Quality Assurance In Health Care Research Articles

Measures of trust in health care.

Research Article Health AffairsVol. 16, No. 1 Perspective: Measures Of Trust In Health CareLee N. Newcomer AffiliationsThe chief medical officer of United Healthcare Corporation, a for-profit managed care plan based in Minnetonka, Minnesota. Health Affairs invited his comments on the paper by Bradford Gray, which precedes this Perspective.PUBLISHED:January/February 1997No Accesshttps://doi.org/10.1377/hlthaff.16.1.50AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleAbstractTrust centers on physicians, not health care organizations, says United Healthcare Corporation's chief medical officer.TOPICSPhysiciansPhysician-patient relationshipClinical careManaged careDiseasesHealth care providersFiduciary relationshipsPhysician payment Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 24 History Published online 1 January 1997 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF downloadCited ByHealth Marketing Quarterly, Vol. 39, No. 2Does Accreditation Symbolise Quality in Public Healthcare Delivery? An Investigation of Hospitals in Kerala20 October 2021 | Journal of Health Management, Vol. 17Primary care physicians’ views on the factors for enhancing patients’ trust in rural areas of Zhejiang province, China: a cross-sectional study27 July 2021 | BMJ Open, Vol. 11, No. 7Patient-centered communication and emotional well-being in the era of medical violence in China4 August 2020 | Health Promotion International, Vol. 15A new service quality scale for hospital emergency roomsInternational Journal of Organizational Analysis, Vol. 28, No. 6An intelligent algorithm for identification of optimum mix of demographic features for trust in medical centers in IranArtificial Intelligence in Medicine, Vol. 88Customer Identification in the Healthcare Industry1 November 2017 | International Journal of Market Research, Vol. 59, No. 6Service Quality and Patient Satisfaction: An Exploratory Study of Pathology Laboratories in Jaipur17 June 2016 | Hospital Topics, Vol. 94, No. 2Interventions for improving patients' trust in doctors and groups of doctors4 March 2014 | Cochrane Database of Systematic Reviews, Vol. 29The Chinese community patient’s life satisfaction, assessment of community medical service, and trust in community health delivery systemHealth and Quality of Life Outcomes, Vol. 11, No. 1The influences of patient's satisfaction with medical service delivery, assessment of medical service, and trust in health delivery system on patient's life satisfaction in ChinaHealth and Quality of Life Outcomes, Vol. 10, No. 1The influences of patient's trust in medical service and attitude towards health policy on patient's overall satisfaction with medical service and sub satisfaction in China15 June 2011 | BMC Public Health, Vol. 11, No. 1Healthcare quality and moderators of patient satisfaction: testing for causalityInternational Journal of Health Care Quality Assurance, Vol. 22, No. 4An integrative model of customers' perceptions of health care services in Taiwan5 December 2008 | The Service Industries Journal, Vol. 28, No. 9Interventions for improving patients' trust in doctors and groups of doctors19 July 2006Trust in micro-health insurance: an exploratory study in RwandaSocial Science & Medicine, Vol. 61, No. 7The service quality dimensions and patient satisfaction relationships in South Korea: comparisons across gender, age and types of serviceJournal of Services Marketing, Vol. 19, No. 3The relationships among quality, value, satisfaction and behavioral intention in health care provider choiceJournal of Business Research, Vol. 57, No. 8The Impact of Visit Frequency on the Relationship between Service Quality and Outpatient Satisfaction: A South Korean StudyHealth Services Research, Vol. 39, No. 1Social capital and trust in providersSocial Science & Medicine, Vol. 57, No. 7Interventions for improving patients' trust in doctors22 April 2003Ethics of Managed Care: In Search of GroundingAn exploration and advancement of the concept of trustJournal of Advanced Nursing, Vol. 36, No. 2An Improved Scale for Assessing Patients' Trust in Their PhysicianHealth Marketing Quarterly, Vol. 19, No. 1

Initial experience of the ORATEL computerised information tools in general practice.

ORATEL (a telematic system for quality assurance indicators in oral health care) is a three-year project with the ultimate objective of improving the quality of oral health care through the use of appropriate computerised information systems. These tools are designed to promote quality assurance and quality of care development in oral health care by using common quality indicators/standards. ORATEL has developed three prototypes of computerised information systems: an interactive multimedia teach software on quality assurance in oral health care, ORATEL-TEACH; a proactive quality assurance support tool for real time use at the dental unit, ORATEL-PROACT; and an integrated set of modules for monitoring and self assessment at the clinical level and for the computerised reporting of aggregated data for evaluation at higher levels, ORATEL-REVAL. The initial experiences of using these tools was assessed during 1993 in general dental practice locations in Liverpool and clinics in for other European countries. Overall, the dentists were positive about the potential usefulness of the ORATEL tools but further improvements were considered necessary. Finding has been approved by the European Commission for further development under a new project called ORQUEST.

