The document discusses measuring and improving health care quality in the United States. It notes that health care quality varies significantly and is not clearly related to spending. While measurement of quality is evolving, focusing on structure, process, outcomes, and patient experience, public reporting is not yet consumer friendly. Some quality measures have improved over time, like prescription of beta blockers, but more work remains, like reducing disparities and addressing the impact of lack of health insurance on outcomes.
Financial Management In Healthcare PowerPoint Presentation SlidesSlideTeam
Presenting this set of slides with name - Financial Management In Healthcare Powerpoint Presentation Slides. This PPT deck displays fourty slides with in depth research. Our topic oriented Financial Management In Healthcare Powerpoint Presentation Slides presentation deck is a helpful tool to plan, prepare, document and analyse the topic with a clear approach. We provide a ready to use deck with all sorts of relevant topics subtopics templates, charts and graphs, overviews, analysis templates. Outline all the important aspects without any hassle. It showcases of all kind of editable templates infographs for an inclusive and comprehensive Financial Management In Healthcare Powerpoint Presentation Slides presentation. Professionals, managers, individual and team involved in any company organization from any field can use them as per requirement.
An introductory overview of the basic concepts of Healthcare Quality, a starter for beginners.
Prepared in 2014 for the new staff of the Quality Management Department in King Saud University Medical City in Riyadh as a part of their capacity building plan.
Acknowledgments:
*Dr. Magdy Gamal Yousef, MBBCh, MS, CPHQ - for his contribution in the scientific content
**Ms. Maram Baksh, MS, CPHQ - for the design of the full HCQ capacity building plan in KSUMC
Financial Management In Healthcare PowerPoint Presentation SlidesSlideTeam
Presenting this set of slides with name - Financial Management In Healthcare Powerpoint Presentation Slides. This PPT deck displays fourty slides with in depth research. Our topic oriented Financial Management In Healthcare Powerpoint Presentation Slides presentation deck is a helpful tool to plan, prepare, document and analyse the topic with a clear approach. We provide a ready to use deck with all sorts of relevant topics subtopics templates, charts and graphs, overviews, analysis templates. Outline all the important aspects without any hassle. It showcases of all kind of editable templates infographs for an inclusive and comprehensive Financial Management In Healthcare Powerpoint Presentation Slides presentation. Professionals, managers, individual and team involved in any company organization from any field can use them as per requirement.
An introductory overview of the basic concepts of Healthcare Quality, a starter for beginners.
Prepared in 2014 for the new staff of the Quality Management Department in King Saud University Medical City in Riyadh as a part of their capacity building plan.
Acknowledgments:
*Dr. Magdy Gamal Yousef, MBBCh, MS, CPHQ - for his contribution in the scientific content
**Ms. Maram Baksh, MS, CPHQ - for the design of the full HCQ capacity building plan in KSUMC
The challenges of leading healthcare organizations and what makes an excellent healthcare leader given the various stake holders and divergent interests
Lean Six Sigma applications in healthcare require an understanding of how the tools and methodologies translate to the people-intensive processes of patient care. Once applied, the possibilities are endless. Using real-world examples of the most common types of errors in clinical services, participants will learn how the DMAIC structure within Lean Six Sigma will lead them to solutions that will prevent future errors.
Total Quality Management in HealthcareGunjan Patel
Now days, Healthcare systems are of fundamental interests to all level of Hospitals in our societies. Eventually, increasing importance and reliance are placed on total quality management in healthcare systems. Due to this rising importance that is also reflected in the increasing percentage of national and international resources for both private and public sector to allocated in hospital management systems. Hospitals and other healthcare organization across the globe have been progressively implementing TQM to reduce costs, improve efficiency and provide high quality patient care.
The challenges of leading healthcare organizations and what makes an excellent healthcare leader given the various stake holders and divergent interests
Lean Six Sigma applications in healthcare require an understanding of how the tools and methodologies translate to the people-intensive processes of patient care. Once applied, the possibilities are endless. Using real-world examples of the most common types of errors in clinical services, participants will learn how the DMAIC structure within Lean Six Sigma will lead them to solutions that will prevent future errors.
Total Quality Management in HealthcareGunjan Patel
Now days, Healthcare systems are of fundamental interests to all level of Hospitals in our societies. Eventually, increasing importance and reliance are placed on total quality management in healthcare systems. Due to this rising importance that is also reflected in the increasing percentage of national and international resources for both private and public sector to allocated in hospital management systems. Hospitals and other healthcare organization across the globe have been progressively implementing TQM to reduce costs, improve efficiency and provide high quality patient care.
Creating a Culture of Quality Health Care in Resource Limited Clinical and Co...David Meyers
Currently, the field of health informatics stands to learn from the success and mistakes of the healthcare quality improvement initiative. This presentation calls for a coupling of these two fields of knowledge and argues that for any technological intervention in healthcare to be successful, there must first be a culture of quality and safety in place.
