1
|
Kueder-Pajares T, Descalzo M, García-Doval I, Ríos-Buceta L, Moreno-Ramírez D. Evaluación de indicadores de estructura en la atención al paciente con cáncer de piel en los servicios de dermatología. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:807-812. [DOI: 10.1016/j.ad.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/20/2018] [Accepted: 06/03/2018] [Indexed: 11/24/2022] Open
|
2
|
Kueder-Pajares T, Descalzo M, García-Doval I, Ríos-Buceta L, Moreno-Ramírez D. Evaluation of Structure Indicators for Assessing Skin Cancer Quality of Care in Dermatology Departments. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
3
|
Pneumonia after Major Cancer Surgery: Temporal Trends and Patterns of Care. Can Respir J 2016; 2016:6019416. [PMID: 27445554 PMCID: PMC4906186 DOI: 10.1155/2016/6019416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/03/2016] [Indexed: 11/17/2022] Open
Abstract
Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS). Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS), a Healthcare Cost and Utilization Project (HCUP) subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC) of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P < 0.001); the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P = 0.01). Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.
Collapse
|
4
|
Amin AN, Cerceo EA, Deitelzweig SB, Pile JC, Rosenberg DJ, Sherman BM. The Hospitalist Perspective on Treatment of Community–Acquired Bacterial Pneumonia. Postgrad Med 2015; 126:18-29. [DOI: 10.3810/pgm.2014.03.2737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
5
|
Yoo S, Kim S, Lee KH, Jeong CW, Youn SW, Park KU, Moon SY, Hwang H. Electronically implemented clinical indicators based on a data warehouse in a tertiary hospital: Its clinical benefit and effectiveness. Int J Med Inform 2014; 83:507-16. [DOI: 10.1016/j.ijmedinf.2014.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 03/27/2014] [Accepted: 04/20/2014] [Indexed: 11/25/2022]
|
6
|
Mukamel DB, Haeder SF, Weimer DL. Top-Down and Bottom-Up Approaches to Health Care Quality: The Impacts of Regulation and Report Cards. Annu Rev Public Health 2014; 35:477-97. [DOI: 10.1146/annurev-publhealth-082313-115826] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Dana B. Mukamel
- School of Medicine and Health Policy Research Institute (HPRI), University of California, Irvine, California 92697-5800;
| | | | - David L. Weimer
- Department of Political Science,
- The La Follette School of Public Affairs, University of Wisconsin, Madison, Wisconsin 53706; ,
| |
Collapse
|
7
|
Kester BS, Wayne JD, Ross MI, Bentrem DJ, Merkow RP, Bilimoria KY. An opportunity to ensure high-quality melanoma care through the use of a preoperative treatment algorithm. Ann Surg Oncol 2013; 20:3976-83. [PMID: 23860805 DOI: 10.1245/s10434-013-3094-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies have demonstrated variable adherence to published melanoma treatment guidelines. Payers have used algorithms to preapprove certain tests and treatments. Our objective was to develop a preoperative treatment assessment algorithm to ensure patients with melanoma receive recommended care. METHODS A treatment algorithm was developed using existing guidelines. Records of patients presenting with melanoma between September 2010 and May 2012 were reviewed. Surgical care was classified as having been adherent or nonadherent with the guideline-based algorithm. The algorithm was incorporated into a Web site for preoperative treatment verification. RESULTS A treatment algorithm was developed on the basis of three critical pieces of preoperative data: Breslow thickness, presence of adverse primary tumor prognostic factors, and regional lymph node metastases. Treatment options included wide local excision (WLE), sentinel lymph node biopsy (SLNB), and completion/formal lymph node dissection. Of 328 patients evaluated, 316 (96%) were treated according to the guideline-based algorithm. Causes of variation from predicted treatment included patient preference, severe comorbidities, difficult tumor location, and uncertain depth. All departures (n = 12) were in clinically node-negative patients: six patients did not undergo SLNB as indicated, and six underwent SLNB that was not concordant with the algorithm. An algorithm-embedded Web site was designed for preoperative verification of planned procedures. CONCLUSIONS As a proof of principle, an algorithm was developed to preoperatively verify that proposed melanoma treatments are concordant with established guidelines. These three pieces of information could be required during precertification, and nonconcordant treatment plans could prompt a peer-to-peer discussion. After additional pilot testing, the algorithm could offer a novel approach for quality improvement and provide a preoperative, prospective safeguard to ensure high-quality care for melanoma patients.
