Changes In Quality Of Care Research Articles

Medicare's Bundled Payment Initiatives for Hospital-Initiated Episodes: Evidence and Evolution.

Bundled payments have been promoted as an alternative to fee-for-service payments that can mitigate the incentives for service volume under the fee-for-service model. As Medicare has gained experience with bundled payments, it has widened their scope and increased their duration. However, there have been few reviews of the empirical literature on the impact of Medicare's bundled payment programs on cost, resource use, utilization, and quality. We examined the history and features of 16 of Medicare's bundled payment programs involving hospital-initiated episodes of care and conducted a literature review of articles about those programs. Database and additional searches yielded 1,479 articles. We evaluate the studies' methodological quality and summarize the quantitative findings about Medicare expenditures and quality of care from 37 studies that used higher-quality research designs. Medicare's bundled payment initiatives have varied in their design features, such as episode scope and duration. Many initiatives were associated with little to no reduction in Medicare expenditures, unless large pricing discounts for providers were negotiated in advance. Initiatives that included post-acute care services were associated with lower expenditures for certain conditions. Hospitals may have been able to reduce internal production costs with help from physicians via gainsharing. Most initiatives were not associated with significant changes in quality of care, as measured by readmission and mortality rates. Of the significant changes in readmission rates, the results were mixed, showing increases and decreases associated with bundled payments. Some evidence suggested that worse patient outcomes were associated bundled payments, although most results were not statistically significant. Results on case-mix selection were mixed: Several initiatives were associated with reductions in episode severity, whereas others were associated with little change. Bundled payments for hospital-initiated episodes may be a good alternative to fee-for-service payments. Bundled payments can help slow the growth of payer spending, although they do not necessarily reduce absolute spending. They are associated with lower provider production costs, and there is no overwhelming evidence of compromised quality. However, designing a bundled payment contract that is attractive to both providers and payers proves to be a challenge.

Providing Health Physicals and/or Health Monitoring Services in Mental Health Clinics: Impact on Laboratory Screening and Monitoring for High Risk Populations.

Providing physical health care in specialty mental health clinics is a promising approach to improving the health status of adults with serious mental illness, but most programs examined in prior studies are not financially sustainable. This study assessed the impact on quality of care of a low-cost program implemented in New York State that allowed mental health clinics to be reimbursed by Medicaid for provision of health monitoring and health physicals (HM/HP). Medicaid claims data were analyzed with generalized linear multilevel models to examine change over time in quality of physical health care associated with HM/HP services. Recipients of HM/HP services were compared to control clinic patients [Per protocol (PP)] and with non-recipients of HM/HP services from both intervention and control clinics [As-Treated (AT)]. HM/HP clinic patients, regardless of receipt of HM/HP services, were compared with control clinic patients [Intent-to-Treat (ITT)]. Analyses were conducted with adjustment for patient demographic and clinical characteristics and prior year service use. The PP and AT analyses found significant improvement in measure of blood glucose screening for patients on antipsychotic medication and HbA1C testing for patients with diabetes (AOR range 1.26-1.33) and the AT analysis found significant improvement in cholesterol screening for patients on antipsychotic medication (AOR 1.24). However, ITT analysis found no significant changes in quality of care in HM/HP clinic caseloads relative to control clinics. The low-cost HM/HP program has the potential to benefit patients who receive supported services, but its impact is limited by remaining barriers to service implementation.

Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda

ObjectiveTo assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala.DesignInterrupted time series (ITS) analysis.SettingNsambya Hospital, Uganda.ParticipantsLive births and stillbirths.InterventionsPND audit.Primary and secondary...

