Health care quality assurance: Difference between revisions

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'''Health care quality assurance''' is "activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps."<ref>{{MeSH}}</ref>
'''Health care quality assurance''' is "activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps."<ref>{{MeSH}}</ref>


Health care quality assurance addresses topics such as [[medical error]], [[cross infection]]s, and [[evidence-based medicine]].
Health care quality assurance addresses topics such as [[medical error]], [[cross infection]]s, and [[evidence-based medicine]].
==Creating quality measures==
==Creating quality measures==
Creating quality measures from [[clinical practice guideline]]s can be problematic.<ref name="pmid15161897">{{cite journal |author=Walter LC, Davidowitz NP, Heineken PA, Covinsky KE |title=Pitfalls of converting practice guidelines into quality measures: lessons learned from a VA performance measure |journal=JAMA |volume=291 |issue=20 |pages=2466–70 |year=2004 |pmid=15161897 |doi=10.1001/jama.291.20.2466}}</ref>
Creating quality measures from [[clinical practice guideline]]s can be problematic.<ref name="pmid15161897">{{cite journal |author=Walter LC, Davidowitz NP, Heineken PA, Covinsky KE |title=Pitfalls of converting practice guidelines into quality measures: lessons learned from a VA performance measure |journal=JAMA |volume=291 |issue=20 |pages=2466–70 |year=2004 |pmid=15161897 |doi=10.1001/jama.291.20.2466}}</ref>
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[[Process control chart]]s can be used to identify specific problems that need improvement.<ref name="pmid9499330">{{cite journal |author=Nelson EC, Splaine ME, Batalden PB, Plume SK |title=Building measurement and data collection into medical practice |journal=Ann. Intern. Med. |volume=128 |issue=6 |pages=460–6 |year=1998 |month=March |pmid=9499330 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=9499330 |issn=}}</ref><ref name="isbn0-527-76293-8">{{cite book |author=Lloyd, Robert M.; Carey, Raymond G. |authorlink= |editor= |others= |title=Measuring quality improvement in healthcare: a guide to statistical process control applications |edition= |language= |publisher=Quality Resources |location=White Plains, N.Y |year=1995 |origyear= |pages= |quote= |isbn=0-527-76293-8 |oclc= |doi= |url=http://books.google.com/books?id=J3eotrgx_4gC |accessdate=}}</ref><ref name="isbn0-87389-562-2">{{cite book |author=Staker, Larry V.; Carey, Raymond G. |authorlink= |editor= |others= |title=Improving Healthcare with Control Charts: Basic and Advanced SPC Methods and Case Studies |edition= |language= |publisher=ASQ Quality Press |location=Milwaukee, Wis |year=2002 |origyear= |pages= |quote= |isbn=0-87389-562-2 |oclc= |doi= |url= |accessdate=}}</ref> Examples are assessing methods to obtain blood cultures<ref name="pmid12585951">{{cite journal |author=Norberg A, Christopher NC, Ramundo ML, Bower JR, Berman SA |title=Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter |journal=JAMA |volume=289 |issue=6 |pages=726–9 |year=2003 |month=February |pmid=12585951 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12585951 |issn=}}</ref>, the impact of screening for methicillin resistant [[Staphylococcus aureus]]<ref name="pmid18334690">{{cite journal |author=Harbarth S, Fankhauser C, Schrenzel J, ''et al'' |title=Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients |journal=JAMA |volume=299 |issue=10 |pages=1149–57 |year=2008 |month=March |pmid=18334690 |doi=10.1001/jama.299.10.1149 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18334690 |issn=}}</ref> and comparing mortality in surgical units<ref name="pmid12689973">{{cite journal |author=Tekkis PP, McCulloch P, Steger AC, Benjamin IS, Poloniecki JD |title=Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data |journal=BMJ |volume=326 |issue=7393 |pages=786–8 |year=2003 |month=April |pmid=12689973 |doi=10.1136/bmj.326.7393.786 |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=12689973 |issn=}}</ref>.
[[Process control chart]]s can be used to identify specific problems that need improvement.<ref name="pmid9499330">{{cite journal |author=Nelson EC, Splaine ME, Batalden PB, Plume SK |title=Building measurement and data collection into medical practice |journal=Ann. Intern. Med. |volume=128 |issue=6 |pages=460–6 |year=1998 |month=March |pmid=9499330 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=9499330 |issn=}}</ref><ref name="isbn0-527-76293-8">{{cite book |author=Lloyd, Robert M.; Carey, Raymond G. |authorlink= |editor= |others= |title=Measuring quality improvement in healthcare: a guide to statistical process control applications |edition= |language= |publisher=Quality Resources |location=White Plains, N.Y |year=1995 |origyear= |pages= |quote= |isbn=0-527-76293-8 |oclc= |doi= |url=http://books.google.com/books?id=J3eotrgx_4gC |accessdate=}}</ref><ref name="isbn0-87389-562-2">{{cite book |author=Staker, Larry V.; Carey, Raymond G. |authorlink= |editor= |others= |title=Improving Healthcare with Control Charts: Basic and Advanced SPC Methods and Case Studies |edition= |language= |publisher=ASQ Quality Press |location=Milwaukee, Wis |year=2002 |origyear= |pages= |quote= |isbn=0-87389-562-2 |oclc= |doi= |url= |accessdate=}}</ref> Examples are assessing methods to obtain blood cultures<ref name="pmid12585951">{{cite journal |author=Norberg A, Christopher NC, Ramundo ML, Bower JR, Berman SA |title=Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter |journal=JAMA |volume=289 |issue=6 |pages=726–9 |year=2003 |month=February |pmid=12585951 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12585951 |issn=}}</ref>, the impact of screening for methicillin resistant [[Staphylococcus aureus]]<ref name="pmid18334690">{{cite journal |author=Harbarth S, Fankhauser C, Schrenzel J, ''et al'' |title=Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients |journal=JAMA |volume=299 |issue=10 |pages=1149–57 |year=2008 |month=March |pmid=18334690 |doi=10.1001/jama.299.10.1149 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18334690 |issn=}}</ref> and comparing mortality in surgical units<ref name="pmid12689973">{{cite journal |author=Tekkis PP, McCulloch P, Steger AC, Benjamin IS, Poloniecki JD |title=Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data |journal=BMJ |volume=326 |issue=7393 |pages=786–8 |year=2003 |month=April |pmid=12689973 |doi=10.1136/bmj.326.7393.786 |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=12689973 |issn=}}</ref>.
===Cultures of quality===
The highest quality takes place when all involved constantly reinforce "lessons learned" to one another, in a learning process. The institution performing this research was a [[United States Air Force]] hospital at which aviation safety techniques were well known.<ref name=Hoff>{{citation
| title =  Advances in Patient Safety: From Research to Implementation  Volume 1. Research Findings
| contribution = Implementing Safety Cultures in Medicine: What We Learn by Watching Physicians
| author = Timothy J. Hoff, Henry Pohl, Joel Bartfield
| url = http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=aps.section.65
| publisher = National Center for Biotechnology Information, [[National Library of Medicine}}</ref>


