QRB. Quality review bulletin (Qual Rev Bull)

Publisher: Joint Commission on Accreditation of Hospitals. Quality Review Center

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Other titles QRB. Quality review bulletin, QRB
ISSN 0097-5990
OCLC 1297544
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

  • QRB. Quality review bulletin 07/1993; 19(6):174-81.
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    ABSTRACT: Cascade iatrogenesis is defined as a related sequence of adverse events that are triggered by an initial medical intervention. In an attempt to determine whether such a phenomenon is be associated with the quality of care provided, physician reviewers identified iatrogenic cascades and the rated quality of care given to a sample of long-stay teaching hospital patients. The care was rated with a structured implicit review instrument. Cascade iatrogenesis was found to occur most frequently among the oldest patients, the most functionally impaired, and those with a high severity of illness on admission. Closer examination of these findings suggests that there is significant potential for improving physicians' initial functional and diagnostic assessment skills when treating frail elderly patients.
    QRB. Quality review bulletin 07/1993; 19(6):199-205.
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    ABSTRACT: A new conceptualization of the related activities QA, RM, and UR may allow an organization to ensure appropriate, proficient, and satisfactory care and to ameliorate the consequences of bad outcomes. Three processes incorporated into the conceptualization are essential to ensuring excellence, as are specific attributes of the care process. The difference in initiation of activities (reactive versus proactive) is part of the model; relationships among the essential activities and processes and between reactive and proactive activities are suggested; and viewing data sources or collection as separate from the processes and activities is suggested. Areas for development and research within the conceptualization that are inadequately understood include data sources and analysis methods useful for the processes needed, evaluation of the consequences of different reactive activities, and the usefulness of TQI activities for setting goals or standards and for changing behavior. Implementing such an approach to ensuring excellence would be a challenge. It is hoped that this formulation will assist in communication among those working to ensure excellence; promote analysis of whether current organizational structures for ensuring excellence and for cost containment are creating redundance, competition, or gaps in needed activities; broaden the perception of the possible and/or appropriate scope of some activities, such as the inclusion of proactive preventive care and the provision of special high-risk programs; and assist in the identification of areas of needed research and development.
    QRB. Quality review bulletin 07/1993; 19(6):182-9.
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    ABSTRACT: An algorithm for screening and management of abdominal aortic aneurysms was developed at the Ochsner Medical Institutions to address the considerable variation identified in clinical practice. A consensus panel of physicians whose opinions differed regarding the management of abdominal aortic aneurysms was convened to develop the algorithm. Based on a literature review and clinical experience, the panel established criteria to determine how frequently and by which methodologies patients with abdominal aortic aneurysms should be followed and when a referral to a vascular surgeon is appropriate. The algorithm developed by the consensus panel method was used to establish practice guidelines that are flexible enough to address individual patient needs yet structured enough to eliminate inappropriate care. Data are being collected and analyzed in real time to determine whether elements of the algorithm should be revised.
    QRB. Quality review bulletin 07/1993; 19(6):190-5.

  • QRB. Quality review bulletin 07/1993; 19(6):196-8.

  • QRB. Quality review bulletin 06/1993; 19(5):142-3.
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    ABSTRACT: Although adverse events (AEs) are not uncommon in hospitalized patients, they are by no means inevitable. A review of records from a population-based study in New York revealed that nearly 4% of hospitalized patients suffered AEs. Two-thirds of those events were considered to be caused by errors in management, most of which were not because of negligence. A large part of the reason preventable AEs occur is that today's medical care is extremely complex, involving a variety of personnel, equipment, and procedures. By seeking to eliminate errors in the system of providing care and raising the awareness of health care providers about the potential for AEs, programs can be established to address and possibly remedy this serious problem.
    QRB. Quality review bulletin 06/1993; 19(5):144-9.
  • L Kaegi ·

    QRB. Quality review bulletin 06/1993; 19(5):165-9.