The impact of the nurses\u2019, doctors\u2019 and clinical officer strikes on mortality in four health facilities in Kenya

BackgroundHealth worker strikes are a significant threat to universal access to care globally and especially in sub Saharan Africa. Kenya’s health sector has seen an increase in such industrial action. Globally there is limited data that has examined mortality related to such strikes in countries where emergency services were preserved. We sought to assess the mortality impact of an 100 day physician strike which was followed by 151 day nurses’ strike and 20 day clinical officer strike in Kenya.MethodsMonthly mortality data was abstracted from four public hospitals, Kenyatta National Referral Hospital, AIC Kijabe Hospital, Mbagathi Hospital and Siaya Hospital between December 2016 and March 2018. Differences in mortality were assessed using t-tests and multiple linear regression adjusting for facility, numbers of patients utilizing the hospital and department.ResultsThere was a significant decline in the numbers of patients seen, comparing the non-strike and strike periods; beta (ß) coefficient − 649 (95% CI -950, − 347) p < 0.0001. The physicians’ strike saw a significant decline in mortality (ß) coefficient − 19.0 (95%CI -29.2, − 8.87) p < 0.0001. Nurses and Clinical Officer strikes’ did not significantly impact mortality. There was no mortality increase in the post-strike period beta (ß) coefficient 7.42 (95%CI -16.7, 1.85) p = 0.12.ConclusionDeclines in facility-based mortality during strike months was noted when compared to a non-striking facility, where mortality increased. The decline is possibly associated with the reduced patient volumes, and a possible change in quality of care. Public health facilities are congested and over-utilized by the local population majority of whom cannot afford even low cost private care. Health worker strikes in Kenya where the public health system is the only financially accessible option for 80% of the population pose a significant threat to universal access to care. Judicious investment in the health infrastructure and staffing may decrease congestion and improve quality of care with attendant mortality decline.

Recurrent costs in primary health care in Ethiopia: facility and disease specific unit costs and their components in government primary hospitals and health centers

BackgroundContinued investment, especially from domestic financing, is needed for Ethiopia to achieve universal health coverage and a sustainable health system over time. Understanding costs of providing health services will assist the government to mobilize adequate resources for health, and to understand future costs of changes in quality of care, service provision scope, and potential decline in external resources. This study assessed costs per unit of service output, “unit costs”, for government primary hospitals and health centers, and disease-specific services within each facility.MethodsQuantitative and qualitative data were collected from 25 primary hospitals and 47 health centers across eight of the eleven regions of Ethiopia for 2013/14, and 2014/15 and 2015/16 but only for primary hospitals, and supplemented by other related health and financial institutions records. A top-down costing approach was used to estimate unit costs for each facility by department – inpatient, outpatient, maternal and child health, and delivery. A mixed-method approach was used for the disease-specific unit costs exempt from fees.ResultsHealth center median unit cost was 146 Ethiopian birr (ETB) (17 PPP$, 2012), the Delivery department had the highest median unit cost (647 ETB; 76 PPP$, 2012) and Outpatient department (OPD) had the lowest (124 ETB; 14 PPP$, 2012). Primary hospital median unit cost was 339 ETB (40 PPP$, 2012), with Inpatient department having the highest median unit cost (1288 ETB; 151 PPP$, 2012), while OPD was the lowest (252 ETB; 29 PPP$, 2012). Drugs and pharmaceutical supplies accounted for most of the costs for both facilities. Among the exempted services offered, tuberculosis and antiretroviral treatment are the costliest with median unit costs from 1091 to 1536 ETB (128–180 PPP$, 2012), with drugs and supplies accounting for almost 90% of the costs.ConclusionsHigh unit costs of service provision could be indicative of underutilization of the primary health care system, coupled with inefficiencies associated with organization and delivery of health services. Data from this study are being used to assess efficiency and productivity among primary care facilities, facilitate premium setting for health insurance, and improve budgeting and allocating health resources for a more sustainable and effective primary health care system.

