DiPietro PharmAd

The increase the likelihood of desired health outcomes and are consistent with current professional knowledge all scientific, clinical, technical, interpersonal, manual, cognitive, organization and management elements of health care

• provide patient-centered care
• work as an interdisciplinary team
• employ evidence-based practices
• apply quality improvement methods
• utilize informatics

• Patients:  tend to base opinions on interpersonal aspects and amenities 
• Provider:  perceive quality in terms of technical performance
• Payer:  assess quality in the context of cost

• safe:  care in facility should be as safe as care at home
• effective:  evidence-based medicine should be applied
• efficient:  care and services should be cost effective; eliminate waste
• timely:  no waits/delays in receiving care and service
• patient-centered:  respect patient preferences
• equitable:  eradicate unequal treatment and disparities

• underuse
• overuse
• misuse

• procedures/prevention known that are not used
• ex. screenings/vaccinations

• intervention used too often
• ex. antibiotics

• something that occurs in the clinical/medical care process that's inappropriate
• ex. medication errors/drug use inappropriately

Measurement that focuses on structure, process, or outcome

• environment in which are is delivered (through education, training, certification of HCPs, adequate staffing, equipment, overall organization, good processes need good structure)
• Limitation:  structure doesn't mean that quality care is being provided

• delivery of care
• appropriateness of care
• skill or how well actions were carried out
• Limitation:  take the patient out of the equation or lack of patient adherence

• result of care
• health status related indicators, patient satisfaction, costs of care

measurement of quality against an established standard

• institutionalizing (system wide/organization wide) quality through ongoing assessment
• can't happen w/o quality assessment

• initiative to link reimbursement to quality and efficiency
• incentive to improve the quality of hc & reduce costs
• reward-based or penalty-based

• individual vs. group incentives
• paying the right amount
• selecting high-impact performance measures
• rewarding all high-quality care
• prioritizing quality improvement for undeserved populations

• higher quality of care provided
• better patient outcomes, QOL
• lower costs
• increased integration of services

• 3rd party determines what services are appropriate and incentivized
• opportunity costs
• unintended effects not well-studied
• impediments to innovation

Measures the following IOM dimensions of quality health care: timely, efficient, patient-centered

Goal:  continuously improve the quality of hc through all levels and functions of the organization

• streamline administration
• reduce lengths of stay
• improve clinical outcomes
• provide higher levels of patient satisfaction

• quality is an integrative concept
• organizational commitment to ongoing improvment
• everyone play a part in quality
• value in striving to exceed prevailing standards
• customer-driven (internal and external customers)
• --> key to CQI is engaging in education and listening to frontline staff who must implement the new procedure

• PLAN:  plan a change
• DO:  do it on a small scale
• STUDY:  study the impact of the "do stage"
• ACT:  act on the results

• DEFINE the project purpose and scope; determine customer needs and benefits
• MEASURE baseline data on current processes/ identify problems
• ANALYZE root cause and validate with data; what needs improved
• IMPROVE implement improvements that will aid the root causes
• CONTROL perform analyses and compare baseline; monitor systems