Introduction to Health Care Quality (eBook)

Theory, Methods, and Tools

Yosef D. Dlugacz (Autor)

eBook Download: PDF

2016
John Wiley & Sons (Verlag)
978-1-118-77957-6 (ISBN)

Infos

Introduction to Health Care Quality explores the issues of quality management in today's health care environment, and provides clear guidance on new and perennial challenges in the field. The idea of 'quality' is examined in the context of a variety of health care situations, with practical emphasis on assessment, monitoring, analysis, and improvement. Students will learn how to utilize statistical tools, patient data, and more to understand new models of reimbursement, including pay for performance and value-based purchasing. They will also learn how to learn how to incorporate technology into everyday practice. Each chapter centers on an essential concept, but builds upon previous chapters to reinforce the material and equip students with a deeper understanding of the modern health care industry. Real-world situations are highlighted to show the intersection of theory and application, while cutting-edge methodologies and models prepare students for today's data-driven health care environment.

Health care quality is defined and assessed according to setting, with factors such as standards, laws, regulations, accreditation, and consumerism impacting measurement and analysis in tremendous ways. This book provides an overview of this complex field, with insightful discussion and expert practical guidance.

Health care today is worlds away from any other point in history. As the field grows ever more complex, quality management becomes increasingly critical for ensuring optimal patient care. Introduction to Health Care Quality helps students and professionals make sense of the issues, and provide top-notch service in today's rapidly changing health care environment.

YOSEF D. DLUGACZ, PHD, is the Senior Vice President and Chief of Clinical Quality, Education and Research of the Krasnoff Quality Management Institute of the Northwell Health system. The goal of the Institute is to bridge the gap between theoretical knowledge learned in the academic setting and the realities of applying quality management methods in today's health care reform environment. Dr. Dlugacz's research focuses on developing models that link quality, safety, good clinical outcomes and financial success for increased value and improved efficiencies.