Changes in Quality of Care after Hospital Mergers and Acquisitions

BackgroundThe hospital industry has consolidated substantially during the past two decades and at an accelerated pace since 2010. Multiple studies have shown that hospital mergers have led to higher prices for commercially insured patients, but research about effects on quality of care is limited.MethodsUsing Medicare claims and Hospital Compare data from 2007 through 2016 on performance on four measures of quality of care (a composite of clinical-process measures, a composite of patient-experience measures, mortality, and the rate of readmission after discharge) and data on hospital mergers and acquisitions occurring from 2009 through 2013, we conducted difference-in-differences analyses comparing changes in the performance of acquired hospitals from the time before acquisition to the time after acquisition with concurrent changes for control hospitals that did not have a change in ownership.ResultsThe study sample included 246 acquired hospitals and 1986 control hospitals. Being acquired was associated with a modest differential decline in performance on the patient-experience measure (adjusted differential change, −0.17 SD; 95% confidence interval [CI], −0.26 to −0.07; P=0.002; the change was analogous to a fall from the 50th to the 41st percentile) and no significant differential change in 30-day readmission rates (−0.10 percentage points; 95% CI, −0.53 to 0.34; P=0.72) or in 30-day mortality (−0.03 percentage points; 95% CI, −0.20 to 0.14; P=0.72). Acquired hospitals had a significant differential improvement in performance on the clinical-process measure (0.22 SD; 95% CI, 0.05 to 0.38; P=0.03), but this could not be attributed conclusively to a change in ownership because differential improvement occurred before acquisition.ConclusionsHospital acquisition by another hospital or hospital system was associated with modestly worse patient experiences and no significant changes in readmission or mortality rates. Effects on process measures of quality were inconclusive. (Funded by the Agency for Healthcare Research and Quality.)

Developing a Value-Based Approach to Outcome Reporting in Pediatric Surgery.

The population that undergoes pediatric surgical procedures in high-resource settings such as Canada primarily comprises healthy patients who undergo low-risk, elective surgeries and fewer higher-risk patients who require more complex surgeries. Given this variability, there is a relatively low incidence of traditionally measured "critical" outcomes within any single pediatric surgical system or even pediatric surgical subspecialty, rendering the currently available quality measurement tools inadequate to provide sensitive measures of quality. In an era when scalable solutions are required to improve health outcomes across entire populations, there is an urgent need for more holistic measures of a child's well-being to benchmark and measure changes in quality of care. This article discusses opportunities for enhanced performance measurement in pediatric surgery using a value-based framework to identify and measure patient and family outcomes of importance over the full care cycle, from initial presentation through surgery and recovery to sustainability of health. In suggesting new avenues for performance measurement, we highlight how these measures can be used to develop, evaluate and refine surgical system innovations such as bundled care pathways and perioperative care homes.

From health care hospitals to health literate organizations: the case of health literacy of health workers in Brazil

Abstract Background Health literacy (HL) presents itself as a strategy to rethink lifestyles and enhance health promotion strategies (with the inclusion of social determinants of health) in the workplace. The aim of this research was to evaluate HL levels of health workers from the urgency and emergency sector of a public hospital in Brazil (Uberaba, Minas Gerais, HC/UFTM-SUS). Methods An exploratory, quantitative and qualitative research based in the European Health Literacy survey (validated to Brasil HLS-EU-BR) collected data from 216 participants, by the means of a CAWI methodology. Results A total of 141 participants were retained for data analysis. HL level of participants from the administrative sector reached a score of 40.0% for insufficient and problematic HL; 33.3% had sufficient HL levels and 26.7% showed excellent HL levels. For the category of Healthcare medium / technical level, 48.2% had inadequate and problematic HL; 37.5% had sufficient and 14.3% showed excellent HL levels. In the third category - Healthcare participants with higher education levels - 31.6% had problematic, 34.2% sufficient and 34.2% showed excellent HL levels. Conclusions This is the first time the instrument (HLS-EU-BR) to evaluate HL is used in a health professional setting in Brazil. This research demonstrated that HL is sensitive to socioeconomic differences and highlights the need to promote HL of health workers. Targeting lower socioeconomic groups that have a routine of dealing with the general public in a public hospital to increment HL levels, seems to be an option worth investigating. Such a proposition could not only benefit the specific worker, but target a social change in quality of care, health promotion and social support that can be centered in hospitals. This would trigger the needed change proposed by WHO in Nairobi and Shangai: shifting health care organizations to health literate organizations.

Delivery practices and care experience during implementation of an adapted safe childbirth checklist and respectful care program in Chiapas, Mexico.

