy decisions
58
Special interest groups: what are they interested in? What do their services support? what outcome data are they interested in?
Interested in trends and intervention outcomes. Their services support individual patients and their family systems. Interested in outcome data based on larger samples of people with similar diagnoses or levels of disability.
59
Professional associations
Serve many functions and constituents. One function they perform is defining a scope of practice relative to other professions and policy makers. Professional associations support outcome research through the funding of publications and educational and research opportunities. They encourage outcome studies to develop clinical pathways and practice guidelines, to support the use and reimbursement for preferred practice patterns, and to influence policy development.
60
Work/community groups
Patients are part of larger social systems including work and community. Successful return to those systems depends in part on the accessibility of the environments and the accommodations that can be made for a patient.
61
Government
Government agencies set policies at all levels that affect the provision of health care.
62
How do Service providers use outcome data?
Healthcare service providers use outcome data to advance patients toward their goals, but it is limited to the individual patient-client relationship. Use individual patient data as a baseline for comparison of progress for that particular patient.
63
How does Business/industry support the provision of healthcare?
Develop and produce durable and consumable medical products, support services for management such as software programs, documentation and billing technology, transportation services, educational services, and publishers of healthcare related books and journals.
64
How different consumers have different needs for outcome data
Patients and clients – Are consumers of outcome data with an interest at a personal level because they are interested in their own progress relative to their prognosis for improvement.
Family and friends – The outcomes desired by family and friends may not always match the outcomes desired by the patient. For instance, a patient may consider the optimal outcome as returning home where family can assist them. In contrast, the family may see the optimal outcome as the patient’s placement in a facility where others give the care, because the family perceives barriers to its own abilities to provide satisfactory care.
Special interest groups – Interested in trends in intervention outcomes so that they can understand the effectiveness of those interventions and make budgetary decisions about the services and research they support as well as assist in their ability to disseminate the latest information.
Work and community groups – Employers use outcome data to support managerial decisions about injury prevention programs and about the benefits they provide to staff. They may also use outcome data to justify preserving, retraining, or replacing an employee who becomes injured.
65
What is Coding? In what 2 ways can it be used? What is coding the process of?
A set of symbols and their definitions used to categorize or organize information about a group of things or people. Code definitions may reflect relative values, such as the coding levels of strength, or that may be based on mutually exclusive conditions, such as the coding of blood types. Coding is the process of converting observations to alphanumeric representations for data entry.
66
What 3 ways are Disease Codes classified?
Can be classified with multiple methods:
1. by the cause (GSW),
2. by the pathology (CAD), or
3. by the presentation of symptoms (fevers with rashes).
67
What is included in Impairment codes?
Impairments such as limited ROM or strength that are measured with an instrument or scale. Because most impairments are defined by a measureable quality, there is no need to create a separate code. It is preferable to enter the raw measurements than transcribe them into larger, less defined categories.
68
What do Disability codes provide?
Provide organizing terminology for a growing body of measurement tools that look at aspects of patient status rather than their impairments.
69
What are the 6 benefits to using coding systems for patient documentation?
1. Standardization of terminology
2. Reduction of variability in documentation
3. Enhanced completion of documentation
4. Comparison within individuals
5. Comparison across individuals within a setting
6. Comparison and collaboration among clinical sites
70
What are 4 qualities of useful coding systems?
1. Operational definitions – Describe the conceptual idea of a code and the differences among the levels within a group code.
2. Mutually exclusive categories – Measurement or characteristics for each category must be exclusively defined. For example, an A grade classifying as 89-100% or 92-100%.
3. Breadth and depth – A coding system should include the entire range of characteristics it is meant to organize. A system with minimal detail may not be useful or reliable.
4. Ease of use – This is the key to successfully using a coding system in patient documentation.
71
Minimum Data Set
Administered by Medicare and contains quarterly data collected through the Resident Assessment Instrument about patients from nursing homes. Contains data on patient tracking and demographics, admission dates, items about the patient’s routine level of functioning prior to admission, and admission status in many areas including communication, wellbeing, ADLs, and mobility skills. Used for reimbursement rates.
72
OASIS
The Outcome and Assessment Information Set is also administered by Medicare and is collected on all patients who receive home health care. It codes information on a variety of impairments, disability, and social limitations. Used for reimbursement rates.
