Medical Care Quality Assessment Methods Research Paper

Medical Care Quality Assessment Methods Research Paper

? A healthcare provider may view quality in a technical sense, such as whether an accurate diagnosis is made, whether a surgical procedure is performed proficiently and whether the patient’s health has improved.

From this view, quality is the difference between what is technically sound and possible, and the actual practice and delivery of healthcare services. ? The health care manager, payer, or purchaser (employer health plan, or government program) may want to know if the healthcare services provided are cost effective. ? Public health officials may want to know if resources are being utilized appropriately to optimize population health and provided equitably within the population.

Quality as defined in Clair G. Meisenheimer’s book, Improving Quality: A Guide to Effective Programs, is “. . . the totality of features and characteristics of a health care process that bear on its ability to satisfy stated or implied needs; a process or outcome that consistently conforms to requirements, meets expectations, and maximizes value or utility for the customer. For the customer: getting what you were expecting and more; for the supplier: getting it right the first time, every time. The Institute of Medicine of the National Academies (IOM), a not-for-profit, non-governmental organization whose purpose is to provide national advice on issues relating to biomedical science, medicine, and health, and to serve as adviser to the nation to improve health, defines healthcare quality as the “degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. ” (Retrieved July 11, 2009 from http://www. iom. edu). Further expounding the definitions provided, the IOM developed six dimensions of quality healthcare: 1.

Timeliness – refers to the length of time it takes to provide care to patients. For example, how long it takes a patient to receive a treatment or follow-up care once a breast mass is detected. Delays should be shortened to increase the efficacy of treatments and to ease the patient’s fears. 2. Safety – refers to the ability or need to avoid injuries that result from the provided care that is intended to help the patient. Injuries such as those resulting from administering the wrong drug or wrong dosage, incorrect diagnoses, etc. 3.

Effectiveness – the extent to which healthcare service is provided based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit, that is avoiding over-and underused of resources. 4. Equity – the extent to which quality care is provided without regards to a patient’s gender, geographic location, gender and socioeconomic status. 5. Efficiency – the extent to which equipment, supplies and energy waste is avoided. 6. Patient-Contentedness – the extent to which the patient’s preferences, values and needs are taken into account when providing healthcare service.Medical Care Quality Assessment Methods Research Paper

Care should be provided respectful of and responsive to the patient. Comparatively, in his book An Introduction to Quality Assurance in Health Care, Avedis Donabedian provides seven components of what he considers quality in health care. Three of these components are included in the IOMs dimension of quality healthcare; effectiveness, efficiency and equity. The remaining four are: 1. Efficacy – the extent to which healthcare technology and science are able to bring about health improvements when used under the most ideal circumstances. 2.

Optimality – balancing the cost of healthcare improvements against the actual improvements, or in other words, by use of cost/benefit analysis ensuring that costs are not incurred which do not result in benefits do not exceed the cost or investment required. 3. Acceptability – the extent to which the expectations, desires and wishes of the patient and responsible members of their families are conformed to. There are five parts to the development of this definition: ? Accessibility – the ease with which patients can obtain healthcare ?

The patient-provider relationship – the extent to which the healthcare provider exhibits towards the patient personal concern, good manners, honesty, truthfulness, attention to the preferences of the patients, making efforts to provide explanations, patience, empathy, respectfulness and the avoidance of condescension. ? Amenities of care – the desirable aspects of the circumstances and/or environment under which healthcare is provided and includes cleanliness, adequate parking, convenience, privacy, comfort, restfulness, availability of refreshments, good food, etc. Patient preferences regarding the risks, cost and effects of care – recognition that the patient’s value of the consequences of care may differ for that of the healthcare provider and from patient to patient. Healthcare providers should take the time to explain to the patient the expected cost, risk and effects of alternatives and be guided by the informed opinions of the patients or responsible family member. ? Patient’s definition of fair and equitable As initially mentioned there are various legitimate definitions of what constitutes healthcare quality.Medical Care Quality Assessment Methods Research Paper

