This document discusses quality measurement and improvement in healthcare. It covers the role of information technology (IT) and informatics in measuring and improving healthcare quality. While IT has potential to enhance quality data, the impact on outcomes is mixed. Barriers include issues with some quality measures, challenges for specific provider types, and ethical concerns. Overall, effectively utilizing IT requires substantial effort and the healthcare system must continuously learn and improve to achieve high performance.
Policy Implications of Healthcare Associated InfectionsAlbert Domingo
On February 19, 2014 at the Ateneo School of Medicine and Public Health in Pasig City, Dr. Albert Domingo presented an introduction to the economic impact of healthcare associated infections (HAIs) as well as related concepts in health policy and management. The speaker discussed common approaches taken to ascertain the economic impact of HAIs, followed by factors/considerations in Philippine health policy and management that must be understood and adjusted in order to minimize HAIs.
The Importance of measuring outcomes, including Patient Reported Outcome Measures (PROMS)
BAOT Lifelong Learning Event
10 November 2010
Dr Alison Laver-Fawcett
Head of Programme, BHSC(Hons) Occupational Therapy
York St John University
An Introduction Patient Reported Outcome Measures (PROMS)Keith Meadows
An introduction to the key concepts of patient Reported Outcome Measures, including reliability and validity, generic versus disease specific,selection criteria and their adaptation for different cultural groups.
What does the public think about assigning priority to end-of-life treatment? In this presentation, OHE's Koonal Shah describes the results of research intended to tease out both preferences and, where possible, the reasoning behind them. The findings may surprise some -- for example, that priority is not given to end-of-life treatments when the treatments they would supplant offer greater health gains.
Policy Implications of Healthcare Associated InfectionsAlbert Domingo
On February 19, 2014 at the Ateneo School of Medicine and Public Health in Pasig City, Dr. Albert Domingo presented an introduction to the economic impact of healthcare associated infections (HAIs) as well as related concepts in health policy and management. The speaker discussed common approaches taken to ascertain the economic impact of HAIs, followed by factors/considerations in Philippine health policy and management that must be understood and adjusted in order to minimize HAIs.
The Importance of measuring outcomes, including Patient Reported Outcome Measures (PROMS)
BAOT Lifelong Learning Event
10 November 2010
Dr Alison Laver-Fawcett
Head of Programme, BHSC(Hons) Occupational Therapy
York St John University
An Introduction Patient Reported Outcome Measures (PROMS)Keith Meadows
An introduction to the key concepts of patient Reported Outcome Measures, including reliability and validity, generic versus disease specific,selection criteria and their adaptation for different cultural groups.
What does the public think about assigning priority to end-of-life treatment? In this presentation, OHE's Koonal Shah describes the results of research intended to tease out both preferences and, where possible, the reasoning behind them. The findings may surprise some -- for example, that priority is not given to end-of-life treatments when the treatments they would supplant offer greater health gains.
Improving Outcomes for Unfunded Cardiac Patients: A Team Approach
Joe Garcia DNP, RN
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
Mobility is Medicine
Loretta Schoen Dillon, PT, DPT, MS
Director of Clinical Education and Clinical Associate Professor
UTEP Physical Therapy Program
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
OHE’s Professor Nancy Devlin has researched, written and spoken widely on the use of the EQ-5D, and related measures, both in her capacity as the Director of Research at the OHE and as Chair of the Executive Committee of the EuroQol Group.
In May, Nancy was invited to participate in the “Workshop on measuring patient-reported outcomes using the EQ-5D”, which was organised by the Swedish National Board of Health and Welfare in collaboration with the EuroQol Group. The workshop brought together policy makers and researchers in Sweden interested in measuring patients’ health outcomes.
Sweden has included the EQ-5D in some of its quality registries and in population health surveys for many years. The Swedish National Board of Health and Welfare now is exploring whether and how to extend use of patient reported outcomes measures in the health care system, including the EQ-5D, to both monitor the quality of providers and services and to facilitate health technology appraisal.
Nancy’s talk, shown below, introduced the EQ-5D instrument; discussed how data from it can be analysed; identified some of the challenges in analysis; and commented on the future of outcomes measurement.