The mission statement sets the direction and priority for developing and implementing the quality plan. It clearly states the nature of the organization’s commitment to quality and should then be tied to the organizational operations through programs, projects, actions and rewards/recognition.
This course deals with the basic concepts, principles and dimensions of quality health care, patient safety, quality standards for Health Provider Organizations and implementing a quality improvement program in the health care system. It provides students with an introduction to quality improvement science in a health care setting. The course challenges students to think in an interdisciplinary manner when problem solving for quality improvement and will provide students with models and tools for leading quality improvement initiatives in a variety of organizational settings.
Chapter 2Factors influencing the application and diffusion of .docxcravennichole326
Chapter 2
Factors influencing the application and diffusion of CQI in health care
Contents
Introduction
The dynamic character of CQI
A CQI case study
The current state of CQI in healthcare
CQI and the science of innovation
The business case for CQI
Factors affecting successful CQI application
Introduction
CQI is utilized across health care sectors (including primary and preventative care) as well as across geographic and economic boundaries
The need for CQI is increasing
One reason: the safety and quality of care has shown little improvement over the last decade despite best efforts of clinicians, managers, researchers, and involvement of public
This lecture will review a number of factors and processes have been shown to facilitate or impede the implementation of CQI in health care
The Dynamic Character of CQI
CQI methodology is constantly being refined and tested: it is an evolutionary quality improvement mechanism
This is because in response to new challenges, CQI applications develop via continuous, ongoing learning and sharing among disciplines about ways to use CQI philosophies, processes and tools in a variety of settings
The Surgical Safety Checklist:
a CQI Success Story
Checklist CQI methodology orginated in aviation
2001 utilised by Pronovost (2006) in Intensive Care Units as a way of reducing central line infections
Surgical Safety Checklist (SSC) developed by Gawande (2009) is disseminated by WHO across the world
The Surgical Safety Checklist:
a CQI Success Story
Development of SSC depended upon:
Effective leadership
Interdisciplinary teamwork
Use of a PDSA improvement cycle to test, learn and improve
Engagement of a broad range of expertise to improve safety on a global scale
The Surgical Safety Checklist:
a CQI success story
Results vary but after the introduction of the SSC:
Haynes et al. (2009) demonstrated a reduction in complication rates from 11.0% at baseline to 7.0% plus, and a reduction in death rates from 1.5% to 0.8% in eight hospitals in eight cities
The SURPASS group study of six hospitals in the Netherlands, showed a statistically significant decrease in the proportion of patients with one or more complications, from 15.4% to 10.6% (de Vries et al. 2010).
So if Checklists are Successful …
Why aren’t more healthcare providers using CQI tools and processes?
Why is the gap between knowledge and practice so large?
Why don’t clinical systems incorporate the findings of clinical science or copy the “best known” practices reliably, quickly, and even gratefully into their daily work simply as a matter of course?
Limitations of Checklists
May be too simple a tool and what is required is more complex system solutions to quality and safety issues (Bosk et al. 2009).
Problems with checklists are indicative of broader CQI and quality improvement issues in healthcare including:
Process vs. outcome;
Cost vs. benefit vs. value;
Minimum standards required to define evidence for change;
How to balanc ...
Walden University
NURS 6050 Policy and Advocacy for Improving Population Health
Module 3
IntroductionResourcesDiscussionAssignmentMy Progress Tracker
NURS 6050 Policy and Advocacy for Improving Population Health | Module 3
IntroductionResourcesDiscussionAssignment☰Menu Walden University
NURS 6050 Policy and Advocacy for Improving Population Health
Module 3
IntroductionResourcesDiscussionAssignmentMy Progress Tracker
NURS 6050 Policy and Advocacy for Improving Population Health | Module 3
IntroductionResourcesDiscussionAssignment☰Menu× NURS 6050 Policy and Advocacy for Improving Population Health Back to Course Home Course Calendar Syllabus Course Information Resource List Support, Guidelines, and Policies Module 1 Module 2 Module 3 Module 4 Module 5 Module 6
Exit and return to the Blackboard App menu to access other tools, assessments, and content. Pull down, then click the "X" button at the top left corner of your mobile device.
Photo Credit: Getty Images/iStockphotoModule 3: Regulation (Weeks 5-6)
Laureate Education (Producer). (2018). Regulation [Video file]. Baltimore, MD: Author.