To evaluate changes in quality of care after implementing an adapted safe childbirth checklist (SCC) in Chiapas, Mexico. A convergent mixed-methods study was conducted among 447 women in labor who attended a rural community hospital between September 1, 2016, and June 30, 2017. Logistic regression analysis was used to evaluate adherence to evidence-based practices over time, adjusting for provider. Participants were surveyed about their perceptions of care after hospital discharge. A purposefully sampled subgroup also completed in-depth interviews. Thematic analysis was performed to evaluate perceptions of care. 384 (85.9%) women were attended by staff that used the adapted SCC during delivery. Of these, 221 and 28 completed the hospital discharge survey and in-depth interview, respectively. Adherence with offering a birth companion (odds ratio [OR] 3.06, 95% CI 1.40-6.68), free choice of birth position (2.75, 1.21-6.26), and immediate skin-to-skin contact (4.53, 1.97-10.39) improved 6-8months after implementation. Participants' perceived quality of care improved over time. Provider communication generated positive perceptions. Reprimanding women for arriving in early labor or complaining of pain generated negative perceptions. Use of the adapted SCC improved quality of care through increased adherence with essential and respectful delivery practices.

Changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda, 2008–15: a prospective study

Abstract Background Every year, an estimated 2·7 million neonatal deaths and stillbirths occur worldwide. Neonatal mortality in Uganda has been 27 deaths per 1000 births between 2008 and 2018, despite an increase in the rate of institutional deliveries from 59% to 74% over this time. Suboptimal care still occurs in hospitals, resulting in maternal and neonatal morbidity. Globally, perinatal death audit has been shown to reduce perinatal mortality by 30%. However, there is paucity of data on the effect of audit on perinatal outcomes in Uganda. Here, we describe perinatal outcomes after introduction of perinatal death audit in a tertiary hospital in Kampala, Uganda. Methods We undertook a prospective review of deaths between January, 2008, and December, 2015. Cause of death was identified through consensus between midwives, intern doctors, postgraduates, paediatricians, and neonatologists. We assessed standard of care against existing guidelines. We used data on outcomes from January, 2006, to December, 2007, for comparison and recorded changes to clinical practice that were implemented in response to cause-of-death data. Findings A total of 58 997 births and 2616 perinatal deaths occured between 2008 and 2015. Of these, 603 [23%] perinatal deaths were selected for audit. Perinatal mortality decreased from 48·4 deaths per 1000 births before the intervention to 43 per 1000 births in 2015; stillbirths decreased from 32·9 per 1000 births to 22 per 1000 births. The proportion of neonatal deaths reduced from 11·2% to 4·9%. The most common causes of death in the study period were: hypoxia (186, 35·4%) and unknown (227, 43·2%). Interventions included: neonatal resuscitation training; building of a new maternity theatre; partograph training; increased human resource for maternity and the newborn care unit; and provision of equipment such as ambubags, bubble continuous positive air way pressure (CPAP) machines, and radiant warmers. Skills introduced included: kangaroo mother care; and use of antenatal steroids, CPAP, surfactant, and phototherapy. Case fatality rates decreased for hypoxia (21·1% to 15·5%) and complications of prematurity (26·4% to 11·1%) but increased for infections (1·9% to 5·7%). Interpretation Perinatal death audits are feasible in Uganda. Furthermore, the data from audits can inform decisions about new training and interventions and might lead to improved perinatal outcomes. Funding None.

Peripherally inserted central catheter, midline, and "short" midline in palliative care: Patient-reported outcome measures to assess impact on quality of care.

A prospective, observational study was conducted in our palliative care unit to assess the impact of peripherally inserted central catheters (PICCs), midline, and "short" midline catheters on the quality of care in cancer and non-cancer patients. The secondary objective was to assess pain and distress during vascular access device insertion. Patients were recruited if they underwent insertion of a PICC, midline, or "short" midline catheter as part of their standard care. The Palliative care Outcome Scale was used to assess changes in quality of care after vascular access device positioning. A numerical rating scale was used to measure pain intensity during catheter insertion. Of the 90 patients enrolled, 52.2% were male with a mean age of 73.0 ± 13 years. Among these patients, 64.4% patients underwent "short" midline insertion, 26.7% PICC, and 8.9% midline catheter. The patients' mean baseline Palliative care Outcome Scale score was 15.7 ± 5.6. Three days after vascular access device positioning, the patients' mean Palliative care Outcome Scale score was 11.5 ± 5.5 (p < 0.0001). Mean pain score during vascular access device insertion was 1.26 ± 1.63, and mean procedural distress score was 1.78 ± 1.93. These findings suggest that medium-term intravenous catheters can have a favorable impact on quality of care and the procedures for these vascular access device insertions are well tolerated. Further research on the performance of different vascular access devices and their appropriateness in palliative care should be encouraged.

