Running head: QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 1 QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 6 Quality Improvement for Public Health Facilities Qualitative Research Methods Evaluation AIU ONLINE HLTH 335 1701A - 01 UNIT 2 IP The type of study in the four listed articles include the following. Article one by Chaudhry et al., (2006) was a qualitative study. The authors conducted a system review from expert opinion and literature review to determine the role that information technology had played in enhancing health care quality, efficiency and costs of medical care. The authors hypothesized that information technology had played a significant role in improving the quality of medical care by increasing adherence to medical guidelines, improving disease surveillance and decreasing medication errors. The type of study for the second article was also a qualitative study that examined 260 hospital on the issue of pay for performance strategy. The authors compared their results to other hospital that did not have the current nationwide pay for performance system, (Werner et al., 2010). The authors hypothesized that pay-for-performance system improved quality health care among hospitals in this system. The third article was also a qualitative study where the authors hypothesized that public reporting of hospital quality data and the pay for performance have emerged as the widely advocated tools for these that accelerate health facility’s improvement (Lindenauer et al., 2007). The fourth article was also a qualitative study article. The authors of the article hypothesized that the Keystone ICU project was associated with a significant decrease on the hospital mortality within Michigan as compared to the surrounding areas, (Lipitz-Snyderman, et al., 2011). Article one utilized data from published expert opinion and literature search from academic data bases. There was no direct involvement of the human subject when collecting data for this article. Article two utilized data from 260 hospitals. The authors chose acute care hospitals that began operating in 2004. The author’s excluded four critical-access hospitals. Researchers of the third article used 2490 health services providers nation-wide who met the criteria for Hospital Quality Alliance (HQA). In the fourth article, the authors chose the patients who were treated in Michigan’s 95 study hospitals from 238, 937 total admissions. All the samples and the populations for these studies were appropriate. During the study documentation Chaudhry et al., (2006) reported that hospital facilities documented and reported data on costs and contextual factors. Limitations of data in this article is that the systematic review utilized a mixed data of private and public initiatives into hospital systems. The public and private initiatives have different agendas. Werner et al., (2010), study results indicated that the two groups of hospitals were simil ...

1. Running head: QUALITY IMPROVEMENT FOR PUBLIC
HEALTH FACILITIES 1
QUALITY IMPROVEMENT FOR PUBLIC HEALTH
FACILITIES 6
Quality Improvement for Public Health Facilities
Qualitative Research Methods Evaluation
AIU ONLINE
HLTH 335 1701A - 01
UNIT 2 IP

2. The type of study in the four listed articles include the
following. Article one by Chaudhry et al., (2006) was a
qualitative study. The authors conducted a system review from
expert opinion and literature review to determine the role that
information technology had played in enhancing health care
quality, efficiency and costs of medical care. The authors
hypothesized that information technology had played a
significant role in improving the quality of medical care by
increasing adherence to medical guidelines, improving disease
surveillance and decreasing medication errors. The type of
study for the second article was also a qualitative study that
examined 260 hospital on the issue of pay for performance
strategy. The authors compared their results to other hospital
that did not have the current nationwide pay for performance
system, (Werner et al., 2010). The authors hypothesized that
pay-for-performance system improved quality health care
among hospitals in this system. The third article was also a
qualitative study where the authors hypothesized that public
reporting of hospital quality data and the pay for performance
have emerged as the widely advocated tools for these that
accelerate health facility’s improvement (Lindenauer et al.,
2007). The fourth article was also a qualitative study article.
The authors of the article hypothesized that the Keystone ICU
project was associated with a significant decrease on the
hospital mortality within Michigan as compared to the
surrounding areas, (Lipitz-Snyderman, et al., 2011).
Article one utilized data from published expert opinion and
literature search from academic data bases. There was no direct
involvement of the human subject when collecting data for this
article. Article two utilized data from 260 hospitals. The
authors chose acute care hospitals that began operating in 2004.
The author’s excluded four critical-access hospitals.
Researchers of the third article used 2490 health services
providers nation-wide who met the criteria for Hospital Quality