DASH - does arthritis self-management help?epicyclops
This lecture was given by Dr Marta Buszewicz, General Practitioner from North London and Senior Lecturer in Community Based Teaching & Research at UCL, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Her lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Guidelines - what difference do they make? A Dutch perspectiveepicyclops
This lecture was given by Dr Raymond Ostelo of the EMGO Institute, VU University Medical Center, Amsterdam, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. His lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Determinants of Fall Risk and Injury in Hispanic Elderly Living in El Paso Community
Guillermina Solis, PhD, RN, F/GNP
Vanessa Guerrero, RN
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
> Why HEOR?
> Costs, Consequences and Perspectives
> Key Stakeholders in HEOR
> What is Health Economics and Pharmaco-economic Research?
> Economic Evaluations
> Incremental Cost Effectiveness Ratio (ICER)
> Concept of HRQoL
> Comparative Effectiveness Research (CER)
> Pragmatic Clinical Trials
> Observational Studies
> Systematic Reviews and Meta-Analysis
> Application of CER
> Health Technology Assessment (HTA)
> Real World Evidence (RWE)
> Patient Reported Outcomes (PROs)
> Patient Focused Drug Development (PFDD)
> Application of Health Economic Evaluations
> Challenges and Barriers
The scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice and hence improve the quality and effectiveness of health services
What is implementation science and why should you careLisa Muldrew
This seminar will discuss the emerging field of implementation science with a focus on its application within clinical settings. Topics will include an overview of implementation science, how implementation science is positioned within the translation continuum, common conceptual models and analytic frameworks used in implementation science and a study example.
Partial and Incremental PCMH Practice Transformation: Implications for Qualit...Paul Grundy
Experience of BCBS Michigan in Building medical homes
Based on the observed relationships for partial implementation,full implementation of the PCMH model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults. Full PCMH implementation is also associated with a 12.2 percent higher preventive composite score, but no reductions in costs for pediatric populations. Incremental improvements in PCMH model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population.
Conclusions. Estimated effects of the PCMH model on quality and cost of care
appear to improve with the degree of PCMH implementation achieved and with incremental improvements in implementation.
Improving Outcomes for Unfunded Cardiac Patients: A Team Approach
Joe Garcia DNP, RN
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
Mobility is Medicine
Loretta Schoen Dillon, PT, DPT, MS
Director of Clinical Education and Clinical Associate Professor
UTEP Physical Therapy Program
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
OHE’s Professor Nancy Devlin has researched, written and spoken widely on the use of the EQ-5D, and related measures, both in her capacity as the Director of Research at the OHE and as Chair of the Executive Committee of the EuroQol Group.
In May, Nancy was invited to participate in the “Workshop on measuring patient-reported outcomes using the EQ-5D”, which was organised by the Swedish National Board of Health and Welfare in collaboration with the EuroQol Group. The workshop brought together policy makers and researchers in Sweden interested in measuring patients’ health outcomes.
Sweden has included the EQ-5D in some of its quality registries and in population health surveys for many years. The Swedish National Board of Health and Welfare now is exploring whether and how to extend use of patient reported outcomes measures in the health care system, including the EQ-5D, to both monitor the quality of providers and services and to facilitate health technology appraisal.
Nancy’s talk, shown below, introduced the EQ-5D instrument; discussed how data from it can be analysed; identified some of the challenges in analysis; and commented on the future of outcomes measurement.
DASH - does arthritis self-management help?epicyclops
This lecture was given by Dr Marta Buszewicz, General Practitioner from North London and Senior Lecturer in Community Based Teaching & Research at UCL, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. Her lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Guidelines - what difference do they make? A Dutch perspectiveepicyclops
This lecture was given by Dr Raymond Ostelo of the EMGO Institute, VU University Medical Center, Amsterdam, to the North British Pain Association Spring Scientific Meeting in Edinburgh on Friday 18th May, 2007. His lecture forms part of a conference "Blurring the Boundaries - Managing Pain in Primary Care and Secondary Care".
Determinants of Fall Risk and Injury in Hispanic Elderly Living in El Paso Community
Guillermina Solis, PhD, RN, F/GNP
Vanessa Guerrero, RN
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
> Why HEOR?