Effect of Changes in Hospital Nursing Resources on Improvements in Patient Safety and Quality of Care: A Panel Study.

Evidence shows hospitals with better nursing resources have better outcomes but few studies have shown that outcomes change over time within hospitals as nursing resources change. To determine whether changes in nursing resources over time within hospitals are related to changes in quality of care and patient safety. Multilevel logistic response models, using data from a panel of 737 hospitals in which cross-sections of nurse informants surveyed in 2006 and 2016, were used to simultaneously estimate longitudinal and cross-sectional associations between nursing resources, quality of care, and patient safety. Nursing resources included hospital-level measures of work environments, nurse staffing, and nurse education. Care quality was measured by overall rating of care quality, confidence in patients managing care after discharge, confidence in management resolving patient care problems; patient safety was measured by patient safety grade, concern with mistakes, and freedom to question authority. After taking into account cross-sectional differences between hospitals, differences among nurses within hospitals, and potential confounding variables, changes within hospitals in nursing resources were associated with significant changes in quality of care and patient safety. Improvements in work environment of 1 SD decrease odds of unfavorable quality care and patient safety by factors ranging from 0.82 to 0.97. Improvements within hospitals in work environments, nurse staffing, and educational composition of nurses coincide with improvements in quality of care and patient safety. Cross-sectional results closely approximate longitudinal panel results.

P832Temporal changes in quality of care for acute myocardial infarction and relation with 1 year survival: acute cardiac care association quality indicators applied to the FAST-MI registries

P832Temporal changes in quality of care for acute myocardial infarction and relation with 1 year survival: acute cardiac care association quality indicators applied to the FAST-MI registries

Changing Roles of Care Team Members within New Models of Care Delivery in Residential Care Facilities: Implications for the Delivery of Quality of Care

Providing quality of care (QoC) to older adults in residential care settings is an ongoing challenge given the increasingly complex needs of this population and the escalating economic constraints within which health authorities operate. While the implementation of the residential care delivery model in a Western Canadian health authority has contributed to some improvements in QoC, it has also highlighted key challenges that are both interpersonal and organizational in nature; specifically, gaps in leadership, teamwork, mentorship, and communication, as well as staffing mix, staffing consistency, resident complexity, and competing policy and program initiatives and directives. The implementation of a major change in care delivery impacts residents, families, and staff and may, in turn, impact their perceptions of change in QoC. When evaluating a model, therefore, it is important to examine both qualitative and quantitative outcomes: stories from those most affected in their everyday lives and trends in QoC indicator data.

Quality of integrated primary care and coproduction of care with community-living frail older persons