A hospital-wide quality assurance programme: the Wilson model.

This article examines the Wilson (1987) model and describes how it offers a more realistic framework for quality assurance (QA) in health care and how it can benefit both staff and patients. The model complements total quality management (TQM) and can incorporate audit mechanisms such as the Dynamic Standard Setting System (DySSSy; Royal College of Nursing, 1990). The importance of strategic review regarding quality and the need to pilot ways of introducing such a concept before any organization-wide implementation can take place is emphasized. In addition, the need for user-friendly QA across all services in order to strengthen the principles of TQM is stressed.

Problem-based medical education in general practice and health care quality assurance.

States that health systems globally are in transition, for which also a correspondingly reformed education is required, involving new--and renewed--basic sciences, principles, skills and methods. To that end, demonstrates how problem-based learning in general practice is almost ideal, although still sparsely implemented, and has much in common with health care quality assurance. Contends that primary care in many ways comprises the most important platform and vehicle of modern health services and their interaction with the population. Uses the example of the Faculty of Health Sciences in Linköping, where all curricula are integrated, community-oriented, problem-based and have a focus on primary care and general practice. Represents a useful and hitherto insufficiently recognized widening of the overall field of health care quality assurance, and summarizes some of the experiences therein. Also provides a brief overview of the literature.

Quality in context

Dorothy Whittington traces the origins and development of health care quality assurance and its implications for practice nursing.

There's a New Society for Quality in Health Care!

The Egyptian Society for Health Care (ESQua) registered as a non-governmental, not-for-profit organization under the sponsorship of His Excellency, Professor Doctor Ali Abdel Fattah, Minister of Health, Egypt, in July 1995. The mission of this new quality society is to introduce the concept of quality assurance and continuous quality improvement to all sectors of health care services in Egypt. How did ESQua come into being? The idea for ESQua came as a result of experiences of staff working in the Quality Assurance and the Cost Recovery Projects in Egypt. Over a twoyear period, the Quality Assurance Project worked closely with public hospitals to institutionalize quality assurance programmes. Both projects learned a lot from this new experience in quality management in health care in Egypt and realized the need for a broader approach to create an awareness of quality and to share important lessons learned with a wider audience. The Minister of Health supported the organization of a national society, with its own agenda on quality in health care, to create an awareness of quality. In June 1995, 50 founding members attended the first meeting of the Society, led by His Excellency, the Minister of Health. The vision, mission, goals, and objectives of the Society were discussed, and Governing Board members were nominated and approved by the members. The goals of the Society are: 1. To create awareness among health care providers in the community about the concept of quality assurance in health care. 2. To emphasize the concept that the patient who is the health care beneficiary is the corner stone for all health care plans. All efforts should be made to meet the patient's needs and expectations. 3. To provide continuous quality improvement for health care in Egypt. 4. To coordinate with relevant organizations to develop, improve, and mobilize human resources in the field of health care to enable them to provide high quality services. Five standing committees were also formed at this meeting, and each founding member will serve on a committee. The five standing committees are: 1. The Accreditation Committee 2. The Consumer Awareness Committee 3. The Standards Committee 4. The Human Resource Development Committee 5. The Research Committee An important first product of the Society was the collaboration with the Ministry of Health, the Cost Recovery in Health Project and the Quality Assurance Project in the sponsorship of the First National Conference on Quality in Health Care in Egypt held in Cairo, Egypt, in September 1995. The conference is reported on elsewhere in this issue. Two full-time staff have been appointed to

Latin American Conference on Quality Assurance in Health Care. Quito, Ecuador; 1-3 August 1995.

Latin American Conference on Quality Assurance in Health Care. Quito, Ecuador; 1-3 August 1995.

Value-added laboratory medicine in an era of managed care

Clinical laboratory consultants (M.D.s and Ph.D.s) must add value and medical relevance to the healthcare system to earn and maintain their roles in an era of managed care. Service opportunities include new and expanded roles in system-wide (a) managing of point-of-care testing, (b) informatics and information systems, (c) clinical consultation, (d) resource management, (e) management of utilization, (f) improving healthcare quality assurance, and (g) technology assessment and implementation. Hypothesis-driven research focused on the linkage between the laboratory and outcome analysis, clinical practice guidelines, total quality improvement, technology assessment, and healthcare policy provides major opportunities to complete for expanding research support. Changes in clinical laboratory consultant training are necessary to provide the knowledge, skills, and experience required to provide value-added and medically relevant services. Clinical laboratory consultants with Ph.D. degrees should initially be trained broadly in all areas of the laboratory, with emphasis on system-wide issues, and then trained as specialized scientists.

