Module 6 Flashcards
Quality in health care
Derived from clinicians making judgements about balancing benefit and harm to achieve desirable patient objective
Degree to which health services for individuals and populations increase the likelihood of desired health outcomes
I HI triple aim initiative
- Improving the patient experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of healthcare
The control function
Links planning with operation
- Quality assessment/improvement
- Financial management
How is quality of care measured
Structure
Process
Outcome
Structure measures
Related to personnel/facilities and their configurations
Ex: Firecode, clean, physicians licensed, RN ratio
Pro: information readily obtained from existing documents
Cons: assumes Structure > Process > Outcome
Has not been validated
Process measures
Refers to what is done to the patient; evaluates:
- compliance with desired care
- effectiveness of educational effort as s measure of behavior
- performance of basic procedures/practices
- Quality (if can be linked to outcome measure)
Outcome measures
Refers to the net changes in health status as a result of care
Indicates the result of the performance of a process measure Types: -clinical outcomes -cost -patient experience (satisfaction)
Attributes of norms and standards
Validity: assess what it should Consensus: degree of agreement Stringency: level of performance Stability: change with time Degree of specification: -implicit: unspecified rules -explicit: laundry list approach
Epidemiologic contributions to quality assurance
- Specify standards of good practice
- Specify characteristics of providers associated with good quality
- Develop measurement tools
- Design monitoring systems
Surveillance programs
- Monitor key indicators (ex: infection rates)
- Identify problems and intervene
- Focus on infections that:
-are frequent
-preventable
-generate high costs
-have serious effects on morb/mort
.
Nosocomial infections
Originate within the hospital
1/3 are preventable
Comorbidity
A pre-existing illness
Conditions occurring at the same time
Surveillance
Collect data overtime (baseline)
Check level/stability of rates
-high rates may trigger further inquiry
-numerators must be precisely defined
-denominators must reflect population at risk
-Adjust rates for intrinsic (host specific) and extrinsic (ex: environmental) risk factors
Quality indicators
Prevention indicators
Patient safety indicators
Inpatient indicators
Pediatric indicators
Total quality management
Focus on processes of healthcare
Each employee receives work for others, processes work, and supplies work to others