Rubic_Print_FormatCourse CodeClass CodeAssignment TitleTotal PointsLDR-463LDR-463-O501Topic 5 Journal Entry30.0CriteriaPercentageUnsatisfactory (0.00%)Less Than Satisfactory (65.00%)Satisfactory (75.00%)Good (85.00%)Excellent (100.00%)CommentsPoints EarnedContent100.0%Response to Journal Entry Prompt80.0%Response to the journal entry prompt is not present.Response to the journal entry prompt is incomplete or incorrect.Response to the journal entry prompt is complete but lacks relevant detail.Response to the journal entry prompt is thorough and contains substantial supporting details.Response to the journal entry prompt is complete and contains relevant supporting details.Mechanics of Writing includes spelling, punctuation, grammar, and language use.20.0%Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.Writer is clearly in command of standard, written, academic English.Total Weightage100%
Walden University
NURS 6050 Policy and Advocacy for Improving Population Health ...
The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduct...The Commonwealth Fund
Slides from the lecture "The Mis-measure of Health Care: Can Measurement, Improvement, and Cost Reduction be Reunited?" which was delivered by Eric Schneider MD on Wednesday, May 1, 2019 at The MacLean Center for Clinical Medical Ethics at The University of Chicago.
mage CaptionUnit and hospital core values in 8 magnet hospita.docxwkyra78
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Unit and hospital core values in 8 magnet hospitals
Article Title:
Walk the Talk: Promoting Control of Nursing Practice and a Patient-Centered Culture.
Source:
Critical Care Nurse, Jun2009, Vol. 29 Issue 3, p77-93, 17p, 2 Charts
Chart; found on p87
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Presence of stated core values in 8 magnet hospitals
Article Title:
Walk the Talk: Promoting Control of Nursing Practice and a Patient-Centered Culture.
Source:
Critical Care Nurse, Jun2009, Vol. 29 Issue 3, p77-93, 17p, 2 Charts
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Chamberlain College of Nursing NR447: RN Collaborative Healthcare
Week 2: The AACN Essentials of Baccalaureate Education for Professional Nursing Self-Assessment
Understanding the competencies related to the AACN Essentials of Baccalaureate Education for Professional Nursing Practice provides you with valuable information as you begin to study this course.
Complete this self-assessment, which is based on The Essentials of Baccalaureate Education for Professional Nursing from the American Association of Colleges of Nursing (2008) prior to posting to the discussion on this topic
Place a check mark or X in the column that best describes your current level of competency or understanding of the Essential’s statement. There are no incorrect answers.
After you have completed the assessment, total the number of points that you earned. Record this number in a location where you will be able to retrieve it at the end of the course, when it will serve as the basis for a future discussion.
AACN (American Association of Colleges of Nursing) Baccalaureate Essentials
Poor
1
Good
2
Very Good
3
Excellent
4
Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety
Apply leadership concepts, skills, and decision-making in the provision of high quality nursing care, healthcare team coordination, and the oversight and accountability for care delivery in a variety of settings.
Demonstrate leadership and communication skills to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team.
Participate in quality and patient safety initiatives, recognizing that these are complex system issues, which involve individuals, families, groups, communities, populations, and other members of the healthcare team.
Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and system-wide practice improvements that will improve the quality of healthcare delivery.
Essential V: Healthcare Policy, Finance, and Regulatory Environments
Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments, incl.
mage CaptionUnit and hospital core values in 8 magnet hospita.docxwashingtonrosy
mage Caption:
Unit and hospital core values in 8 magnet hospitals
Article Title:
Walk the Talk: Promoting Control of Nursing Practice and a Patient-Centered Culture.
Source:
Critical Care Nurse, Jun2009, Vol. 29 Issue 3, p77-93, 17p, 2 Charts
Chart; found on p87
Image Type:
Chart
Cite:
How do I cite this image?
Permission:
What am I allowed to do with this image?
mage Caption:
Presence of stated core values in 8 magnet hospitals
Article Title:
Walk the Talk: Promoting Control of Nursing Practice and a Patient-Centered Culture.
Source:
Critical Care Nurse, Jun2009, Vol. 29 Issue 3, p77-93, 17p, 2 Charts
Chart; found on p91
Image Type:
Chart
Cite:
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Chamberlain College of Nursing NR447: RN Collaborative Healthcare
Week 2: The AACN Essentials of Baccalaureate Education for Professional Nursing Self-Assessment
Understanding the competencies related to the AACN Essentials of Baccalaureate Education for Professional Nursing Practice provides you with valuable information as you begin to study this course.
Complete this self-assessment, which is based on The Essentials of Baccalaureate Education for Professional Nursing from the American Association of Colleges of Nursing (2008) prior to posting to the discussion on this topic
Place a check mark or X in the column that best describes your current level of competency or understanding of the Essential’s statement. There are no incorrect answers.
After you have completed the assessment, total the number of points that you earned. Record this number in a location where you will be able to retrieve it at the end of the course, when it will serve as the basis for a future discussion.
