This document summarizes a presentation on clinical care quality and its relationship to surgical disparities. It discusses how differences in healthcare structure (e.g. location, volume) and process (e.g. choice of procedure) are associated with racial disparities in surgical outcomes. It identifies gaps in understanding the causes of these differences and effective remedies. Future research should evaluate strategies to address differences in structure and process in order to reduce disparities in outcomes and improve surgical value.
Dr. Grant Williams talks about considerations for those who are older with colorectal cancer. He discusses adjuvant treatment options for older adults, management of existing comorbidities, potential risks of new morbidities related to treatment, and more.
Presented at American Association for Cancer Research (AACR) at New Orleans 2016 annual conference. Fight Colorectal Cancer and Cancer Research Institute joint effort.
Presented by
Al B. Benson III, MD FACP FASCO
Professor of Medicine
Associate Director for Cooperative Groups Robert H. Lurie Comprehensive Cancer Center of Northwestern University
Dr. Grant Williams talks about considerations for those who are older with colorectal cancer. He discusses adjuvant treatment options for older adults, management of existing comorbidities, potential risks of new morbidities related to treatment, and more.
Presented at American Association for Cancer Research (AACR) at New Orleans 2016 annual conference. Fight Colorectal Cancer and Cancer Research Institute joint effort.
Presented by
Al B. Benson III, MD FACP FASCO
Professor of Medicine
Associate Director for Cooperative Groups Robert H. Lurie Comprehensive Cancer Center of Northwestern University
Dr. Michael Morse from Duke University and Fight CRC’s Andi Dwyer discuss the state of the science and clinical care of Immunotherapy (IO); giving a glimpse of the contributions of the Fight CRC IO Workgroup.
Dr. Michael Morse from Duke University and Fight CRC’s Andi Dwyer discuss the state of the science and clinical care of Immunotherapy (IO); giving a glimpse of the contributions of the Fight CRC IO Workgroup.
Research Articles List (1)Daviglus, M. L., Kiang, L., Pizada, .docxdebishakespeare
Research Articles List
(1)Daviglus, M. L., Kiang, L., Pizada, A., Yan, L. L., & Garside, D. G. (2005). Cardiovascular risk profile earlier in life and Medicare costs in the last year of life. Archives of Internal Medicine, 165, 1028–1034.
(2)
Boockyar, K., Fishman, E., Kyriacou, C. K., Monias, A., Gayl, S., & Cortes, T. (2004). Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities. Archives of Internal Medicine, 164, 545–550.
(3)
Romo, R. (2007). A cost-benefit analysis of music therapy in a home hospice. Nursing Economics, 25(6), 353–358.
(4)
Virnig, B. A., Moscovice, I. S., Durham, S. B., & Casey, M. M. (2008). Do rural elders have limited access to Medicare hospice services? Journal of American Geriatric Society,52(5), 731–735.
(5)
Hsu, J., Fung, V., Price, M., Huang, R., Brand, R., et al. (2008). Medicare beneficiaries’ knowledge of Part D prescription drug program benefits and responses to drug costs. JAMA,299(16), 1929–1936.
(6)
Wilk, J. F., West, J. C., Rae, D. S., Rubio-Stipec, M., Chen, J. J., & Regier, D. A. (2008). Medicare Part D prescription drug benefits and administrative burden in the care of dually eligible psychiatric patients. Psychiatric Services,59, 34–39.
(7)
Kennedy, B. R. (2005). Stress and burnout of nursing staff working with geriatric clients in long-term care. Journal of Nursing Scholarship, 3(37), 281–282.
(8)
Intrator, O., & Mor, V. (2004). Effect of state Medicaid reimbursement rates of hospitalizations from nursing home. Journal of American Geriatric Society, 52(3), 393–398.
(9)
Schreyogg, J., Stargardt, O. T., & Reinhard, R. (2004). Methods to determine reimbursement rates for diagnosis-related groups (DRGs): A comparison of nine European countries. Health Care Management, 9(3), 215–223.
(10)
Wiener, J. M. (2003). An assessment of strategies for improving quality of care in nursing homes. The Gerontologist, 43, 19–27.
(11)
Braun, K. L., Cheang, M., & Shigeta, D. (2005). Increasing knowledge, skills, and empathy among direct care workers in elder care: A preliminary study of an active-learning model. Gerontologist,45(1), 118–124.
(12)Lorenz, K. A., Lynn, J., Sydney, M. Dy, Shugarman, L. R., Wilkinson, A., Mularski, R. A., et al. (2008). Evidence for improving palliative care at the end of life: A systematic review. Annals of Internal Medicine, 148(2), 147–159.