Introduction: The Chronic Care Model (CCM) was developed to guide quality improvement efforts in primary care and identifies important elements that promote high-quality integrated care and foster coproduction. We aimed to increase our knowledge on the CCM in the primary care setting for community-dwelling frail older persons in the Netherlands. The objective was therefore to assess congruency of care with (elements of) the CCM, professionals’ perceptions of quality of care and coproduction of care. Methods: A longitudinal study was conducted with a control group (4 GP practices delivering usual primary care) and an intervention group. The intervention group consisted of 11 GP practices that implemented a proactive, integrated care approach for frail older persons, which is called ‘Finding and Follow-up of Frail older persons’ (FFF). The FFF approach combines interrelated components of integrated primary care (e.g. case management, self-management support, multidisciplinary teams) that are assumed to promote high-quality primary care and coproduction of care. We assessed coproduction of care (relational coproduction instrument) and perceived quality of care (Assessment of Chronic Illness Care Short version; ACIC-S) among 75 healthcare professionals. Data were collected at baseline (T0) and 12 months after (T1) and were analyzed by chi-square tests, McNemar test, t-tests and regression analysis. To assess congruency of (integrated) primary care with the CCM, we conducted structured interviews with the 15 GPs. The interview format comprised 64 interventions across six CCM dimensions, i.e. community linkages, healthcare organization, self-management support, delivery system design, decision support, and clinical information systems. We assessed which interventions were implemented successfully in the intervention and control GP practices and we collected additional qualitative data. Results: Each GP practice implemented (various) interventions within each of the six dimensions of the CCM. Intervention GP practices implemented more interventions that are congruent with (dimensions of) the CCM than control GP practices (respectively 33 and 23 interventions on average). At baseline, ACIC-S scores on the CCM dimensions ‘healthcare organization’ and ‘delivery system design’ were significantly higher in the intervention group compared with the control group. Over time, quality of care improved significantly in the intervention group while there were no significant changes in quality of care in the control group. At T1, ACIC-S scores on all dimensions of the CCM were significantly higher in the intervention group compared with the control group. Furthermore, quality of care at baseline and improvements therein positively influenced coproduction of care with frail older persons in the intervention group. Discussion and conclusion: Overall, our study showed that the integrated care approach FFF successfully improved quality of care as perceived by professionals. This conclusion is in line with the finding that intervention GP practices implemented more interventions that are congruent with the CCM. Moreover, (improvements in) quality of care positively influenced coproduction of care with community-living frail older persons. Lessons learned: Redesigning primary healthcare systems and implementing integrated care based on (elements of) the CCM may contribute to improved quality of care and coproduction of care. Limitations: A limitation of our study was the small number of healthcare professionals in the control group. Suggestions for future research: Although the presence of a control group strengthened our findings, we recommend involving a larger sample of professionals providing usual care.

Implementation of WHO package of essential non-communicable disease interventions in the occupied Palestinian territory: assessment of patient perceptions to changes in quality of care with participatory ranking methods

BackgroundNon-communicable diseases (NCDs) are major contributors to disease and economic burden in the occupied Palestinian territory. From January 2013, to June 2013, the Palestine Ministry of Health and WHO introduced an evidence-based, cost-effective package called the WHO Package of Essential NCD Interventions (PEN), through a pilot project in 14 primary care clinics in Salfit District, West Bank. After a 6 month pilot, an assessment was done to ascertain patients perceptions of changes in NCD services, and to determine the feasibility of using Participative Ranking Methodology (PRM) to understand perceptions of quality of care in primary care clinics in the occupied Palestinian territory. MethodsPRM includes a qualitative component that allows for in-depth discussions with patients, and a quantitative component that ranks issues identified by participants as important. We completed PRM discussions with two groups of men and two groups of women patients with a NCD, representing 11 of the 14 pilot clinics. Group size varied from eight to 12 participants. Selection of clinics and participants was based on convenience. FindingsAll four groups identified positive changes in NCD service delivery since the PEN was introduced. More thorough physical examination by a doctor, more time with the doctor, perceived improvement in prescription of drugs, and better organisation of laboratory tests were all ranked in the top three positive changes by two out of four groups. Regular measurements of blood pressure, waist circumference, and weight taken by nurses, and health education messages provided by nurses to patients as part of the protocol, in addition to shorter waiting times were in the top eight improvements noted by all four groups. Additionally, application of an appointment system was identified as a positive change by three groups. Both male groups appreciated an increased follow-up period between visits, whereas neither group of women mentioned this as a substantial factor. No negative perceptions related to the PEN were expressed. InterpretationPatients perceived positive changes in the quality of NCD services since the introduction of the PEN. PRM is a relatively rapid and easy to implement method for data collection that has potential for use in understanding patient perceptions' of quality of care. FundingNone.

Use of a Digital Modified Checklist for Autism in Toddlers – Revised with Follow-up to Improve Quality of Screening for Autism

To assess changes in quality of care for children at risk for autism spectrum disorders (ASD) due to process improvement and implementation of a digital screening form. The process of screening for ASD was studied in an academic primary care pediatrics clinic before and after implementation of a digital version of the Modified Checklist for Autism in Toddlers - Revised with Follow-up with automated risk assessment. Quality metrics included accuracy of documentation of screening results and appropriate action for positive screens (secondary screening or referral). Participating physicians completed pre- and postintervention surveys to measure changes in attitudes toward feasibility and value of screening for ASD. Evidence of change was evaluated with statistical process control charts and χ2 tests. Accurate documentation in the electronic health record of screening results increased from 54% to 92% (38% increase, 95% CI 14%-64%) and appropriate action for children screening positive increased from 25% to 85% (60% increase, 95% CI 35%-85%). A total of 90% of participating physicians agreed that the transition to a digital screening form improved their clinical assessment of autism risk. Implementation of a tablet-based digital version of the Modified Checklist for Autism in Toddlers - Revised with Follow-up led to improved quality of care for children at risk for ASD and increased acceptability of screening for ASD. Continued efforts towards improving the process of screening for ASD could facilitate rapid, early diagnosis of ASD and advance the accuracy of studies of the impact of screening.

