Quality Care Metrics Research Articles

Quality care process metrics (QCP-Ms) in nursing and midwifery care processes: a rapid realist review (RRR) protocol

Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QCP-Ms) and respective indicators for the practice areas – acute care, midwifery, children’s, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QCP-Ms in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods : The review will explore if there are benefits of using the QCP-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QCP-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into the use of a rapid realist review as a framework and how nursing and midwifery QCP-Ms have been implemented previously.

Quality care metrics (QC-M) in nursing and midwifery care processes: a rapid realist review (RRR) protocol

Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QC-Ms) and respective indicators for the practice areas – acute care, midwifery, children’s, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QC-M in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods: The review will explore if there are benefits of using the QC-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QC-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into realism as a framework and how nursing and midwifery QC-Ms have been implemented previously.

Defining and measuring quality cancer survivorship care: An environmental scan.

219 Background: It is recognised that current models of survivorship care are suboptimal and unsustainable. The landmark Institute of Medicine (IOM) report ‘From Cancer Patient to Cancer Survivor: Lost in Transition’ suggested four essential components of survivorship care: prevention of recurrent and new cancers; surveillance for recurrent or second cancers; intervention for consequences of cancer and its treatment, and coordinated care between health providers. The report also recommended “quality of survivorship care measures should be developed... and quality assurance programs implemented to monitor and improve the care that all survivors receive.” Nekhlyudov et al (JNCI 2019) built on the IOM’s recommendations to develop a quality of cancer survivorship care framework. We undertook an environmental scan to understand how quality survivorship care is conceptualised internationally, and what metrics are available. Methods: This scan comprised limited literature review, review of organisations’ websites, and expert consultation to source documents that described and measured quality survivorship care. Documents were assessed against the domains proposed by Nekhlyudov et al. Metrics were categorised as policy, process or outcome measures. Results: The search yielded 40 documents from six countries. There was agreement that quality survivorship care is founded on the IOM elements, expanded by Nekhlyudov et al. The review also noted risk stratification/personalised pathways of care and patient self-management as other elements of quality care. Many countries have proposed or implemented quality measures, with greater emphasis on processes over outcome assessments. Only the USA was found to have implemented policy measures. In the process domain, frequently reported metrics included completion of needs assessments and survivorship care plans, and adherence to recommended follow up guidelines. Regarding outcome measures, patient-reported outcomes and experiences were commonly proposed, however there was a lack of specific elements, or recommended instruments. Conclusions: There is broad agreement on what constitutes quality survivorship care internationally. Future work should consider policy or structural elements that support optimal care. Findings from this scan will inform a modified reactive Delphi study to establish consensus-based criteria for high quality survivorship care. Additional work should consider how to define and implement metrics of quality care, and how to use metrics to improve survivors’ outcomes.

Cleveland Clinic Florida “pay-for performance” reimbursement: why the best care does not always make the happiest patients

Theoretical basis The assignment is to design a plan that aligns patient satisfaction scores with quality care metrics. The instructor’s manual (IM) introduces models for designing and implementing a strategic plan to approach the quality improvement process. Research methodology This is a field research case. The author(s) had access to the Chief Operating Officer (COO) and other members of the management team, meeting with them on numerous occasions. Cleveland Clinic Florida (CCF) provided the data included in the appendices. Additionally, relevant hospital data, also included in the appendices, is required to be made public on Centers for Medicare and Medicaid Services (CMS) databases. Accordingly, all data and information are provided by original sources. Case overview/synopsis Osmel “Ozzie” Delgado, MBA and COO of CCF was faced with a dilemma. Under the new CMS reimbursement formula, patient satisfaction survey scores directly impacted hospital reimbursement. However, the CCF patient satisfaction surveys revealed some very unhappy patients. Delgado pondered these results that really made no sense to him because CCF received the highest national and state rankings for its clinical quality at the same time. Clearly, patients were receiving the best medical care, but they were still unhappy. Leaning back in his chair, Delgado shook his head and wondered incredulously how one of the most famous hospitals in the world could deliver such great care but receive negative patient feedback on CMS surveys. What was going wrong and how was the hospital going to fix it? Complexity academic level This case is designed for graduate Master’s in Business Administration (MBA), Master’s in Health Sciences Administration (MHSA) and/or Public Health (PA) audiences. While a healthcare concentration is useful, the case raises the generic business problems of satisfying the customer to increase brand recognition in the marketplace and displacing competition to increase annual revenues. Indeed, the same analysis can be applied in other heavily regulated industries also suffering from a change in liquidity and growth occasioned by regulatory change.