AACN (American Association of Colleges of Nursing) Baccalaureate Essentials
Poor
1
Good
2
Very Good
3
Excellent
4
Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety
Apply leadership concepts, skills, and decision-making in the provision of high quality nursing care, healthcare team coordination, and the oversight and accountability for care delivery in a variety of settings.
Demonstrate leadership and communication skills to effectively implement patient safety and quality improvement initiatives within the context of the interprofessional team.
Participate in quality and patient safety initiatives, recognizing that these are complex system issues, which involve individuals, families, groups, communities, populations, and other members of the healthcare team.
Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and system-wide practice improvements that will improve the quality of healthcare delivery.
Essential V: Healthcare Policy, Finance, and Regulatory Environments
Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments, incl.
Improve Nursing Performance and Staff Engagement using the CLIPSE Model April...iCareQuality.us
Implementing a continuous daily improvement (CDI) program is a simple standardized approach to reducing clinical variability in patient care delivery settings. The CLIPSE model engages front-line care providers using a collaborative, professional peer-peer process, and may positively impact patient outcomes, cost of care, patient safety, and quality improvement initiatives at the point of care (POC).
HS410 Unit 6 Quality Management - DiscussionDiscussionThi.docxAlysonDuongtw
HS410 Unit 6: Quality Management - Discussion
Discussion
This is a graded Discussion
. Please refer to the Discussion Board Grading Rubric in Course Home / Grading Rubrics.
Respond to all of the following questions and be sure to respond to two of your other classmates’ postings:
1.
What are the steps in the quality improvement model and how is benchmarking involved?
2. What are the stages in which data quality errors found in a health record most commonly occur?
3. What is the definition of risk management?
4. What are the parts of an effective risk management program?
5. What is utilization review and why is it important in healthcare?
6. What is the process of utilization review?
Please paper should be 400-500 words and in an essay format, strictly on topic, original with real scholar references to support your answers.
NO PHARGIARISM PLEASE!
This is the Chapter reading for this assignment:
Read Chapter 7 in
Today’s Health Information Management
.
INTRODUCTION
Quality health care “means doing the right thing at the right time, in the right way, for the right person, and getting the best possible results.”1 The term quality, by definition, can mean excellence, status, or grade; thus, it can be measured and quantified. The patient, and perhaps the patient's family, may interpret quality health care differently from the way that health care providers interpret it. Therefore, it is important to determine—if possible—what is “right” and what is “wrong” with regard to quality health care. The study and analysis of health care are important to maintain a level of quality that is satisfactory to all parties involved. As a result of the current focus on patient safety, and in an attempt to reduce deaths and complications, providing the best quality health care while maintaining cost controls has become a challenge to all involved. Current quality initiatives are multifaceted and include government-directed, private sectorsupported, and consumer-driven projects.
This chapter explores the historical development of health care quality including a review of the important pioneers and the tools they developed. Their work has been studied, refined, and widely used in a variety of applications related to performance-improvement activities. Risk management is discussed, with emphasis on the importance of coordination with quality activities. The evolution of utilization management is also reviewed, with a focus on its relationship to quality management.
In addition, this chapter explores current trends in data collection and storage, and their application to improvements in quality care and patient safety. Current events are identified that influence and provide direction to legislative support and funding. This chapter also provides multiple tips and tools for both personal and institutional use.
DATA QUALITY
Data quality refers to the high grade, superiority, or excellence of data. Data quality is intertwined with the concept of.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
1. Figure 1
Measuring Health Care Quality
Carolyn M. Clancy, MD
Director
U.S. Agency for Healthcare Research and Quality
for
KaiserEDU.org
May 2008
Return to tutorials
2. Figure 5
Health Care Quality
Varies A LOT; NOT clearly related to $$ spent
Matters – can be measured and improved
Measurement science is evolving:
– Structure, process and outcomes
– Broad recognition that patient experience is essential
component
Strong focus on public reporting
– Motivates providers to improve
– Not yet ‘consumer friendly’
Return to tutorials
3. Figure 6
70 Million Americans Benefit
from Quality Measurement
96% of heart attack victims were
prescribed beta-blocker treatment in
2005, up from 62% in 1996*
77.7% of children enrolled in private
health plans received all
recommended immunizations, up
5% from 72.5% in 2004*
Evidence-based guidelines from
the American College of Cardiology
and the American Heart Association
have reduced mortality among
patients who have had a heart
attack
* National Committee for Quality Assurance Return to tutorials
4. Figure 7
AHRQ’s National Reports
on Quality and Disparities
New editions available
– New efficiency chapter
– Disability data added
– More on health literacy
Return to tutorials
5. Figure 8
2007 National Reports: Some Good
News, Need for Improvement
The rate of improvement in quality
between 1994 and 2005 was 2.3%,
down from 3.1% from 1994-2004
More than 60% of the disparities in
quality of care have stayed the same or
worsened for Blacks, Asians and the
poor, and approximately 56% of
disparities have not improved for
Hispanics
For Blacks, Asians, Hispanics and poor
populations, about half of the core
measures of quality used to track
access to care are improving
Return to tutorials
6. Figure 9
Uninsurance is a Major Barrier to
Reducing Disparities
Uninsured individuals do Better
100% Same
worse than privately 1 Worse
insured individuals on
almost 90% of quality
75%
measures
Uninsured individuals do
worse than privately 50%
insured individuals on all
access measures
25%
0
s
ity es
Q ual ) c c M)
A R
RM
2007 National Healthcare Disparities Report, AHRQ (9C (6C Return to tutorials
7. Figure 10
Overall Scope
Patients receive the proper diagnosis and
treatment only about 55% of the time*
Overall, disparities in health care quality and
access are not getting smaller **
Total health care expenditures in 2006 totaled
$2.1 trillion (16% of GDP) and are projected to
reach $4.1 trillion (19.6% of GDP) by 2016***
* McGlynn E, Asch S, et al. The Quality of Health Care Delivered to Adults in the United States
N Engl J Med 2003;348:2635-45.