In developing this research paper, each of the definitions above will be utilized to address the issue of improving healthcare quality. The State of Quality Healthcare Surveys show growing concern over the eroding performance of the health care system. In November of 1999, the Institute of Medicine released a report entitled To Err Is Human: Building a Safer Health System, which concluded that 44,000 to 98,000 people die each year in hospitals due to preventable medical errors. In 2003 The National Committee for Quality Assurance (NCQA) released their first annual State of Healthcare Quality eport which found: More than 57,000 Americans die needlessly each year because they do not receive appropriate health care. The majority, almost 50,000 die because known conditions – high blood pressure or elevated cholesterol – are not adequately monitored and controlled. Others die or are at increased risk of death because they have not received the right preventative or follow-up care. [This is because] people with high blood pressure do not have it controlled, . . . people who have suffered a heart do not have their cholesterol levels monitored . . . and] smokers receive no advice to quit. Put simply, the healthcare system regularly fails to deliver care we know to be appropriate. (Nash & Goldfarb (2006) p 7-8) Although quality improvements have been made in some areas since that first report, the NCQA’s 2007 report illustrated significant room for improvement. In the area of medication management and prescription, the report found inappropriate use of some treatment medications, specifically antibiotics. Americans suffer an estimated one billion upper respiratory infections or common colds annually.

Colds are especially common among children, who suffer approximately three to eight colds a year. Because the common cold is most often viral, existing clinical guidelines do not prescribe the use of antibiotics as a treatment measure. Nevertheless, antibiotics are frequently prescribed to children with colds. Complications ranging from fevers and rashes to drug allergies, prolonged hospital stays and even death often arise from antibiotic treatment. Additionally, inappropriate antibiotic use contributes to bacterial resistance to antibiotics and represents wasted health care resources.

Annually $227 million is spent for inappropriate treatment for the common cold. The impact upon the elderly is just as damaging. Despite medical consensus that certain medications increase the risk of adverse effects to the elderly and should generally be avoided, these medications are still often prescribed to the elderly. One in 20 prescriptions filled by the elderly are for drugs deemed as “always avoid”. More than 1 in 10 filled prescriptions are for drugs that would rarely be considered appropriate.

Studies show that 21 to 37 percent of elderly patients had prescriptions filled for at least one potentially inappropriate drug and more than 15 percent had filled at least two. More than 40 percent of serious, life-threatening or fatal adverse drug events and 80 percent of adverse drug events in the elderly are avoidable. One study found that almost 3 percent of all elderly patients in a managed care organization suffered a preventable adverse drug event in a year. Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings.

Conservative estimates of extra costs due to potentially inappropriate medications in the elderly average $7. 2 billion a year. The 2007 State of Healthcare Quality report found in total between 38,300 and 88,900 avoidable deaths due to unexplained variations in care and avoidable hospital costs between $1. 9 and $3. 5 billion. Additionally, the report determined an estimated 51. 6 million avoidable sick days due to unexplained variation in care at a cost of lost productivity of approximately $8. 5 billion.Medical Care Quality Assessment Methods Research Paper

These findings alone suggests and supports the employment of continuous improvement measures in the quality of healthcare. Quality Indicators “In health care as in other arenas, that which cannot be measured is difficult to improve. Providers, consumers, policy makers, and others seeking to improve the quality of health care need accessible, reliable indicators of quality that they can use to flag potential problems, follow trends over time, and identify disparities across regions, communities, and providers. (Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions, 2007, p 4) There are a number of measures that have been developed or defined by various organizations, measures that are utilized to determine, adjust and/or improve healthcare quality. One such organization has developed and implemented quality indicators (QI) to assist providers, policy makers, and researchers in the analysis of data to identify variations in the quality of either inpatient or outpatient care; the Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ).

The AHRQ’s aim is to improve the quality, safety, efficiency and effectiveness of healthcare and does so through researching: quality improvement and patient safety, outcomes and effectiveness of care, clinical practice and technology assessment, health care organization and delivery systems, primary care including preventive services, healthcare costs and sources of payment. The indicators defined by the AHRQ are used to measure various aspects of health care quality based upon hospital administrative data. The quality indicators or QIs are grouped into four modules: ? Prevention Quality Indicators (PQI) – used to identify ambulatory care sensitive conditions (ACSC) which are “preventable hospitalizations” or conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. Despite these indicators being based upon hospital inpatient data, PQIs provide insight into the quality of healthcare outside the hospital setting.

For example, a diabetic patient may be hospitalized for complications associated with diabetes if their condition is not sufficiently monitored, if they do not receive proper patient education or if they do not manage their condition. Even though other factors outside of the healthcare system may result in hospitalization such as patient failure to follow treatment recommendations, or poor environmental conditions, PQIs are a good beginning point for assessing the quality of healthcare within a community and “serve as a screening tool rather than as definitive measures of quality problems.