Implementation and Enforcement of Quality and Safety in Long-Term Care

Long before the new coronavirus struck, nursing homes and other long-term care facilities have had declining quality care that coincides with inadequate staffing and rampant infections. These pre-pandemic conditions increased the vulnerability of these facilities to an infectious disease outbreak. As the elderly death toll rises into the tens of thousands, an overdue national discussion on how to prioritize long-term care in the US has emerged, revealing an opportunity to better link quality care metrics with sufficient reimbursement and meaningful regulatory oversight. However, the opposite approach has also surfaced, which would allow the status quo to continue and may erode the minimum standards of care that currently exist. This concerning trend is on the rise with efforts to relax the Centers for Medicare and Medicaid Services (CMS) regulatory authority over nursing homes by waiving requirements and reducing enforcement penalties. In addition, states are passing measures to limit liability exposure for nursing homes during COVID-19 and similar protections are under consideration at the federal level, even as infection rates climb and there is no evidence of frivolous lawsuits. While political will is uncertain, public outcry is ready for legislative reform that will lead to better later-in-life care. The stakes have never been higher — act now and pass laws that connect funding with regulation to support quality care in nursing homes during and after the COVID-19 pandemic — or continue to condone practices that allow infection to spread and take many lives before their time. This paper was prepared as part of Assessing Legal Responses to COVID-19, a comprehensive report published by Public Health Law Watch in partnership with the de Beaumont Foundation and the American Public Health Association.

Lessons learned from the development and implementation of an electronic paediatric emergency and acute care database in Lilongwe, Malawi

As the field of global child health increasingly focuses on inpatient and emergency care, there is broad recognition of the need for comprehensive, accurate data to guide decision-making at both...

Development of nursing quality care process metrics and indicators for intellectual disability services: a literature review and modified Delphi consensus study

BackgroundNursing process quality care metrics and indicators are quantifiable measures of the nursing care delivered to clients. They can be used to identify and support nurses’ contribution to high quality, safe, client care and are lacking in specialist intellectual disability nursing. In a national Nursing Quality Care-Metrics project for Irish intellectual disability services, a set of nursing quality care process metrics and associated indicators were established for intellectual disability services.MethodsA two-stage design approach was undertaken; a broad scoping review of the literature and a modified Delphi consensus process. The Delphi included a four round e-Delphi survey and a consensus meeting. Four hundred one intellectual disability nurses working in Ireland were recruited for the surveys and 20 stakeholders attended the consensus meeting.ResultsFrom the review, 20 existing and 16 potential intellectual disability nursing metrics were identified for nurses to prioritise in the e-surveys. After the four survey rounds, 12 intellectual disability nursing metrics and 84 associated indicators were identified. Following the consensus meeting, these were reduced to 12 metrics and 79 indicators.ConclusionsThis first set of intellectual disability nursing process metrics and associated indicators has been identified for implementation in practice. These metrics while developed in Ireland have international relevance and their application and appropriateness in practice needs to be evaluated.

Identifying and prioritising midwifery care process metrics and indicators: a Delphi survey and stakeholder consensus process

BackgroundMeasuring care processes is an important component of any effort to improve care quality, however knowing the appropriate metrics to measure is a challenge both in Ireland and other countries. Quality of midwifery care depends on the expert knowledge of the midwife and her/his contribution to women and their babies’ safety in the healthcare environment. Therefore midwives need to be able to clearly articulate and measure what it is that they do, the dimensions of their professional practice frequently referred to as midwifery care processes. The objective of this paper is to report on the development and prioritisation of a national suite of Quality Care Metrics (QCM), and their associated indicators, for midwifery care processes in Ireland.MethodsThe study involved four discrete, yet complimentary, phases; i) a systematic literature review to identify midwifery care process metrics and their associated measurement indicators; ii) a two-round, online Delphi survey of midwives to develop consensus on the set of midwifery care process metrics to be measured; iii) a two-round online Delphi survey of midwives to develop consensus on the indicators that will be used to measure prioritised metrics; and iv) a face-to-face consensus meeting with midwives to review the findings and achieve consensus on the final suite of metrics and indicators.ResultsFollowing the consensus meeting, 18 metrics and 93 indicators were prioritised for inclusion in the suite of QCM Midwifery Metrics. These metrics span the pregnancy, birth and postpartum periods.ConclusionThe development of this suite of process metrics and indicators for midwifery care provides an opportunity for measuring the safety and quality of midwifery care in Ireland and for adapting internationally. This initial work should be followed by a rigorous evaluation of the impact of the new suite of metrics on midwifery care processes.