** AHRQ 2007 National Healthcare Disparities Report
*** National Health Expenditure Accounts
Return to tutorials
9. Figure 12
Why?
The “why” is a systems challenge:
– The U.S. has extremely talented and
qualified health care professionals who
have not been trained to work in teams
– The delivery system is fragmented, so
information doesn’t follow patients as
they move from hospitals to other sites
of care
– Payment is quality neutral
Light Figure Fragment
Craig A. Kraft
Washington, DC
Return to tutorials
10. Figure 13
There Are Major Opportunities
for Improvement: Examples
Uptake of health information
technology, while still relatively
slow, is gaining traction
Growing focus on comparative
effectiveness research
HHS Secretary Michael
Leavitt’s Value-Driven Health
Care Initiative
Downtown USA
– Chartered Value Exchanges Alejandra Vernon
– National Learning Network
Return to tutorials
11. Figure 14
Emerging Methods in
Comparative Effectiveness & Safety
A series of 23 articles by AHRQ
researchers on new approaches
in comparative effectiveness
methods are compiled in a special
October edition of Medical Care
A valuable new resource for
scientists committed to advancing
the comparative effectiveness and
safety research
The Resource Center in Oregon
led the development process,
helped draft the document and
manage work groups, and
handled public comment
Source: http://effectivehealthcare.ahrq.gov/reports/med-care-report.cfm Return to tutorials
12. Figure 16
Role Of IT In Reducing
Medical Errors
Percent who say… Have you or a family member ever
created your own set of medical
records to ensure that you and all
The coordination among the of your health care providers have
different health professionals 69% all of your medical information?
that they see is a problem
Yes
They have seen a health care
32%
professional and noticed that
48%
they did not have all of their
medical information
They had to wait or come back
for another appointment 1%
32%
because the provider did not Don’t
have all their medical know
information No
67%
Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality / Harvard School of Public Health National Survey
on Consumers’ Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 – September 5, 2005). Return to tutorials
13. Figure 17
Personal Experience
Have you been personally involved Did the error have serious health
in a situation where a preventable consequences, minor health
medical error was made in your own consequences, or no health
medical care or that of a family consequences at all?
member?
Yes Serious health
21% consequences
34%
No
Minor health
65% 10% consequences
3% No health
consequences
1% Don’t
Know
Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality / Harvard School of Public Health National Survey on
Consumers’ Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 – September 5, 2005). Return to tutorials
14. Figure 18
Guidelines & Measures
More emphasis needs to be placed
on what’s most important
Identifying what
We measure Rather Than counts and
what we can determining how
it can be measured
Return to tutorials
15. Figure 19
Guidelines Measures
Incentives
“You can get 60% of the improvement from 15% of the
change”
Don Berwick
Where should the busy primary care practice begin?
Where should policy makers target their incentives?
To changes that:
Produce the greatest benefit
Address the biggest quality gap
Can be implemented most easily, cheaply and safely
Return to tutorials
16. Figure 20
Reconciling Guidelines
and Quality Measures
Developing guidelines that address a wide range of needs…
Low-Risk Patients
Higher Risk Patients
Return to tutorials
17. Figure 21
Challenges in Addressing
Multiple Conditions
Interactions
between illnesses
Multiple Interactions between
medications treatments
Multiple providers Tension between
therapeutic goals
Return to tutorials
18. Figure 22
Setting Priorities for Patients
with Multiple Conditions
Address the need for clinicians to set
priorities, weighing the benefits and burdens
of increasingly complex medical regiments
Make sure guidelines keep up with unique
issue of treating older and more frail patients
Return to tutorials
19. Figure 23
“Patient-Centered” Guidelines
If care is to be patient
centered, guidelines
need to reflect this goal
– Quality measures
must accommodate
differences in:
Patient values
Patient preferences
Return to tutorials
20. Figure 24
What Level of Collaboration
Is Practical?