> Costs, Consequences and Perspectives
> Key Stakeholders in HEOR
> What is Health Economics and Pharmaco-economic Research?
> Economic Evaluations
> Incremental Cost Effectiveness Ratio (ICER)
> Concept of HRQoL
> Comparative Effectiveness Research (CER)
> Pragmatic Clinical Trials
> Observational Studies
> Systematic Reviews and Meta-Analysis
> Application of CER
> Health Technology Assessment (HTA)
> Real World Evidence (RWE)
> Patient Reported Outcomes (PROs)
> Patient Focused Drug Development (PFDD)
> Application of Health Economic Evaluations
> Challenges and Barriers
The scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice and hence improve the quality and effectiveness of health services
What is implementation science and why should you careLisa Muldrew
This seminar will discuss the emerging field of implementation science with a focus on its application within clinical settings. Topics will include an overview of implementation science, how implementation science is positioned within the translation continuum, common conceptual models and analytic frameworks used in implementation science and a study example.
Partial and Incremental PCMH Practice Transformation: Implications for Qualit...Paul Grundy
Experience of BCBS Michigan in Building medical homes
Based on the observed relationships for partial implementation,full implementation of the PCMH model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults. Full PCMH implementation is also associated with a 12.2 percent higher preventive composite score, but no reductions in costs for pediatric populations. Incremental improvements in PCMH model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population.
Conclusions. Estimated effects of the PCMH model on quality and cost of care
appear to improve with the degree of PCMH implementation achieved and with incremental improvements in implementation.
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 ...
Clinical Journal of Oncology Nursing • Volume 18, Number 2 .docxbartholomeocoombs
Clinical Journal of Oncology Nursing • Volume 18, Number 2 • Evidence-Based Practice 157
The Iowa Model of Evidence-Based Practice to Promote
Quality Care: An Illustrated Example in Oncology Nursing
Carlton G. Brown, PhD, RN, AOCN®, FAAN
Evidence-based practice (EBP) improves the quality of patient care and helps control
healthcare costs. Numerous EBP models exist to assist nurses and other healthcare
providers to integrate best evidence into clinical practice. The Iowa Model of Evidence-
Based Practice to Promote Quality Care is one model that should be considered. Using
an actual clinical example, this article describes how the Iowa Model can be used
effectively to implement an actual practice change at the unit or organizational level.
Carlton G. Brown, PhD, RN, AOCN®, FAAN, is the director of Professional Services at the Oregon Nurses
Association in Tualatin. The author takes full responsibility for the content of the article. The author did not
receive honoraria for this work. No financial relationships relevant to the content of this article have been
disclosed by the author or editorial staff. Brown can be reached at [email protected], with copy to
editor at [email protected]
Key words: evidence-based practice; research; decision making
Digital Object Identifier: 10.1188/14.CJON.157-159
N
urses understand that evidence-
based practice (EBP) improves the
quality of patient outcomes while
controlling the cost of healthcare (Mel-
nyk, Fineout-Overholt, Gallagher-Ford, &
Kaplan, 2012). But even in the year 2014,
barriers and roadblocks exist to imple-
menting EBP at the bedside or chair side.
The Institute of Medicine estimated that
it takes more than 17 years to implement
a research finding into clinical practice
(Institute of Medicine, 2001). Although
research may exist that should be trans-
lated into practice, the time it takes to
deliver these research-based interventions
to patients takes too long. In their study
of 1,054 RNs, Melnyk et al. (2012) discov-
ered that although nurses value EBP, they
required education, access to information,
and time to implement EBP into daily prac-
tice. Nurses and other healthcare provid-
ers want their practice based in evidence,
but they also acknowledge the barriers
of lack of education and time to actually
implement and use EBP.
