Article

Improving Methods for Measuring Quality of Care A Patient-Centered Approach in Chronic Disease

Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Bedford, MA, USA.
Medical Care Research and Review (Impact Factor: 2.57). 04/2009; 66(2):147-66. DOI: 10.1177/1077558708327174
Source: PubMed

ABSTRACT As health care systems seek to provide patient-centered care as a cornerstone of quality, how to measure this aspect of quality has become a concern. Previous development of quality indicators for treating individual chronic disease has rarely included patient perspectives on quality of care. Using epilepsy as an exemplar, the authors sought to develop an approach to measuring patient-centered quality of care. They conducted six focus groups with adults with epilepsy. Using qualitative methods, the authors initially identified 10 patient-generated quality indicators, 5 of which were subsequently rated, along with literature-based quality indicators, by an expert panel using a modified RAND appropriateness methodology. The authors discuss similarities and differences in aspects of care patients and providers value as essential for good quality. The process presented in this article may serve as a model for incorporating patient perceptions of quality into the future development of quality indicators for chronic diseases.

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    • "Therefore, alternative strategies to incorporate patient perspectives may need to be considered. For example, Bokhour et al. used focus groups to generate patient-centered indicators and presented them to clinical experts for evaluation [28]. "
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    ABSTRACT: Background Consensus methodologies are often used to create evidence-based measures of healthcare quality because they incorporate both available evidence and expert opinion to fill gaps in the knowledge base. However, there are limited studies of the key domains that are considered during panel discussion when developing quality indicators. Methods We performed a qualitative content analysis of the discussions from a two-day international workshop of injury control and quality-of-care experts (19 panel members) convened to create a standardized set of quality indicators for injury care. The workshop utilized a modified RAND/UCLA Appropriateness method. Workshop proceedings were recorded and transcribed verbatim. We used constant comparative analysis to analyze the transcripts of the workshop to identify key themes. Results We identified four themes in the selection, development, and implementation of standardized quality indicators: specifying a clear purpose and goal(s) for the indicators to ensure relevant data elements were included, and that indicators could be used for system-wide benchmarking and improving patient outcomes; incorporating evidence, expertise, and patient perspectives to identify important clinical problems and potential measurement challenges; considering context and variations between centers in the health system that could influence either the relevance or application of an indicator; and contemplating data collection and management issues, including availability of existing data sources, quality of data, timeliness of data abstraction, and the potential role for primary data collection. Conclusion Our study provides a description of the key themes of discussion among a panel of clinical, managerial, and data experts developing quality indicators. Consideration of these themes could help shape deliberation of future panels convened to develop quality indicators.
    Implementation Science 04/2013; 8(1):45. DOI:10.1186/1748-5908-8-45 · 3.47 Impact Factor
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    • "The themes will be presented in the form of QIs (e.g. provider team should offer to meet with patient and/or family within 24 hours of admission to hospital) [27]. A modified version of the RAND/UCLA Appropriateness Method (RAM), a reproducible and valid nominal group technique used in health services research to gather feedback and information from relevant experts [54-57], will be utilized. "
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    ABSTRACT: Background Quality indicators (QI) are used in health care to measure quality of service and performance improvement. Health care professionals and organizations caring for patients with injuries need information regarding the quality of care provided and the outcomes experienced in order to target improvement efforts. However, very little is known about the quality of injury care provided to individual patients and populations and even less about patients’ perspectives on quality of care. The absence of QIs that incorporate patient or family preferences, needs or values has been identified as an important gap in the science and practice of injury quality improvement. The primary objective of this research protocol is to develop and evaluate the first set of patient and family-centred QIs of injury care for critically injured patients Methods/design This mixed methods study is comprised of three Sub-Studies. Sub-Study A will utilize focus group methodology to describe the preferences, needs and values of critically injured patients and their family members regarding the quality of health care delivered. Qualitative content analysis of the transcripts will begin after the first completed focus group and will draw on grounded theory using a process of open, axial and selective coding. A panel of stakeholders will be assembled during Sub-Study B to review the themes identified from the focus groups and develop a catalogue of potential patient and family-centred QIs of injury care using the RAND/UCLA Appropriateness Method (RAM). The QIs developed by the stakeholder panel will be pilot tested in Sub-Study C using surveys of patients and their family members to determine construct validity, intra-rater reliability and clinical sensibility. Discussion Measuring the quality of injury care is but a first step towards improving patient outcomes. This research will develop the first set of patient and family-centred QIs of injury care. To improve patient care, we need accessible, reliable indicators of quality that are important to patients, and that can then be used to establish quality of care benchmarks, to flag potential problems or successes, follow trends over time and identify disparities across organizations, communities, populations and regions.
    BMC Health Services Research 01/2013; 13(1):31. DOI:10.1186/1472-6963-13-31 · 1.66 Impact Factor
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    • "Even rarer in the healthcare literature are studies that compare stakeholder views. The emphasis has been on facility-based care, mostly contrasting physicians/nurses to patients (Laine et al., 1996; Lynn and McMillen, 1999; Boudreaux et al., 2000; Durieux et al., 2004; Lynn et al., 2007; Bokhour et al., 2009) with few studies incorporating other stakeholder views (Tennstedt et al., 1992; Campbell et al., 2004; Lang et al., 2009). "
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    ABSTRACT: This article aims to discuss the relevancy of different instruments used to gather information on homecare service quality from multiple stakeholders and the challenges encountered when trying to blend their views for prioritizing areas needing improvement. The study centers on four homecare agencies: one public, one private for-profit and two not-for-profit services, implementing continuous quality improvement (CQI) programs. Various instruments were tested with random and convenience elderly service user, family caregiver and front-line worker samples. Instrument evaluation included operational effectiveness and agency manageability. A qualitative approach, centered on small stakeholder samples, is fairly effective at assessing service quality, yet demands a strong commitment from agencies in personnel time and resources, as well as the necessary skills. Small-size, private homecare providers seem less-well equipped to handle comprehensive assessments without external support More importantly, assessments have to be done strategically, such that timing and work needed does not undermine program viability. The approach and instruments tested have practical implications for decision makers and homecare organization managers interested in CQI. The article systematically evaluates quality assessment and priority-setting instruments applied to various stakeholders and homecare settings.
    International Journal of Health Care Quality Assurance 06/2012; 25(5):403-20. DOI:10.1108/09526861211235900
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