Globalize the evidence, localize the decision-making
Guidelines may need to reflect local values, disease
burdens, priorities and resources
BUT WE NEED TO SHARE…
Information on how to develop clear and practical
guidelines
Evidence on barriers and facilitators to implementing
guidelines
Evidence about integration of guidelines in electronic
health records
Return to tutorials
21. Figure 25
The Goal
Historically, the focus
has been on structure
In recent years, there
has been more interest
in process – the right
care
Tomorrow’s goal?
Outcomes and end
results
Return to tutorials
22. Figure 26
The Information Exists
Information on topics including guidelines,
measures, incentives and outcomes are available
for a wide range of uses. Included is information
about:
– Hospitals: Hospital Compare
– Nursing Homes: Nursing Home Compare
– Health Plans: National Committee for Quality Assurance
– Various Health Care Organizations: Quality Check ®
Return to tutorials
23. Figure 27
CBO Report on
Comparative Effectiveness
Congressional Budget Office
Report:
Discusses several
mechanisms for organizing
and funding additional
comparative effectiveness
research efforts
Reviews the different types of
research that could be
pursued and the likely
benefits and costs
Considers the potential
effects that such research
could have on health care
spending
Return to tutorials
24. Figure 28
Reasons for Optimism
Multiple stakeholders are working together
– AQA & HQA established the Quality Alliance Steering
Committee to promote quality measurement,
transparency and improvement in care
There is clear recognition that there should
be one set of measures
– A move is underfoot toward real standardization
across agencies and organizations
A shared sense of urgency exists on
improving patient outcomes, workforce
productivity and costs
– The National Quality Forum is bringing stakeholders
together to establish priorities for moving forward
Return to tutorials
25. Figure 29
Future Opportunities
The primary opportunity
involves patients
– We will not improve
chronic illness care
without active, informed
patients
– Patients as shoppers
– Women are key
Return to tutorials
26. Figure 30
This is not a Political Issue,
It’s a Practical Issue
Quality and access
are linked
Quality will be a major
theme of multiple
reform proposals
Quality is central to
getting better value for
what we’re spending
on health care
Return to tutorials
27. Figure 31
21st Century Health Care
Improving quality by promoting a culture of safety
through Value-Driven Health Care
Information-rich, patient-
focused enterprises
Information and
Evidence is evidence transform
continually refined 21st Century interactions from
as a by-product of Health Care reactive to
care delivery proactive (benefits
and harms)
Actionable information available – to
clinicians AND patients – “in real time”
Return to tutorials
28. Figure 32
Measuring Health Care Quality
AHRQ Mission
To improve the quality, safety,
efficiency, and effectiveness of
health care for all Americans
AHRQ Vision
As a result of AHRQ's efforts,
American health care will provide
services of the highest quality, with
the best possible outcomes, at the
lowest cost
http://www.ahrq.gov
Return to tutorials
29. Figure 33
Resources
To learn more about health care quality, visit these websites:
Agency for Heathcare Research and Quality,
http://www.ahrq.gov/
Quality of Care, Reference Library, KaiserEDU.org
http://www.kaiseredu.org/topics_reflib.asp?id=139&parentid=70&rID=1
The Commonwealth Fund,
http://www.commonwealthfund.org/topics/topics_list.htm?attrib_id=15312
Institute for Healthcare Improvement,
http://www.ihi.org/ihi
National Committee on Quality Assurance,
http://www.ncqa.org/
Robert Wood Johnson Foundation,
http://www.rwjf.org/pr/topic.jsp?topicid=1053
Return to tutorials
Editor's Notes
We know that health care quality varies a great deal and is not clearly related to the amount of money spent on health care. In fact, some regions where health care spending is higher have poorer quality of care. We’re getting much smarter about how to measure quality and how to improve it. Traditionally we have thought about measuring quality in terms of the structures of care (for example, the people who provide care and the facilities where that care is provided) the processes of care (such as what types of services are offered) and the outcomes…that is to say the end results that patients experience and care about. There has been a strong focus in recent years on public reporting on selected aspects of quality of care. There are many report cards nationally and at the state level on selected aspects of care. By and large, this has been a positive development. Providers have been motivated to improve. It’s very fair to say it’s not yet very easy to understand for most consumers, including me.