EBP is a problem-solving approach to
clinical decision making that integrates
the best evidence from well-designed
studies with a clinician’s expertise along
with patients’ preferences and values
(Melnyk et al., 2012). Numerous EBP
models are available to help nurses orga-
nize and systematically track progress in
implementing evidence into practice, in-
cluding the Stetler Model of Research Uti-
lization (Stetler, 2001), the Iowa Model of
Evidence-Based Practice to Promote Qual-
ity Care (hereafter referred to as the Iowa
Model) (Titler et al., 2001), and the Johns
Hopkins Nursing Model (Newhouse, Dear-
holt, Poe, Pugh, &.
Diabetic Care
Lanetra Evans-Shelton
Walden University
Nursing 6052- Dr. Smith
Essentials of Evidence-Based Practice
Diabetic Care
Introduction
The organization I am affiliated with is a correctional facility. It houses over 300 detainees with some being newly diagnosed diabetics. The officers need training because the facility doesn’t have 24-hour nursing and they are responsible for letting the detainees check their blood sugar levels at night and providing snacks. There is increasing interest in quality improvement strategies to improve diabetic management.
The purpose is to provide ongoing preventive care through new activities which will allow us to identify and interfere in the advancement of diabetes while in jail.
The current problem is over half the time the nurses are unaware of the people who have diabetes unless they puts in a medical request which sometimes takes days. The jail has an intake process of getting booked into jail but does not have a medical intake process. And that’s a big change that needs to happen. The stakeholders who needs to be part of the design and implementation for it to make a difference are the quorum courts, the Sherriff, and the Jail’s Chief Administrator. The risk associated with the change is jail administration have no standard strategies to follow when implementing something new..
Proposal
Patients with a diagnosis of diabetes should have a complete medical history and physical examination by a licensed health care team member in a timely manner. Goals should be individualized depending on the situation. This should be documented in the patient's record and communicated to all persons involved in his/her care, including security staff.
The necessity of the change must be acknowledged and acceptable. Staff must be trained for the new procedures. A training curriculum must explain the role, its technical procedures, its strengths and weaknesses, legal requirements, and professional relationship standards. The success of this project prompts conversation with the major, chief and the sheriff. With the organizational adaption and staff involvement the implementation of the change should be successful (Melnyk & Fineout-Overholt, 2018).
People with diabetes should obtain care that meets national standards. Being incarcerated does not change these standards. Patients must have right to medication and nutrition needs to manage their disease. In patients who do not meet treatment goals, medical and behavioral plans should be adjusted by health care providers in collaboration with the prison staff (Worswick, Wayne, Bennett, Fiander, Mayhew, Weir, & Grimshaw, 2013).
It is critical for correctional facilities to identify patients in need of more intensive evaluation and therapy, including pregnant women, patients with advanced complications, a history of repeated severe hypoglycemia, or recurrent DKA (ADA, 2011).
Outcomes
Critical Appraisal Summary
Diet and physical activity ...
American Heart Association Lifestyle Recommendations to Reduce.docxjesuslightbody
American Heart Association Lifestyle Recommendations to Reduce Obesity
Jane Doe
University
Project and Practicum
Summer 2022
Abstract
The prevalence of obesity and sedentary lifestyle complications are increasing at alarming rates, representing a common but preventable cause of severe medical complications like diabetes, cardiovascular diseases, and early mortality. This chronic condition has been for a long time a public health concern and social determinant. The Fitbit app offers a unique opportunity to enhance the efficacy of weight loss plans as it is used to track activity, monitor steps, heart rate, energy expenditure, sleep, and sedentary behavior. The integrative review focused on how the American Heart Association (AHA) Diet and Lifestyle recommendations and the Fitbit app are used as innovative solutions to reduce obesity in adult patients.
Research Methodology: A systematic review was conducted to identify research articles completed in the preceding 4-5 years centered on obesity care, diet, physical activity, activity trackers, and lifestyle implications.
Results and Discussion: The databases searched were Chamberlain Library, PubMed, and CINHAL. Initial searches yielded over 2000 articles, of which 45 were chosen and examined because they fit the integrative review's theme. The 15 papers most relevant to the PICOT question were studied in further detail and appraised using the Johns Hopkins Evidence Appraisal table. The studies reported positive physical activity outcomes.
Conclusions and Further Recommendations:This systematic review supported the effectiveness of the AHA Diet and Lifestyle recommendations to reduce obesity, and clinical use generalization is recommended. Fitbit app provides new ways to improve physical activity habits, and the easy availability of electronic devices may enhance their generalizability use.