Collapse
Affiliation(s)
- Benjamin S Kester
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,
| | | | | | | | | | | |
Collapse
|
8
|
Avdic E, Cushinotto LA, Hughes AH, Hansen AR, Efird LE, Bartlett JG, Cosgrove SE. Impact of an Antimicrobial Stewardship Intervention on Shortening the Duration of Therapy for Community-Acquired Pneumonia. Clin Infect Dis 2012; 54:1581-7. [DOI: 10.1093/cid/cis242] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
9
|
Domingo GRR, Reyes FC, Thompson FV, Johnson PM, Shortridge-Baggett LM. Effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia: A systematic review. ACTA ACUST UNITED AC 2012. [DOI: 10.11124/jbisrir-2012-61] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
10
|
Domingo GRR, Reyes FC, Thompson FV, Johnson PM, Shortridge-Baggett LM. Effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia: A systematic review. ACTA ACUST UNITED AC 2012; 10:1086-1121. [PMID: 27820311 DOI: 10.11124/01938924-201210180-00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Hospital readmission soon after discharge is common and costly. To date, published studies of effectiveness of structured discharge process addressing reduction of hospital readmission have focused on patients with chronic conditions and complex needs, but not in adult patients with community acquired pneumonia. OBJECTIVES To examine and synthesise the best available evidence related to effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia. INCLUSION CRITERIA This review considered studies that included hospitalised adult patients diagnosed with community acquired pneumonia regardless of gender, ethnicity, severity, and co-morbidities.Structured discharge process related to early patient engagement, patient-caregiver dyad intervention, transitional care, coordinated care, and multidisciplinary team approach.The outcome measures included in this review were hospital readmission, emergency room visits, and unscheduled visits to healthcare provider.Randomised controlled trials (RCTs) and quasi-experimental studies were considered for inclusion. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies in English language without date limits. A search of PubMed/MEDLINE, CINAHL, CINAHL Plus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Academic Search Premier, Health Source Nursing/Academic Edition and seven other databases was conducted. METHODOLOGICAL QUALITY Studies were critically appraised by two independent reviewers using the Joanna Briggs Institute's standardised critical appraisal tool. DATA EXTRACTION Data were extracted using the standardised Joanna Briggs Institute's data extraction instruments. DATA SYNTHESIS Statistical pooling in meta-analysis was not appropriate. Findings are presented in a narrative form. RESULTS Three articles were included in the review, two RCTs and one pseudo-randomised controlled clinical trial. Structured discharge process did not have a positive impact in reducing hospital readmission at 30, 90, and 180 days and in reducing emergency room visit at 30 days. The outcome measure of unscheduled visit to healthcare provider was not measured in any of the three studies. The incorporation of medication reconciliation with follow-up telephone calls either by an advanced practice nurse, care coordinator, or a clinical pharmacist were effective strategies in reducing hospital readmission in all three studies and in reducing emergency room visits in one of the studies. CONCLUSIONS Medication reconciliation with the addition of follow-up telephone calls and incorporation of either an advanced practice nurse, care coordinator, or a clinical pharmacist using a multidisciplinary team approach may have implications in existing coordination of care of adult patients with community acquired pneumonia.This review recommends use of medication reconciliation with follow-up telephone calls either by an advanced practice nurse, care coordinator, or a clinical pharmacist as part of the structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.Further research is needed in examining the effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.
Collapse
Affiliation(s)
- Grace Rita R Domingo
- 1. Pace University, New York, NY 2. Pace University, New York, NY; New Jersey Center for Evidence Based Practice at the University of Medicine and Dentistry of New Jersey (UMDNJ) a collaborating centre of the Joanna Briggs Institute
| | | | | | | | | |
Collapse
|
11
|
Lee JS, Primack BA, Mor MK, Stone RA, Obrosky DS, Yealy DM, Fine MJ. Processes of care and outcomes for community-acquired pneumonia. Am J Med 2011; 124:1175.e9-17. [PMID: 22000624 PMCID: PMC3578284 DOI: 10.1016/j.amjmed.2011.05.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 05/24/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although processes of care are common proxies for health care quality, their associations with medical outcomes remain uncertain. METHODS For 2076 patients hospitalized with pneumonia from 32 emergency departments, we used multilevel logistic regression modeling to assess independent associations between patient outcomes and the performance of 4 individual processes of care (assessment of oxygenation, blood cultures, and rapid initiation [<4 hours] and appropriate selection of antibiotic therapy) and the cumulative number of processes of care performed. RESULTS Overall, 141 patients (6.8%) died. Mortality was 0.3% to 1.7% lower for patients who had each of the individual processes of care performed (P≥.13 for each comparison); mortality was 7.5% for patients who had 0 to 2 processes of care, 7.2% for those with 3 processes of care, and 5.8% for those with all 4 processes of care performed (P=.39). Mortality was not significantly associated with either individual or cumulative process measures in multivariable models. CONCLUSION Neither the individual processes of care nor the cumulative number performed is associated with short-term mortality for pneumonia.