3. Alliance (HQA). In the fourth article, the authors chose the
patients who were treated in Michigan’s 95 study hospitals from
238, 937 total admissions. All the samples and the populations
for these studies were appropriate.
During the study documentation Chaudhry et al., (2006)
reported that hospital facilities documented and reported data
on costs and contextual factors. Limitations of data in this
article is that the systematic review utilized a mixed data of
private and public initiatives into hospital systems. The public
and private initiatives have different agendas. Werner et al.,
(2010), study results indicated that the two groups of hospitals
were similar with respect to market characteristics and pay-for-
performance strategy. The authors also reported that hospitals
experienced a better overall pay-for-performance demonstration
project within participating hospitals. However, the difference
of hospital groups began to differentiate in 2007 during the
introduction of a new hospital payment system. The limitation
of these results according to the authors is that they did not
document other contributory factors that lead to high level of
pay per-for-performance initiative within the study hospitals.
Lindenauer et al., (2007) documented their results as many
study hospitals were not having a for-profit pay-for-
performance participation and ownership. The more likely urban
hospitals were participating in sourcing for large funds to
improve their facilities and services to a competitive advantage
as compared to making a large profit margin. The limitation of
the results of this study is that there were limiting variables of
study. The variables of this study were ten measure yet the
largest hospital system in America is dependant on market
economy factors. In the last article, Lipitz-Snyderman, et al.,
(2011), documented their study results and showed that the
patient’s characteristics of the hospitals admissions were
similar in the study group as compared to the control group. The
results of this article continued to indicate that teaching
hospitals and not teaching hospitals had different proportions of
performance with teaching hospitals having a large proportion

4. of improved performance. The limitation of this study is similar
with other limitations analyzed here in that pay-for-performance
require more variables.
Chaudhry et al., (2016) results led to the conclusion that health
information technology offer a discernible solution to the
performance improvement of the health facilities. The
application of this research information raise the needs to adopt
information technology within the healthcare system tied with
benefits of better performance. Werner et al., (2010), study
results led to the conclusions that hospital payment systems are
in constant change process. The payment system will change
according to the policy and market demand changes. For
example, payment system changed during the implementation of
the Affordable Care Act, which implemented the performance-
based payment. The application of the study results in the
payment system is that hospital facilities should use systems
that are familiar, but should aim at improving the familiar
systems as compared to adopting new unknown system of
payment strategies. Lindenauer et al., (2007) results led to the
conclusion that financial incentives are modestly increasing the
improvement of quality among hospitals that already engage in
public reporting. Hospitals should not be given all the
opportunities to choose their public reporting. Instead, this
reporting should be standardized for the benefit of providing
public incentives. The application of this reporting is that
research is required to determine the most effective mode of
payment model that can stimulate more meaningful
improvements to the programs that are cost-effective. Lipitz-
Snyderman, et al., (2011) results led to the conclusion that
implementation of a new mode of payment leads to efficiency in
service offering. The results led to the conclusion that
efficiency in hospitals led to the improved hospital
performance. Efficiency also led to improved cost reduction and
reduced effects of quality improvement initiative. The
application of this results indicated that hospital’s healthcare
system as payers within an investment strategy was similarly

5. successful in large scale hence robust quality improvement
initiatives are critical in maximizing the benefits of patients and
the hospitals.
Reference
Lipitz-Snyderman, A., Steinwachs, D., Needham, D. M.,
Colantuoni, E., Morlock, L. L., & Pronovost, P. J. (2011).
Impact of a statewide intensive care unit quality improvement
initiative on hospital mortality and length of stay: retrospective
comparative analysis. BMJ, 342, d219.
Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W.,
Roth, E., ... & Shekelle, P. G. (2006). Systematic review:
impact of health information technology on quality, efficiency,
and costs of medical care. Annals of internal medicine, 144(10),
742-752.
Werner, R. M., Kolstad, J. T., Stuart, E. A., & Polsky, D.
(2011). The effect of pay-for-performance in hospitals: lessons
for quality improvement. Health Affairs, 30(4), 690-698.
Lindenauer, P. K., Remus, D., Roman, S., Rothberg, M. B.,
Benjamin, E. M., Ma, A., & Bratzler, D. W. (2007). Public

6. reporting and pay for performance in hospital quality
improvement. New England Journal of Medicine, 356(5), 486-
496.
Running head: QUALITY IMPROVEMENT
1
QUALITY IMPROVEMENT
5
Quality improvement for public health facilities
Quantitative Research Methods Evaluation and Statistical
Applications
HLTH335 1701A-01
UNIT 3 IP
Summary
The types of research are both qualitative and quantitative.
They are set to find out a series of events, their causes as well
as the consequences of these events. The four studies may be
different in that they are set to find out different phenomenon,
but they also use experiments and the collection of data to
justify the research question, topic and draw conclusions.
Quality improvement is something that has been emphasized in
all the studies as they compare the desired situation with the
current one. A study done by Wangari, Anyango & Wanjau
(2013), sets to find out the factors that are affecting the
provision of quality services within the Kenyan public health
sector. This is a common phenomenon in most countries as