For the past 10 or 15 years, health plans have been reporting voluntarily on selected aspects of quality of care. What we’ve seen from that experience is steady improvement over time. If you begin to calculate what this means we know that 96% of heart attack patients received a treatment in a form of a beta blocker drug which is associated with a subsequent decreases in overall mortality and that’s up from 62% 10 years ago. Almost 80% of children enrolled in private health plans received almost all recommended immunizations. That is up 5% from 2004 We’ve also seen that evidence-based guidelines from the professional organizations in cardiology have significantly reduced overall death rates among patients who have had a heart attack.
Every year, the Agency for Health Care Research and Quality reports to the Congress on how we’re doing in quality of care and disparities in health care. The covers of these two reports for 2007 are shown here.
Our most recent report showed some good news, as well as some need for improvement. For all populations and all setting of care, overall improvement went up 2.3 %, which is down from the previous year. That is to say the rate of improved slowed. However, what we saw is that 60% of disparities in care and in quality have stayed the same or gotten worse for blacks, Asians and the poor and approx. 56% of disparities have not improved for Hispanics. In addition to that, for these same populations, about half of the core measures used to track access to care are actually improving.
It stands to reason and it’s actually true that people who don’t have insurance tend to do worse than privately insured individuals on almost 90% of quality measures. That makes a great deal of sense. We can’t get to quality of care for everyone until we get to a point where uninsurance is something we no longer have to count.
In general terms, we know from a ground-breaking study published almost 5 years ago that using a very large and robust set of measures, overall, Americans receive proper diagnosis and treatment a little over half the time. We also know from our annual reports on disparities that disparities in health care quality and access. That is to say, differences in quality of care associated with patient race, ethnicity, income and education are not getting smaller and at the same time, what we’re spending on health care continues to increase very steadily. So we’re not getting the full return on investment in health care that we could get.
So that’s the “what” of quality care. All of these descriptions I’m giving you a much more important question…
… which is “why?” We’ve got terrific facilities here in the U.S., very well-trained professionals, so what’s going on here. What’s very clear from numerous reports from the Institute of Medicine and others, is that we haven’t begun to think and implement a health care delivery system. Health care delivery remains very fragmented, and what that means is that information doesn’t necessary easily follow individual patients as they move from one point of care another. And at best, how we pay for care is quality neutral. In other words, we don’t pay for value or quality, we pay for volume. If you do more things, you get more money.
So there are major opportunities for improvement that we’re seeing on the horizon that give us cause for great optimism. It’s very clear that we’re not going to close the gap between best possible care and the care that’s routinely provided without using health IT. Now the uptake for health information technology, including computerized records, has been relatively modest but it is growing steadily over time. In addition to that, there is a growing focus and interest on what is called comparative effectiveness research understanding when there are two or more options to treat a particular condition, which options are best for which patients. And a focus on value has been a strong focus of health and human services for the past several years, working very collaboratively with the private sector.
As more and more parts of the health delivery system make investments in health IT, there’s going to be huge opportunity to take advantage from the data that are generated that as a byproduct of providing care to give us good information about which treatments are most effective for individual patients under specific circumstances. To do that well, we’re going to need continued improvements in the methods we use to take advantage of all of these data. That has been a very strong focus of the work at AHRQ in comparative effectiveness.
In terms of the importance of information technology, several years ago, the agency partnered with the Kaiser Family Foundation to ask patients what they saw as a result of the poor flow of information in health care and what you see here is what patients told us. Most strikingly, when asked the question, have you and your family member created your own set of medical records to ensure that you and all of your health care providers have all the right information, 1/3 of the patients said yes. We were quite stunned by that. Similarly, 70% said the coordination among different health care professionals they see is a problem. So clearly there are opportunities to improve how information can follow patients as they move from one point of care to another.
When asked about issues related to medical errors, almost 1/3 of patients said they had been in a situation where preventable medical error was made in their own medical care or that of a family member. Of those patients, 21% said that there were serious health care consequences involved. So there’s a huge opportunity to improve patient safety as well.
What’s very, very clear is that we need to continually improve measuring quality from an exercise that focuses on what’s easy to measure to one that focusing on what’s important. Focusing on the what are the most important priorities to improve the health of the American people.
We know that right now there are literally hundreds of measures out there and what many professionals are struggling with is what are the most important measures. If we’re going to make policies that reward delivery of higher quality of care, which measures should we be using. What’s clear is that we need to identify which measures produce the greatest improvements in patient’s health, which addresses the greatest gaps in quality of care, and which can be the most easily implemented so they can be a part of the routine delivery on care.
Most quality measures that are used now derive from clinical practice guidelines that are most often developed by professional organizations, medical professional organizations, nursing and so forth. It’s also clear that there needs to be a tighter link between the guidelines that specify how care should be provided under certain circumstances with the measures that tell us whether in fact those recommendations were followed. In addition to that, if you’re going to be focusing on improving care, you want to make sure the guidelines in quality measures address the patients, for whom there’s the greatest opportunity for improvement-those at the highest risk for poor quality.
