Effectiveness Of Quality Improvement Initiative Research Articles

Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Uncertainty, emergence and adaptation: A complex adaptive systems approach to quality improvement

The healthcare quality improvement (QI) literature is replete with examples stating that continued failure to regard healthcare as a complex adaptive system (CAS) reduces the effectiveness of quality improvement initiatives. Recommendations and strategies for managing change within CAS exist, but the specific mechanisms that bring about successful change within CAS and the implications for quality practitioners are under-explored. This article presents a generalizable model for QI within CAS and provides a specifically CAS explanation for incremental change. We develop a conceptual model from foundational CAS principles that is then operationalized as an agent-based simulation model. Our model captures critical complex system behavior in a generic manner easily applied to different improvement contexts. We tested the simulation model using a recognizably complex healthcare improvement case: reducing antipsychotic prescribing levels in aged residential care. Nonlinear phase transitions were observed in the agent network, conditioned on the network’s ability to learn solution options and simultaneously maintain cooperation. We believe that a CAS explanation of change can assist practitioners navigating complex QI activities.

Examining the effect of quality improvement initiatives on decreasing racial disparities in maternal morbidity

The objective of this study was to evaluate the impact of quality improvement (QI) and patient safety initiatives and data disaggregation on racial disparities in severe maternal morbidity from hemorrhage...

An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review.

ObjectivesThe main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions.ProblemThe rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade.SettingThe research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs.ResultsThe most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation.ConclusionThese strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions.

Quality improvement in the national cancer institute community cancer centers program: the quality oncology practice initiative experience.

The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) began in 2007; it is a network of community-based hospitals funded by the NCI. Quality of care is an NCCCP priority, with participation in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) playing a fundamental role in quality assessment and quality improvement (QI) projects. Using QOPI methodology, performance on quality measures was analyzed two times per year over a 3-year period to enhance our implementation of quality standards at NCCCP hospitals. A data-sharing agreement allowed individual-practice QOPI data to be electronically sent to the NCI. Aggregated data with the other NCCCP QOPI participants were presented to the network via Webinars. The NCCCP Quality of Care Subcommittee selected areas in which to focus subsequent QI efforts, and high-performing practices shared voluntarily their QI best practices with the network. QOPI results were compiled semiannually between fall 2010 and fall 2013. The network concentrated on measures with a quality score of ≤ 0.75 and planned voluntary group-wide QI interventions. We identified 13 measures in which the NCCCP fell at or below the designated quality score in fall 2010. After implementing a variety of QI initiatives, the network registered improvements in all parameters except one (use of treatment summaries). Using the NCCCP as a paradigm, QOPI metrics provide a useful platform for group-wide measurement of quality performance. In addition, these measurements can be used to assess the effectiveness of QI initiatives.

Results of a Mixed-Methods Evaluation of Partnerships for Health: A Quality Improvement Initiative for Diabetes Care

Quality improvement (QI) initiatives have been implemented to facilitate transition to a chronic disease management approach in primary health care. However, the effect of QI initiatives on diabetes clinical processes and outcomes remains unclear. This article reports the effect of Partnerships for Health, a QI program implemented in Southwestern Ontario, Canada, on diabetes clinical process and outcome measures and describes program participants' views of elements that influenced their ability to reach desired improvements. Part of an external, concurrent, comprehensive, mixed-methods evaluation of Partnerships for Health, a before/after audit of 30 charts of patient of program physicians (n = 35) and semistructured interviews with program participants (physicians and allied health providers) were conducted. The proportion of patients (n = 998) with a documented test/examination for the following clinical processes significantly improved (P ≤ .005): glycosylated hemoglobin (A1c), cholesterol, albumin-to-creatinine ratio, serum creatinine, glomerular filtration rate, electrocardiogram, foot/eye/neuropathy examination, body mass index, waist circumference, and depression screening. Data showed intensification of treatment and significant improvement in the number of patients at target for low-density lipoprotein (LDL) and blood pressure (BP) (P ≤ .001). Mean LDL and BP values decreased significantly (P ≤ .01), and an analysis of patients above glycemic targets (A1c >7% at baseline) showed a significant decrease in mean A1c values (P ≤ .01). Interview participants (n = 55) described using a team approach, improved collaborative and proactive care through better tracking of patient data, and increased patient involvement as elements that positively influenced clinical processes and outcomes. QI initiatives like Partnerships for Health can result in improved diabetes clinical process and outcome measures in primary health care.

1548 The Effect of Quality Improvement Initiatives as Measured by Nurses’ Perceptions in a Department of Children and Adolescents

IntroductionIn the context of a medium-sized Department of Pediatrics in Norway, a recent increase in the number of eligible patients including critically ill ones, has called for changes in the...

A structural equation modelling approach to assessing the effectiveness of quality improvement initiatives in service organisations: a systematic perspective

This study examines the strategic and operational outcomes of effective implementation of quality improvement initiatives in different service operational environments. Using a sample of 354 service organisations, this study utilises a structural equation modelling (SEM) approach to investigate the effectiveness of quality improvement initiatives. The results show clear strategic and operational benefits of effective implementation of quality improvement initiatives. The study concludes that the quality improvement efforts of service organisations should be viewed from a system-wide perspective. This systematic orientation leads to benefits which are not always achievable based on a piece-meal implementation orientation.

