Methodologic approaches to quality care evaluation

A number of problems inherent to quality of care evaluation have been described above. Although issues such as limited resources and clinical staff resistance may not be specific to cancer care, they certainly impact on the evaluation of the quality of care offered to cancer patients. Other issues such as complexity of care and the time span over which care can occur are more applicable to the cancer patient population alone. In response to these issues, I have offered a number of solutions, such as reorganizations of tasks, the use of statistical techniques such as sampling and power analysis, and various feedback mechanisms which have been implemented at MSKCC. The data presented indicate that these mechanisms have been at least partially successful; however, given the absence of a controlled environment, drawing firm conclusions about the relationship between cause and effect is not possible. I hope that in the future these results may be replicated at other institutions who elect to implement any of the suggestions I have made.

Risk management. Recommendations for the freestanding oncology center. Part two

Risk management is an active ongoing process for identification and management of possible losses. It is no longer possible, in this day of escalating numbers of suits and escalating dollar amounts for damages, to solely manage this by transfer of liability through insurance. An active program, in order to reduce the potential for liability, needs to be implemented and needs to be continued on an active ongoing basis, even in the freestanding radiation oncology center. This will require expenditure of time and dollars for periodic review by consultants, but will pay handsome rewards by reducing the potential for loss.

Joint Commission perspective: using standards and indicators to monitor performance

Two activities are concurrently underway at the Joint Commission on Accreditation of Healthcare Organizations: revision of standards for "Infection Control" which will continue to be used for the survey of hospitals development of the "Agenda for Change", a progress report on an extensive research and development project which is expected to use several infection control-related topics in the development of hospital-wide clinical indicators. This article outlines the Joint Commission's scope of services, and discusses the proposed new infection control standards and the topics to be pilot-tested for potential use as hospital-wide clinical indicators. The initiatives defined in the Agenda for Change, which involve several programmatic changes and modifications in the standards and survey procedures for the 1990s, are also addressed.

[Quality assurance in x-ray diagnosis as specified in DIN 6868]

Regular quality control and safety assurance in diagnostic radiological systems are included in the new radiation protection regulations. The monitoring program for both the equipment and the film processor can enable the user to recognize loss of quality early. Variables in the film processing unit can be differentiated from faults in the X-ray equipment more easily, including its use. The cost and time spent in setting up a safety assurance program are justified by the increase in quality.

Computerized data bases: an integrated approach to monitoring quality of patient care

Common information is shared by rehabilitation program evaluation, utilization review, and quality assurance. These administrative functions sometimes operate in isolation, not taking advantage of information sharing. This approach fails to recognize the potential for increased efficiency of integrating pertinent information to produce timely and useful reports. We report on a system design which addresses this concern by encouraging information sharing, reducing data duplication and creating a data base to produce needed statistical and management reports. Our discussion highlights the key elements of program evaluation, utilization review, and quality assurance. These elements are described as an integrated approach to meet the Commission on Accreditation of Rehabilitation Facilities and revised Joint Commission on Accreditation of Hospitals standards.

Creating a quality assurance program for long-term care

A system approach to quality assurance in long-term care facilities considers residents' total environment and all aspects of their livers--physical, social, psychological, spiritual, and intellectual. This approach lends a holistic perspective to quality assurance, expanding it from a "numbers game" to an integral part of the facility's philosophy. In developing measurement criteria for a quality assurance program, staff should not overlook systems, procedures, and reporting mechanisms already in place that may provide useful data. Some of these systems include risk management activities, continuing education programs, compliance reports, clinical affiliations, performance reviews, and peer review and administrative audits. Residents and their families are key sources of information about the quality of care. In addition to surveying these groups, long-term care facilities also should involve their resident councils in the quality assurance process.

Passing JCAH muster, or, six essential ingredients for a successful quality assurance program

Quality assurance deficiencies result in more contingency-based accreditation decisions than any other factor. The authors examine how trustees can ensure that their hospitals' quality assurance programs meet all necessary standards.