June 4, 2012
“Abstract: The National Quality Forum (NQF), a private, nonprofit membership organization committed to improving health care quality performance measurement and reporting, was awarded a contract with the U.S. Department of Health and Human Services (HHS) to establish a portfolio of quality and efficiency measures. The portfolio of measures would allow the federal government to examine how and whether health care spending is achieving the best results for patients and taxpayers. As part of the scope of work under the HHS contract, NQF was required to conduct an independent evaluation of the uses of NQF-endorsed measures for the purposes of accountability (e.g., public reporting, payment, accreditation, certification) and quality improvement. In September 2010, NQF entered into a contract with the RAND Corporation for RAND to serve as the independent evaluator. This article presents the results of the evaluation study. It describes how performance measures are being used by a wide array of organizations and the types of measures being used for different purposes, summarizes key barriers and facilitators to the use of measures, and identifies opportunities for easing the use of performance measures moving forward.”
Posted in Journal Articles, READ Portal | Tagged with Quality assessment, Quality improvement | No Comments
May 30, 2012
“There is growing interest in the systematic assessment and international benchmarking of quality of care provided in different healthcare systems, and major work is under way to support this process through the development and validation of quality indicators that can be used internationally…
Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Indicators, Quality assessment | No Comments
May 28, 2012
“Abstract: The ratio of patients to physicians has long been used as a tool for measuring and planning healthcare resources in Canada. Some current changes in primary care, such as enrolment of patients with physicians, make this ratio easier to calculate, while others, such as changing practice structure, make it more complex to interpret. Based on information gleaned from a review of the literature, we argue that before panel size can be used as an accountability measure for individual physicians or practices in primary care, we must understand its relationship to quality and outcomes at individual and population levels, as well as the contextual factors that affect it.”
Posted in Journal Articles, READ Portal | Tagged with Canada, Primary health care, Quality assessment, Quality of care | No Comments
May 24, 2012
“The patient-centered medical home has emerged as a promising solution to address the significant fragmentation, poor quality, and high costs that afflict the U.S. health care system. The medical home model includes core components of primary and patient-centered care, recent innovations in practice redesign and health information technology, and changes to the way practices and providers are paid. There are initiatives across the country testing the promise of the medical home model. However, to properly evaluate and compare results that will aid in the implementation of these and other initiatives, researchers need a standard set of core measures. This brief describes the process and recommendations of more than 75 researchers who came together to identify a core set of standardized measures to evaluate the patient-centered medical home. It focuses on two domains of medical home outcomes: cost/utilization and clinical quality.”
Posted in READ Portal, Reports & Papers | Tagged with Indicators, Patient-centered care, Quality assessment, Statistics & numerical data | No Comments
May 8, 2012
In this paper, we discuss the current capacity for governments and their health information and quality agencies to report on the performance of their health systems. We also provide international and Canadian examples of governments that are using improved performance reporting mechanisms to support their health care priorities and goals. To do this, they rely on strategic health plans to guide service implementation, complemented by reporting frameworks that use health indicators to monitor performance over a set period of time, and report their achievements regularly to the public. The strategic plans are revised regularly in light of changing political, economic, and social circumstances within each jurisdiction. In some cases, governments have begun using performance-based funding programs as a way to drive performance improvement and achievement of their health care objectives.
As a country, how can we improve the way we set goals and measure changes to health care and the health of Canadians? How do we make sure that activities are focused on achieving positive results? How do we improve accountability for achieving these results, especially in light of the significant public resources employed in the delivery of health care in Canada? These questions predate the existing health accords and remain to be answered.
This paper is intended to raise the profile of performance reporting in Canada’s health care system and to increase our collective understanding of the opportunities to improve it in the interest of better accountability.
Posted in 2014 Health Accord, READ Portal, Reports & Papers | Tagged with Canada, Indicators, Quality assessment | No Comments
May 7, 2012
“This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country. However this high spending cannot be attributed to higher income, an older population, or greater supply or utilization of hospitals and doctors. Instead, the findings suggest the higher spending is more likely due to higher prices and perhaps more readily accessible technology and greater obesity. Health care quality in the U.S. varies and is not notably superior to the far less expensive systems in the other study countries. Of the countries studied, Japan has the lowest health spending, which it achieves primarily through aggressive price regulation.”
Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Health care costs, Indicators, Quality assessment | No Comments
February 9, 2012
“At a time when hospitals are under pressure to improve quality and make productivity savings, they need to find tools to support them. Service-line management (SLM) and service-line reporting (SLR) offer one approach. Service-line management is a system in which a hospital trust is divided into specialist clinical areas that are then managed, by clinicians, as distinct operational units. SLM enables clinicians and managers to plan service activities, set objectives and targets, monitor financial and operational activity and manage performance. Service-line reporting provides the necessary data on financial performance, activity, quality and staffing.
Service-line management: Can it improve quality and efficiency? presents the findings from a series of interviews with staff at seven NHS trusts that are using SLM or SLR, revealing how they are implementing this approach and identifying what helps and what hinders this way of working.
The paper outlines a number of important issues for trusts to consider when introducing SLM.
- The role of the board – including the need for both clear and consistent executive support for using SLM and for executives to be willing to relinquish control over decisions and budgets.
- Clinical engagement – especially the need to provide support and training to enable clinicians to take on leadership and management roles and to develop shared and realistic goals.
- Data – including identifying and evaluating existing sources of data and the need to accept that the time needed to implement SLM, the value of the information obtained, and the ease of data collection will vary between service lines because of external and clinical factors.
- Resources – including the challenge of finding the time and resources to dedicate to the introduction of SLR and SLM and the need for well-resourced and suitably skilled financial and informatics support.
The paper concludes that implementing SLR and SLM well is challenging, but it works best when it is part of the overall management approach of the trust and its day-to-day way of working.”
Posted in READ Portal, Reports & Papers | Tagged with Hospital administration, Quality assessment, Quality improvement | No Comments
January 11, 2012
“It has become a core belief in U.S. health care that improving clinical quality will reduce health care costs. It seems intuitive that reducing readmissions, shortening lengths of stay, and building efficiency into clinical processes will reduce resource utilization and thereby lower costs. Certainly, evidence suggests that there is no association between high quality and high costs. Yet true bottom-line savings from improved clinical quality rarely materialize, and costs continue to climb. Manufacturing and service companies around the world have demonstrated the cost benefits of improving product quality and production efficiency. So why haven’t nearly two decades of work on improving health care quality had a measurable effect on health care costs?”
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Posted in Journal Articles, READ Portal | Tagged with Quality assessment, Quality of care | No Comments
December 14, 2011
“Background: Nursing homes provide long-term housing, support and nursing care to frail elders who are no longer able to function independently. Although studies conducted in the United States have demonstrated an association between for-profit ownership and inferior quality, relatively few Canadian studies have made performance comparisons with reference to type of ownership. Complaints are one proxy measure of performance in the nursing home setting. Our study goal was to determine whether there is an association between facility ownership and the frequency of nursing home complaints.
Methods: We analyzed publicly available data on complaints, regulatory measures, facility ownership and size for 604 facilities in Ontario over 1 year (2007/08) and 62 facilities in British Columbia (Fraser Health region) over 4 years (2004–2008). All analyses were carried out at the facility level. Negative binomial regression analysis was used to assess the association between type of facility ownership and frequency of complaints.
Interpretation: Compared with for-profit chain facilities, non-profit, charitable and public facilities had significantly lower rates of complaints in Ontario. Likewise, in British Columbia’s Fraser Health region, non-profit owned facilities had significantly lower rates of complaints compared with for-profit owned facilities.”
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Posted in Journal Articles, READ Portal | Tagged with Health services for the aged, Quality assessment, Quality of care | No Comments
November 30, 2011
“Background: In health care, many organizations are working on quality improvement and/ or innovation of their care practices. Although the effectiveness of improvement processes has been studied extensively, little attention has been given to sustainability of the changed work practices after implementation. The objective of this study is to develop a theoretical framework and measurement instrument for sustainability. To this end sustainability is conceptualized with two dimensions: routinization and institutionalization.
Methods: The exploratory methodological design consisted of three phases: a) framework development; b) instrument development; and c) field testing in former improvement teams in a quality improvement program for health care (N teams = 63, N individual =112). Data were collected not until at least one year had passed after implementation. Underlying constructs and their interrelations were explored using Structural Equation Modeling and Principal Component Analyses. Internal consistency was computed with Cronbach’s alpha coefficient. A long and a short version of the instrument are proposed.
Conclusions: The theoretical framework offers a valuable starting point for the analysis of sustainability on the level of actual changed work practices. Even though the two dimensions routinization and institutionalization are related, they are clearly distinguishable and each has distinct value in the discussion of sustainability. Finally, the sub scales conformed to psychometric properties defined in literature. The instrument can be used in the evaluation of improvement projects.”
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Posted in Journal Articles, READ Portal | Tagged with Process improvement, Quality assessment, Quality improvement | No Comments