73
Unified Parkinson Disease Rating Scale (UPDRS)
(UPDRS) is an example of a disease-specific rating tool used to describe levels of disability in patients with PD. It has 3 major components (mentation, ADLs, and motor) that combine questions about impairments and functional limitations to determine levels of disability.
74
PEDI
The Pediatric Evaluation of Disability Inventory is an example of an age-related tool that is not diagnosis-specific. It is a parent-report questionnaire about the functional abilities of children, ages 6 months - 7 years. It measures all aspects of functional status, looking at 3 major domains: self-care, mobility and social functions.
75
Data set
Collection of organized observations and measurements.
76
Spreadsheet
Paper or software design for managing rows of data organized under labeled variable columns. A type of flat file. Excellent for conducting mathematical functions on numerical data.
77
Flat files
A way to store data sets. Simpler to organize and are adequate for smaller data sets.
78
Rows
On a spreadsheet, represent the different cases or patients.
79
Columns
On a spreadsheet, represent the study variables.
80
Relational database
Software design for managing complex collections of data.
81
Transformed data
Raw data that are converted to a different format for analysis or reporting, such as conversion of actual age to age groups.
82
Data recording form
Form to record data on the variables of interest; useful for reducing data omissions and translation errors. This step should be taken prior to harvesting data.
83
What is the Coding handbook? what does it do to the data collection process? What does it contain?
Steps that can be taken prior to data collection to strengthen the methods of any outcome study.
Make the data collection process more efficient, reduce potential errors in the data, and maintain a history of decisions made during data harvesting and coding. A road map for the study.
Contains the terminology, operational definitions, assigned numerical codes, and other procedures that are followed in the data harvesting.
84
What 6 things should the coding handbook include?
1. Location of the variables
2. Determine the format for recording each variable
3. Convert text data into numerical codes
4. Create procedure for storing data
5. Create accounting procedures
6. Keep an exception log
85
What is the difference between a flat file and a relational database?
Relational database requires a little more planning and software knowledge but offers more flexibility in analyzing in analyzing larger or more complicated data sets. They can also accommodate both numerical and text data.
Flat files- simpler to organize and are adequate for smaller data sets.
86
Apply coding knowledge and tips for entering data into a spreadsheet
One data bit per cell – Only one number code should be entered in each cell of the spreadsheet.
Record the smallest unit of measurement possible – For example, ROM measures should be recorded in specific degrees, not in ranges of 10-degree increments. Age can be recorded in years for adults, but it might be important to record age in months for toddlers if a difference of 3 months is relevant to the study.
Avoid entering transformed data – These are data that have been manipulated, recorded, or collapsed into different values or label prior to entry into the data set. Enter data in its original measure. For example, do not convert raw scores to percentages or pain scale measures to coded categories of “no pain”, “mild pain”, or “severe pain”.
Missing data – Have a code that indicates missing data. If the cell is empty, it is impossible to distinguish between cells that are accidentally skipped and cells for which the data are actually missing.
Cleaning the data – Once entered from the data collection forms, review the quality of the data for missing data and typographical data. Strategies to clean the data include:
Print out the data set and look at the alignment of the numbers entered. If there are 3-digit numbers where 2-digit numbers should be and they are not missing-data codes, then recheck the data recording form.
Run a frequency count on all the variables and compare the results with the coding handbook. If a code on the data set does not match the codes in the handbook, review the data collection form for that subject.
Double-check the entry of data from randomly selected data collection forms. If there are many data, it is appropriate to conduct more than one type of data review to ensure that data are error-free.
87
Answerable question
Once an issue or question is identified, it needs to be framed so it can be answered. This is the process of honing a question to accurately reflect that the issue is important.
88
PICO
Acronym in evidence-based practice approaches to organize the components of an answerable, comparative question; Patient, Interventions, Comparison interventions, Outcomes. The PICO format parallels to Model of Rehabilitation Service Delivery as follows: P is the patient, provider and service setting inputs, I is one of the processes of interest, C is a comparison process, O is the outcome of interest expressed as a measurable quality.
89
PIO
Acronym in evidence-based practice approaches to organize the components of an answerable, descriptive question; Patient, Interventions, Outcomes.
90
Literature search
After the question is clarified, a thorough review of related literature is conducted to see if the question has already been answered, to see how it has (or has not) been studied, and to identify what is already known about the question.
91
Internet resources
Allow anyone to peruse national library holdings through Pub Med and online journal collections.
