Performance Of Health Care System Research Articles

The Vidant Health Quality Transformation

Vidant Health (VH), a private, not-for-profit health system in eastern North Carolina, began a systemwide quality transformation in 2006 after a serious blood event resulted in a patient's death. Systemwide patient safety training served as the foundation of the transformation. Strategic planning of the quality work outlined a series of approaches that included board literacy in quality, an aggressive transparency policy, patient-family partnerships, and leader and physician engagement. The transformation of the system has resulted in an 85% reduction in serious safety events, a 62% reduction in health care-associated infections, 98% optimal care in the Centers for Medicare & Medicaid Services (CMS)/Joint Commission core measures, Hospital Consumer Assessment of Healthcare Providers and Systems performance in the top 20%, and more than 150 patient advisors partnering with leaders, physicians, and frontline staff. From the bedside to the boardroom the improvement in quality is evident across VH's nine hospitals, 70 physician practices, ambulatory surgery, and home health, hospice, and wellness services. Strategic planning for quality set an ambitious agenda for VH's quality work and continues to drive action today. Engaging patients in quality work at all levels--as partners on performance improvement teams, in safety rounds, in quality improvement committee meetings, and in the boardroom--has been a deliberate strategy and a significant part of the quality transformation at VH. Additional requirements for public reporting, CMS's new payment reform, and the challenges inherent in the evolving health care industry at large make it imperative to maintain a focus on zero events of harm and exceptional patient experiences.

Building on the EGIPPS performance assessment: the multipolar framework as a heuristic to tackle the complexity of performance of public service oriented health care organisations.

BackgroundPerformance of health care systems is a key concern of policy makers and health service managers all over the world. It is also a major challenge, given its multidimensional nature that easily leads to conceptual and methodological confusion. This is reflected by a scarcity of models that comprehensively analyse health system performance.DiscussionIn health, one of the most comprehensive performance frameworks was developed by the team of Leggat and Sicotte. Their framework integrates 4 key organisational functions (goal attainment, production, adaptation to the environment, and values and culture) and the tensions between these functions.We modified this framework to better fit the assessment of the performance of health organisations in the public service domain and propose an analytical strategy that takes it into the social complexity of health organisations. The resulting multipolar performance framework (MPF) is a meta-framework that facilitates the analysis of the relations and interactions between the multiple actors that influence the performance of health organisations.SummaryUsing the MPF in a dynamic reiterative mode not only helps managers to identify the bottlenecks that hamper performance, but also the unintended effects and feedback loops that emerge. Similarly, it helps policymakers and programme managers at central level to better anticipate the potential results and side effects of and required conditions for health policies and programmes and to steer their implementation accordingly.