  • QRB. Quality review bulletin 06/1993; 19(5):150-1.
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    ABSTRACT: As part of a small-area analysis of carotid endarterectomy (CE) surgery, this review of Medicare claims data for a 26-month period addresses variations in surgical volume, mortality, readmissions, and charges. A surprisingly high percentage of surgeons performing CE did few procedures, and surgical volume appeared to be associated with higher mortality and charges. The implications of these data for both hospital credentialing committees and management and for purchasers and consumers of care, as well as the ways in which the Health Care Financing Organization's (HCFA) Health Care Quality Improvement Initiative (HCQII) will reorder their relationships with peer review organizations (PROs), are discussed. This study is useful in addressing the potential of efforts by PROs to increase the quality of care under the HCQII.
    QRB. Quality review bulletin 06/1993; 19(5):152-7.
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    ABSTRACT: Rather than explain adverse results on the basis of flawed data, a physician-directed quality improvement program was initiated to improve the delivery of care to patients admitted to Forbes Health System (Monroeville, Penn) with community-acquired pneumonia. Following the introduction of standardized physician orders and modification and elimination of inefficient processes of care, the mortality rate for this infection decreased from 10.2% to 6.8%. This initial exposure to the quality improvement process led to the participation of the medical staff in other related clinical and support service initiatives. In addition, Forbes and its clinical partners are now better positioned to respond to increasing government, managed care, and consumer inquiries relating to cost and quality outcomes. Finally, this positive experience facilitated the organization's transition from inspection-based quality assessment to quality improvement activities, which should assist in efforts to meet or exceed new accreditation standards.
    QRB. Quality review bulletin 05/1993; 19(4):124-30.
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    ABSTRACT: The Foundation for Health Care Quality (Washington) used three administrative public databases and indicators recommended by the Joint Commission and the American College of Obstetrics and Gynecology to build algorithms to measure quality of obstetric care in the state of Washington. Analyses demonstrated a high degree of variability across hospitals for major processes of care such as cesarean section, vaginal birth after cesarean section, and forceps deliveries. Eighty-five percent of the participating hospitals concluded that important aspects of care were being measured. Ninety-four percent found the information useful in describing their performance compared with other hospitals. Sixty-two percent believed the information was useful for initiating quality improvement projects. Of the 25 indicators tested in the project, indicators rated as most useful were the same 10 obstetric indicators chosen by the Joint Commission after alpha testing.
    QRB. Quality review bulletin 05/1993; 19(4):110-8.
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    ABSTRACT: New expensive biotechnology products create financial as well as clinical dilemmas for hospitals. Clinical guidelines that govern the use of these new products are often viewed as the best response to these dilemmas. This article describes a prospective analysis of the impact of one new drug and the guidelines developed to control its use. A simple model of clinical decision making is used to evaluate alternative scenarios. The analysis illustrates the importance of evaluating the cost containment potential of clinical guidelines before they are implemented.
    QRB. Quality review bulletin 05/1993; 19(4):119-23.
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    ABSTRACT: A study of utilization management (UM) practices in 13 health maintenance organizations (HMOs) with Medicare members was undertaken as part of an evaluation of the Medicare Risk Contract strategy. Although there were significant variations among HMOs, the common challenges of managing care for this particular population also led to important similarities. Most notable was the emphasis on redirecting the focus of control-oriented utilization review to promotion of continuous improvement in care management. The multiple medical and social service needs of Medicare beneficiaries have forced HMOs to cultivate close collaboration with physicians and UM personnel. Thus, UM personnel are involved throughout the continuum of care and play an important role in assisting HMOs to approach the "seam-less delivery system" ideal. HMOs report that the experience of managing care for Medicare members has made them more responsive to serving all of their members and to promoting long-term partnerships with their physicians.
    QRB. Quality review bulletin 05/1993; 19(4):131-7.
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    ABSTRACT: Many health care organizations are attempting to rapidly implement total quality management (TQM) and continuous quality improvement (CQI) philosophies and concepts. In the case of hospitals, a number of issues resulting from traditional organizational design and management practices as well as the characteristics of health care professionals pose significant challenges to rapid implementation. Recognizing and developing strategies to address these challenges, along with realizing that TQM and CQI represent viable processes for conducting organizational "preventive maintenance," may help in changing the focus of quality assessment and enhancement initiatives from processes that are "broken" to processes that should be "fixed" before they "break." This article discusses strategies for overcoming some of the major barriers and challenges to successful TQM and CQI implementation to the hospital setting.
    QRB. Quality review bulletin 04/1993; 19(3):83-8.

  • QRB. Quality review bulletin 04/1993; 19(3):78.

  • QRB. Quality review bulletin 04/1993; 19(3):79-82.
  • A Lewis ·
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    ABSTRACT: Some hospitals are rushing into continuous quality improvement (CQI) without understanding the pitfalls, one of which is the issue of empowerment. To prevent middle managers from inappropriately reinvolving themselves in the activities of empowered front-line workers, empowerment of employees must be accompanied by a substantial decrease in the number of middle managers. Despite its importance, however, this move is rarely undertaken for two reasons: first, a failure to analyze management "spans of control" in the context of empowerment; second, the fear that staff reductions will imperil the CQI implementation. This article presents case studies of effective and ineffective management to demonstrate that without span of control adjustments, empowerment will fail, whereas appropriate adjustments will allow it to succeed even beyond expectations.
    QRB. Quality review bulletin 04/1993; 19(3):95-101.

  • QRB. Quality review bulletin 04/1993; 19(3):102-3.
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    ABSTRACT: The literature documents little research regarding patients' good and bad surprises in the hospital. Such experiences may inform a patient's future decisions about recommending or returning to the hospital. Utilizing a database of survey respondents, the authors conducted qualitative and quantitative analyses of patients' self-reported surprises about their hospital stay and the relationship between those surprise experiences and their overall feelings of satisfaction. Analysis of these data shows that patients do experience surprises during their hospital stays, that specific events are associated with these surprises, and that these surprises influence patient satisfaction. These results suggest that in order for health care providers to continuously improve and meet patients' needs and expectations, providers must determine steps to take to delight their patients, to avoid patient disappointments, and to meet patients' basic expectations.
    QRB. Quality review bulletin 04/1993; 19(3):89-94.