Outcome-based Quality Improvement Research Articles

Value-Based Healthcare: A Primer for the Dermatologist.

Value-based healthcare (VBHC) is an increasingly employed strategy to transform healthcare organizations into economically sustainable systems that deliver high-value care. In dermatology, the need for VBHC is evident as chronic skin diseases require long-term, often expensive treatments. This narrative review aims to introduce dermatologists to the principles and implementation of VBHC. VBHC emphasizes maximizing outcomes that are directly relevant to patients. Key components of VBHC include a systematic assessment of standardized patient-relevant outcomes by using core outcome sets and measurement of healthcare cost for the individual patient. Systematic reporting and comparing of risk-adjusted outcomes across the full cycle of care for a specific condition provide benchmarked feedback and actionable insights to promote high-value care and reduce low-value care. VBHC aims to organize care around the patient in condition-specific and team-based integrated practice units with multidisciplinary collaboration, utilize information technology platforms to enable digital data monitoring, reduce cost, and eventually reform payment systems to support bundled payments for the overall care cycle. VBHC implementation in practice necessitates the establishment of a systematic framework for outcome-based quality improvement, the incorporation of value and outcomes in shared decision-making practices, and the cultivation of a value-centric culture among healthcare professionals through continuous training. Dermatologists can benefit from implementing VBHC principles in their practice. An essential step toward value-driven dermatological care is to start measuring outcomes relevant for patients for each patient, which is lacking partly due to the absence of core outcome sets developed for clinical practice. By reducing low-value care and emphasizing optimal patient-centered outcomes, VBHC has the potential to improve the quality of care and ensure cost containment. Efforts are needed to enhance the development and uptake of VBHC in dermatological clinical practice to realize these benefits.

Health Outcomes Management Evaluation-A National Analysis of Dutch Heart Care.

AimsA group of heart centres in the Netherlands have been at the forefront internationally to implement the principles of value-based healthcare. This study aims to give an up-to-date assessment of outcome-based quality improvement in 2020 at a national level in Dutch heart care.Methods and resultsPhysicians and healthcare professionals for each participating hospital filled out a questionnaire with 26 detailed questions on quality improvement and organization of care. In total, 20 hospitals participated; 11 heart centres with thoracic surgery and 9 without thoracic surgery. Results show that outcome reports are actively used within the heart centres to support quality improvement initiatives. In 50% of the centres, apart from physicians, also nurses and hospital management are involved. For 60% of the heart centres, outcome measurement is embedded in strategy and annual plans. The stage of development of supporting IT infrastructure (outcome measurement in the Electronic Health Record and dashboards) is very diverse. A wide range of different learning strategies supports outcome-based quality improvement.ConclusionHealth outcomes have become a relevant element in quality improvement and organization of Dutch heart centres. Earlier research shows that in 2012–2016 heart centres focused mainly on measuring outcomes. Now in 2020, heart centres are more able to actually use the acquired insights based on these measurements to initiate improvement projects. The diversity in how this is done indicates that this field is still strongly developing and shows potential for heart centres to share best practices in the implementation of value-based healthcare.

Better survival after transcatheter aortic valve replacement by process improvements.

ObjectiveThe aim of this study is to assess the effects on procedural, 30-day, and 1‑year all-cause mortality by a newly introduced quality improvement strategy in patients after transcatheter aortic valve replacement (TAVR).MethodsIn October 2015, a coherent set of quality improving interventions with respect to patient geriatric screening, general diagnostic examination and safety of the procedure was implemented at a single centre in the Netherlands. Patients undergoing TAVR in 2013–2018 were included for retrospective analysis. Mortality was assessed in the pre-quality improvement strategy cohort (January 2013 to October 2015; cohort A) and in the post-quality improvement strategy cohort (November 2015 to December 2018; cohort B). Logistic regression analysis was used to estimate the influence of patient and procedural characteristics on the results of the quality improvement strategy in terms of procedural, 30-day, and 1‑year all-cause mortality.ResultsIn total, 806 patients were analysed with 274 patients in cohort A and 532 patients in cohort B. After introduction of the quality improvement strategy, procedural (4.4% to 1.3%, p < 0.01), 30-day (8.4% to 2.7%, p < 0.01) and 1‑year (16.4% to 8.5%, p < 0.01) all-cause mortality significantly decreased. Multivariate regression analysis showed that the quality improvement strategy also significantly reduced 30-day (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.09–0.42) and 1‑year (OR 0.38, 95% CI 0.24–0.61) all-cause mortality if corrected for patient characteristics.ConclusionStructural meetings on evaluation of outcomes highlight potential areas for improvement and subsequent outcome-based quality improvement initiatives can result in lower procedural, 30-day, and 1‑year all-cause mortality.Electronic supplementary materialThe online version of this article (10.1007/s12471-020-01526-7) contains supplementary material, which is available to authorized users.

Organization of outcome-based quality improvement in Dutch heart centres.

Fourteen Dutch heart centres collected patient-relevant outcomes to support quality improvements in a value-based healthcare initiative that began in 2012. This study aimed to evaluate the current state of outcome-based quality improvement within six of these Dutch heart centres. Interviews and questionnaires among physicians and healthcare professionals in the heart centres were combined in a mixed-methods approach. The analysis indicates that the predominant focus of the heart centres is on the actual monitoring of outcomes. A systematic approach for the identification of improvement potential and the selection and implementation of improvement initiatives is lacking. The organizational context for outcome-based quality improvement is similar in the six heart centres. Although these heart centres in the Netherlands measure health outcomes for the majority of cardiac diseases, the actual use of these outcomes to improve quality of care remains limited. The main barriers are limitations regarding (i) data infrastructure, (ii) a systematic approach for the identification of improvement potential and the selection and implementation of improvement initiatives, (iii) governance in which roles and responsibilities of physicians regarding outcome improvement are formalized, and (iv) implementation of outcomes within hospital strategy, policy documents, and the planning and control cycle.

Milestone Project Called Paradigm Shift In Residency Education

Milestone Project Called Paradigm Shift In Residency Education

Improving the outcome of colorectal cancer: the European Registration of Cancer Care (EURECCA) project

SUMMARY Colorectal cancer is one of the most common types of cancers. Although there have been several improvements in screening, staging and treatment in recent decades, differences in the quality of care between European countries remain. Quality control on surgery, radiotherapy and pathology have been introduced in trials, followed by incorporation into general care. Another option is an audit structure in which hospitals and clinicians can also improve their results by learning from their own outcome statistics and those from colleagues treating a similar patient group. Although all these audit structures have achieved excellent results, differences in outcomes between European countries remain. To reduce the differences between the countries, an international, multidisciplinary, outcome-based quality improvement program has been initiated – European Registration of Cancer Care. One of the next steps will be to use the European Registration of Cancer Care data set to perform research on subgroups, such as elderly patients and patients with comorbidities, which are often excluded from trials.

Say Goodbye to Wet-to-Dry Wound Care Dressings

Say Goodbye to Wet-to-Dry Wound Care Dressings

2010 SSO John Wayne Clinical Research Lecture: Rectal Cancer Outcome Improvements in Europe: Population-Based Outcome Registrations will Conquer the World

During the past two decades, rectal cancer treatment has improved considerably in Europe. Clinical trials played a crucial role in improving surgical techniques, (neo)adjuvant treatment schedules, imaging, and pathology. However, there is still a wide variation in outcome after rectal cancer. In most western health care systems, efforts are made to reduce hospital variation by focusing on selective referral and encouraging patients to seek care in high-volume hospitals. On the other hand, the expertise for diagnosis and treatment of common types of cancer should be preferably widespread and easily accessible for all patients. As an alternative to volume-based referral, hospitals and surgeons can improve their results by learning from their own outcome statistics and those from colleagues treating a similar patient group. Several European surgical (colo)rectal audits have led to improvements with a greater impact than any of the adjuvant therapies currently under study. However, differences remain between European countries, which cannot be easily explained. To generate the best care for colorectal cancer in the whole of Europe and to meet political and public demands for transparency, the European CanCer Organisation (ECCO) initiated an international, multidisciplinary, outcome-based quality improvement program: European Registration of Cancer Care (EURECCA). The goal is to create a multidisciplinary European registration structure for patient, tumor, and treatment characteristics linked to outcome registration. Clinical trials will always play a major role in improving rectal cancer treatment. To further improve outcomes and diminish variation, EURECCA will establish the basis for a strong, multidisciplinary, international audit structure that can be used as a template for similar projects worldwide.

6069 European audit on cancer treatment outcome: an international, multidisciplinary, outcome-based quality improvement project of the European CanCer Organisation

6069 European audit on cancer treatment outcome: an international, multidisciplinary, outcome-based quality improvement project of the European CanCer Organisation

Improving Oral Medication Management in Home Health Agencies

This study focused on home health agency characteristics and evidence-based practices that could have an impact on the ability to improve the home health outcome-based quality improvement measure: improvement in the management of oral medications. The findings of this Quality Improvement Organization-approved study suggest that there are organizational characteristics and evidence-based practices associated with better rates for this outcome measure. Organizational characteristics include belonging to a healthcare system that is hospital based, not-for-profit part of a network focused on quality, and intentionally working on the oral medications outcome. Evidence-based practices include use of reminder strategies, phone follow-up interventions, repeat patient education about medications at subsequent home care visits, and use of medication simplification strategies for patients receiving multiple medications.

IMPROVING THE OUTCOMES OF Home Care Services in New York State

Despite the rapid growth of Medicaid home care services, no uniform system for measuring and improving the quality of these services has been implemented on a large scale. The Personal and Skilled Care Outcomes (PESO) data set was developed to provide non-Medicare-certified home care agencies with a data set to support the systematic assessment and improvement of patient outcomes. This article describes the key features of the data set and outlines ways that a PESO-based outcome-based quality improvement process can be refined to accommodate the unique mix of services provided by home care agencies serving the Medicaid and private-pay populations.

SU-FF-T-334: Outcomes-Based Quality Improvement: The Future Role of Outcomes in Monitoring the Radiotherapy Process

Purpose: Current quality assurance/improvement regimens are based on part of the radiation therapy chain of events, and typically ignore the goal, namely positive patient outcomes. We propose that the widespread implementation of Outcomes-based Quality Assurance/improvement programs (‘OQA,’ programs, pronounced ‘OK’) have the capability to fundamentally improve radiation oncology practice. Our short-term goal is: (1) to be able to routinely generate customizable reports which summarize clinical outcome rates (stratified by known risk factors), as well as (2) provide data-mining and modeling capabilities to identify outcomes correlates for further consideration. Methods: Our institutional informatics infrastructure to support an OQA program is under development. Key components which are partially implemented include: (1) tools for routine capture of treatment planning information, (2) web-based tools to facilitate remote treatment data reviews, (3) treatment report tools which summarize dose-volume information about a treatment plan, (4) the database design, (5) interfaces to routinely enter patient followup data, customized to clinical service needs, (6) query interfaces, and (7) tools to explore outcomes data vs. extracted dose-volume data. Key future challenges include processing followup dictation, interfacing with the hospital IS system, and incorporating tools which capture IGRT data. Results: Limited applications of this strategy have previously shown significant success in identifying important, previously unappreciated correlates to local control and toxicity (de Crevoisier et al., IJROBP 2005, 62:965–73; Hope et al., IJROBP 2006, 63:S231). Disadvantages include the cost of collecting the data and the potential for misreading results due to statistical fluctuations or changes in the patient cohort mix. Conclusion: Adding outcomes to the analysis of treatment quality increases the validity and sensitivity of the quality improvement process in radiation oncology. Outcomes-based quality assurance should be developed and practiced on a more routine basis, with datasets available for comparison between institutions. Research partially sponsored by the NIH and TomoTherapy, Inc.

How Does “Quality” Fit in “Pay for Performance”?

Pay for performance in home care has been on the horizon for some time now. Outcome and Assessment Information Set (OASIS) data collection and the outcomes-based quality improvement process have been helping agencies to prepare for payment based on the quality of care they provide. How can managers ensure that their agency is ready to reap the benefits of performance-based rewards? This article will explore the events leading up to pay for performance and a number of options for improving quality, boosting patient outcomes, and positioning agencies for the next step.

Success Through Teamwork in the Home Health Setting: The Role of Occupational Therapy

Since 2002 and the introduction of outcome-based quality improvement reports by the Centers for Medicare and Medicaid Services, all home health professionals have recognized a heightened importance in the measurement of change in the daily functioning of patients from onset to discharge of the agency's service. As health care professionals whose expertise focuses on safe and meaningful participation in occupations of daily living, occupational therapists can play a key role on the inter-disciplinary team in a home health care agency. This article outlines the potential benefits of expanding the role of the occupational therapist as an interdisciplinary team member and explores challenges and solutions to maximize collaborative opportunities with the occupational therapy practitioner in home health.

A QUEST for QUALITY in Home Healthcare

This article discusses the effect that the quality improvement organizations (QIOs) have achieved in the home healthcare industry under their contracts with the Centers for Medicare and Medicaid Services (CMS). Specific successes are related to partnerships between QIOs and home health agencies (HHAs) and the future of outcome-based quality improvement (OBQI) in improving acute care hospitalization (ACH). Data are from the OBQI evaluation system and show outcomes for the baseline collection period (May 2001-April 2002) through the remeasurement period (April 2003-July 2004). Data reported are for cardiac care measures that affect ACH.

Integration of a Medication Management Model into Outcome-Based Quality Improvement: A Pilot Program in a Rural Proprietary Home Healthcare Agency

SUMMARY This article describes a rural proprietary home health agency's successful initiative to adapt a previously tested medication management model and integrate it into existing processes of care. The rationale to improve medication management in response to current national fiscal, clinical and external quality measures and evolution of this process in the agency is detailed. The agency refined the model's screening procedures, incorporating them into the mandated OASIS assessment and then computerizing the medication risk analysis, in keeping with the original intent of the model. In a four-month pilot test of the computerized risk assessment procedure 1006 OASIS assessments were screened; risk factors for medication-related problems in 201 (19.9%) resulted in pharmacist review. Of these, 30 (17%) were ruled out as potential medication errors, 143 (82.6%) were found with potential MRP and 58 (33.5%) had evidence of problems warranting follow-up. With this computer-assisted process, the agency created a more comprehensive assessment that was in line with the new regulatory emphasis on patient outcomes. Consultant pharmacist services also transitioned from drug regimen review to more comprehensive medication therapy management. By enhancing efficiencies in its medication management program, an agency not only stands to improve quality of care, but also to maximize resources, making the intervention affordable to implement and decreasing burden on staff.

Total Quality Management and Outcomes Based Quality Improvement: Revisiting the Basics

Initiating and maintaining a total quality management (TQM) program can be one answer to rising costs and decreasing reimbursement in health care. Identifying ways that an outcome-based corporate culture fully extends to both internal and external customers is the responsibility of leadership. Developing and using simple tools can aid in that process. Once systems are implemented, maintaining a true commitment to TQM becomes a powerful challenge. But, to the persevering leader, the rewards of quality customer service can go hand in hand with a positive bottom line.

Snoezelen Activity

Care of the resident with dementia can be both challenging and unpredictable. Activities provided for nursing home residents often have rules and may be a source of frustration for residents with advancing dementia. Snoezelen, or multisensory therapy, offers a failure-free activity in an enabling environment that can both stimulate and relax the resident with dementia. Good Shepherd Nursing Home in Versailles, Mo, undertook a 1-year outcome-based quality improvement project to find if use of Snoezelen therapy could reduce the number of behavioral symptoms that residents were suffering from. While there are still barriers to the use Snoezelen therapy, employees at Good Shepherd Nursing Home believe that the use of Snoezelen therapy has been a successful and rewarding experience for both residents and staff members.

The Quality Network Adverse-Event Benchmarking Project: a New Jersey Perspective

The New Jersey Home Care Association initiated and conducted a benchmarking project in collaboration with the New Jersey Hospital Association involving the examination of the Outcome and Assessment Information Set and Outcome Based Quality Improvement (OBQI) reports generated byhome health agencies. The purpose was to determine if statewide trends existed. The plan was flexible and dependent upon the data results, but the design of appropriate educational programs for member agencies prior to the onset of risk-adjusted reports and Medicare’s mandated benchmarking was anticipated. Although no clear trends were identified as a result of the survey, the project was an important first effort that offered direct experience with the process of outcomes measurement and helped to demonstrate the value of data analysis to all agencies. Because of the project, agencies recognized the need to become informed about, participate in, and prepare for the next steps of Medicare’s OBQI and Outcome Based Quality Monitoring.

The development of a client health status outcome evaluation instrument in home care

This study was to develop a client health status outcome evaluation instrument, and examine content validity, reliability, construct validity, and the acceptability of this instrument. A preliminary list was made of such key information as standards, criteria, indicators and measures, by means of a broad review of literature within the field. After determining the preliminary instruments, the study sought to obtain examination, consensus, and modification of two groups of experts in the home-care field. Finally, the instrument examined content validity, reliability, construct validity, and the acceptability of this instrument. The tool was considered of 13 criteria, 48 indicators, and 167 detail measures. The content validity index of the tool was above 0.8 according to the expert group. Regarding the reliability of the evaluators of standards 1 and 2, the degree of agreement between evaluators was high(96.4% through 98.2%). Construct validity in this study, the difference in the mean score between the baseline point and the follow up point of each of standards 1 and 2 was significant, and the mean score of the follow up point was more than that of the baseline point. After examining the acceptability of this instrument with practice managers and home care nurses in home care institutions, a positive opinion was given of this instrument, and it was indicated that to be useful and applicable in home care practice. The results of evaluating client outcome will contribute to overall outcome-based quality improvement and service marketing in home care by providing a constant gauge of home care effectiveness.