Abstract C68: Towards more equitable quality of breast cancer care: The role of the Chicago Breast Cancer Quality Consortium and expansion throughout the state of Illinois

Abstract Background: The Metropolitan Chicago Breast Cancer Task Force (MCBCTF) began its mission of eliminating Black/White breast cancer disparities in 2007. At the time, Black women in Chicago were 62% more likely to die from breast cancer than their White counterparts; which at the time represented one of the highest breast cancer mortality disparities of any urban area in the nation. Here we describe the current status of this quality improvement program, its successful expansion statewide, the variety of data collection and feedback approaches being undertaken, and some preliminary results. Methods: The MCBCTF created the Chicago Breast Cancer Quality Consortium (consortium) in response to 2007 report of stakeholders that called for such a QI program. The consortium is the first patient safety organization in the nation that addresses breast cancer care. Initially, the consortium collected aggregate counts on screened patients across approximately 50 facilities in metropolitan Chicago. A set of 11 quality benchmarks were based on data from the Breast Cancer Surveillance Consortium. Aggregate counts were used to calculate 11 corresponding measures including those pertaining to recall rate, timely follow up care, and cancer detection. In 2013 the initiative went statewide and was tied to supplemental reimbursement for screening mammography of Medicaid patients to equal that of Medicare. The statewide initiative includes the following data collection initiatives: benchmarks measures described earlier; a mammography facility survey; a survey of radiologists at these facilities; facility counts of the number of screened patients by zip code of residence, an estimate of patient mix regarding recent prior screening (how well screened a facility's patient population is impacts ability to meet benchmarks). Future initiatives will include obtaining an estimate of patient mix with respect to race/ethnicity and age (age affects risk which in turn impacts benchmarks). Data are analyzed and reported back to the facility. Metrics are reviewed and revised after each collection cycle. Results: Data submitted in 2016 for screenings conducted in calendar year 2013 represented over 700,000 screening mammograms performed in Illinois at 174 facilities, representing nearly 80% of Medicaid volume and a 54% increase in facility participation from 2015. In addition, 354 radiologists completed the radiologist survey, providing input on their attitudes regarding audits, and other aspects of performance. Of the 174 participating facilities, 168 facilities submitted patient residential zip codes, allowing the MCBCTF to map where the women each facility serves live. Conclusion: By enabling facilities the opportunity to participate in activities to improve the quality of care, by helping facility staff in collecting and reporting out measures and in feeding results back to institutions, this initiative strives to create substantial change in quality of care that will translate into reductions in breast cancer mortality and mortality disparities. Additionally, understanding the landscape in which women receive care allows the MCBCTF to employ interventions to reduce disparities. Citation Format: Bethliz Irizarry, Garth H. Rauscher, Anne-Marie Murphy. Towards more equitable quality of breast cancer care: The role of the Chicago Breast Cancer Quality Consortium and expansion throughout the state of Illinois. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C68.

Changes in quality of care for migrants during the economic crisis. Health workers’ perspective

Changes in quality of care for migrants during the economic crisis. Health workers’ perspective

Establishing a National Maternal Morbidity Outcome Indicator in England: A Population-Based Study Using Routine Hospital Data.

IntroductionAs maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1) the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI) by reproducing an Australian indicator using routinely available hospital data, 2) the impact of modifications to the indicator to address potential data quality issues, 3) the reliability of the indicator.MethodsWe used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES) database of the Health and Social care Information centre (HSCIC). A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies.ResultsEMMOI included 26 morbid events (17 diagnosis and 9 procedures). Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out.ConclusionWhile routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate.