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  1. What is quality of care?
    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
  2. 5 Core competencies all HCP must develop in the 21st century
    • provide patient-centered care
    • work as an interdisciplinary team
    • employ evidence-based practices
    • apply quality improvement methods
    • utilize informatics
  3. What perspective of quality do patients, providers, and payers have?
    • 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
  4. 6 Dimensions of quality in which HC should be:
    • 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
  5. Quality "defects" in HC
    • underuse
    • overuse
    • misuse
  6. underuse
    • procedures/prevention known that are not used
    • ex. screenings/vaccinations
  7. overuse
    • intervention used too often
    • ex. antibiotics
  8. misuse
    • something that occurs in the clinical/medical care process that's inappropriate
    • ex. medication errors/drug use inappropriately
  9. Evaluation of quality of care
    Measurement that focuses on structure, process, or outcome
  10. Structure
    • 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
  11. Process
    • 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
  12. Outcome
    • result of care
    • health status related indicators, patient satisfaction, costs of care
  13. Quality Assessment
    measurement of quality against an established standard
  14. Quality Assurance
    • institutionalizing (system wide/organization wide) quality through ongoing assessment
    • can't happen w/o quality assessment
  15. Pay for Performance (P4P)
    • initiative to link reimbursement to quality and efficiency
    • incentive to improve the quality of hc & reduce costs
    • reward-based or penalty-based
  16. 5 Key Design Elements of P4P
    • individual vs. group incentives
    • paying the right amount
    • selecting high-impact performance measures
    • rewarding all high-quality care
    • prioritizing quality improvement for undeserved populations
  17. Potential benefits of P4P
    • higher quality of care provided
    • better patient outcomes, QOL
    • lower costs
    • increased integration of services
  18. Concerns with P4P
    • 3rd party determines what services are appropriate and incentivized
    • opportunity costs
    • unintended effects not well-studied
    • impediments to innovation
  19. Patient Satisfaction
    Measures the following IOM dimensions of quality health care: timely, efficient, patient-centered
  20. Quality Assurance/Continuous Quality Improvement (CQI)/ Total Quality Management (TQM)
    Goal:  continuously improve the quality of hc through all levels and functions of the organization
  21. CQI shown organizations have been able to 
    • streamline administration
    • reduce lengths of stay
    • improve clinical outcomes
    • provide higher levels of patient satisfaction
  22. 5 Main Elements of QA
    • 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
  23. PDSA
    • PLAN:  plan a change
    • DO:  do it on a small scale
    • STUDY:  study the impact of the "do stage"
    • ACT:  act on the results
  24. Six Sigma
    • 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
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