Racial differences in treatment of psychiatric inpatients.

The study examined several aspects of inpatient psychiatric treatment to determine if differences existed between treatment of African-American and white patients. Using a structured chart review, data were collected on 76 African-American and 88 white patients consecutively admitted to an acute inpatient setting with a principal axis I diagnosis of a major mood or psychotic disorder. Racial differences in treatment were examined using analysis of variance and logistic regression to assess the effects of diagnosis and socioeconomic status. Nonpsychotic African-American patients had shorter lengths of stay than white patients with similar disorders. White patients were more likely to be on one-to-one observational status. Clinicians were more likely to order urine drug screens for African-American patients with high socioeconomic status than for comparable white patients. African-American patients with schizophrenic disorders received higher neuroleptic dosages than white patients with similar diagnoses. Most racial differences cited in earlier studies of psychotic patients were not found or were not statistically significant once socio-economic status and diagnosis were accounted for. However, racial differences related to the detection, phenomenology, treatment, and course of psychotic disorders and the diagnosis and management of alcohol and drug use disorders and personality disorders were found.

Quality assurance in an ear, nose and throat department in Saudi Arabia. A surgical audit.

Quality assurance (QA) in health care is being introduced in developing countries also. However, QA still meets resistance from some clinicians. A prospective voluntary surgical audit was set up in the ENT department of a university teaching hospital in Saudi Arabia. Roles, responsibilities and objectives were defined and designated facilities were provided. There were 2125 admissions and 2389 operations in a 3-yr period. The stated objectives were achieved concerning resource management, post-graduate training, and, especially, the successful establishment of surgical audit as an on-going and open-forum activity in a developing country. We conclude that other clinicians can feel encouraged by our positive experience and implement QA.

Using management information systems to enhance health care quality assurance.

Examines how computers and quality assurance are being used to improve the quality of health care delivery. Traditional quality assurance methods have been limited in their ability to effectively manage the high volume of data generated by the health care process. Computers on the other hand are able to handle large volumes of data as well as monitor patient care activities in both the acute care and ambulatory care settings. Discusses the use of computers to collect and analyse patient data so that changes and problems can be identified. In addition, computer models for reminding physicians to order appropriate preventive health measures for their patients are presented. Concludes that the use of computers to augment quality improvement is essential if the quality of patient care and health promotion are to be improved.

Developing and Managing Cardiac Rehabilitation Programs

Part 1 Program development: issues and special populations in inpatient rehabilitation (Lance H. Crosby) early outpatient rehabilitation (Martha D. Livingston) Phases I and II - practical application (Linda K. Hall) outpatient maintenance (Ruth Townsend and Linda K. Hall) exercise prescription for cardiac patients (Linda K. Hall) high-risk and special populations (Kathy Berra and Cindy Lamendola Rudd). Part 2 Program implementation and operation: staffing the program (Linda K. Hall) use of a registered dietician (Karen Luffey) social work and pastoral care (Linda J. Walker) management principles (Linda K. Hall) marketing and public relations (Terri Hornbach) reimbursement issues (G. Curt Meyer) budget and revenue - meeting the bottom line (Linda K. Hall) productivity and utilisation (Linda K. Hall) quality assurance in health care (Linda K. Hall).

