Unit 12 - AHS 450 QUALITY MANAGEMENT IN HEALTH CARE UNIT...

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Unformatted text preview: AHS 450 QUALITY MANAGEMENT IN HEALTH CARE UNIT 12: GUIDELINE-DRIVEN HEALTH CARE Topics Covered in This Lecture History and purpose of evidence-based medicine Techniques for integrating evidence-based medicine into health care practices Evidence-based performance measure, assessment, and improvement Evidence-Based Medicine: Why Its Important While 20% of medicine relies on research, as much as 80% is still based on tradition and opinion. Tradition and opinion is the clutter that is encumbering safe and productive outcomes in health care today. Dr.Brent James speech to Robert Wood Johnson Grant recipients, March 1991 Variation in Clinical Practice Age Specific Rates Per 100,000 for CABG in 1989 Area 4 5- 5 4 5 5- 6 4 6 5- 7 4 7 5 + California 95 270 480 310 New York 86 230 360 180 British Columbia 58 160 240 100 Ontario 89 190 230 50 Appropriateness of Care Appropriateness of Cardiovascular Procedures in New York State in 1990 Procedure Necessary % Appropriate % Less than Appropriate % Bypass 82 8 10 Angioplasty 3 5 23 42 Angiography 6 4 12 24 Appropriateness - expected health benefits to patients exceed expected risks Evidence-Based Medicine: Why Its Important Presidents Advisory Commission on Consumer Protection and Quality in the Health Care Industry - 1998 Report Reduce: Avoidable errors Over use/under use Wide practice variations Guidelines Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. National Guidelines Clearinghouse http://www.guideline.gov/ Clinical Algorithm Worker complains Obtain demographics Obtain job data, exposures Obtain complaint data Obtain past history Other medical history Red flags? Focused physical exam Diagnosis (Decision rules) No Decision rules Initial treatment/ comfort Activity modification Work related? To red flag process Yes Bill GH Patient discussion and agreement Yes Screen for barriers, risks of delay Mod duty needed? Return to work No Yes File first report No ACOEM Occupational Medicine Practice Guideline Narrative Guideline Format Screening Guidelines for Hypertension Periodic screening for hypertension is recommended for all persons >=21 years of age. The optimal interval for blood pressure screening has not been determined and is left to clinical discretion. Current expert opinion is that adults who are believed to be normotensive should receive blood pressure measurements at least once every 2 years if their last diastolic and systolic blood pressure readings were below 85 and 140 mm Hg, respectively, and annually if the last diastolic blood pressure was 85-89 mm Hg. Sphygmomanometry should be performed in accordance with recommended technique. Hypertension should not be diagnosed on the basis of a single measurement; elevated readings should be confirmed on more than one reading at each of three separate visits. In adults, current blood pressure criteria for the diagnosis of hypertension are an average diastolic pressure of 90 mm Hg or...
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This note was uploaded on 08/21/2011 for the course AHS 450 taught by Professor Spath during the Spring '11 term at University of Alabama at Birmingham.

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Unit 12 - AHS 450 QUALITY MANAGEMENT IN HEALTH CARE UNIT...

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