MP6-02 HEALTHCARE SYSTEM QUALITY AND OUTCOMES AMONG MEN TREATED FOR PROSTATE CANCER

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2014MP6-02 HEALTHCARE SYSTEM QUALITY AND OUTCOMES AMONG MEN TREATED FOR PROSTATE CANCER Florian Schroeck, Samuel Kaufman, Bruce Jacobs, Ted Skolarus, David Miller, Anne Suskind, and Brent Hollenbeck Florian SchroeckFlorian Schroeck More articles by this author , Samuel KaufmanSamuel Kaufman More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , Ted SkolarusTed Skolarus More articles by this author , David MillerDavid Miller More articles by this author , Anne SuskindAnne Suskind More articles by this author , and Brent HollenbeckBrent Hollenbeck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.236AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nationally endorsed prostate cancer quality of care measures are thought to be reflective of quality prostate cancer care. Therefore, it is possible that healthcare systems performing well on these measures will have better outcomes. However, some feel that these measures represent a low bar and thus may not be tightly linked with outcomes. We assessed relationships between healthcare system performance on nationally endorsed prostate cancer quality of care measures and outcomes of prostate cancer treatment. METHODS We used Surveillance Epidemiology and End Results – Medicare linked data on 48,050 Medicare beneficiaries diagnosed with localized prostate cancer between 2004 and 2009. Based on a composite quality measure incorporating five nationally endorsed individual measures, we categorized healthcare systems into 1-star (bottom 20%), 2-star (middle 60%), and 3-star (top 20%) systems. We assessed relationships between star-ranking and outcomes of treatment with logistic and Cox proportional hazards regression, adjusting for patient- and market-level covariates. RESULTS Patients who underwent prostatectomy in 3-star versus 1-star healthcare systems had a lower risk of perioperative complications (odds ratio 0.80, 95% confidence interval [CI] 0.64-1.00). However, these patients were more likely to undergo a procedure addressing treatment-related morbidity (e.g., 11.3% vs. 7.8% treated for sexual morbidity, p=0.043, Figure). Among patients who underwent radiotherapy, healthcare system quality was not associated with undergoing procedures addressing treatment-related morbidity (Figure). Among all patients, star-ranking was not significantly associated with all-cause mortality (Hazard Ratio [HR] 0.99, 95% CI 0.84-1.15) or secondary cancer therapy (HR 1.04, 95% CI 0.91-1.20). CONCLUSIONS We found no consistent associations between healthcare system quality and outcomes. Our findings highlight the need for development of quality measures that are more tightly linked to outcomes. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e56 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Florian Schroeck More articles by this author Samuel Kaufman More articles by this author Bruce Jacobs More articles by this author Ted Skolarus More articles by this author David Miller More articles by this author Anne Suskind More articles by this author Brent Hollenbeck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP6-03 TOWARD BETTER RADIOGRAPHIC STAGING OF MEN WITH EARLY-STAGE PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: Nationally endorsed prostate cancer quality of care measures are thought to be reflective of quality prostate cancer care. Therefore, it is possible that healthcare systems performing well on these measures will have better outcomes. However, some feel that these measures represent a low bar and thus may not be tightly linked with outcomes. We assessed relationships between healthcare system performance on nationally endorsed prostate cancer quality of care measures and outcomes of prostate cancer treatment. METHODS: We used Surveillance Epidemiology and End Results e Medicare linked data on 48,050 Medicare beneficiaries diagnosed with localized prostate cancer between 2004 and 2009. Based on a composite quality measure incorporating five nationally endorsed individual measures, we categorized healthcare systems into 1-star (bottom 20%), 2-star (middle 60%), and 3-star (top 20%) systems. We assessed relationships between star-ranking and outcomes of treatment with logistic and Cox proportional hazards regression, adjusting for patientand market-level covariates. RESULTS: Patients who underwent prostatectomy in 3-star versus 1-star healthcare systems had a lower risk of perioperative complications (odds ratio 0.80, 95% confidence interval [CI] 0.64-1.00). However, these patients were more likely to undergo a procedure addressing treatment-related morbidity (e.g., 11.3% vs. 7.8% treated for sexual morbidity, p1⁄40.043, Figure). Among patients who underwent radiotherapy, healthcare system quality was not associated with undergoing procedures addressing treatment-related morbidity (Figure). Among all patients, star-ranking was not significantly associated with all-cause mortality (Hazard Ratio [HR] 0.99, 95% CI 0.84-1.15) or secondary cancer therapy (HR 1.04, 95% CI 0.91-1.20). CONCLUSIONS: We found no consistent associations between healthcare system quality and outcomes. Our findings highlight the need for development of quality measures that are more tightly linked to outcomes. Source of Funding: American Cancer Society PF-12-118-01CPPB.

Adherence to Performance Measures and Outcomes among Men Treated for Prostate Cancer

We assessed the relationship between health care system performance on nationally endorsed prostate cancer quality of care measures and prostate cancer treatment outcomes. This retrospective cohort study included 48,050 men from SEER-Medicare linked data diagnosed with localized prostate cancer between 2004 and 2009, and followed through 2010. Based on a composite quality measure we categorized the health care systems in which these men were treated into 1-star (bottom 20%), 2-star (middle 60%) and 3-star (top 20%) systems. We then examined the association of health care system level quality of care with outcomes using multivariable logistic and Cox regression. Patients who underwent prostatectomy in 3-star vs 1-star health care systems were at lower risk for perioperative complications (OR 0.80, 95% CI 0.64-1.00). However, they were more likely to undergo a procedure addressing treatment related morbidity, eg for sexual morbidity (11.3% vs 7.8%, p = 0.043). In patients who received radiotherapy star ranking was not associated with treatment related morbidity. In all patients star ranking was not significantly associated with all-cause mortality (HR 0.99, 95% CI 0.84-1.15) or secondary cancer therapy (HR 1.04, 95% CI 0.91-1.20). We found no consistent association between health care system quality and outcomes, which questions how meaningful these measures ultimately are for patients. Thus, future studies should focus on developing more discriminative quality measures.

The Establishment of Evidence‐Based Practice Competencies for Practicing Registered Nurses and Advanced Practice Nurses in Real‐World Clinical Settings: Proficiencies to Improve Healthcare Quality, Reliability, Patient Outcomes, and Costs

Although it is widely known that evidence-based practice (EBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still not the standard of care delivered by practicing clinicians across the globe. Adoption of specific EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health care. The aim of this study was to develop a set of clear EBP competencies for both practicing registered nurses and APNs in clinical settings that can be used by healthcare institutions in their quest to achieve high performing systems that consistently implement and sustain EBP. Seven national EBP leaders developed an initial set of competencies for practicing registered nurses and APNs through a consensus building process. Next, a Delphi survey was conducted with 80 EBP mentors across the United States to determine consensus and clarity around the competencies. Two rounds of the Delphi survey resulted in total consensus by the EBP mentors, resulting in a final set of 13 competencies for practicing registered nurses and 11 additional competencies for APNs. Incorporation of these competencies into healthcare system expectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion processes could drive higher quality, reliability, and consistency of healthcare as well as reduce costs. Research is now needed to develop valid and reliable tools for assessing these competencies as well as linking them to clinician and patient outcomes.

The Dutch health care performance report: seven years of health care performance assessment in the Netherlands

In 2006, the first edition of a monitoring tool for the performance of the Dutch health care system was released: the Dutch Health Care Performance Report (DHCPR). The Netherlands was among the first countries in the world developing such a comprehensive tool for reporting performance on quality, access, and affordability of health care. The tool contains 125 performance indicators; the choice for specific indicators resulted from a dialogue between researchers and policy makers. In the ‘policy cycle’, the DHCPR can rationally be placed between evaluation (accountability) and agenda-setting (for strategic decision making). In this paper, we reflect on important lessons learned after seven years of health care system performance assessment. These lessons entail the importance of a good conceptual framework for health system performance assessment, the importance of repeated measurement, the strength of combining multiple perspectives (e.g., patient, professional, objective, subjective) on the same issue, the importance of a central role for the patients’ perspective in performance assessment, how to deal with the absence of data in relevant domains, the value of international benchmarking and the continuous exchange between researchers and policy makers.

Papéis profissionais de médicos e enfermeiros em Portugal: limites normativos à mudança

IntroductionThe healthcare workforce composition in Portugal indicates an inefficient combination of doctors’ and nurses’ roles. One of the possible answers to this problem could be the expansion of nursing staff responsibilities. Evidence shows that this option can improve the performance of healthcare systems, in terms of efficiency and access. Knowing that the legal framework that regulates each of these professions can hinder the review of their respective scope of practice, we assessed the need to change the Portuguese law in order to allow adjustments in nursing staff tasks’ boundaries. MethodsReview of publish and non‐published literature and document analysis. ResultsWe found that in the Portuguese law there is no definition of the medical act. There is, however, a regulatory protection on the exercise of medical diagnosis acts, drugs prescription and autonomous management of patients. We also observed that other actions considered unique to the medical profession, and many are so considered merely because of social conventions, can be delegated. ConclusionsThe intent of attributing to the nursing staff tasks previously held solely by medical doctors will need prior legal changes. There is still normative framework for a more effective use of nursing staff skills in order to attain a better performance by the Portuguese health care system. But the success or failure of a political strategy does not depend only on its legal feasibility; social acceptability also must be considered and some Portuguese stakeholders expressed reservations in supporting a nurse's scope of practice enhancement.

Motivation, leadership, empowerment and confidence: their relation with nurses' burnout.

Introduction:Burnout is usually defined as a state of physical, emotional and mental exhaustion that results from long-term involvement in work situations that are emotionally demanding. A great deal of researches has been devoted to the understanding of factors contributing to burnout and the negative effects that burnout has in the cost and the quality of the provided healthcare.Discussion:Many researchers believe that in difficult and stressful working conditions the work environment should be changed in order to reduce burnout levels successfully. Indeed, recent studies have highlighted the role of human resources management in burnout. It has been widely recognized that human resource management policies should be at the core of any sustainable solution that aims to increase health care systems performance and efficient.Conclusion:Motivation, leadership, empowerment and confidence are very important factors that should be considered in this direction because they are strongly related with burnout levels.

The general population and the evaluation of healthcare system performance

The general population and the evaluation of healthcare system performance

Benchmarking health IT among OECD countries: better data for better policy

To develop benchmark measures of health information and communication technology (ICT) use to facilitate cross-country comparisons and learning. The effort is led by the Organisation for Economic Co-operation and Development (OECD). Approaches to definition and measurement within four ICT domains were compared across seven OECD countries in order to identify functionalities in each domain. These informed a set of functionality-based benchmark measures, which were refined in collaboration with representatives from more than 20 OECD and non-OECD countries. We report on progress to date and remaining work to enable countries to begin to collect benchmark data. The four benchmarking domains include provider-centric electronic record, patient-centric electronic record, health information exchange, and tele-health. There was broad agreement on functionalities in the provider-centric electronic record domain (eg, entry of core patient data, decision support), and less agreement in the other three domains in which country representatives worked to select benchmark functionalities. Many countries are working to implement ICTs to improve healthcare system performance. Although many countries are looking to others as potential models, the lack of consistent terminology and approach has made cross-national comparisons and learning difficult. As countries develop and implement strategies to increase the use of ICTs to promote health goals, there is a historic opportunity to enable cross-country learning. To facilitate this learning and reduce the chances that individual countries flounder, a common understanding of health ICT adoption and use is needed. The OECD-led benchmarking process is a crucial step towards achieving this.

ENTRY INTO THE PHYSICIANS’ MARKET: EMPIRICAL EVIDENCE FROM THE OUTPATIENT SECTOR IN AUSTRIA

Abstract In forming strategies to improve the macro performance of health care systems, effective interaction between the public and private service provisions is considered an important aspect of institutional design. Recent economic research has provided valuable insights into the significance of this interaction. We study the market entry decisions of private physicians in the outpatient health care sector inAustria by applying an entry=exit model at two different spatial levels of aggregation and using data from the time period 2002-2008. By estimating a Poisson panel data model with community=district fixed effects, we find a significantly negative effect of existing physician capacities in a specialty, both in the public and private sectors, on the entry of new private physicians. On the contrary, we find a significantly positive effect of existing private general practitioners on the entry of private specialists. These findings indicate that private physicians tend to (i) compensate for regional differences in public outpatient capacities, and (ii) establish cooperative networks where they collaborate with other private physicians in the local market.

Interventions aimed at improving performance on medication adherence metrics

medication adherence is one determining factor of treatment success. Poor medication adherence mitigates optimum clinical benefits and increases total health care costs. Current evidence suggests that for population-based adherence interventions to be effective, a multidisciplinary, multifactorial approach that can be tailored for each individual should be adopted. In the United States, national organizations such as the National Committee for Quality Assurance and the Centers for Medicare and Medicaid Services include medication adherence as a metric of health care system performance Aim of the This article provides an overview of efforts at Kaiser Permanente Colorado to impact medication adherence-related metrics. Described interventions are supported by electronic data gathering processes with an emphasis on the role of pharmacists.

Quality Improvement Initiatives in Neonatal Intensive Care Unit Networks: Achievements and Challenges

Neonatal intensive care unit networks that encompass regions, states, and even entire countries offer the perfect platform for implementing continuous quality improvement initiatives to advance the health care provided to vulnerable neonates. Through cycles of identification and implementation of best available evidence, benchmarking, and feedback of outcomes, combined with mutual collaborative learning through a network of providers, the performance of health care systems and neonatal outcomes can be improved. We use examples of successful neonatal networks from across North America to explore continuous quality improvement in the neonatal intensive care unit, including the rationale for the formation of neonatal networks, the role of networks in continuous quality improvement, quality improvement methods and outcomes, and barriers to and facilitators of quality improvement.

