Quality of Health Care Flashcards
Institute of Medicine Quality Aims
Equitable timely effective safe efficient patient centered
components of high quality care
five
- access to care
- adequate scientific knowledge
- competent health care providers
- separation of financial and clinical decisions
- organization of health care institutions
1.common barriers to care include
distance
income inequality
low health literacy
2.adequate scientific knowledge base
need continuously updated body of knowledge to guide providers to effective care
3.competent health care providers
to prevent errors
1 out of every 25 patients develops a hospital acquired infection
medicare patient have a 24% chance of experiencing injury, harm or death when admitted to a hospital
- separation of financial and clinical decisions
fee for service payments encourages physicians to perform more services (over utilization)
capitation payments sometimes reared those who perform fewer services (underutilization)
ideal goal: financially neutral decision making
5.organization of health care institutions
large multi speciality group practices that pool resources have better outcomes at lower cost than dispersed practices
nurse understaffing associated with higher mortality and surgical complication rates
traditional methods of improving quality care
three
- licensing and accreditation
- peer review
- malpractice
1.licensing and accredidation
ensure tht providers meet a basically level of knowledge
however, skills and judgement can lapse with time
- peer review
rely on physicians to evaluate quality and competence of each other
focused on punishing bad apples on an individual basis
- malpractice
what are the cons
financially compensate injured patients and to punish negligent physicians
fear of lawsuits lead to over utilized dx testing
wasteful spending on lawyer premiums and court costs
they have more satisfaction with communication and resolution programs (which are hospital dispute resolution programs which disclose adverse events , apologize, and may give compensation)
newer methods of improving quality of care
7
- clinical practice guidelines
- measuring practice ocnerns
- continuous quality improvement
- computerized information systems
- public reporting
- pay for performance
- financially neutral clinical decision making
1,clinical practice guidelines
provides recommendations on treating pts. based on scientific evidence.
benefits. useful when there are gaps in training, limited experience, or insufficient time to stay updated. can be incorporated into CIS
cons
may be tainted by monetary interests
based on narrowly defined population
2.computerized information systems
computerized physician order entry systems can be used as an alert system, creates list of pts overdue for services, incorporates protocols for sharing EMR across health systems
3.continuous quality improvement
emphasizes systematic and continuous monitoring of care to provide internal feedback. focuses on the process rather than the individual
