scholarly journals Connecting funds with quality outcomes in health care: a blueprint for a Clinical Practice Improvement Payment

2007 ◽  
Vol 31 (5) ◽  
pp. 54 ◽  
Author(s):  
Michael Ward ◽  
Sandra A Daniels ◽  
Gary J Walker ◽  
Stephen Duckett
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Quality Of Health Care ◽  
Geographic Variations ◽  
Quality Outcomes ◽  
Practice Improvement ◽  
Global Problem

There are significant geographic variations in the quality of health care, often with substantial gaps between what is known to be achievable and what is actually achieved in practice. This is a global problem that has persisted for many years despite a variety of conventional quality improvement initiatives. Attention has therefore recently turned to realignment of funding with specified levels of desired quality of care as an alternative. This paper outlines one approach that will be introduced as a pilot in Queensland.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2021 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Performance Measurement ◽  
Clinical Performance ◽  
The United States ◽  
Performance Measure ◽  
Care Performance

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This review contains 1 figure, 3 tables, and 56 references Keywords: Quality of care, performance measure, quality improvement, clinical practice, sigma six, transparency

A atuação do enfermeiro auditor na qualidade da assistência à saúde: revisão bibliográfica integrativa

2021 ◽  
Vol 21 (83) ◽  
Author(s):  
Gabriela Marchiori do Carmo Azzolin
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Quality Of Health Care ◽  
Nursing Process ◽  
Inclusion Criteria ◽  
Great Relevance ◽  
Role Of Nursing ◽  
Selection Of

Objetivo: descrever a atuação do enfermeiro auditor na qualidade da assistência a saúde. Método: trata-se de uma revisão integrativa de artigos publicados no período de 2015 a 2020. A pesquisa e seleção dos artigos foi realizada nas bases de dados: BEDENF, LILACS e MEDLINE, por meio dos descritores “Enfermagem”, “Auditoria de enfermagem” , “Registros de enfermagem” e “ Qualidade da assistência à saúde”. Os critérios de inclusão foram artigos online gratuitos, com textos completos, publicados de 2015 a 2020, nos idiomas português e inglês. Resultados: foram selecionados 11 artigos, por cumprirem os critérios estabelecidos no estudo. Na análise dos resultados foi possível evidenciar a importância significativa da qualidade dos registros no processo de enfermagem. Conclusão: a atuação da enfermagem na auditoria tem ganhado notoriedade nos últimos anos, por ser de grande relevância para a qualidade da assistência prestada e abranger muito mais que a gestão de custos.Palavras-chave: Enfermagem; Auditoria de enfermagem; Registros de enfermagem; Qualidade da assistência à saúde. The auditor's nurse's performance in the quality of health care: integrative bibliographic review ABSTRACTObjective: to describe the role of the nurse auditor in the quality of health care. Method: this is an integrative review of articles published from 2015 to 2020. The research and selection of articles was carried out in the databases: BEDENF, LILACS and MEDLINE, using the descriptors “Nursing”, “Nursing audit "," Nursing records "and" Quality of health care ". The inclusion criteria were free online articles, with full texts, published from 2015 to 2020, in Portuguese and English. Result: 11 articles were selected, as they meet the criteria established in the study. In the analysis of the results, it was possible to highlight the significant importance of the quality of the records in the nursing process. Conclusio: the role of nursing in the audit has gained notoriety in recent years, as it is of great relevance to the quality of care provided and covers much more than cost management.Keywords: Nursing; Nursing audit; Nursing records; Quality of health care.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2017 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This chapter contains 56 references.

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2015 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement. This chapter contains 56 references.

scholarly journals A Qualitative Exploration of Weight Bias and Quality of Health Care Among Health Care Professionals Using Hypothetical Patient Scenarios

2018 ◽  
Vol 55 ◽  
pp. 004695801877417 ◽  
Author(s):  
Justine Seymour ◽  
Jennifer L. Barnes ◽  
Julie Schumacher ◽  
Rachel L. Vollmer
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Quality Of Health Care ◽  
Health Care Professionals ◽  
Online Survey ◽  
The United States ◽  
Weight Bias ◽  
Hypothetical Patient ◽  
Qualitative Exploration

The purpose of this study was to determine whether weight bias exhibited by health care professionals (HCPs) impacts quality of health care provided to individuals with obesity. HCPs (n = 220; 88% female, 87% nurses) in the Midwest region of the United States were recruited to complete an online survey. In this within-subjects study design, participants completed the Attitudes Towards Obese Persons (ATOP) scale to assess weight bias and responded to 2 (1 person with obesity and 1 person without obesity) hypothetical patient scenarios to evaluate quality of care. A median split was calculated for ATOP scores to divide participants into high or low weight bias groups. Within these groups, thematic analysis was used to uncover themes in quality of care based on participants’ responses to each scenario. The analysis revealed that HCPs in the high weight bias group gave specific diet and exercise recommendations, offered health advice regarding weight loss, and used less teaching discourse when responding to the patient with obesity. In addition, in both weight bias groups, patients with obesity were started on pharmaceutical therapies sooner. The findings of this study suggest a need to educate HCPs on the importance of empathy and compassion when providing treatment to all patients, regardless of weight, to increase quality of care and ultimately improve patient outcomes.

scholarly journals Effectiveness of UK provider financial incentives on quality of care: a systematic review

2017 ◽  
Vol 67 (664) ◽  
pp. e800-e815 ◽  
Author(s):  
Rishi Mandavia ◽  
Nishchay Mehta ◽  
Anne Schilder ◽  
Elias Mossialos
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Quality Of Care ◽  
Quality Of Health Care ◽  
Financial Incentives ◽  
Healthcare Quality ◽  
Standards Of Care ◽  
Positive Effects ◽  
The Uk