Inhalt

Cover 1
Title Page 5
Copyright 6
Contents 9
List of Figures and Tables 19
Preface 23
Acknowledgments 27
About the Author 29
Introduction 31
Part I: Quality Management Fundamentals 39
Chapter 1: Foundations of Health Care Quality 41
Defining Quality 42
Contributions of Quality Theorists-Nothing New under the Sun 43
Florence Nightingale 43
Ernest A. Codman 45
William Andrew Shewhart 46
William Edwards Deming 47
Avedis Donabedian 48
Joseph M. Juran 49
Philip Crosby 51
Quality Management Methodologies 52
Total Quality Management 52
Continuous Quality Improvement 53
Organizations Making an Impact on Quality and Safety Standards 54
Institute of Medicine 55
The Joint Commission 56
Centers for Medicare and Medicaid Services 59
Hospital Compare 59
Patient Education 60
Pay for Performance 61
Never Events 62
Institute for Healthcare Improvement 62
Agency for Health Research and Quality 63
National Quality Forum 65
The Leapfrog Group 65
Data: The Foundation of Quality Management 66
Case Example: Falls 67
Quality Indicator 68
Barriers to Using Quality Data to Assess Care 68
Case Example: Cardiac Surgery Mortality 69
Summary 70
Key Terms 71
Quality Concepts in Action 71
References 71
Suggestions for Further Reading 72
Useful Websites 73
Chapter 2: Understanding the Impact of Health Care Reform 75
The Affordable Care Act 76
Accountable Care Organizations 77
Health Insurance Exchanges 79
New Models of Payment 80
Bundled Payment 80
Pioneer and Advance Payment Accountable Care Organization 81
Comprehensive Primary Care Improvement 81
Value-Based Purchasing 81
Pay for Performance 82
Case Example: Communicating with Clinicians through P4P Data 83
New Models of Providing Care 85
Patient-Centered Medical Homes 85
Community Health Centers 86
Prevention and Wellness 87
Local Prevention Efforts 88
Case Example: Influenza Vaccination 90
New Models for Collecting Data 91
Background 91
Advantages of Electronic Health Records 92
Challenges to Effective Use of Electronic Health Records 93
International Classification of Diseases Codes 94
Improving Interpersonal Communication 94
Narrative Medicine 95
Improving Documentation 97
Looking Ahead 97
Summary 98
Key Terms 98
Quality Concepts in Action 99
References 99
Suggestions for Further Reading 100
Useful Websites 101
Chapter 3: Making the Case for Change 103
What Is Involved in Change? 104
New Models of Care 104
Case Example: Advanced Illness Screening 105
Improving Quality 106
Managing and Measuring Quality in the Reform Environment 107
Measuring Quality Performance 107
Measuring Care in the Community 108
Who Is Involved in Change? 109
Leaders 110
Managers 110
Governance 112
Case Example: Developing a Quality Structure for Change 112
Administrators and Clinicians 112
Monitoring Quality 114
Quality Managers 114
Changing Communication 115
Breaking Down Silos 115
Educating Patients 116
Case Example: Confronting Choices 116
Health Literacy 117
Communicating across Institutions and Organizations 120
Organizing Information 120
Communicating Information 121
The Role of Data in Promoting Change 124
Tables of Measures 124
Quality Measures 125
Performance Improvement 127
Summary 127
Key Terms 128
Quality Concepts in Action 128
References 129
Suggestion for Further Reading 130
Useful Websites 130
Chapter 4: New Challenges for Health Care Professionals 131
Meeting Statistical Expectations for Standards of Care 132
The Evolution of Quality 133
Measures of Quality 134
Case Example: Heart Failure Readmission 135
Meeting Patient Expectations 135
HCAHPS 136
Case Example: Cleveland Clinic 137
Role of Dashboards 138
Leadership Reports 139
Role of Data Analysis 142
Case Example: Assessing High-Risk Pregnancy 142
Data for Performance Improvement 143
Understanding Different Kinds of Data 143
Challenges with Health Information Technology 145
Different Data Sources and Clinical Research 146
Data and Quality 147
Managing Care for Chronic Illness across the Continuum 147
The Medicare Chronic Conditions Dashboard 148
Quality Measures 148
Case Example: Readmission 150
Managing Aggregated Patient Care Issues 150
Population-Based Measures 151
Case Example: Aspirin Administration 152
Microsystems/Macrosystems 153
Microsystems and Lean 154
Case Example: Total Joint Replacement 155
Improving Communication 159
Teamwork 159
Case Example: Improving Cardiac Mortality 161
Summary 165
Key Terms 165
Quality Concepts in Action 165
References 166
Suggestions for Further Reading 167
Useful Websites 168
Chapter 5: Improving Patient Safety 171
Understanding Medical Errors and Adverse Events 172
Reporting Patient Safety Issues 173
Systems Errors 173
Institutionalizing Error Prevention 174
The Necessity of Culture Change 176
High-Reliability Organizations 177
Guiding Principles 178
Becoming a High-Reliability Organization 179
The Role of Quality Management in Promoting a Safety Culture 180
Using Quality Data to Promote Safety 180
Case Example: Monitoring Falls 181
Monitoring with Measures 182
Case Example: APACHE 184
Prioritizing Improvements 185
Using Data to Define Priorities 186
Case Example: Understanding Suicide 188
Defining Priorities Locally 189
Case Example: Implementing Prioritization 189
Expanding Data Sources: Partnerships to Develop Best Practice 192
Case Example: Collaborations to Promote Patient Safety 192
Leading Organizational Improvements 193
Supporting Quality Data 194
Business Intelligence 194
The Role of Nursing Leaders in Promoting Safety 196
Communication Strategies 197
Integrating New Responsibilities 198
Transformational Leadership 199
Case Example: Monitoring Patient Safety 199
The Role of the Medical Staff in Promoting Safety 200
Providing Education to New Physicians 201
Case Example: Resident Education Program 201
Promoting Safety through Effective Communication 203
Breaking Down Silos 203
Case Example: Reducing Length of Stay for Stroke Patients 204
Summary 207
Key Terms 207
Quality Concepts in Action 207
References 208
Suggestions for Further Reading 208
Useful Websites 209
Part II: Applying Quality Tools and Techniques 211
Chapter 6: Working with Quality Tools and Methods 213
Identifying a Problem 214
Cause-and-Effect Diagram 215
Flowchart 216
Checklist 217
Run Chart 219
Histogram 219
Describing Information 221
Mean 221
Median 222
Mode 223
Variability 223
Range 223
Standard Deviation 223
Bell Curve 225
Making Use of Data 226
Significance 227
Using Quality Tools and Techniques to Improve Safety 227
Root Cause Analysis 227
Case Example: Sepsis Mortality 229
Failure Mode and Effects Analysis 230
Case Example: Blood Transfusion 232
Clinical Pathways or Care Maps 233
Care Map Characteristics 234
Variance 235
Improving Efficiency 237
Case Example: Creating Guidelines 237
Improving Performance: Plan-Do-Study-Act 239
Plan 241
Do 242
Study 242
Act 242
Case Example: Workplace Violence 243
Summary 244
Key Terms 244
Quality Concepts in Action 244
Suggestions for Further Reading 245
Useful Websites 245
Chapter 7: Working with Quality Data 247
Working with Measurements 248
Compliance 249
Case Example: Using Data to Change Practice 249
Performance Improvement 250
Case Example: Pressure Injury Performance Improvement Initiative 250
Understanding Issues in Data Collection 252
Case Example: Standardizing Data 253
Moving from Manual to Electronic Records 254
Extracting Accurate Data from Electronic Health Records 254
Using Data to Understand Appropriateness of Care 256
Case Example: Analyzing Mortality 256
Analyzing End-of-Life Care 258
Case Example: Understanding Mortality 258
The Value of Aggregated Data in Performance Improvement 260
Case Example: Improving Transplant Mortality 260
The Role of Data in Managing Chronic Disease 263
Understanding Readmission 263
Case Example: Heart Failure Readmissions 264
Using Data to Monitor Variability 268
Control Chart 268
Variance Analysis 270
Publicly Reported Data 272
Hospital Compare 272
Interpreting and Making Use of Data 275
Administrative Concerns 275
Data Analytics in the Future 276
Quality Management in the Future 277
Summary 278
Key Terms 279
Quality Concepts in Action 279
References 279
Suggestions for Further Reading 280
Useful Websites 280
Chapter 8: Working with Quality and Safety Measures 283
Commitment to Quality 284
The Future of Quality 285
Using Measures to Understand Care 285
For the Consumer 285
For the Administrator 286
For the Physician 287
Defining the Measure 288
Define the Numerator and the Denominator 288
Measuring for Improvement 289
Process Measures 291
Case Example: Medication Measures 291
Complying with Process Measures 295
Case Example: Mammography Rate 297
Understanding Variables 298
Making Compliance Meaningful 298
Case Example: Reducing Central Line Infections 300
Pay for Performance 301
P4P Measures 302
Patient Satisfaction Measures 302
Interpreting Patient Satisfaction Scores 303
Understand the Process 303
Refine the Process 304
Define Expectations 305
Monitoring Measures 306
Dashboards in the Past 306
Dashboards Today 307
Performance Details 309
Safety and Environment of Care Measures 311
Case Example: Monitoring Safety 312
Linking Environmental and Clinical Variables 314
Summary 315
Key Terms 315
Quality Concepts in Action 315
References 316
Suggestions for Further Reading 317
Useful Websites 317
Chapter 9: Translating Information into Action 319
Maximizing Efficiency 320
Throughput 321
Bottlenecks 322
Theory of Constraints 323
Queueing Theory 324
Case Example: Managing Throughput 325
Determining Appropriate Levels of Care 326
End-of-Life Care/Advanced Illness 327
The Reform Mandate 328
Understanding Mortality 329
Financial Implications 330
Mortality Data 332
Improving ICU Care 333
Case Example: Introducing APACHE 333
Analyzing Readmission 336
Case Example: Readmission 336
Using Data for Improvements 337
Case Example: Joint Replacement Surgery 337
Case Example: Bariatric Surgery 338
Patient-Centered Care 341
SF-36 341
Case Example: Quality of Life 342
Delivering the Message 343
Data and Nursing Staff 343
Data and Medical Directors 344
Multidisciplinary Teams 344
Working with Measures 345
Summary 346
Key Terms 346
Quality Concepts in Action 347
References 347
Suggestions for Further Reading 348
Useful Websites 349
Chapter 10: Preparing for the Future 351
The New Quality Management 352
The New Role of Administrators 352
The Business of Health Care 353
Improve the Product 354
Measures of Success 355
Transparency 355
Case Example: Improving a Hospital in Trouble 356
Measurements Are the Nuts and Bolts of Quality 357
Know What the Data Mean 358
Make the Data Useful 359
Measures Reflect Values 359
Getting Everyone on Board 360
Case Example: Improving Transplant Services 360
Changing Behavior 361
Case Example: Understanding Complex Processes 362
Challenges for the Future 362
New Strategies 362
Break Down the Silos 363
Summary 364
Key Terms 365
Quality Concepts in Action 365
Suggestions for Further Reading 365
Useful Websites 366
Index 367
EULA 387

Produkt-Details

• Erscheint lt. Verlag: 22.11.2016
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Gesundheitswesen
• Themenwelt: Studium ► Querschnittsbereiche ► Prävention / Gesundheitsförderung
• Schlagworte: Öffentlicher Gesundheitsdienst u. Gesundheitspolitik • Business & Management • challenges of modern health care quality • Gesundheits- u. Sozialwesen • Health & Social Care • health care quality analysis • health care quality assessment • health care quality assessment metrics • health care quality assurance • health care quality concepts • health care quality data • health care quality management • health care quality management strategy • health care quality methodologies • Introduction to Health Care Quality: Theory, Methods, and Tools • measuring health care quality • Öffentlicher Gesundheitsdienst u. Gesundheitspolitik • Public Health • Public Health Services & Policy • Qualitätsmanagement • Qualitätsmanagement • Quality management • using patient data • Wirtschaft u. Management • Yosef D. Dlugacz
• ISBN-10: 1-118-77957-6 / 1118779576
• ISBN-13: 978-1-118-77957-6 / 9781118779576