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 reduction in [[medical error]] and [[cross infection]]s.


==Creating quality measures==
==Creating quality measures==

Revision as of 08:51, 7 January 2009

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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."[1]

Health care quality assurance addresses topics such as reduction in medical error and cross infections.

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].

Audit and feedback

Audit and feedback has been systematically reviewed by the Cochrane Collaboration who concluded its "effects are generally small to moderate."[11]

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 ."[12] 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".[13] However, a comparative study found concerns with the quality of data that is publically available.[14]

Research on quality improvement

Guidelines exist for the reporting of studies on quality improvement (http://www.squire-statement.org/).[15]

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. 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.
  12. 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.
  13. 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]
  14. 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.
  15. 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]