Breast masses

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Breast masses

  1. 2. AIDS TO CLINICAL IMPROVEMENT By: Dr. Gamal Abdulrahman P.I. Physician On 31 May, 2007 @ 11:45 hrs
  2. 3. INTRODUCTION <ul><li>WHO BELIEVES IMPROVING QUALITY REDUCES COST? </li></ul>
  3. 5. <ul><li>Overuse (inappropriate procedures & medical treatments, where the risk to the patient outweighs any potential benefit.) </li></ul><ul><li>Under use (Failure to deliver care that would benefit the patient. </li></ul><ul><li>Misuse </li></ul>
  4. 6. GOAL <ul><li>The goal is the best possible medical outcomes at the lowest necessary cost </li></ul>
  5. 7. INTRODUCTION <ul><li>QUALITY IMPROVEMENT IS THE SCIENCE OF PROCESS MANAGEMENT </li></ul><ul><li>Start With knowledge of: </li></ul><ul><li>Processes </li></ul><ul><li>Systems </li></ul><ul><li>Human Psychology </li></ul><ul><li>Variation </li></ul><ul><li>A system for ongoing learning </li></ul>
  6. 8. INTRODUCTION <ul><li>HOW DO CLINICIANS REDUCE COSTS? </li></ul><ul><li>Improving the Quality of Care by managing processes of care. </li></ul>
  7. 9. MANAGING A PROCESS MEANS: <ul><li>The right data </li></ul><ul><li>In the right format </li></ul><ul><li>At the right time & place </li></ul><ul><li>In the right hands (the clinicians who operate the process) </li></ul>
  8. 10. PATIENTS’ QUALITY FACTORS <ul><li>Hospital cleanliness </li></ul><ul><li>Smoothness of admission & discharge </li></ul><ul><li>Accuracy & clarity of billing statements </li></ul><ul><li>Courtesy of Hospital employees </li></ul><ul><li>Response times for calls & requests </li></ul><ul><li>Level of technology available </li></ul><ul><li>Nurse Competency </li></ul><ul><li>Availability of physician specialists in the field </li></ul>
  9. 11. PATIENTS’ QUALITY FACTORS <ul><li>“ track record” for medical complications </li></ul><ul><li>Availability of good emergency care </li></ul><ul><li>Price –reasonable </li></ul><ul><li>Respect patient’s rights for decision </li></ul>
  10. 12. DEFINITION <ul><li>A CUSTOMER (Patient) is anyone who has expectations regarding a process’s operation or outputs. </li></ul><ul><li>Expectations arises from past experiences, current needs, unique internal preferences. </li></ul>
  11. 13. QUALITY HEALTH CARE SHOULD BE: Safe - avoiding injuries to patients from the care that is intended to help them. • Effective - providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding under use and overuse , respectively).
  12. 14. QUALITY HEALTH CARE SHOULD BE: <ul><li>Patient centered - providing care that </li></ul><ul><li>is respectful of and responsive </li></ul><ul><li>individual patient preferences, </li></ul><ul><li>needs, and values and ensuring </li></ul><ul><li>that patient values guide all </li></ul><ul><li>clinical decisions. </li></ul><ul><li>Timely - reducing waits and </li></ul><ul><li>sometimes harmful delays for </li></ul><ul><li>both those who receive and </li></ul><ul><li>those who give care. </li></ul>
  13. 15. QUALITY HEALTH CARE SHOULD BE: <ul><li>Efficient - avoiding waste, including </li></ul><ul><li>waste of equipment, supplies, </li></ul><ul><li>ideas, and energy. </li></ul><ul><li>Equitable - providing care that does not </li></ul><ul><li>vary in quality because of </li></ul><ul><li>personal characteristics </li></ul><ul><li>such as gender, ethnicity, </li></ul><ul><li>geographic location, and </li></ul><ul><li>socioeconomic status. </li></ul>
  14. 16. CLASSES OF OUTCOMES <ul><li>Physical Outcomes </li></ul><ul><ul><li>Medical outcomes: complications & therapeutic goals </li></ul></ul><ul><ul><li>Includes functional status measures (patient perceptions of medical outcomes) </li></ul></ul><ul><li>Service Outcomes </li></ul><ul><li>Satisfaction : patient & families, communities, professionals, purchasers, & employees </li></ul><ul><ul><li>Includes access issues (eg. waiting times) </li></ul></ul><ul><li>Cost Outcomes </li></ul><ul><ul><li>Another outcome of a clinical process </li></ul></ul><ul><ul><li>Includes the cost of the burden of disease. </li></ul></ul>
  15. 17. MEDICAL OUTCOMES <ul><li>Medical outcomes relate directly to </li></ul><ul><li>health care costs. </li></ul><ul><li>Are of 3 types: </li></ul><ul><li>Therapeutic goals/biologic function </li></ul><ul><li>The patient’s ability to function (functional status, as reported by the patient) </li></ul><ul><li>Complications (process failures/defects) </li></ul>
  16. 18. SERVICE OUTCOMES <ul><li>Are of 2 types: </li></ul><ul><li>The physician-patient relationship. </li></ul><ul><li>Access issues : convenience Vs hassle (scheduling, travel times, registration, physical comfort, waiting times etc) </li></ul>
  17. 19. COST OUTCOMES <ul><li>Quality & cost are two sides of a coin, anything you do to one, </li></ul><ul><li>affects the other. </li></ul>
  18. 20. Health care Consumers seek VALUE <ul><li>VALUE = Medical Outcomes + Service Outcomes </li></ul><ul><li>Cost Outcomes </li></ul>
  19. 21. VARIATION IN CLINICAL PRACTICE <ul><li>Variation in hospitalization rates – the “decision to treat”. High rates of care judged inappropriate or equivocal. Variation in the process of care – the “manner of treatment” Variation in “expert” opinion – perceived treatment outcomes. </li></ul>
  20. 22. REASONS FOR PRACTICE VARIATION <ul><li>Complexity (how many factors can the human mind simultaneously balance to optimize an outcome). </li></ul><ul><li>Lack of valid clinical knowledge. </li></ul><ul><li>Subjective judgment/uncertainty (subjective evaluation is notoriously poor across groups or overtime). </li></ul><ul><li>Human error (humans are inherently fallible information processors). </li></ul>
  21. 24. CLINICAL STANDARDS <ul><li>CLINICAL PRACTICE : Peer review, clinical audit & confidential enquiries are examples of this approach which may involve single or multiple professional groups & their interface with management. </li></ul><ul><li>CLINICAL COMPETENCE : system to assess individual practitioners against clear criteria in order to recognize achievement & to promote continuing development. </li></ul>
  22. 28. Thank You

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