Collapse
Affiliation(s)
- Jonathan S Lee
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, USA
| | | | | | | | | | | | | |
Collapse
|
12
|
Nunez-Smith M, Bradley EH, Herrin J, Santana C, Curry LA, Normand SLT, Krumholz HM. Quality of care in the US territories. ARCHIVES OF INTERNAL MEDICINE 2011; 171:1528-40. [PMID: 21709184 PMCID: PMC3251926 DOI: 10.1001/archinternmed.2011.284] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Health care quality in the US territories is poorly characterized. We used process measures to compare the performance of hospitals in the US territories and in the US states. METHODS Our sample included nonfederal hospitals located in the United States and its territories discharging Medicare fee-for-service (FFS) patients with a principal discharge diagnosis of acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PNE) (July 2005-June 2008). We compared risk-standardized 30-day mortality and readmission rates between territorial and stateside hospitals, adjusting for performance on core process measures and hospital characteristics. RESULTS In 57 territorial hospitals and 4799 stateside hospitals, hospital mean 30-day risk-standardized mortality rates were significantly higher in the US territories (P<.001) for AMI (18.8% vs 16.0%), HF (12.3% vs 10.8%), and PNE (14.9% vs 11.4%). Hospital mean 30-day risk-standardized readmission rates (RSRRs) were also significantly higher in the US territories for AMI (20.6% vs 19.8%; P=.04), and PNE (19.4% vs 18.4%; P=.01) but was not significant for HF (25.5% vs 24.5%; P=.07). The higher risk-standardized mortality rates in the US territories remained statistically significant after adjusting for hospital characteristics and core process measure performance. Hospitals in the US territories had lower performance on all core process measures (P<.05). CONCLUSIONS Compared with hospitals in the US states, hospitals in the US territories have significantly higher 30-day mortality rates and lower performance on every core process measure for patients discharged after AMI, HF, and PNE. Eliminating the substantial quality gap in the US territories should be a national priority.
Collapse
Affiliation(s)
- Marcella Nunez-Smith
- Department of Medicine, Yale UniversitySchool of Medicine, PO Box 208088, IE-61 SHM, New Haven, CT 06520, USA.
| | | | | | | | | | | | | |
Collapse
|
13
|
File TM, Solomkin JS, Cosgrove SE. Strategies for Improving Antimicrobial Use and the Role of Antimicrobial Stewardship Programs. Clin Infect Dis 2011; 53 Suppl 1:S15-22. [DOI: 10.1093/cid/cir364] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
14
|
Abstract
Many regulatory bodies and payers measure the quality of care provided to patients admitted to the hospital with pneumonia. Some pneumonia quality measures were not based on high-level evidence, and there is also concern that public reporting of performance could drive excessive use of diagnostic testing and antibiotic treatment. There have been significant increases in the performance rate of several process of care recommended for patients hospitalized with pneumonia, accompanied by a decrease in 30-day mortality. To maximize the potential for improved patient outcomes, physicians and regulators must remain vigilant to detect unintended negative consequences related to performance measurement.
Collapse
Affiliation(s)
- Mark L Metersky
- Division of Pulmonary and Critical Care Medicine, University of Connecticut Health Center, Farmington, CT 06030-1321, USA.
| |
Collapse
|
15
|
Sexually Transmitted Diseases Program Performance Measures: How Are They Performing? Sex Transm Dis 2011; 38:610-6. [DOI: 10.1097/olq.0b013e31820a8d9b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Bratzler DW, Normand SLT, Wang Y, O'Donnell WJ, Metersky M, Han LF, Rapp MT, Krumholz HM. An administrative claims model for profiling hospital 30-day mortality rates for pneumonia patients. PLoS One 2011; 6:e17401. [PMID: 21532758 PMCID: PMC3075250 DOI: 10.1371/journal.pone.0017401] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 02/03/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. METHODOLOGY/PRINCIPAL FINDINGS Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998-2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998-2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25(th), 50(th), and 75(th) percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). CONCLUSIONS/SIGNIFICANCE An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model.
