Quality Indicators, Health Care

Large databases can be a rich source of clinical and administrative information on broad populations. These datasets are characterized by demographic and clinical data for over 1000 patients from multiple institutions. Since they are often collected and funded for other purposes, their use for secondary analysis increases their utility at relatively low costs. Advantages of large databases as a source include the very large numbers of available patients and their related medical information. Disadvantages include lack of detailed clinical information and absence of causal descriptions.

This article describes a process developed by Eastern Mercy Health System (EMHS), headquartered in Radnor, PA, to identify opportunities for quality improvement using defined outcome-based indicators in skilled nursing and long-term care (SN/LTC). The model is built on collaboration among the system's freestanding and hospital-based facilities; it includes a cyclical approach to the exchange of information.

This article describes a knowledge transfer process that was developed by Catholic Health East (CHE), headquartered in Newtown Square, PA, and that focuses upon one indicator of care, physical restraint use, in the skilled nursing/long-term care setting. The values-based process focuses on preserving residents' rights and using comparative data sharing as the basis for identifying opportunities for improvement. Further, it builds upon a collaborative cyclical model employed by all the CHE System's freestanding and hospital-based long-term care facilities.

SSM Health Care last year won the nation's most prestigious award for business quality. How it did so provides valuable lessons for all hospitals striving for excellence.

This article evaluates the impact of the Centers for Medicare & Medicaid Services/Premier pay-for-performance demonstration project on performance improvement in three clinical areas in a multihospital health care system. The study compares a group of hospitals participating in this project against a control group of similar hospitals that did not participate. Although the incentives are extremely small, the findings show that participation in the pay-for-performance initiative had a significant impact on the rate and magnitude of performance improvement.

Healthcare organizations that want to implement a productivity program should: Name an executive champion to lead the initiative. Develop a business model. Establish a productivity steering committee in each hospital. Use standardized definitions and auditable data. Define and monitor goals.

BACKGROUND: People aged 75†years and over account for 1 in 4 of all hospital admissions. There has been increasing recognition of problems in the care of older people, particularly in hospitals. Evidence suggests that older people judge the care they receive in terms of kindness, empathy, compassion, respectful communication and being seen as a person not just a patient. These are aspects of care to which we refer when we use the term 'relational care'.

BACKGROUND: Previous studies have documented that hospitals decrease costs in response to reimbursement cutbacks. However, research concerning how this may affect quality of care has produced mixed results. Until recently, the ability to study changes in patient safety and payment has been limited. OBJECTIVE: The objective of the study was to determine whether changes in 4 hospital patient safety indicator (PSI) rates are related to changes in the generosity of payers over time.

BACKGROUND: Fiscal constraints faced by Medicare are leading to policies designed to reduce expenditures. Evidence of the effect of reduced reimbursement on the mortality of Medicare patients discharged from all major hospital service lines is limited. METHODS: We modeled risk-adjusted 30-day mortality of patients discharged from 21 hospital service lines as a function of service line profitability, service line time trends, and hospital service line and year-fixed effects. We simulated the effect of alternative revenue-neutral reimbursement policies on mortality.

BACKGROUND: We hypothesize that medical centers that prioritize altruism can also deliver superior quality care. METHODS: Data were obtained from California's Office of Statewide Health Planning and Development, Medicare Hospital Compare, and the Joint Commission US Census Bureau's American Community Survey. Outcomes were measured using summary statistics, regression analysis, and quality indices. Total discounted revenue/total revenue (TDR/TR) served as a proxy for altruistic care.