Improving Methods for Measuring Quality of Care A Patient-Centered Approach in Chronic Disease
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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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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ABSTRACT: This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective.Health Care Analysis 07/2011; 20(3):231-49. DOI:10.1007/s10728-011-0183-y · 1.02 Impact Factor
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ABSTRACT: Patient-centered care (PCC) has been studied for several decades. Yet a clear definition of PCC is lacking, as is an understanding of how specific PCC processes relate to patient outcomes. We conducted a systematic review of the PCC literature to examine the evidence for PCC and outcomes. Three databases were searched for all years through September 2012. We retained 40 articles for the analysis. Results found mixed relationships between PCC and clinical outcomes, that is, some studies found significant relationships between specific elements of PCC and outcomes but others found no relationship. There was stronger evidence for positive influences of PCC on satisfaction and self-management. Future research should examine specific dimensions of PCC and how they relate to technical care quality, particularly some dimensions that have not been studied extensively. Future research also should identify moderating and mediating variables in the PPC-outcomes relationship.Medical Care Research and Review 11/2012; 70(4). DOI:10.1177/1077558712465774 · 2.57 Impact Factor