Collapse
Affiliation(s)
- Dale W. Bratzler
- Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma, United States of America
| | - Sharon-Lise T. Normand
- Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, and Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Walter J. O'Donnell
- Pulmonary and Critical Care Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark Metersky
- Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, United States of America
| | - Lein F. Han
- Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States of America
| | - Michael T. Rapp
- Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States of America
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, and Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, and Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| |
Collapse
|
17
|
Domingo GR, Johnson PM, Reyes FC, Thompson FV, Shortridge-Baggett LM. Effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia: A systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2011; 9:1-11. [PMID: 27820118 DOI: 10.11124/01938924-201109481-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Grace R Domingo
- 1Pace University Pace University Lienhard School of Nursing in collaboration with the New Jersey Centre for Evidence Based Nursing: A Collaborating Centre of the Joanna Briggs Institute, University of Medicine and Dentistry of New Jersey School of Nursing, Newark, USA 2Pace University Pace University Lienhard School of Nursing in collaboration with the New Jersey Centre for Evidence Based Nursing: A Collaborating Centre of the Joanna Briggs Institute, University of Medicine and Dentistry of New Jersey School of Nursing, Newark, USA 3Pace University 4Pace University 5Professor, Pace University
| | | | | | | | | |
Collapse
|
18
|
Ingraham AM, Cohen ME, Bilimoria KY, Dimick JB, Richards KE, Raval MV, Fleisher LA, Hall BL, Ko CY. Association of Surgical Care Improvement Project Infection-Related Process Measure Compliance with Risk-Adjusted Outcomes: Implications for Quality Measurement. J Am Coll Surg 2010; 211:705-14. [DOI: 10.1016/j.jamcollsurg.2010.09.006] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 08/16/2010] [Accepted: 09/15/2010] [Indexed: 10/18/2022]
|
19
|
Bynum JPW, Fisher ES, Song Y, Skinner J, Chandra A. Measuring racial disparities in the quality of ambulatory diabetes care. Med Care 2010; 48:1057-63. [PMID: 21063231 PMCID: PMC3005338 DOI: 10.1097/mlr.0b013e3181f37fcf] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Improving the health of minority patients who have diabetes depends in part on improving quality and reducing disparities in ambulatory care. It has been difficult to measure these components at the level of actionable units. OBJECTIVE To measure ambulatory care quality and racial disparities in diabetes care across groups of physicians who care for populations of ambulatory diabetes patients. RESEARCH DESIGN Prospective cohort analysis using administrative data. SUBJECTS Using fee-for-service Medicare claims data from 2003 to 2005, we link patients to their principal ambulatory care physician. The patients are then linked to the hospital where their physicians work or have their patients admitted, creating physician-hospital networks. MEASURES Proportion of recommended diabetes testing received by black and nonblack diabetes patients. RESULTS Blacks received 70% of recommended care compared with nonblacks who received 76.9% (P < 0.001). However, for black and nonblack patients, variation in the quality of care exceeds the racial gap in treatment. The network-specific performance rates for blacks and nonblacks were highly correlated (r = 0.67, P < 0.001), but 47% of blacks, versus 31% of nonblacks, received care from the third of networks with lowest quality. Physician-hospital networks with higher overall quality, or patients with higher socioeconomic status, were no less likely to exhibit black-white disparities. CONCLUSIONS It is possible to measure, benchmark, and monitor the quality of minority care at the level of networks responsible for ambulatory care. Consequently, it should be easier to provide patients with information on network performance and to design policies that improve the quality of minority-serving providers.
Collapse
Affiliation(s)
- Julie P W Bynum
- Dartmouth Institute for Clinical Practice and Health Policy, Dartmouth Medical School, Hanover, NH 03766, USA.