Recent clinical trials of pain control: Impact on quality of life

The understanding and treatment of pain is one of the oldest challenges for physicians, scientists and philosophers. Much of our present rationale of pain control is based on the Cartesian idea that pain mostly originates from external or internal noxious stimuli, which are transmitted to and interpreted in the brain. Consequently, removal (blocking) of the stimuli and modification of cerebral awareness have been the prime targets of analgesic interventions. Only recently has the relationship between pain and other physical, psychological and social aspects of illness been considered in the overall management plan. Most of the literature on pain control reveals the physical bias of measurement. Apart from simple but reliable tools such as visual analogue scales and Likert-type verbal scales, more sophisticated measures such as multidimensional pain inventories have also been used when it is necessary to characterise pain more specifically. In clinical studies, it is usual to ask the patient to report on his own pain, although proxy measures such as mobility, performance status and analgesic consumption are also often used. The hospice concept of "total pain", in which the psychological, social, spiritual and other aspects are emphasised, has been influential in our new approach to pain measurement. Particularly when it is chronic and related to advancing disease as in metastatic cancer, pain can interact significantly with many facets of daily living. A holistic model of quality of life in such patients should, therefore, include a multidimensional or modular assessment of these areas. Medical interventions themselves can affect quality of life in both positive and negative ways. Some side-effects may be so common as to be accepted as "normal", e.g. constipation or sedation with opioids: it is only by their careful evaluation, when comparing opioids with essentially similar analgesic potentials, that differential toxicities may be revealed. Simple recording of physical side-effects of drugs is really not sufficient, because analgesics as well as other therapies may be associated with mood changes and broader consequences for quality of life. Only in the past few years has quality of life been seriously addressed in palliation research. For example, standardised quality of life scales are now included almost routinely in oncological studies involving radiotherapy or chemotherapy by the Medical Research Council (MRC) of Great Britain. Trials of the new biphosphonates, which can reduce bone pain in metastatic cancer, have been enhanced by incorporating quality of life measures. Based on the experience from earlier efficacy/safety studies with the new transdermal route of drug delivery for the opioid fentanyl, important areas of life such as sleep and cognitive function have been addressed. Randomised controlled trials of analgesics which include quality of life endpoints are still rare, but should be encouraged as these represent the most rigorous way of evaluating new therapies. The current preoccupation with quality assurance in healthcare is directed, ultimately, to the delivery of a better quality of care, which should also be more cost-effective, for large populations. An important intermediate step towards that ideal is the collection of data on pain and other symptoms, but also validated quality of life parameters on well-defined groups. Only by widening the scope of analgesic studies to include these dimensions can we hope to define appropriate strategies for more rational healthcare.

ORATEL: telematic system for quality assurance in oral health care (AIM project A2029)

ORATEL is a 3-year project with the ultimate objective of improving oral health through use of appropriate computerized information systems. These tools will promote quality assurance and development in oral health care by using common quality indicators/standards. The project has completed its first phase, during which two European surveys were made, one on quality assurance clinical practices, and another on existing computerized information systems in oral health care. Pan European consensus was reached on 3 and 4 September 1992 when quality assurance indicators for oral health care services were endorsed. A manual on quality assurance indicators in oral health care has also been issued by the project.

Secondments in health care quality assurance.

Describes different types of secondment in quality assurance. Addresses the social and occupational characteristics of the associated roles. Demonstrates that the benefits of secondment outweigh the limitations. Suggests that changes in the health care system are providing continuous scope for secondment and that this, therefore, should be taken advantage of.

Health care quality assurance: Techniques and approaches

The authors carried out a review of the literature on QA in health care (Ellis and Whittington, 1993), from which it emerged that techniques can be considered under two headings: those that appeared to have been developed specifically for the purpose; and those that rely on the application of established techniques from the social sciences. The aim of this article is to provide an overview of these techniques and approaches and to highlight some of the methodological problems which beset them.

Quality assurance in health care. From a traditional towards a modern approach

This review article is about some recent developments in quality assurance in health care. A traditional and a modern approach are distinguished. The traditional approach is marked by a medical perspective and quality is defined as a property of medical care. Development of standards and criteria and inspection of conformance to them is the guiding principle for traditional medical quality assurance. The modern approach is marked by a strong influence of industrial principles on medical quality assurance. Industrial principles provide a new theory upon which medical quality assurance can be based. Aspects of care which are associated with the perceived quality are identified and are legitimate objects of medical quality assurance. The guiding principle is to influence experiences of (internal or external) customers by modelling the care according to clarified expectations. The university hospital of Maastricht provides an example of how modern principles of quality assurance are put into practice.

Issues and challenges in quality assurance of health care.

In this paper I review the health care crisis in the United States and conclude that fundamental changes must be made. I then present: (1) an organizational approach that might be encompassed in President Clinton's program for health care reform; (2) my "dream" of a national quality improvement system for reform, based on The Netherlands Model; and (3) a suggestion that strengthening primary care will be the key to the success of this reform in the coming years.

Book Review: Quality Assurance in Health Care. A Handbook

Book Review: Quality Assurance in Health Care. A Handbook

Book reviews

Books reviewed in this article: Constructing Questions for Interviews and Questionnaires: Theory and Practice in Social Research by William Foddy. Incontinence in the Elderly by Gerald W. Tobin. Quality of Life Assessment: Key Issues in the 1990s edited by Stuart R. Walker and Rachel M. Rosser. Quality Assurance in Health Care: A Handbook by Roger Kills and Dorothy Whittington. Rachel: the ‘Write’ to Speak by Sandra Capelin. Obstetric Ultrasound: flow, Why and When (2nd edn) by Patricia Chudleigh and J. Malcolm Pearce. Health Care Research by Degrees by Norma Reid. Managing Aggression by Stevie Holland.