92
Data mining
Process of exploring large data sets
93
Describe strategies for searching the literature and other information sources
1. Review the search terms
2. Search a variety of sources
3. Search all health-care professions
4. Avoid common search mistakes
5. Study individual characteristics
6. Visit the websites of related organizations
7. Shift the focus from answers to theories
8. Other information sources – Access through electronic databases of publications has made the searching process more time-efficient. Internet access allows anyone to peruse national library holdings through PubMed and online journal collections.
94
What is the rational for a study? what does it include?
Explains the purpose for conducting the study. Includes a hypothesis about the relationship among the selected inputs, processes, and outcomes and how the potential results will be applied in practice.
95
Action plans
Keep the study focused and improve the likelihood that only essential data are being collected and analyzed.
96
Descriptive studies
The results may show strong evidence for the variable or process, strong evidence against the variable or process, the variable or process appears equivalent to other variables or processes, no support for the variable or process.
97
Comparative studies
The results may show that A is better than B, B is better than A, or A is equivalent to B.
98
Describe the 3 benefits of identifying a rationale for conducting an outcome study
- The rationale puts the study in perspective and guides the clinician in the use of the results.
- In a well-considered rationale, there is a plan of action for each of the possible outcomes (listed above under descriptive and comparative studies).
- Having a clear rationale is helpful in focusing the time, expense, and effort invested in the study.
99
Identify four reasons for conducting outcome studies
1. To measure the clinician’s own clinical effectiveness
2. To provide clinician- or setting-specific data to support patient management approaches
3. To improve the internal management processes of a clinical setting
4. To add to the larger body of clinical evidence and knowledge
100
Descriptive statistics
Distribution of data points for a variable category.
101
Correlative statistics
Describe the relationship of changes in one variable to changes in another variable.
102
Comparative statistics
Determine whether two or more groups of data are different and suggest cause-and-effect relationships between an intervention and an outcome.
103
Statistical significance
Results of data analysis that exceed the level of chance.
104
Clinical significance
Changes in a measured variable that result in useful changes.
105
Sampling bias
Imbalance of one or more characteristics in a group of patients studied. Therefore, group does not represent the typical subject profile that was defined.
106
Procedure variability
Range of methods used by clinicians to perform the same task or to achieve the same endpoint.
Clinicians may use a controlled research study to study interventions where everything is standardized, a retrospective outcome study that may not be standardized or applied to every patient across the data set, or actual practice where a myriad of variables present at the moment of intervention.
107
Measurement bias
Imbalance in the data resulting from the choice of a measurement tool, from inherent errors associated with the application or recording of the measure, from limits of tool construction (selection of the items in a tool that create ceiling or floor effects), and from variations in documentation on the measure.
108
Historical bias
Imbalance in the data resulting from an event that happens outside of the patient care interaction and that might influence some aspect of patient care service or the measured outcomes.
For example, changes in documentation requirements by third party payers, training of clinicians in a particular examination or intervention approach, administrative changes implemented by supervisory personnel, and even natural events (blizzard) that influence the nature of problems with which patients present or their ability to access treatment.
109
Experimental bias
Imbalance of data that occurs when either the participants or the investigators have expectations for outcomes because either party knows who or what is being studied.
This is less of an issue in retrospective chart reviews because the patients and clinicians do not know that their charts will be selected, although bias can creep into the decisions about how items are coded. Experimental bias can also influence the interpretation of statistical results.
110
What are 3 levels of data analysis?
1. Descriptive analysis
2. Correlated or trend analysis
3. Comparative analysis
111
What is descriptive analysis?
Summarizes patterns in the data. Describe the distribution of data points for a variable or category. This includes such formulae as the sum, the mean, the mode, standard deviations, and frequency counts of nominal variables. Descriptive analyses will confirm if there is an actual occurrence or if there is a bias of the sample (for example, if the sample of patients is between the ages of 40-60 but 80% fall between 40-45 y/o, results will be skewed).
112
What is correlated or trend analysis?
Describe how two variables are similar or relate to each other.
Examples of statistical formulae include the Pearson Product-Moment Correlation Coefficient (r), Intraclass Correlation Coefficient (ICCs), Spearman Rank Correlation Coefficients (rs), and Point Biserial Coefficient (rpb). It is helpful to graph correlative data as scatter plot measures of the two variables, creating a slope. The closer the slope is closer to 45* from the perpendicular axis, the stronger the correlation. Numerically, correlation coefficients are reported as decimals ranging from 0-1, with 0 representing no correlation and 1 representing the perfect correlation.