(13)
Shnoor, U. (2007). The cost of home hospice care for terminal patients in Israel. American Journal of Hospice and Palliative Medicine, 24(4), 284–290.
(14)Menec, V. H., Lix, L., Nowicki, S., & Okechukwu, O. (2007). Health care use at the end of life among older adults: Does it vary by age? The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62, 400–407.
(15)
Béland, F., Bergman, H., Lebel, P., Clarfield, A. M., Tousignant, P., Contandriopoulos, A. P., & Dallaire, L. (2006). A system of integrated care for the older persons with disabilities ...
n Pursuit of High-Value HealthcareThe Case for Improving Qu.docxrosemarybdodson23141
n Pursuit of High-Value Healthcare:
The Case for Improving Quality and
Achieving Equity in a Time of Healthcare
Transformation
JOSEPH R . BETANCOURT
S U M M A R Y • The passage of the Patient Protection and Affordable Care Act
and current efforts in payment reform signal the beginning of a significant
transformation for the US healthcare system. As we embark on this transfor-
mation, disparities have emerged as the hallmark of low-value healthcare—care
that does not meet quality standards, is inefficient, and is usually of high cost.
A new set of structures is being developed to facilitate increased access to care
that is cost-effective and high in quality—otherwise known as high-value health-
care. Addressing disparities and achieving equity are the perfect target areas for
recouping value, and doing so will pave the way for high-value healthcare.
As healthcare leaders make difficult choices, they should consider the
realities of healthcare equity. Eirst, racial and ethnic disparities in healthcare
persist and are a clear sign of poor-quality, low-value healthcare. Second, the
root causes of these disparities are complex, but a well-developed set of evi-
dence-based approaches is available to help leaders address healthcare ineq-
uity. Third, evidence suggests that being inattentive to the root causes of dis-
parities adversely affects efficiency and an organization's bottom line. Einally, if
healthcare organizations are progressive, thoughtful, and prepared for success
in such an environment, a new healthcare system that offers accessible, high-
value, equitable, culturally competent, and high-quality care to all is well within
reach.
Joseph R. Betancourt, MD, is director of the Disparities
Solution
s Center and of Mul-
ticultural Education for Massachusetts General Hospital, both in Boston. He also is
a cofounder of Quality Interactions Inc., located in Cambridge, Massachusetts.
i 6 • F R O N T I E R S O F H E A L T H S E R V I C E S M A N A G E M E N T 3 0 : 3
INTRODUCTION
The passage of the Patient Protection and
Affordable Care Act (ACA) and current
efforts in payment reform signal the
beginning of a significant transformation
for the US healthcare system. A new set
of structures is being developed to facili-
tate increased access to care that is cost-
effective and high in quality—otherwise
known as high-value healthcare. Pursuing
high-value healthcare is the ultimate goal,
and healthcare leaders across the country
are faced with the daunting challenge of
succeeding—perhaps just surviving—in
this brave new world (Böhmer 2011).
In the area of quality, we are not with-
out a basic blueprint, however. Cuided
by the Institute of Medicine (IOM) report
Crossing the Quality Chasm (Corrigan,
Donaldson, and Kohn 2001), we have
charted a path to deliver care that is safe,
efficient, effective, timely, patient centered,
and equitable. Significant gains have been
made in this effort, particularly in the area
of patient safety (Hosford 200.
Participation in lung cancer screening is lower in populations with the highest burden of lung cancer risk (through the social patterning of smoking behavior) and lowest levels of healthcare utilization (through care which is structurally inaccessible). This leads to a widening of health inequities. In this webinar, participants will learn about inequities across the lung cancer care continuum. They will also learn to understand the need to take an equity-oriented approach to lung cancer screening, and consider future directions for improving access to lung cancer screening in all eligible population groups.
Jefferson University Hospitals' April 2013 Cancer Survivorship Conference Pre...jeffersonhospital
At Jefferson University Hospitals' Cancer Survivorship Conference on April 12, 2013, Mary McCabe of Memorial Sloan-Kettering Cancer Center gave the keynote address. Jefferson's new Survivorship platform includes biannual conferences featuring keynote speakers and several breakout sessions to give cancer patients, survivors and caregivers a better understanding of survivorship and what comes next after a cancer diagnosis. This is a free event open to all cancer patients and survivors. Learn more: http://www.jeffersonhospital.org/departments-and-services/kimmel-cancer-center/cancer-survivorship-program
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay.
