Using Outcomes and other Assessment Tools to Improve Quality Quality Improvement

Consider quality as a major priority over cost, choice or doctor, or range of service Sources for information comes from family and friends Concerned about the physician’s skills, but place increasing emphasis on communication skills, care attitude and certification How Individuals Determine Quality

The degree to which health services for individuals increases the likelihood of desired outcomes and are consistent with professional practices (IOM, 1990) Quality Defined

Technical Performance (Quality of Care or clinical quality) Interpersonal Care (Quality of Life or Service Quality) Elements of Performance

Applying the best in current knowledge and technology to a personal health problem Outcomes compared for effectiveness Based on future expectations Technical Performance

Care that meets individual and social expectations and standards Patients communication of symptoms to the clinician Clinician communication of options to the patient Interpersonal Performance

(Donebedian, 1980) Structure ProcessOutcomes Model of Health Care Quality

Creating the capacity for quality Staff qualifications Safety and Sanitation Care documentation Adequacy of care resources Organizational Structure measures Structure Measures

Activities between the provider and patients or between provider and provider Initial care assessment and comprehensiveness Care plan based on assessment Compliance with treatment protocols/guidelines/standards of care Process Measures

Change in health status to due to antecedent (structure/process) activities Short-term measures Long-term measures Outcome Measures

Intervening Factors Severity of Illness Non-Health Factors Patient Compliance Social Support Patient Motivation Outcome Standards

Must consider the appropriateness of outcome standards Assume that the are representative of the condition (do they reflect treatment goals) Validity of Outcomes – the outcomes are attributable to prior success Outcome Standards cont.

Mortality Rates Co-morbidity Health Status Patient Satisfaction Access to care Measures of Quality Outcomes

Disease management targets disorders that require a comprehensive care system Focus is on chronic illness Emphasis is on preventive care that delays of prevents complications caused by acute care illness Uses practice guidelines and clinical support tools Uses a clinical team approach Improving Outcomes through Disease Management

Structure Staff Qualifications Care Resources Safety Standards Documentation Process Needs Assess Care Planning Protocol Adherence Outcomes Short-term Long-term Intervening Factors Severity of Illness Patient Compliance Social Support Revised Model of Healthcare Quality

Quality Indicators Rates can be used to assess quality in terms of structure, process, and outcome. Number of physicians in an area is example of structure. Rate of follow-up visits is example of process. Rate of re-admissions is an example of outcomes.

Types of Quality Assessment Tools Small Area Analysis - to compare utilization rates in small populations Analytic studies. Analytic studies are necessary to determine effectiveness or to assist in the planning process. Practice guidelines. Practice Guidelines/Critical Paths (clinical pathways) tools for implementing effective practice patterns and discouraging variation form those patterns. Critical Paths (Clinical Guidelines) – optimal sequencing and timing of interventions by providers for a particular diagnosis or procedure to determine cause and effect relationships.