One of the growing challenges for our heath care system overall is the challenge of people with multiple chronic illnesses. And the reason this is so important as these people often, they see multiple providers, take multiple medications, which means there is a potential for not only interactions between illnesses but also potential interaction between treatments and sometimes in actually tensions between therapeutic goals. Now beyond showing you pretty overlapping circles, this becomes incredibly important and it says to me that the greatest opportunity for developing better quality measures is going to be to address the needs of complex patients with multiple chronic illnesses. To a large extent, this remains a future tense activity.
What’s clear is that clinicians today need to set priorities for patients with multiple chronic conditions. It's very clear that if we’re going to be supporting and improving health care, we need to make sure that the guidelines and measures keep up with the needs of patients with multiple complex conditions.
What this means in essence is the guidelines themselves need to be patient-rather than disease-focused. By that, I mean the quality measures and outcomes of guidelines need to accommodate differences in what patients value and in what they prefer. Some patients do not want surgery ever under any circumstances, if it can be avoided. Others are willing to do so if it means stop taking medicines. We have the science to be able to accommodate those preferences.
One of the questions that comes up all the time is that, are guidelines and measures actually mandates or are they guidance to practice? What’s clear is that we have room to go in terms of make sure guidelines are actually practical tools in the delivery of care everyday. It’s also clear that guidelines need to be flexible enough so that the individual needs of patients who are very unique can be accommodated and the capacity of local communities can also be accommodated. We also know that there is a great deal of opportunity to continue to work to integrate practice guidelines into electronic health records so they’re routinely available at the point of care when clinicians and patients are making decisions together.
The goal of measuring and assessing quality is ultimately to get to the outcomes and results that people experience and care about. Historically we focused on structure; for example, are there fire extinguishers in the hospital, do we have the right facilities in the operating room, and so forth. In the past 10-15 years there’s been a lot more focus on process. Are we doing the right thing? Where we ultimately need to get to is, are the end results what we want?
We know right now that you can go and search for information on quality. The Hospital Compare website provides a growing array of information on quality of care in hospitals. Similarly, there are sites that give you information on nursing homes, health plans, and various other health care organizations shown here on this slide.
Now the Congressional Budget Office, interestingly enough, as they look to the future and understand the implications of rising health care costs for the federal budget, have become increasingly interested in comparative effectiveness research because they understand if we’re going to get more value in return for our substantial investments in health care, then we need to make sure that we’re matching the science that’s available to the care that patients get.
One of the reasons I’m optimistic, even though we have so many opportunities for improvement, is that over the past 5 years we’ve seen a growing recognition among multiple stakeholders that we can only improve quality of care if we’re using common, consistent measures that are valid and based on the best sense of science; and that we share a sense of urgency on helping patients getting the best care possible.
The future opportunities I see on the horizon are, first and foremost, giving patients information that they can understand so they can become an effective part of the health care team as well. We will not improve chronic illness care dramatically without the help of active informed patients. We know that a proportion of patients are increasingly interested in knowing which health care facilities and practitioners are best equipped to meet their needs. We expect that women are likely to be taking the lead here more than men because they are often the people who make health care decisions on their own behalf and on behalf of their families.
At the end of the day, this is not a political issue-it’s a highly practical issue that has great importance to all of us. We can’t get to quality of care for everyone unless we’ve got access to care for everyone. Conversely, getting access to care for everyone without knowing the quality of that care is likely to put a lot of stresses on a system that’s already stressed. It may not get us the results we want. It’s my hope and expectation that a focus on quality is likely to be a very major theme of multiple proposals to reform our health care system and it is clearly central to getting better value for what we’re spending on health care.
At the end of the day where I think we need to be going for 21st century health care is to get to an enterprise that is information-rich but patient-focused. What I mean by that is by having information that is based on the best science available at the point of care. We can actually transform the enterprise of providing health care from one that is currently reactive to one that’s proactive that anticipates individual’s needs and actually is able to give them information about benefits and harms of potential treatments customized to their own individual circumstances. That actionable information has to be available to clinicians and patients in real time, in the same way that if you logged on to amazon.com, it give you information that is helpful to you right now, not 6 months from now. That same infrastructure can also give us the capacity to refine and improve evidence as a byproduct of care delivery so that we are continually doing a better job of making sure patients get the best care possible.
Our job at AHRQ is to improve the safety, quality, efficiency and effectiveness in health care for all Americans. Our highest aspiration is that as results of our efforts, American health care will provide services of the highest quality, with the best possible outcomes, at the lowest possible cost.