Anesthesia Management to Facilitate Same-Day Ambulatory Total Joint ReplacementRajnish Gupta
Some of the strategies for successful anesthesia management of patients with goal for same day or 23 hour observation total knee and total hip replacement surgery
This week you will submit your Outline for Strategic Plan for Change.docxrowthechang
This week you will submit your Outline for Strategic Plan for Change paper. Use the guidelines and formatting provided to organize your strategy. Be sure to include the required references that you are gathering for your final portfolio paper
Strategic Plan for Change
Topic:
Improving Patient Experience who are Undergoing Chemotherapy from an Outpatient setting to an Inpatient Setting
References:
Davidoff, A. J., Zuckerman, I. H., Pandya, N., Hendrick, F., Ke, X., Hurria, A., Lichtman, S. M., Edelman, M. J. (April 01, 2013). A novel approach to improve health status measurement in observational claims-based studies of cancer treatment and outcomes.
Journal of Geriatric Oncology, 4,
2, 157-165.
Joana, L., Mary, H., Alan, M., Andrew, B., & Steven, C., (1987). Case Mix and Changes for inpatient and outpatient chemotherapy.
PubMed 8(4): 65-71.
Fisher, M. D., Punekar, R., Yim, Y. M., Small, A., Singer, J. R., Schukman, J., McAneny, B. L., ... Malin, J. (January 01, 2017). Differences in Health Care Use and Costs Among Patients With Cancer Receiving Intravenous Chemotherapy in Physician Offices Versus in Hospital Outpatient Settings.
Journal of Oncology Practice, 13,
1, 37.
Foster, A. E., & Reeves, D. J. (June 01, 2017). Inpatient antineoplastic medication administration and associated drug costs: Institution of a hospital policy limiting inpatient administration.
P and T, 42,
6, 388-393.
Hayes, J. (2014).
The theory and practice of change management
. Palgrave Macmillan.
Mathews, M, Buehler, S. & West, R. (2009). Perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket cost for cancer care.
PubMed Central
, 16(4): 3-8.
Michael, E. P, & Thomas, H. L, (2013). The Strategy That Will Fix Health Care.
Harvard Business Review
.
Numico, G., Cristofano, A., Mozzicafreddo, A., Cursio, O. E., Franco, P., Courthod, G., Trogu, A., ... Silvestris, N. (January 01, 2015). Hospital admission of cancer patients: avoidable practice or necessary care?.
Plos One, 10,
3.)
Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource.
Journal of Nursing Administration
,
43
(2), 69-72.
Vegunta, R. K. R., Blue, B. J., Fernandes, H. D., Upadhyayula, S., Burhanna, P., Rodin, M. B., & Poddar, N. (January 20, 2016). Impact of an inpatient palliative consultation in terminally ill cancer patients.
Journal of Clinical Oncology, 34,
77.
...
Running head STRATEGIC PLAN FOR CHANGE1STRATEGIC PLAN FOR.docxtoltonkendal
Running head: STRATEGIC PLAN FOR CHANGE
1
STRATEGIC PLAN FOR CHANGE
2
Strategic Plan for Change
Jennifer Zimmerman
Walden University- NURS 6201
December 29, 2017
Improving Patient Experience who are Undergoing Chemotherapy from an Outpatient setting to an Inpatient Setting
1.
Introduction and Statement of the Problem
1.1.
What is the problem?
Outpatient chemotherapy sessions are sufficient in most organizations, especially for those receiving curative intent chemotherapy (Davidoff et al. 2013). The patients who meet the set criteria end up receiving supportive care post induction chemotherapy, as well as different cycles as other outpatients. Outpatient management can be made safe and the transition to inpatient more efficient, which is considered a challenge for most healthcare organizations. The problem at hand in this section has been adequately analyzed, which involves the transition of patients receiving chemotherapy from outpatient to inpatient in healthcare facilities.
1.2.
Why is it important enough to warrant a change?
Outpatient care especially for most patient has become a familiar concept that is driven by increased healthcare costs and more so, the increased demand for existing inpatient resources in different organizations (Joana et al. 1987). Improved supportive care in inpatient is also another reason for the need to embrace the transition, and patient wishes to spend the least amount of time, especially in waiting for service delivery in the outpatient setting. With these concepts in mind, it is important enough to warrant a change. Patient satisfaction ought not to be ignored in different healthcare organizations. There is a need to, therefore, be on the forefront in enhancing adequate care, and embracing inpatient plans for the chronically ill patients.
1.2.1.
Scholarly Reference #1
Joana, L., Mary, H., Alan, M., Andrew, B., & Steven, C., (1987). Case Mix and Changes in inpatient and outpatient chemotherapy. PubMed 8(4): 65-71.
In most healthcare settings, the therapy provided in outpatient has been associated with substantial tumors, chemotherapy involving high doses, and then followed by autologous stem cell transplantation. Outpatient administration of consolidation cycles has been reported, which emphasizes the major problem in this scholarly soured. According to the authors, the transition to inpatient to outpatient care should be considered and priority to solve the efficiency problems at hand.
