Quality management in health care (Qual Manag Health Care )

Description

This peer-reviewed quarterly journal provides a forum to explore the theoretical, technical, and strategic elements of total quality management in health care. Each issue of Quality Management in Health Care (QMHC) features a timely symposium that addresses a key issue in health care quality management. Also included in each issue is an in-depth interview with a key individual in health care quality management, an educational tutorial on basic quality management tools and processes, an information clearinghouse to encourage informal communication among those involved in the field of health care quality management, and a reference center that reviews books, journal articles, seminars, and videos of interest.

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  • 5-year impact
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  • Website
    Quality Management in Health Care website
  • Other titles
    Quality management in health care, QMHC
  • ISSN
    1063-8628
  • OCLC
    26178154
  • Material type
    Periodical
  • Document type
    Journal / Magazine / Newspaper

Publications in this journal

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    Quality management in health care 06/2009; 18(3):149-50.
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    ABSTRACT: Following the landmark Leuven study in 2001, health care organizations implemented intensive insulin therapy (IIT) as the standard of care for critically ill patients. However, a recent meta-analysis showed no mortality benefit and an increased safety risk for patients treated with IIT. IIT affects labor and capital decisions related to nurses, physicians, pharmacists, managers, laboratory personnel, and informatics staff. The expenditure of labor and capital to provide IIT without corresponding outcome improvements suggests the adoption of IIT produces inefficiency in hospital. In sociology and organizational studies, the tendency for organizations to become more similar without necessarily becoming more efficient is called normalfont institutional isomorphism. Institutional isomorphism examines the pressure that organizations encounter from peers, regulators, and professions through mimetic, coercive, and normative mechanisms, respectively. To enhance their prospects of survival, organizations establish and maintain legitimacy by adopting socially acceptable approaches to work endorsed by successful peer organizations, regulatory agencies, and professional societies. ORGANIZATIONAL INFLUENCE IN THE ADOPTION OF IIT: This paper describes how organizational influence-through the Leuven study, the Joint Commission, and professional organizations-played a role in the widespread adoption of IIT. Divergence from institutionalized forms may explain variation in IIT studies following Leuven. Health care researchers practitioners, and managers should consider organizational influence when implementing large-scale clinical activities.
    Quality management in health care 01/2009; 18(2):115-9.
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    ABSTRACT: While the importance of teaching quality improvement (QI) is recognized, formal opportunities to teach it are limited and are not always successful at getting physician trainee buy-in. We summarize findings that emerged from a QI curriculum designed to promote physician trainee insights into the evaluation and improvement of quality of care. Grounded-theory approaches to thematic coding of responses from 24 trainees to open-ended items about aspects of a QI curriculum. The 24 trainees were subsequently divided into 9 teams that provided group responses to open-ended items about assessing quality care. Coding was also informed by notes from group discussions. Successes associated with QI projects reflected several aspects of optimizing care such as approaches to improving processes and enabling providers. Counterproductive themes included aspects of compromising care such as creating blinders and complicating care delivery. Themes about assessing care included absolute versus process trade-offs, time frame, documentation completeness, and the underrecognized role of the patient/provider dynamic. Our mapping of the themes provides a useful summary of issues and ways to approach the potential lack of buy-in from physician trainees about the value of QI and the "mixed-messages" regarding inconsistencies in the application of presumed objective performance measures.
    Quality management in health care 01/2009; 18(3):209-16.
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    ABSTRACT: Clinical guidelines call for more exercise than many patients are willing to undertake. More modest goals are more acceptable but may not improve overall self-rated health (SRH) in primary care patients. Furthermore, whether exercise should be measured in minutes per week, times per week, or both is unclear. A random sample of 939 primary care patients met criteria for the study. Exercise was measured in self-reported minutes and times per week. Multiple logistic regression analysis was used to test for the independent effects of minutes and times per week of exercise on SRH in primary care patients. Exercising 1 to 150 minutes per week was independently related to good SRH (odds ratio = 3.41, confidence interval = 1.73-6.73) as was exercising 151 to 300 minutes per week (odds ratio = 4.13, confidence interval = 1.45-11.71). The number of exercise times per week was not significant. In our sample of relatively healthy primary care patients, exercising 1 to 300 minutes per week appears to promote good SRH.