113
What is a comparative analysis?
Describe how two or more variables are different. Suggests cause-and-effect relationships between intervention and outcome.
Comparative analyses included such formulae as t-tests, ANOVA, Mann-Whitney U Tests, Wilcoxen Signed-Rank Test, MANOVA, and ANCOVA. The comparisons are often between pre- and post-test measure or between sample groups receiving different interventions.
114
Descriptive statistics: Sum, Mean, Mode, Median, Range, Standard deviation, Frequency count
Sum – The total resulting from adding a series of numbers.
Mean – The sum of observations divided by the total number of observations.
Mode – The most commonly occurring score.
Median – The middle score in a ranked distribution such that 50% of the scores fall below it.
Range – The breadth of scores in a distribution equal to the difference between the highest and lowest scores.
Standard deviation – A calculation representing the spread of scores around the mean.
Frequency count – A total number of times that a variable code occurs; most often used with nominal variables.
115
What are 2 types of Correlative statistics for parametric data?
Person Product-Moment Correlation Coefficient (r) – Correlation statistics used to determine if the scores of two variables vary together.
Intraclass Correlation Coefficient (ICC) – A reliability coefficient used to determine if the scores of two variables vary together and how closely those numbers are matched.
116
What are 3 correlattive statistics for nonparametric data?
1. Spearman Rank Correlation Coefficient – Similar to the Pearson r; for use with ordinal data.
2. Phi coefficient – Correlation of dichotomous variables in which each variable has only two values.
3. Point biserial correlation – Correlation of one dichotomous variable with one continuous variable.
117
What are 5 comparative statistics for parametric data?
1. Independent or unpaired t-test – Compares the means of two groups in which there are no repeated measures. The T-test assumes a normal distribution of the sample and random selection and assignment to groups.
2. Paired t-test – Compares the means of two repeated measures from the same sample group or from matched pairs of subjects.
3. Analysis of variance (one way) – Compares the means of three or more groups on a single measure, or three or more repeated measures on the same group.
4. Analysis of variance (two way) – Compares the means of two or more groups on two measures or repeated measures from two or more groups.
5. Multifactor analysis of variance – Compares three or more independent variables.
118
What are 3 comparative statistics for nonparametric data?
1. Mann-Whitney U Test – Compares the rank order of scores from two groups on an independent variable; the test can be used with unequal group sizes.
2. Wilcoxen Rank Sum Test – Similar to the Mann-Whitney U Test; for samples of 30 or less.
3. Kruskal-Wallis One-Way Analysis of Variance by Ranks – Compares rank or ordinal data from three or more groups.
119
Outcomes orientation
Using an outcomes perspective in patient management means that the patient and the therapist agree on the same expected outcomes, and both understand how to measure or recognize when the outcome is achieved.
120
Patient documentation
Routine patient documentation. Studies of patient records often reveal less consistency in documentation patterns than clinicians expect.
121
Service delivery
Service delivery processes refer to all the clinical and administrative activities experienced by a patient or that a business provides in order to manage a patient’s episode of care.
122
Staff development
Outcome studies on any aspect of the patient management process, including the types of examination processes used, the application frequency of selected interventions, or the consistency in documentation processes, can result in a variety of staff development initiatives.
123
Final report
Formalizing the steps of a study into a written report, where some of the real insights occur. During this stage, the clinician must step back from the “micro” details of methodology to revisit the original question in the context of the Model for Rehabilitation Service Delivery, or a “macro” view to put the study back into the broader context of the inputs, processes, and outcomes.
124
Tailoring a report
When the initial draft is finished, consider tailoring the introduction and the discussion sections for the audiences who may read the report.
125
Dissemination
Process of presenting ideas or study results publicly.
The processes of sharing the investigative experience, methods, results, and interpretations with larger audiences for the purposes of informing them and engaging in dialogue about the issues that have been studied.
126
6 practice recommendations
1. Outcomes orientation of initial visit forms
2. routine patient documentation
3. Use of standardized tests and measures
4. clinical processes
5. Administrative processes
6. Cost and revenue analysis
127
What is a study for internal use only?