Keywords: Obesity care; Obesity complications; Lifestyle recommendations; Obesity management; Physical activity intervention using Fitbit activity trackers.
Dedication
Thanks to my family for their unwavering support of this project; their cooperation means a lot to me. To my husband Armando, thank you for your love, understanding, and patience during this time. I credit my achievement to all of you for your unwavering love and belief in me.
Acknowledgments
First, I must acknowledge the help of all my professors who inspired, encouraged, and supported me throughout the DNP program. My heartfelt thanks to my teammates, without whom I would never have completed this phase in my life. Their encouragement has had a significant influence on my strong determination during this trip.
Contents
American Heart Association Lifestyle Recommendations to Reduce Obesity 1
Abstract 2
Introduction Error! Bookmark not defined.
Dedication 3
Acknowledgments 4
American Heart Association Lifestyle Recommendations to Reduce Obesity 6
Problem Statement 6
S.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Quality Measurement and Improvement Lecture 3_slides
1.
2. The Culture of Health Care
Quality Measurement and Improvement
Lecture c
This material (Comp 2 Unit 7) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award
Number 90WT0002.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
3. Quality Measurement and
Improvement
Learning Objectives
• Define health care quality and the major types of quality
measures: structural, process, and outcome measures
(Lecture a).
• Describe the current state of health care quality in the
United States (Lecture a).
• Discuss quality measures used in various health care
settings in the US, including those required for the
HITECH meaningful use program (Lecture b).
• Describe the role of information technology in measuring
and improving health care quality (Lecture c).
• Describe the results of current health care quality efforts
in the United States (Lecture c).
3
4. Role of IT and Informatics
• Need electronic data (IT) and means to understand it (informatics)
• Series of case studies demonstrate real-world use for quality
measurement and improvement (Fowles et al., 2008)
• Standards emerging for measures and their reporting
– Quality Reporting Document Architecture (QRDA) for quality reports
(Alschuler et al., 2007)
– Hospital Quality Measures Format (HQMF) for individual measures
(http://www.hqmf.org)
– eMeasures: Effort to “retool” 113 quality measures easy to extract from
EHR data and express in HQMF
o http://www.qualityforum.org/Projects/eg/eMeasures/Electronic_Quality_Meas
ures.aspx
4
5. Role of IT and Informatics
Continued
• In inpatient settings
– University HealthSystem Consortium (UHC) sites at HIMSS Analytics
Stage 4 or higher adoption have higher scores on quality measures
(HIMSS Analytics, 2006)
– “Most wired” hospitals more likely to have higher quality measures
(Weinstock 2015)
• Mixed results in outpatient settings
– Presence of EHR not correlated with better quality in treatment of
diabetes measures (Crosson et al., 2007) and general ambulatory
quality measures (Linder et al., 2007; Romano & Stafford, 2011)
– Targeted quality improvement does lead to better outcomes (Cebul et
al., 2011)
• Better quality “not automatic” and requires substantial effort (Baron,
2007)
5
6. Case Studies, Best Practices, and
Education Resources
• Institute for Healthcare Improvement
(ihi.org)
• American Society for Quality (ASQ.org)
• National Heart, Lung, and Blood Institute
(NHLBI.org)
• National Institutes of Health (NIH.org)
• AHRQ: Centers for Excellence and case
studies (CAHPS.AHRQ.org)
6
7. Resources for Quality-Related
Activities
• Systems and Tools
– Source systems: Clinical systems, EHRs, and so on
– Decision support systems
– Data warehousing, analytics, and reporting tools
• Organizational and executive support
– Data governance
– Quality activities
• Staffing
– All staff
– Information technology
o Analysts, application support, etc.