1.2.2.
Scholarly Reference #2
Hayes, J. (2014). The theory and practice of change management. Palgrave Macmillan.
This source deals with theory and practice of change management. Change management is an adequate practice in the healthcare setting. There is a need for all healthcare organizations to be at the forefront to ensure that healthcare, both inpatient and outpatient are realized. The source provides and explains outpatient inefficiency for chronic patients as the worst problem in the medical profession. Th ...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
1. CENTER FOR SURGERY
AND PUBLIC HEALTH
Clinical Care and Quality:
Relationships with Surgical
Disparities
Peter A. Najjar, M.D.
Harvard Medical School Fellow in Patient Safety and Quality
Arthur Tracy Cabot Fellow in Health Services Research
Center for Surgery and Public Health
Brigham and Women’s Hospital
N I H - A C S S Y M P O S I U M O N S U R G I C A L D I S PA R I T I E S R E S E A R C H
2. CENTER FOR SURGERY
AND PUBLIC HEALTH
Healthcare Quality Framework1
• Context of care
delivery.
• Easy to measure.
Structure
• Acts of healthcare
delivery.
• Harder to measure
(opacity).
Process • Effects of care
delivered.
• Harder to measure
(risk adjustment).
• Value = Quality/Cost2
Outcome
“The degree to which health services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with current professional
knowledge.” –Institute of Medicine
3. CENTER FOR SURGERY
AND PUBLIC HEALTH
Importance to Disparities
Are there interventions that can reduce:
-the causes of structural differences associated with race?
-the impact of structural differences associated with race?
-the causes of associations between process and race?
What impact on value would such interventions have?
Structure Process Outcome
4. CENTER FOR SURGERY
AND PUBLIC HEALTH
Known Associations with Disparities
Structure
Volume.3-14,16
Location.10-12,15-17
Quality
Infrastructure.18-19
Specialty
Certification.20-21
Process
Choice of
Procedure.14,17,22-27
Prophylaxis.19
Referral
Patterns.4,15
Outcome
Mortality.5,7,9,13,28-36
Complications.
3,23,31,33-34,37-38
Length of
Stay.3,18,36,39
Discharge.7
Readmission.40-
42
5. CENTER FOR SURGERY
AND PUBLIC HEALTH
Gaps in the Literature
What are the differences in process that may drive disparities
in outcomes?
What might be responsible for those differences in process?
What role do structural considerations play?
What are effective remedies to structural and process
differences?
If structural and process differences are remedied, do
disparities in outcomes decrease?
What impact on surgical value would such decreases have?
6. CENTER FOR SURGERY
AND PUBLIC HEALTH
Future Directions
IOM Approach: To Err is Human (1999) and Crossing the
Quality Chasm (2001)
Further surgical disparities research in the quality arena
should be aimed at:
• Reforming health professions education.
• Redesigning care delivery.
• Encouraging information technology implementation.
• Learning from systems demonstrations.
• Furthering measurement and informed purchasing.
7. CENTER FOR SURGERY
AND PUBLIC HEALTH
Conclusions
The outcomes of surgical care are dictated by the structure
and process of care delivery.
When differences in structure and process are associated with
race, disparities in outcomes follow.
Addressing gaps in our understanding and evaluating
strategies to alleviate these differences is critical to reducing
disparities in surgical outcomes.
“The evidence is compelling. Millions of Americans are not
reached by proven effective interventions that can save lives
and prevent disability.”43
8. CENTER FOR SURGERY
AND PUBLIC HEALTH
1. Donabedian A. Evaluating the quality of medical care. 1966.
Milbank Q. 2005;83(4):691-729.
2. Porter ME. What is value in health care? N. Engl. J. Med.
2010;363(26):2477-2481.
3. Hauch A, Al-Qurayshi Z, Friedlander P, Kandil E. Association of
socioeconomic status, race, and ethnicity with outcomes of patients
undergoing thyroid surgery. JAMA Otolaryngol.-- Head Neck Surg.
2014;140(12):1173-1183.
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References
Editor's Notes
Donabedian model for measuring healthcare quality, detecting deficits, and characterizing opportunities for improvement. Structure and Process interact to determine Outcome. Disparities have been detected across all three domains in multiple surgical specialties.
Evidence to suggest that, broadly, across-hospital differences (as opposed to within-hospital) may explain a significant portion (perhaps up to 50%) of disparities and that, accordingly, higher quality hospitals/care may reduce disparities. The mechanisms (process) through which these findings are mediated are less clear.
Much work has been done to investigate outcome disparities, whereas structure and process interact to create outcomes and are more readily addressable. Structural and process based factors are modifiable, and evidence of improvement in outcomes disparities from those modifications is included.