BackgroundProvider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.AimTo review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.Design and settingSystematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.MethodMEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.ResultsOf the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.ConclusionThe effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.

scholarly journals Editorial Vol.3(1)

Pulse ◽  
1970 ◽  
Vol 3 (1) ◽  
pp. 3
Author(s):  
Anisur Rahman
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Medical Practice ◽  
Practice Guidelines ◽  
Guideline Development ◽  
Evidence Based ◽  
Practice Parameters

Bangladesh is a country with a large population. The health care needs of this huge population are met by a plethora of health care workers many of whom are not even trained formally for this work (traditional healers). Even in those who are trained in formal medicine we find doctors with various academic background and training. There is an amulgation of medical degrees which is not seen anywhere else in the world. As a result the diagnostic and clinical approach to patient varies widely. This setup denies the patient the standard of care that he or she deserves. In this context clinical practice guidelines can play a major role in standard patient care. Clinical practice guidelines are systematically developed to assist practitioners’ and patients' decisions about appropriate health care for specific clinical circumstances. Many terms have been developed including practice guidelines, practice standards, practice parameters, practice policies, protocols, algorithms, and critical paths, but the collective purpose is the same - reduction in unnecessary variability of care. Historically it started in USA, from attempts to monitor quality of care and cost of care. Experimental Medical Review Organizations were started in USA in 1971 by the National Center for Health Services Research and Development, which provided grants to assess quality of care. Legislation was signed into law as part of the Omnibus Reconciliation Act of 1989, creating the Agency for Health Care Policy and Research (AHCPR) [1]. A guideline is a stepwise evaluation of a clinical diagnosis or management strategy that requires observations to be made, decisions to be considered, and actions to be taken. Processes used during development of guidelines include informal and formal consensus methods, evidence-based methods, and explicit methods. Informal consensus method leads to poor quality and have been largely abandoned. Formal consensus development, based on the delphi technique is a stepwise process leading to recommendations that reflect the extent of agreement amongst individuals. This technique is limited in that it does not rely on explicit linkage between recommendation and the quality of the evidence reviewed. Evidence based methods have emerged with specific rules defined to link recommendations and supporting evidence [2]. Basic Steps in Guideline Development [3], [4] have been standardized by various international bodies and may be implemented in our country with a few adjustments. There are still methodological problems that have been identified. These include the needs to further define consistent definitions, to avoid publication bias, to maintain sensitivity to evolution in scientific understanding, and to develop criteria for validity of clinical research methods. Economic factors affecting guideline development also need to be avoided and include specialist interests, payer interests, and the need to disclose economic self interests [5]. A final problem is the challenge of disseminating already written guidelines to physicians and presents a formidable task unto itself and adds to the large burden of new data and information practitioners already have available. Guidelines should, therefore, be viewed as broad templates to assist physicians or patients in various clinical circumstances [6]. Clinical practice guideline is becoming an important determinant of how medicine and surgery is practiced in Western societies. It is time that this strategy is also introduced in Bangladesh to reduce variability in care, improve quality, measure outcomes, and reduces costs. It is expected of such institution as BCPS, and the professional bodies like Society of Surgeons and Association of Physicians of Bangladesh to initiate and implement such clinical guidelines.Prof. Dr. Anisur RahmanSenior Consultant & CoordinatorDepartment of General and Laparoscopic SurgeryApollo Hospitals DhakaReferencesGosfield A. Clinical practice guidelines and the law: applications and implications. In: Health Law Handbook. New York: Clark Boardman Callaghan; 1994:67-99.Roper WL, Winkenwerder W, Hackharth GM, Krakauer H. Effectiveness in health care: an initiative to evaluate and improve medical practice. NEJM. 1988; 319:1197-1202.American Medical Association. Office of Quality Assurance. Attributes to Guide the Development of Practice Parameters. Chicago.Schoenbaum SC, Sundwall DN, Reqman D. Using Clinical Practice Guidelines to Evaluate Quality of Care. AHCPR 95-0045, 1995;1&2.Ayres JD. The Use and Abuse of Medical Practice Guidelines. J Legal Med. 1994; 15:421-443.Tunis SR, Hayward R, Wilson MC. Internists’ attitudes about clinical practice guidelines. Ann Intern Med. 1994; 120:956-963.DOI: 10.3329/pulse.v3i1.6542Pulse Vol.3(1) July 2009 p.3

Quality of Care: Performance Measurement and Quality Improvement in Clinical Practice

2012 ◽  
Author(s):  
Sonali P. Desai ◽  
Allen Kachalia
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Financial Incentives ◽  
Clinical Performance ◽  
Care Delivery ◽  
The United States ◽  
Technological Advancement

Attention to the quality of care within the United States health care system has grown tremendously over the past decade. We have witnessed a significant change in how quality improvement and clinical performance measurement are approached. The current focus on quality and safety stems in part from the increasingly clear realization that more services and technological advancement are not automatically equivalent to high-quality care. Much of the discussion about cost and quality in health care is shifting towards the concept of value. Value is defined as health outcomes achieved per dollar spent (in other words, an assessment of the quality of care per cost). This chapter reviews the current state of quality improvement in health care and, because improvement cannot be determined without measurement, reviews several aspects of effective clinical performance measurement. Since many measures are already in place, the chapter describes some of the organizations involved in quality measurement and improvement, as well the approaches they utilize. It looks at the multiple strategies in place to improve quality, from process management to collaboration, from financial incentives to transparency, and reviews newer models of care delivery that may materialize in the near future. Tables list types of quality measures, characteristics to consider when developing a quality measure, and organizations involved in quality improvement and performance measurement. A figure shows strategies used by the federal government to spur performance measurement and quality improvement.  This review contains 1 highly rendered figure, 3 tables, and 56 references.

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