    Quality management in health care 01/2009; 18(2):135-40.
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    ABSTRACT: The Centers for Disease Control and Prevention (CDC) defines influenza-like illness (ILI) for its sentinel providers as fever (temperature > or =100.5 degrees F or 37.8 degrees C) and a cough and/or a sore throat in the absence of a known cause other than influenza. For electronic disease surveillance systems, classifying ILI with clinical data that identify only individual aspects of the case definition may add excessive levels of unwanted noise to the system; however, the capability to analyze a patient's body temperature along with other available clinical data (International Classification of Diseases, Ninth Revision codes) could improve diagnostic precision and more accurately classify cases of ILI in a syndromic surveillance system. Developing Boolean algorithms to properly classify true cases of influenza plays an important role toward understanding accurate levels of disease in a community and can also be a key tool for allocating urgent prophylaxis such as antiviral medications during severe outbreaks and pandemics. Results for this study show that elevated body temperature was 40% efficient in correctly predicting laboratory-positive confirmations of influenza (sensitivity) but at the same time was 76% efficient in ruling out influenza (specificity) in the group of sampled members who were tested for influenza.
    Quality management in health care 01/2009; 18(2):91-102.
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    ABSTRACT: We originally examined the effectiveness of strategies, proven successful in improving appointment availability in primary care, at a large tertiary-care academic medical center. We then sought to describe the reasons for the initial failure of these strategies. Clinics participating in an access improvement initiative were matched to control clinics. Intervention clinics used a variety of techniques to improve access. Run charts were used to determine the impact of the interventions on appointment availability. Linear models, control charts, and other graphic displays were used to understand the relationship among supply, demand, and appointment availability. Access did not improve in intervention clinics. Neither a linear models approach nor the use of control charts resulted in a simple tool to help clinics better understand the relationship among supply, demand, and days to third next available appointment. However, the development of a single clinic chart that incorporated supply and demand, plus estimates of future supply and demand, made it clear that current supply would not be able to meet demand. This helped teams focus their efforts on improving supply. Use of detailed data-based tools to guide choices of interventions, coupled with new and explicit institutional expectations for physician attendance at clinics, appears to be a promising strategy for enhancing access.
    Quality management in health care 09/2008; 17(4):320-9.
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    ABSTRACT: A computer simulator of pain care provided an environment for residents to learn to (1) rapidly induce pain relief; (2) measure pain scores at appropriate time intervals; (3) use induction doses to estimate, early in care, the long-acting pain medication requirements; and (4) escalate long-acting agents to ensure a smooth and nonvarying pain-control curve. We studied whether lessons learned on the simulator translated into improved pain control for patients with cancer-related pain crises. STUDY DESIGN AND MEASURES: We compared pain scores for 48 hours in 2 groups: 20 patients admitted consecutively, solely because of an acute exacerbation of pain, prior to training our residents on a simulator and 20 patients post-training. Training at the beginning of an oncology rotation consisted of education about pain control followed by practice on simulated cases of patients with cancer-related pain crises. Outcome measures were average pain scores compared using linear regression and the frequency of using long-acting agents early in a patient's care. Pain control in the first 48 hours of care improved in the postintervention period; the slope of the pain scores actually increased in the preintervention period and declined in the postintervention period (P < .0005). Residents used long-acting agents early in patients' care in 35% (7/20) in the preperiod and 90% (18/20) in the postperiod (P < .001). Residents developed pain care treatment skills on a computer-based simulator that translated into improved control of acute, cancer-related pain.