Health Care System Performance of Mixed Public-Private Finance and Provision

Health Care System Performance of Mixed Public-Private Finance and Provision

An international comparison of efficiency of inpatient mental health care systems

There is a fundamental gap in the evidence base on quantitative cross-country comparison of mental healthcare systems due to the challenges of comparative analysis in mental health including a paucity of good quality data. We explore whether existing limited data sources can potentially be exploited to examine technical efficiency of inpatient mental healthcare systems in 32 OECD countries in 2010. We use two analytical approaches: Data Envelopment Analysis (DEA) with bootstrapping to produce confidence intervals of efficiency scores and country rankings, and Cluster Analysis to group countries according to two broad efficiency groupings. We incorporate environmental variables using a two-stage truncated regression. We find slightly tighter confidence intervals for the less efficient countries which loosely corresponds with the ‘inefficient’ cluster grouping in the Cluster Analysis. However there is little stability in country rankings making it difficult with current data to draw any policy inferences. Environmental factors do not appear to significantly impact on efficiency scores. The most pressing pursuit remains the search for better national data in mental healthcare to underpin future analyses. Otherwise the use of any sophisticated analytic techniques will prove futile for establishing robust conclusions regarding international comparisons of the performance of mental healthcare systems.

Improving The Health Care Systems Performance By Simulation Optimization

Studying and improving health care services levels are considered as an essential issue in urban management systems and also crisis management. In such areas, detecting effective factors, managing the relationships, control of costs, defining and planning for health care services resources are significance. In current paper, by analyzing the patients’ behavior in one hospital unit, development and optimization of the mentioned unit’s performance and defining the optimum resources have been studied. In order to modeling of the study, simulation software ExtendSim has been used. By implementing the outcome of the study and optimization of the hospital resources, waiting time for the patients could be reduced significantly, and also the related costs can be controlled properly.

The international performance of healthcare systems in population health: Capabilities of pooled cross-sectional time series methods

This paper outlines the capabilities of pooled cross-sectional time series methodology for the international comparison of health system performance in population health. It shows how common model specifications can be improved so that they not only better address the specific nature of time series data on population health but are also more closely aligned with our theoretical expectations of the effect of healthcare systems. Three methodological innovations for this field of applied research are discussed: (1) how dynamic models help us understand the timing of effects, (2) how parameter heterogeneity can be used to compare performance across countries, and (3) how multiple imputation can be used to deal with incomplete data. We illustrate these methodological strategies with an analysis of infant mortality rates in 21 OECD countries between 1960 and 2008 using OECD Health Data.

Should European perinatal indicators be revisited?

ObjectivesOur study presents the results of a survey of physicians and/or researchers working in 21 European countries, on their opinion about the relevance of perinatal indicators, in order to compare it with the EURO-PERISTAT recommendations. Study designIn this cross-sectional study, we selected 21 out of the initial set of 34 indicators of the national data supply on the European Perinatal Health Report, and added four other indicators based on expert opinion. The relative relevance of these 25 perinatal indicators was then rated by 134 respondents – expert physicians and/or researchers who have published in perinatal medicine – through a web-based survey. We summarized our data using descriptive statistics. ResultsThe top five perinatal indicators, according to the respondents’ rating were: neonatal mortality rate by gestational age, birth weight and plurality; percentage of highly preterm babies delivered in units without a NICU; prevalence of severe maternal morbidity; severe neonatal morbidity among babies at high risk and prevalence of hypoxic-ischemic encephalopathy. Of these top five indicators, however, only neonatal mortality rate by gestational age, birth weight and plurality was considered a core indicator, in 2003. Moreover, severe neonatal morbidity among babies at high risk and prevalence of hypoxic-ischemic encephalopathy, that were considered in 2003 as requiring further development, were now considered by the respondents as highly relevant. ConclusionsCurrent views of European physicians and/or researchers working in the perinatal field may not be in agreement with the EURO-PERISTAT recommendations. A revision of the set of perinatal indicators is, therefore, mandatory if a more comprehensive view of health care systems performance across Europe is to be achieved.

The Assessment of Health Care System Performance based on the Variation of Life Expectancy

The performance of health care systems can be assessed through specific outcomes such as life expectancy. In the paper we aim to identify significant differences over time in life expectancy of world countries. We analyse a sample of 193 countries grouped by income level and by geographic region. The results show that life expectancy increased in the last two decades, although there are important variation among countries. These findings highlight that health policy-makers should be concerned with regional features of health systems and the need for convergence of health systems goals.