Used for only feedback and quality improvement. Used internally as a starting point to address practice issues. The purpose is to reflect on practice and make improvements in that clinician’s approach to patient care or documentation.
128
What is a report that others may read?
The amount of explanation provided is affected by who that audience is. If it is other clinicians that share some understanding of the same language, amount of tailoring may be minimal. Still, it is necessary to provide a set of terms and operational definitions; these may differ among clinicians. If the audience will be non-clinicians or clinicians with different clinical outcomes, then more tailoring will be necessary. When tailoring a report for others, think about how they might use the data or recommendations. The goal of tailoring a report for others is to support the recommendations fairly and to provide enough explanation to prevent the misuse of data or misinterpretation of recommendations.
129
What are 6 avenues for disseminating results?
1. Discussions- informal discussion with clinicians
2. Internal reports- clinician takes care to explain jargon, concepts, methods, and limitations of the study.
3. Poster presentations- formal presentation of the study in a graphic format on a large board.
4. Platform presentations- presentations to audiences that last 10-30 minutes. More formal than a poster session
5. Non-peer reviewed publications- newspapers, magazines, trade journals, electronic bulletin boards
6. Peer-reviewed publication- most rigorous form of dissemination, most often focused on the presentation of original data.
130
Project manager
The project manager should possess the energy, commitment, and basic knowledge to conduct an outcomes study.
131
Consensus
Consensus begins with developing agreement among staff that some evaluation of practice needs to occur.
132
Project costs
Direct and indirect expenses, including time, required to conduct an outcome study.
133
What are 6 responsibilities of an outcomes manager?
1. Commitment and communication
2. identifying a question
3. Time and task management
4. institutional review board preparation
5. Education and morale management
6. Preparation of the final report
134
8 aspects of staff preparation
1. Consensus on the need for studying outcomes
2. Consensus on the use of data
3. The value of identifying best practice patterns
4. The impact on documentation time
5. Documentation changes
6. Staff reliability for coding data
7. Staff reliability for patient documentation
8. Appreciation of everyone’s contributions
135
What are. Hidden costs of outcome studies?
1. Time
2. Training and supplies
3. Number of charts to review
4. Membership fees
5. Technical assistance
6. Extending a study
136
3 strategies to enhance success when conducting outcome studies
1. Keep it simple.
2. Balance “necessary” with “interesting”.
3. Choose and outcome study with confidence.
137
Quality assurance
Process used to monitor whether predetermined standards of service delivery are actually met in daily practice that has traditionally emphasized the correction of errors or the identification of poor performers.
The standards may reflect expectations for documentation or procedural routines.
138
Small qa
Focuses primarily on the structure of the activity; it is initiated after a problem is identified to determine minimum levels of compliance or competence. Focuses on what is missing.
139
Large QA
Broader focus. This process addresses the presence or absence of compliance with standards as well as the reasons for variation. There is commitment to ongoing evaluation regarding the initial problem. Focuses on why items are missing.
140
Continuous Quality Improvement (CQI)
Ongoing process of measuring the quality of services provided and making the services more effective.
It builds on the concept of large QA and emphasizes understanding and improvement of the foundation work processes or routines. CQI addresses customer satisfaction, procedures for continuous improvement, involvement of the entire organization such that everyone perceives a sense of ownership, and use of data and provider knowledge to improve decision-making.
141
Total Quality Management (TQM)
Participatory and systematic approach to planning and implementing continuous organizational improvement focused on customer satisfaction.
142
Clinical pathways
Sometimes called critical pathways, outline of agreed-upon steps for the diagnosis and interdisciplinary management of a condition or procedure for individual patients.
They specify the interdisciplinary services to be delivered, the timing of the services, and the responsible parties for those services. Used to reduce variability and cost, increase efficiency, and monitor and improve patient care.
143
Care paths
Documentation mechanisms that indicate if the clinical pathway has been followed.
144
Protocols
Progression of a specific intervention for a particular diagnostic group initiated by a service provider within a specific discipline.
145
Practice guideline
Recommendations for patient management that are not unique to any one institution; that are established to improve patient outcomes, reduce wrongful management of patient conditions, control costs, and inform patients and clinicians about appropriate choices for medical management.
146
Benchmarking
Process of comparing one’s own procedures and outcomes with a known or best available gold standard in order to improve consumer or client service outcomes. The intention is to compare current performance against the performance of a person or company that has a known record of excellence.