    Quality management in health care 01/2008; 17(3):200-3.
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    ABSTRACT: Health care delivery systems are widely studying and implementing physician pay for performance (P4P) initiatives to improve quality and control costs. However, the increasing focus on quality-driven financial incentives has some troubling implications for medical professionalism. This article examines the P4P concept in light of a notion of medical fiduciary professionalism that dates back to the 18th-century Scottish physician John Gregory. Gregory's principles serve as a framework to assess the appropriateness of P4P initiatives in disseminating the principles of high-quality care without damage to professionalism, the patient-physician relationship, and access to care for all patients.
    Quality management in health care 01/2008; 17(1):9-18.
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    ABSTRACT: In determining intervention effects, quality improvement researchers typically use statistical testing--Fisher's "significance testing" and/or Neyman and Pearson's "hypothesis testing." Such tests are employed in an effort to demonstrate whether or not a statistically and practically significant difference exists when comparing experimental and comparison group(s). Although power analysis is often not considered when these tests are applied, this article postulates potential benefits of including power analysis in the early stages of a study's design. Two procedures developed by Fisher and Neyman and Pearson are reviewed. Important background statistical concepts including alpha values, beta values, P values, effect sizes, and statistical power analysis are defined and discussed. A proposed statistical approach combining both Fisher and Neyman-Pearson procedures along with power analysis for sample size determination and the effect sizes is described and illustrated in a hypothetical research context. The benefits of this combination are discussed within a framework of adding value to a study design and data analysis.
    Quality management in health care 01/2008; 17(4):304-11.
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    ABSTRACT: Accredited medical care organizations are expected to assess pain levels in their patients. Appropriate responses to high pain levels have not been specified. This study was a retrospective analysis of information abstracted from medical records of 673 adult patients utilizing family medicine. Pain was measured using a scale ranging from 0 to 10. Scores of 7 and above were judged to represent high levels of pain. Multiple logistic regression was used to test the relationship between body mass index (BMI) and general pain, after adjustment for co-morbidity, physical limitations, and demographic characteristics. Multiple logistic regression analysis revealed that, in comparison with patients with normal body mass, patients with BMI greater than 35 had higher odds of experiencing pain scored 7 or over after adjusting for physical limitations, co-morbidity, age, and gender (adjusted odds ratio [AOR] = 1.89, P = .03). Odds ratios also were significant for subjects with any (vs none) physical limitations (AOR = 1.91, P = .01) and for men relative to women (AOR = 0.65, P = .04). co-morbidity, common diagnoses, and moderate BMI scores were not independently related to high pain levels. In our sample of patients utilizing family medicine, BMI greater than 35 is a risk factor for elevated pain scores. This relationship appears to be independent of orthopedic consequences of obesity. Referral to weight management programs might be useful as a quality indicator for obese adults reporting high levels of general pain.
    Quality management in health care 01/2008; 17(3):204-9.
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    ABSTRACT: A previously published analysis of an interesting dataset consisting of time intervals between medication errors is replicated and some errors in the original analysis are discussed. The dataset is then analyzed using well-known methods from the field of statistical process control. The results and conclusions of the analysis are not consistent with those of the original analysis. The need for future collaborations between health care and quality management professionals are discussed.
    Quality management in health care 01/2008; 17(4):349-52.
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    ABSTRACT: It is well-known that standard statistical process control tools (eg, Shewhart charts) are not robust to certain features of human-generated data typically seen in health care management. For example, the presence of positive serial correlation (the tendency for successive outcomes to cluster as opposed to being truly random) leads to increased "false alarms." Previous work has introduced potential work-arounds in the case of continuous data (eg, data that can take on many values). In this article we describe a different but related problem in the case of binary data (eg, "survived" vs "deceased"). We demonstrate the value of using the Cumulative Sum chart, which is shown to be relatively robust to serial correlation, and much more efficient and effective than existing control charts.