| | | | | | | | | |
Collapse
|
20
|
Lindenauer PK, Bernheim SM, Grady JN, Lin Z, Wang Y, Wang Y, Merrill AR, Han LF, Rapp MT, Drye EE, Normand SLT, Krumholz HM. The performance of US hospitals as reflected in risk-standardized 30-day mortality and readmission rates for medicare beneficiaries with pneumonia. J Hosp Med 2010; 5:E12-8. [PMID: 20665626 DOI: 10.1002/jhm.822] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pneumonia is a leading cause of hospitalization and death in the elderly, and remains the subject of both local and national quality improvement efforts. OBJECTIVE To describe patterns of hospital and regional performance in the outcomes of elderly patients with pneumonia. DESIGN Cross-sectional study using hospital and outpatient Medicare claims between 2006 and 2009. SETTING A total of 4,813 nonfederal acute care hospitals in the United States and its organized territories. PATIENTS Hospitalized fee-for-service Medicare beneficiaries age 65 years and older who received a principal diagnosis of pneumonia. INTERVENTION None. MEASUREMENTS Hospital and regional level risk-standardized 30-day mortality and readmission rates. RESULTS Of the 1,118,583 patients included in the mortality analysis 129,444 (11.6%) died within 30 days of hospital admission. The median (Q1, Q3) hospital 30-day risk-standardized mortality rate for patients with pneumonia was 11.1% (10.0%, 12.3%), and despite controlling for differences in case mix, ranged from 6.7% to 20.9%. Among the 1,161,817 patients included in the readmission analysis 212,638 (18.3%) were readmitted within 30 days of hospital discharge. The median (Q1, Q3) 30-day risk-standardized readmission rate was 18.2% (17.2%, 19.2%) and ranged from 13.6% to 26.7%. Risk-standardized mortality rates varied across hospital referral regions from a high of 14.9% to a low of 8.7%. Risk-standardized readmission rates varied across hospital referral regions from a high of 22.2% to a low of 15%. CONCLUSIONS Risk-standardized 30-day mortality and, to a lesser extent, readmission rates for patients with pneumonia vary substantially across hospitals and regions and may present opportunities for quality improvement, especially at low performing institutions and areas.
Collapse
Affiliation(s)
- Peter K Lindenauer
- Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Ingraham AM, Richards KE, Hall BL, Ko CY. Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach. Adv Surg 2010; 44:251-267. [PMID: 20919525 DOI: 10.1016/j.yasu.2010.05.003] [Citation(s) in RCA: 434] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The history and development of the NSQIP, from its inception in the Veterans Administration Health System to its implementation within the private sector sponsored by the ACS, documents the growth of a program that has substantially improved the quality of surgical care and has had a considerable influence on the culture of quality improvement in the profession. The success of the ACS NSQIP is the result of providing hospitals with rigorous, clinical data, networking opportunities, and resources to improve their risk-adjusted outcomes. In this manner, the ACS NSQIP challenges its hospitals and health care providers to continually improve the care they provide. In addition to reducing the complications and mortality experienced by patients after surgical procedures, hospitals that participate in the ACS NSQIP have seen the financial rewards of their quality improvement efforts. Continued growth of the ACS NSQIP will facilitate achievement of the primary goal surrounding the current health care reform debate: efficient, high-quality care.
Collapse
Affiliation(s)
- Angela M Ingraham
- Division of Research and Optimal Patient Care, American College of Surgeons, 633 North Saint Clair Street, Floor 22NE, Chicago, IL 60611, USA.
| | | | | | | |
Collapse
|
22
|
Development of national performance measures on the prevention and treatment of venous thromboembolism. J Thromb Thrombolysis 2009; 29:148-54. [DOI: 10.1007/s11239-009-0407-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
23
|
Bilimoria KY, Raval MV, Bentrem DJ, Wayne JD, Balch CM, Ko CY. National assessment of melanoma care using formally developed quality indicators. J Clin Oncol 2009; 27:5445-51. [PMID: 19826131 DOI: 10.1200/jco.2008.20.9965] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There is considerable variation in the quality of cancer care delivered in the United States. Assessing care by using quality indicators could help decrease this variability. The objectives of this study were to formally develop valid quality indicators for melanoma and to assess hospital-level adherence with these measures in the United States. METHODS Quality indicators were identified from available literature, consensus guidelines, and melanoma experts. Thirteen experts ranked potential measures for validity on the basis of the RAND/University of California, Los Angeles Appropriateness Methodology. Adherence with individual valid indicators and a composite measure of all indicators were assessed at 1,249 Commission on Cancer hospitals by using the National Cancer Data Base (NCDB; 2004 through 2005). RESULTS Of 55 proposed quality indicators, 26 measures (47%) were rated as valid. These indicators assessed structure (n = 1), process (n = 24), and outcome (n = 1). Of the 26 measures, 10 are readily assessable by using cancer registry data. Adherence with valid indicators ranged from 11.8% to 96.5% at the patient level and 3.7% to 83.0% at the hospital level. (Adherence required that >OR= 90% of patients at a hospital receive concordant care.) Most hospitals were adherent with 50% or fewer of the individual indicators (median composite score, five; interquartile range, four to seven). Adherence was higher for diagnosis and staging measures and was lower for treatment indicators. CONCLUSION There is considerable variation in the quality of melanoma care in the United States. By using these formally developed quality indicators, hospitals can assess their adherence with current melanoma care guidelines through feedback mechanisms from the NCDB and can better direct quality improvement efforts.