The role of quality improvement initiatives in healthcare operational environments

The purpose of this paper is to shed some light on the utilization of quality improvement initiatives in healthcare operational environments. In the process, environmental changes and strategic responses are examined for a sample of healthcare organizations. A survey-based research methodology is utilized in this study. Factor analysis is used to extract relevant factors representing environmental changes and strategic options relevant to healthcare organizations. In addition, simple percentages are utilized to assess the extent of implementation and effectiveness of quality improvement initiatives. In general, the findings appear to indicate that the studied organizations have achieved both operational and strategic benefits due to the effective implementation of quality improvement initiatives. The implementation of quality improvement initiatives appears to be in response to environmental changes and challenges faced by healthcare organizations. Based on the findings of this study, decision-makers are encouraged to commit organizational resources toward the effective implementation of quality improvement initiatives. Investing in quality improvement not only is justified, but also appears to be very much needed in a changing competitive environment. This study contributes to enhancing one's practical and theoretical understanding of the competitive impact of quality improvement initiatives in different operational settings.

The effectiveness of quality improvement initiatives in service operational context

PurposeThe purpose of this paper is twofold: first, to study the environmental and competitive factors in the service organizations and second, to investigate the extent of effective implementation of quality improvement initiatives in different operational settings.Design/methodology/approachIn this paper factor analysis is used to determine the underlying factors associated with the changes in the competitive environment. Proportional measures are used to study the implementation of quality improvement initiatives.FindingsThe paper finds that quality improvement initiatives are not implemented uniformly by all the service industries. Organizations implementing quality improvement initiatives face varying degrees of effectiveness. Positive operational and strategic outcomes have been observed by organizations implementing the quality improvement initiatives.Practical implicationsThe results of this paper show that implementation of different types of quality improvement initiatives has a positive impact on operational and strategic aspects of service organizations.Originality/valueThe empirical investigation in this paper shows the practical and theoretical value of issues related to the performance of service organizations.

Measuring quality in services for children with an intellectual disability

To evaluate the application of one particular quality measurement tool, the SERVQUAL instrument, as a potential mechanism to measure quality in services for children with disabilities Staff and family of children with an intellectual disability in two organisations providing specialist therapy and day completed an adapted SERVQUAL questionnaire. A total of 81 SERVQUAL questionnaires were distributed and 59 questionnaires were returned (response rate of 73 per cent). The SERVQUAL instrument can be considered as a useful diagnostic tool to identify particular strengths and areas for improvement in services for people with disabilities as the instrument lends itself for the monitoring of the effectiveness of quality improvement initiatives over time. The findings also showed relatively high customer expectations and the organisations involved in this research are currently not meeting all of these high expectations as significant quality gaps were found in the areas of reliability and responsiveness. The sample size was relatively small and the measurement of quality using the SERVQUAL instrument remains a challenge, due to the conceptual and empirical difficulties. The SERVQUAL instrument is probably most be attractive to service managers and funding organisations because of its ability to identify gaps in the quality of the service. The tool had been used to measure quality in services for people with disabilities and the research has shown that this tool might be an important additional quality measurement tool for services.

Barriers to communication regarding end-of-life care: perspectives of care providers

Objective Communication regarding end-of-life care is frequently perceived as suboptimal, despite the intent of both health care providers and patients. We interviewed health care providers to determine their perspective regarding these barriers to communication. Materials and Methods Eleven focus groups with a total of 10 attending physicians, 24 residents, and 33 nurses were convened to explore barriers to end-of-life discussions on the Internal Medicine service at a 600-bed tertiary care hospital in Toronto, Canada. An interview schedule was designed to elicit information regarding the process of end-of-life discussions, barriers to these discussions, and possible interventions for limiting such barriers. Transcripts were qualitatively analyzed by 6 raters who independently identified “themes.” Themes were refined using the Delphi technique and classified under broader “categories.” Results Four main categories of barriers emerged, relating to (1) patients, (2) the health care system, (3) health care providers, and (4) the nature of this dialogue. Attending physicians and residents most frequently identified patient-related factors as barriers to discussions, followed by system, dialogue, and provider barriers (43%, 39%, 10%, and 8%, respectively, for attending physicians; 40%, 34%, 13%, and 13%, respectively, for residents). Nurses similarly identified patient-related and system barriers most frequently, but provider barriers were discussed more often than dialogue barriers (46%, 28%, 22%, and 4%, respectively). Conclusions Attending physicians, residents, and nurses perceive the recipients of their care, and the system within which they provide this care, to be the major source of barriers to communication regarding end-of-life care. This finding may impact on the effectiveness of quality-improvement initiatives in end-of-life care.

Effectiveness of quality improvement initiative (Guidelines Applied to Practice [GAP] project) in improving the care of medicare patients and women with acute myocardial infarction

Effectiveness of quality improvement initiative (Guidelines Applied to Practice [GAP] project) in improving the care of medicare patients and women with acute myocardial infarction

Quality Screening and Management Using Claims Data In a Managed Care Setting

Quality screening and management (QSM), developed by United HealthCare Corporation for its own health plans but applicable to other settings, analyzes health care provided to an enrolled population using claims and administrative data supplemented, when necessary, with medical record review. For selected topics/conditions, QSM compares the care received by patients to that recommended by established practice guidelines and also reports and describes quality through incidence rates, condition-specific process and outcome measures, occurrence of adverse events, and use of preventive services. Results of the analyses are linked to appropriate quality management actions and are used to identify strategies for improvement. Data permit health plans to make performance comparisons on individual indicators and longitudinal comparisons on the effectiveness of quality improvement initiatives.