Considerable insight from [[aviation safety]] appears applicable to health care. <ref name=Helmreich>{{citation
| date = 2000 March 18
| volume = 320(7237)
| pages = 781–785.
| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=ncbibooks&artid=1117774
| pmid =  10720367
|journal = British Medical Journal
title = On error management: lessons from aviation
|author = Robert L Helmreich}}</ref>
===Audit and feedback===
===Audit and feedback===
Audit and feedback has been systematically reviewed by the Cochrane Collaboration who concluded its "effects are generally small to moderate."<ref name="pmid16625533">{{cite journal |author=Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD |title=Audit and feedback: effects on professional practice and health care outcomes |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD000259 |year=2006 |pmid=16625533 |doi=10.1002/14651858.CD000259.pub2 |url=http://dx.doi.org/10.1002/14651858.CD000259.pub2 |issn=}}</ref>
Audit and feedback has been systematically reviewed by the Cochrane Collaboration who concluded its "effects are generally small to moderate."<ref name="pmid16625533">{{cite journal |author=Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD |title=Audit and feedback: effects on professional practice and health care outcomes |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD000259 |year=2006 |pmid=16625533 |doi=10.1002/14651858.CD000259.pub2 |url=http://dx.doi.org/10.1002/14651858.CD000259.pub2 |issn=}}</ref>
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| title = Publication Guidelines for Quality Improvement Studies in Health Care: Evolution of the SQUIRE Project
| title = Publication Guidelines for Quality Improvement Studies in Health Care: Evolution of the SQUIRE Project
| journal = Journal of General Internal Medicine | accessdate = 2008-12-18 | date = 2008-12-01 | url = http://dx.doi.org/10.1007/s11606-008-0797-4 }}</ref>
| journal = Journal of General Internal Medicine | accessdate = 2008-12-18 | date = 2008-12-01 | url = http://dx.doi.org/10.1007/s11606-008-0797-4 }}</ref>
==References==
==References==
<references/>
<references/>

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Template:TOC-right Health care quality assurance is "activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps."[1]

Health care quality assurance addresses topics such as medical error, cross infections, and evidence-based medicine.

Creating quality measures

Creating quality measures from clinical practice guidelines can be problematic.[2]

Measuring quality

Chart abstraction may underestimate quality.[3]

Improving quality

More experience, as measured by volume of care, is associated with better quality of care.[4]

Process control charts can be used to identify specific problems that need improvement.[5][6][7] Examples are assessing methods to obtain blood cultures[8], the impact of screening for methicillin resistant Staphylococcus aureus[9] and comparing mortality in surgical units[10].

Cultures of quality

The highest quality takes place when all involved constantly reinforce "lessons learned" to one another, in a learning process. The institution performing this research was a United States Air Force hospital at which aviation safety techniques were well known.[11]

Considerable insight from aviation safety appears applicable to health care. [12]

Audit and feedback

Audit and feedback has been systematically reviewed by the Cochrane Collaboration who concluded its "effects are generally small to moderate."[13]

More recently, a factorial, cluster randomized controlled trial of audit and feedback concluded "enhanced feedback of requesting rates and brief educational reminder messages, alone and in combination, are effective strategies ."[14] The feedback in this trial was enhanced with an educational message.

