Unformatted text preview: Session 25 Policies dealing w/ health care quality
12/1/09 Current Stress on Quality 2000 IOM Report: "To Err is Human" 4498 K deaths per year due to Medical mistakes 2001 IOM Report "Crossing the Quality Chasm" Disjuncture b/w care people should receive & care they actually get Holds true for all levels of care Holds true for all demographic groups Patient Care Should Be: 1 Safe Patients not injured by course of treatment Use of best available scientific are 2 Effective evidence based 3 patient centered Given respectful manner Honor patient's values, beliefs, preferences Patient Care Should Be: 4 Timely Reduce waiting times & delays Avoid wastages of time/equipment/energy Should not vary as function of geography/gender/ ethnicity/socioeconomic status 5 Efficient 6 Equitable Framework of Quality Ala Avedis Donabedian Said that can look @ quality in 3 measures: Measures of
Structures Process outcomes Structures Measures of: Physical plant, Equipment, information technology Staffing, Licensure, Accreditation, Organizational culture Structures Structures are certainly essential for provision of quality services But don't, by themselves, guarantee that quality services will result Structures ARE easy & inexpensive to measure Process Measures of PatientCare Processes: Standard procedures Documented followthrough Specific services provided to customers (Patients) Process i.e. Diabetes Care Quarterly HbAIC B/P & cholesterol readings Periodic Eye Exam Regular Foot Exam Neuropathy Assessment Are Diagnosed diabetics receiving these services/tests? Process Even w/ appropriate ongoing monitoring Barriers to Good Outcomes PatientRelated Personal health habits Behaviors & beliefs Genetic factors Poverty/lack of insurance SystemRelated May not be general agreement on appropriate processes for condition many health care conditions lack consensus on treatment plans Outcomes Measures of: Mortality rates Morbidity rates Readmission rates Satisfaction & Quality of life measures Outcomes Outcome focused quality improvment is relatively rare Many different outcomes measures (could) be used Outcomes 1) Clinical Outcome Measures 2) Patient Care experience measures 3) Function Status measures 4) Financial outcome measures Outcomes Whose perspective of outcomes hsould be measured & tracked?
Patient Provider Payer Policymaker In Health Care Neither the demand for health care services, nor the provision of these services are a given disease condition, Is STATIC or stable over time Zone of Complexity Low to Moderate Certainty of outcomes & low to moderate agreement on what should be done This zone is where significant portions of health care occur NO one set procedure or regime to accomplish this even if we know what needs to be done Factors changing the Zone of Complexity New Knowledge From basic sciences & clinical research Updated Diagnostic & treatment
New procedures New technology Healthcare financing & regulations New diseases & bioterrorism threats This Moving Zone of Complexity Causes conceptual models of Health care to be viewed as A continually adaptive complex system Quality Defined No Universally accepted definition Varied Perspectives:
To Providers To Patients To payers To Policymakers Quality Defined No Universally Accepted Definition To Providers: Emphasize technical quality To Patients: Emphasize touch quality 5 "Rights" in Health Care To Payers: Emphasize Technical & touch quality How well the patient feels treated, satisfaction, access, communication, compassion, respect Appropriateness, cost, effectiveness, patient satisfaction Appropriateness, cost, effectiveness, patient, satisfaction, accessible, meet societal needs To Policy Makers: Emphasize touch & technical quality Focus on "Outcomes" not Uniform Individual Patient Outcomes are influenced by Multiple Factors Some factors are External to the specific provider or Organization
1) May receive care from multiple source 2) Differences in Patient characteristics Adds to complexity of quality & quality measures 5 rights of patient care Right care Right Patient Right Way Right time Right amount Differences in patient characteristics Healtha status Gneetic makeup Health habits & behavior Wealth/insurance Social support system Attitudes & beliefs ...
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- Spring '10
- different outcomes measures