– Informatics: CNIO, CMIO
– Training and education of quality program and use of systems
7
8. Supporting the Advancement of
Health IT
• Health IT certification requirements
• Standards development organizations
– Example: http://www.HL7.org
• Integrating the Healthcare Enterprise (IHE)
• Commonwell Health Alliance
• Other industry resources
8
9. Demonstrating Effective Use of
Health IT
• HIMSS Davies Award of Excellence
winners
• HIMSS Analytics EMRAM model
• HIMSS Continuity of Care Maturity model
• HIMSS IT Value Suite
• KLAS Research
9
10. EHRs Can Augment Data Used in
Quality Measures
• Coded information in EHR
– Improves ability to assess diabetes quality measures (Tang, 2007)
– Administrative (or “claims”) data insufficient to calculate HEDIS
measures—EHR data can improve accuracy of calculating HEDIS
measures (Pawlson, Scholle, & Powers, 2007)
• But some measures are in narrative text that is harder to access
– In heart failure, important data inaccessible in clinical notes, especially
exclusion data for medications (Baker et al., 2007)
– Some data can be extracted by natural language processing (NLP) as
effectively as manual abstractors in areas such as smoking cessation
advice (Hazlehurst et al., 2005), diabetic foot exam (Pakhomov et al.,
2008), and congestive heart failure (CHF) (Pakhomov et al., 2008)
• Overall, EHR data quality is mixed for quality measurement;
important attributes to improve include are granularity, timeliness,
and comparability (Chan, Fowles, & Weiner, 2010)
10
11. Results of Current Approaches
• Does better performance on measures
lead to improved patient outcomes?
• What problems arise from current
approaches?
• Results in other countries, such as in
England
11
12. English Quality and Outcomes
Framework (QOF)
• P4P program that ties 25% of pay to 129 quality indicators
• Initial assumption In England was 75% achievement, but it ended up
being 97%, which increased costs (Doran et al., 2006)
– Most quality improvement occurred during pre-evaluation period and
has since leveled out (Campbell et al., 2009)
• Other findings of note
– Ability to exclude patients in measures has not led to “gaming” of
system (Doran et al., 2008)
– Major “unintended consequence” has been excess focus on EHR and
prompts for quality measures (McDonald & Roland, 2009)
– Gap for care in more “deprived” areas has been reduced (Ashworth,
Medina, & Morgan, 2009)
12
13. Better Performance on Measures
= Better Outcomes? Yes
• Patients choosing top-performing hospital or
surgeon had one-half mortality of those who
chose one in lowest quartile (Jha & Epstein,
2006)
• Participation in HQA associated with lower
mortality for MI, pneumonia, and CHF (Jha et al.,
2007)
• Adopting Leapfrog Group practices associated
with better quality and lower mortality for acute
MI (Jha et al., 2008)
13
14. Better Performance on Measures
= Better Outcomes? No
• Process measures in hospitals predict small differences in mortality
in MI, CHF, and pneumonia (Werner & Bradlow, 2006)
• CHF measures of ACC/AHA have little relationship to mortality or
rehospitalization rates (Fonarow et al., 2007)
• Participation of hospitals in MI P4P quality effort did not improve
quality of care or better outcomes (Glickman et al., 2007)
• Smoking cessation quality metric did not correlate with actual
smoking cessation (Reeves et al., 2008)
• Door-to-balloon measure for acute MI not correlated with other
quality measures or mortality (Wang et al., 2009)
• CMS heart failure measures not associated with better outcomes
(Patterson et al., 2010)
14
15. Effect of Public Reporting of
Quality
• Systematic review finds scant evidence for documented benefit in
quality of care (Fung et al., 2008)
• Combining public reporting with P4P improves performance on
measures, whereas reporting alone does not (Lindenauer et al.,
2007)
• US general internists support financial incentives for quality,
although they have concerns about public reporting, especially its
impact on incentive to care for sicker or more complex patients
(Casalino et al., 2007)
• Public report cards in Canada did not improve indicators for MI or
heart failure (Tu et al., 2009)
• Patients have difficulty understanding; better approach consists of a
framework and plain language (Hibbard, Greene, & Daniel, 2010)
15
17. Measurement Issues
• Elderly patients often have complex comorbidities that render
recommendations in guidelines (and performance measures) inappropriate
(Boyd et al., 2005)
– Experience to date in England (Doran et al., 2008) and US (Persell et al., 2010)