Public reporting of quality measures

A systematic review found that "publicly releasing performance data stimulates quality improvement activity at the hospital level. The effect of public reporting on effectiveness, safety, and patient-centeredness remains uncertain".[15] However, a comparative study found concerns with the quality of data that is publically available.[16]

Research on quality improvement

Guidelines exist for the reporting of studies on quality improvement (http://www.squire-statement.org/).[17]

References

  1. ↑ Anonymous (2024), Health care quality assurance (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Walter LC, Davidowitz NP, Heineken PA, Covinsky KE (2004). "Pitfalls of converting practice guidelines into quality measures: lessons learned from a VA performance measure". JAMA 291 (20): 2466–70. DOI:10.1001/jama.291.20.2466. PMID 15161897. Research Blogging.
  3. ↑ How well does chart abstraction measure quality? A...[Am J Med. 2000 - PubMed Result]. Retrieved on 2008-02-12.
  4. ↑ Lin HC, Xirasagar S, Lin HC, Hwang YT (2008). "Does physicians' case volume impact inpatient care costs for pneumonia cases?". J Gen Intern Med 23 (3): 304-9. DOI:10.1007/s11606-007-0462-3. PMID 18043982. Research Blogging.
  5. ↑ Nelson EC, Splaine ME, Batalden PB, Plume SK (March 1998). "Building measurement and data collection into medical practice". Ann. Intern. Med. 128 (6): 460–6. PMID 9499330. [e]
  6. ↑ Lloyd, Robert M.; Carey, Raymond G. (1995). Measuring quality improvement in healthcare: a guide to statistical process control applications. White Plains, N.Y: Quality Resources. ISBN 0-527-76293-8. 
  7. ↑ Staker, Larry V.; Carey, Raymond G. (2002). Improving Healthcare with Control Charts: Basic and Advanced SPC Methods and Case Studies. Milwaukee, Wis: ASQ Quality Press. ISBN 0-87389-562-2. 
  8. ↑ Norberg A, Christopher NC, Ramundo ML, Bower JR, Berman SA (February 2003). "Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter". JAMA 289 (6): 726–9. PMID 12585951. [e]
  9. ↑ Harbarth S, Fankhauser C, Schrenzel J, et al (March 2008). "Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients". JAMA 299 (10): 1149–57. DOI:10.1001/jama.299.10.1149. PMID 18334690. Research Blogging.
  10. ↑ Tekkis PP, McCulloch P, Steger AC, Benjamin IS, Poloniecki JD (April 2003). "Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data". BMJ 326 (7393): 786–8. DOI:10.1136/bmj.326.7393.786. PMID 12689973. Research Blogging.
  11. ↑ {{citation | title = Advances in Patient Safety: From Research to Implementation Volume 1. Research Findings | contribution = Implementing Safety Cultures in Medicine: What We Learn by Watching Physicians | author = Timothy J. Hoff, Henry Pohl, Joel Bartfield | url = http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=aps.section.65 | publisher = National Center for Biotechnology Information, [[National Library of Medicine}}
  12. ↑ Robert L Helmreich (2000 March 18), British Medical Journal title = On error management: lessons from aviation 320(7237): 781–785.
  13. ↑ Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD (2006). "Audit and feedback: effects on professional practice and health care outcomes". Cochrane Database Syst Rev (2): CD000259. DOI:10.1002/14651858.CD000259.pub2. PMID 16625533. Research Blogging.
  14. ↑ Thomas RE, Croal BL, Ramsay C, Eccles M, Grimshaw J (June 2006). "Effect of enhanced feedback and brief educational reminder messages on laboratory test requesting in primary care: a cluster randomised trial". Lancet 367 (9527): 1990–6. DOI:10.1016/S0140-6736(06)68888-0. PMID 16782489. Research Blogging.
  15. ↑ Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG (2008). "Systematic review: the evidence that publishing patient care performance data improves quality of care". Ann. Intern. Med. 148 (2): 111–23. PMID 18195336. [e]
  16. ↑ Rothberg, Michael B.; Elizabeth Morsi, Evan M. Benjamin, Penelope S. Pekow, Peter K. Lindenauer (2008-11-01). "Choosing The Best Hospital: The Limitations Of Public Quality Reporting". Health Aff 27 (6): 1680-1687. DOI:10.1377/hlthaff.27.6.1680. Retrieved on 2008-11-10. Research Blogging.
  17. ↑ Davidoff, Frank; Paul Batalden, David Stevens, Greg Ogrinc, Susan Mooney, for the SQUIRE development group (2008-12-01). "Publication Guidelines for Quality Improvement Studies in Health Care: Evolution of the SQUIRE Project". Journal of General Internal Medicine 23 (12): 2125-2130. DOI:10.1007/s11606-008-0797-4. Retrieved on 2008-12-18. Research Blogging.

External links

Quality measures

Measuring quality improvement

Reporting studies of quality improvement

  1. ↑ Iglehart JK (1996). "The National Committee for Quality Assurance". N. Engl. J. Med. 335 (13): 995-9. PMID 8786789. [e]
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