7. private health sector has the tendency to provide more quality
service than public health sector.
For quality improvement to be a reality, there must be support
and involvement of the patients in the process. Through their
study, Hibbard & Greene (2013) confirm that there is indeed
significance for the patients to participate in the provision of
quality health care within healthcare facilities. There is need to
practice quality improvement in health facilities for reduction
of deaths and infant mortality among low-income countries.
Spector et al. (2012) conducted an investigation that was geared
to express the link between better health care and improved
health care outcomes. Finally, according to Aiken et al. (2012),
the relationship between improved quality care and nurses and
patients’ satisfaction are very slim. The study was initiated to
establish the connection between the two so as to find out a way
to improve care within the US and Europe.
Sample and population
In all the studies the sample and study population used were
suitable for the individual study. The appropriateness of the
population was directly related to the geographical coverage of
the study and its applicability. For example, to understand the
phenomenon studied by Aiken et al. (2012), the sample used
was both from the US and Europe. A study is relevant if there is
a close relationship between the population and the anticipated
results. Hibbard & Greene (2013) take on a different approach
which uses the qualitative aspect to come to conclusions. They
use an array of researchers that have been previously conducted
to come up with similar and viable conclusions. While this
approach may work to serve the purpose, it also draws a
sensible conclusion as more work is covered. The number of
previous studies used by Hibbard & Greene (2013) justifies the
results of the findings as in the other cases.
Summary of results, limitations, conclusions, and applications
The studies above draw one general conclusion to their study,
that is, the need for quality improvement. Some factors may

8. hinder the provision of services in the public health sector, but
the general idea is that there is a need for adjustment of how
services are delivered so as to promote health. The second
conclusion is that studies have justified the need for patients to
take part in the improvement of their healthcare actively. If they
do not complain or advocate for change, there is little that can
be done for them to achieve the same. The researchers sparingly
spotted challenges, but it can be assumed through the sampling
methods that they used that the data was not very easy to
collect. Additionally, covering a wider geographical region data
collection could potentially result in more expenses for the
researcher. Application of the research findings into real
healthcare facility should be practiced as the results of the
findings are based on facts. The researchers go deeper into the
problem and use evidence-based practice to draw a conclusion
to their work. It is recommended that the relevant information
attained from the study be applied to the relevant healthcare
facilities so as to see to it that there is improved care and
service within the healthcare facilities.
Results, conclusions, and applications
The use of the study significantly varies as they all study
different factors. First of all, the application of the findings of
patient involvement can be used to educate patients on their
roles in the provision of health care. The study done on factors
that hinder improved service delivery in public hospitals can be
applied to address the issues raised as well as formulate better
strategies that will be used to rectify the situation within these
facilities. One general conclusion made is that there is indeed
the need for quality improvement within the healthcare
facilities.
Statistical method used in the cited research studies
The data was statistically analyzed for most of the studies. In
the study conducted by Spector et al. (2012), there was the use
of checklists and graph presentation for the study. Wangari et
al. (2013) analyzed their study both qualitatively and
statistically. They used ANOVA technique to draw conclusions

9. on the service quality within the health facility under study.
Odd ratios and regression were used by Aiken et al. (2012) to
draw the difference between nurse staffing in Europe and
America. The quality of the data analysis and the type of
analysis used greatly depend on the study type and what one
intends to establish. It is recommended that more than one
analysis be used to make the conclusions even more reliable.
ReferencesAiken. L. H. et al. (2012). Patient safety,
satisfaction, and quality of hospital care: cross sectional
surveys of nurses and patients in 12 countries in Europe and the
United States. The bmj. Retrieved from:
http://www.bmj.com/content/344/bmj.e1717.shortHibbard, J. H.
& Greene, J. (2013). What the evidence shows about patient
activation: Better health outcomes and care experiences; fewer
data on costs. Health Affairs. Retrieved from:
http://content.healthaffairs.org/content/32/2/207.fullSpector JM,
Agrawal P, Kodkany B, Lipsitz S, Lashoher A, Dziekan G, et al.
(2012) Improving Quality of Care for Maternal and Newborn
Health: Prospective Pilot Study of the WHO Safe Childbirth
Checklist Program. PLoS ONE 7(5): e35151.
doi:10.1371/journal.pone.0035151Wangari, M. B., Anyango, D.
M. O. & Wanjau, K. (2013). Factors affecting provision of
service quality in the public health sector: A case of Kenyatta
national hospital. Prime journal of business administration and
management. Retrieved from:
http://www.primejournal.org/BAM/pdf/2013/aug/Wangari%20et
%20al.pdf