show most physician-recorded exceptions appropriate
• Medicare patients’ care dispersed among many physicians, so it’s hard to
attribute quality (Pham et al., 2007)
• New results in clinical trials can render some measures obsolete (e.g.,
lowering cholesterol, diabetes) (Krumholz & Lee, 2008)
• Some measures have unintended consequences, (e.g., time to first
antibiotic dose in pneumonia) (Wachter et al., 2008)
• Multiplicity of measures leads to conflict reports (e.g., in stroke care) (Kelly
et al., 2008)
• Most physicians don’t have large enough practice caseloads to reliably
measure differences (Scholle et al., 2008; Nyweide et al., 2009)
– Need to focus on multiple measures and all payers (Berwick et al., 2009)
17
18. Challenges for Certain Practice
Environments
• Small numbers in small hospitals can inflate
performance relative to large hospitals (O’Brien, DeLong,
& Peterson, 2008)
• “Safety-net” hospitals—ongoing funding and staffing
issues impact ability to provide quality care. Mission
could be adversely affected by P4P (Werner, Goldman,
& Dudley, 2008) and worsen already existing disparities
(Casalino et al., 2007)
• Small practices have limited time, multiple payers, and
low capital investment (Landon & Normand, 2008)
– Is it overly burdensome? (Vonnegut, 2007)
18
19. Ethical Issues
• Patient consent
– Treat as part of care or like research with human subjects protection
(Lynn et al., 2007; Snyder & Neubauer, 2007; Miller & Emanuel, 2008)?
• Not paying for preventable complications
– Some obvious (e.g., objects left in patients), others less so (e.g.,
ventilator-associated pneumonia) (Pronovost, Goeschel, & Wachter,
2008)
• Tensions between
– “Customers” and “purchasers” in US system (Milstein & Lee, 2007)
– “Needing to improve care and knowing how to do it” (Auerbach,
Landefeld, & Shojania, 2007)
– Physician internal motivations—not found to be adversely impacted in
one UK study (McDonald et al., 2007)
19
20. How Can We Achieve a “High-
Performance” Health Care System?
• Need a “learning” health care system (Olsen, Aisner, &
McGinnis, 2007)
– Must build infrastructure, including informatics, to learn what
works (Olsen, 2010; Friedman, 2010)
• Should be guided by principles (Shih et al., 2008)
– Patients have access to care and information but are also
accountable
– System must provide coordination of care and aim for
continuous learning and improvement
• Should we be thinking more of “value” than “quality?”
(Porter, 2010; Brook, 2010)
20
21. 2016 CMS Quality Strategy Goals
• Six priority goals
– Safer care
– Patient/family engagement
– Communication across care coordination
– Effective prevention and treatment of chronic
disease
– Healthy living best practices
– Affordable care
21
22. How to Achieve Quality
Strategy Goals?
CMS will:
• Measure and publicly report providers’ performance and
cost
• Provide technical assistance and foster learning
networks
• Adopt evidence-based National Coverage
Determinations
• Create incentives for quality and value
• Set quality standards for providers
• Create processes to evaluate quality improvement
22
23. Quality Measurement and
Improvement
Summary – Lecture c
• There is an important role for informatics
and IT in helping to measure health care
quality
• The research to date shows conflicting
results for quality improvement efforts
• There are also challenges in measuring
quality, particularly in certain practice
environments, as well as ethical issues to
resolve
23
24. Quality Measurement and
Improvement
Summary
• There are three major types of health care quality
measures: structural, process, and outcome measures
• Many different health care quality measures are used in
a variety of settings, from health plans to inpatient to
outpatient, including those that are part of the HITECH
meaningful use program
• Information technology has an important role in
measuring and improving health care quality
• The results of current health care quality efforts in the
United States show mixed successes and a number of
challenges
24
25. Quality Measurement and
Improvement
References – Lecture c
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33
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34
35. The Culture of Health Care
Quality Measurement and
Improvement
Lecture c
This material was developed by Oregon Health &
Science University, funded by the Department of
Health and Human Services, Office of the National
Coordinator for Health Information Technology
under Award Number IU24OC000015. This
material was updated in 2016 by Bellevue College
under Award Number 90WT0002.
35