Collapse
Affiliation(s)
- Karl Y Bilimoria
- Department of Surgery, American College Surgeons, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-3211, USA.
| | | | | | | | | | | |
Collapse
|
24
|
|
25
|
de Vos M, Graafmans W, Kooistra M, Meijboom B, Van Der Voort P, Westert G. Using quality indicators to improve hospital care: a review of the literature. Int J Qual Health Care 2009; 21:119-29. [PMID: 19155288 DOI: 10.1093/intqhc/mzn059] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To review the literature concerning strategies for implementing quality indicators in hospital care, and their effectiveness in improving the quality of care. DATA SOURCES A systematic literature study was carried out using MEDLINE and the Cochrane Library (January 1994 to January 2008). STUDY SELECTION Hospital-based trials studying the effects of using quality indicators as a tool to improve quality of care. DATA EXTRACTION Two reviewers independently assessed studies for inclusion, and extracted information from the studies included regarding the health care setting, type of implementation strategy and their effectiveness as a tool to improve quality of hospital care. RESULTS A total of 21 studies were included. The most frequently used implementation strategies were audit and feedback. The majority of these studies focused on care processes rather than patient outcomes. Six studies evaluated the effects of the implementation of quality indicators on patient outcomes. In four studies, quality indicator implementation was found to be ineffective, in one partially effective and in one it was found to be effective. Twenty studies focused on care processes, and most reported significant improvement with respect to part of the measured process indicators. The implementation of quality indicators in hospitals is most effective if feedback reports are given in combination with an educational implementation strategy and/or the development of a quality improvement plan. CONCLUSION Effective strategies to implement quality indicators in daily practice in order to improve hospital care do exist, but there is considerable variation in the methods used and the level of change achieved. Feedback reports combined with another implementation strategy seem to be most effective.
Collapse
Affiliation(s)
- Maartje de Vos
- Department of Tranzo, University of Tilburg, Tilburg, the Netherlands.
| | | | | | | | | | | |
Collapse
|
26
|
Moon S, Lee JS, Kim Y, You SJ, Choi YK, Suh SK, Kim YI. Quality and Affecting Factor of Care for Patients Hospitalized with Pneumonia. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.66.4.300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sangjun Moon
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
| | - Jin-Seok Lee
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
| | - Sun-Ju You
- Korea Health Industry Development Institute, Seoul, Korea
| | | | - Soo Kyung Suh
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
| | - Yong-Ik Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
27
|
Bratzler D. Antibiotic Timing for Pneumonia. Clin Infect Dis 2008; 47:1115-6; author reply 1156-7. [DOI: 10.1086/591800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
28
|
Abstract
PURPOSE OF REVIEW To summarize studies of pay-for-performance programmes designed to address clinical quality of care markers in ambulatory settings at the level of the physician group or individual physician. RECENT FINDINGS Seven randomized controlled trials and 15 nonrandomized studies were reviewed. Less than half of the randomized controlled trials showed positive results, whereas all but one of the nonrandomized studies showed positive or mixed results. Characteristics of the quality measures, incentives, providers, patients, and concurrent interventions probably influenced the results. Study methodology problems such as small sample sizes, selection bias, and inadequate control for confounders were common. Asthma quality of care markers were included in three nonrandomized studies, two of which showed positive results and one of which was negative. SUMMARY The data reviewed in this article suggest that pay-for-performance programmes can improve markers of quality, though not always. Even when studies suggest positive effects, the designs often do not permit assurance that the effects are due to the incentives as compared with other factors. More and better-designed studies are needed to determine the actual effectiveness of incentives themselves isolated from other factors, circumstances that promote effectiveness, effectiveness relative to other strategies, and cost-effectiveness.
Collapse
|
29
|
Current World Literature. Curr Opin Pulm Med 2008; 14:266-73. [DOI: 10.1097/mcp.0b013e3282ff8c19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Évaluation de la qualité des soins en pneumologie : enjeux et perspectives. Rev Mal Respir 2007; 24:939-41. [DOI: 10.1016/s0761-8425(07)92759-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|