    Quality management in health care 01/2008; 17(3):218-26.
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    ABSTRACT: This article briefly describes natural induction approach to knowledge discovery, and then applies it to the problem of bad habit relapse prevention by analyzing patients' diaries. Natural induction seeks patterns in data that are in forms easy to understand and interpret, because they resemble those in which humans represent knowledge, such as natural language descriptions and visual forms. The application of natural induction to the problem of bad habit relapse has produced patterns easy to understand, in some cases of surprising simplicity.
    Quality management in health care 01/2008; 17(1):80-9.
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    ABSTRACT: The purpose of this retrospective study was to evaluate nursing home quality measures (QMs) available in a national database called Nursing Home Compare. The aim was to determine whether differences in QM scores occurred with changing staffing-level mix. All Missouri nursing home facilities were included for the analysis of the 14 QMs downloaded in February 2004. Analyses of variance were used to examine differences in the dependent QM scores; the independent range of staffing levels for 3 disciplines, certified nurse assistant (CNA), licensed practical nurse (LPN), and registered nurse (RN), was analyzed on the basis of their number of hours per resident per day worked in the nursing home. Planned contrasts and post hoc Bonferroni adjustments were calculated to further evaluate significance levels. Finally, residents were used as a covariate to determine effects on significant analyses of variance. Care is proportionate to the percentage of CNA/LPN/RN staffing-level mix, with 2 long-stay QMs (percentage of residents who lose bowel or bladder control and percentage of residents whose need for help with activities of daily living has increased) and 2 short-stay measures (percentage of residents who had moderate to severe pain and percentage of residents with pressure ulcers) revealed differences in mean quality scores when staffing levels changed.
    Quality management in health care 01/2008; 17(3):242-51.
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    ABSTRACT: Given the important functions that hospital quality departments perform or support (including regulatory readiness, team facilitation, and submission of data for mandatory reporting), insuring sufficient resources in the quality department to support those functions is an important task for hospital leaders. Yet, currently there is little information available to assist leaders in determining optimal staffing for hospital quality departments. This article reports the results of several benchmarking surveys conducted to examine staffing levels and functions for quality departments.
    Quality management in health care 01/2008; 17(4):341-8.
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    ABSTRACT: The health care industry is slowly embracing the use of statistical process control (SPC) to monitor and study causes of variation in health care processes. While the statistics and principles underlying the use of SPC are relatively straightforward, there is a need to be cognizant of the perils that await the user who is not well versed in the key concepts of SPC. This article introduces the theory behind SPC methodology, describes successful tactics for educating users, and discusses the challenges associated with encouraging adoption of SPC among health care professionals. To illustrate these benefits and challenges, this article references the National Hospital Quality Measures, presents critical elements of SPC curricula, and draws examples from hospitals that have successfully embedded SPC into their overall approach to performance assessment and improvement.
    Quality management in health care 06/2007; 16(3):205-14.
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    Quality management in health care 03/2007; 16(2):187-189.
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    ABSTRACT: Alemi and colleagues in this issue of the journal have proposed that rare events can be monitored by shifting from frequency of the event to the examination of the time to the event. This article examines their claim with data obtained from an acute care hospital in the United States. We examined the data on medication omissions to see whether changes in underlying process can be detected through control charts. Medication errors are rare; the article examines medication errors due to omission, which makes the phenomena rarer. The empirical question was whether changes in process of care could be detected using control charts from data on medication omissions. Two different types of control chart, the XmR and Tukey charts, were used to analyze the data. The control chart with the tightest control limits was chosen for further interpretation. The XmR chart showed that there was sufficient power to detect unusual days in which the time to omission error was higher than historical norm. This article suggests that even rare events can be monitored through judicious use of time to the event. It shows the viability of safety teams using time to sentinel events to monitor progress in reducing frequency of sentinel events.
    Quality management in health care 01/2007; 16(4):321-7.