Abstract 5: Differences in Stroke Care Among Patients in the REGARDS Study by Admission to a Hospital Participating versus Not Participating in GWTG-Stroke

Introduction: Get With The Guidelines (GWTG)-Stroke is a stroke-care quality-improvement program implemented in 1,656 of 5,564 (30%) US hospitals; however, the assessment of the effectiveness of GWTG is limited by the lack of data from hospitals not participating in the program. Methods: The REasons for Geographic And Racial Differences in Stroke (REGARDS) is a national population-based longitudinal cohort study of 30,239 black & white participants aged 45+ years. Participants with an incident stroke were hospitalized in their local hospital. The proportion of patients receiving each of 10 quality-care metrics was calculated among the stroke victims admitted to hospitals with and without GWTG-Stroke. Logistic regression was used to adjust for participant and hospital differences of those seen in GWTG/non-GWTG hospitals. Results: Between 2003 and 2015, 207 of the 546 (38%) REGARDS participants suffering an ischemic stroke were treated in a hospital currently participating in the GWTG-Stroke program (the remainder in a non-GWTG hospital). Those hospitalized in a GWTG hospital were of similar age, race, sex, and risk factor profile as those in non-GWTG hospital (data not shown); however, fewer residents of the Stroke Belt were treated in a GWTG hospital (46.9% vs. 60.8%). Among the hospitals where participants were treated, the GWTG hospitals significantly larger (average 425 versus 289 beds) and were more likely to participate in GME resident training (59.9% versus 40.7%). After adjustment for these differences (see table), patients treated in GWTG hospitals were more likely to receive tPA (OR = 3.69), education on stroke risk factors and warning signs (OR = 1.52), swallowing evaluation (OR = 1.26), lipid profile evaluation (OR = 1.17), and evaluation by a neurologist (OR = 1.12). Conclusions: The care of stroke patients admitted to hospitals participating in the GWTG-Stroke were more likely to meet important stroke quality care metrics.

Development of a national suite of nursing and midwifery quality care-metrics and indicators using consensus methodology

Development of a national suite of nursing and midwifery quality care-metrics and indicators using consensus methodology

Nursing & Midwifery Quality Care-Metrics (QCM)-The Journey

Introduction: Care delivery should be safe, patient-centred, compassionate, effective and efficient. Nurses and midwives deliver clinical care around the clock yet measuring this care and its effectiveness has been seen as a deficit. Quality Care-Metrics (QCM) are “a measure of the nursing and midwifery clinical care processes, in healthcare settings in Ireland, aligned to evidenced based standards and agreed through consensus” (1). Measuring the degree to which nurses and midwives adhere to fundamental care processes assures the quality of care delivered to patient and clients.The HSE Office of Nursing and Midwifery Services Director (ONMSD) introduced the care quality measurement in 2015. Currently, more than 80% of acute hospitals, incorporating Midwifery and Children’s Services undertake QCM collection. There is a growing penetration of QCM also in Community Services, public health, mental health, intellectual disability and older person’s settings.Practice Change- The ONMSD provide a national standardised tool to measure nursing and midwifery care processes. This involves developing national standardised Metrics measuring the fundamentals of care and the provision of an electronic data collection and reporting system to facilitate easy data entry and reporting for staff on the ground.Many services collected local audits which lacked consistency between what was measured. QCM is bringing about that change and assisting staff to become more familiar with standards measured each month. Aim and Theory of Change Objectives include to:provide a national standardised approach to care quality and measurement collate and report on all results in a standardised formatprovide real time data to nurses, midwives and their managers on delivery of safe, quality careMeasuring the quality of care is deemed critical by the Health Information and Quality Authority who stated:“Unless we actually measure the quality and safety of care, we cannot determine if improvements are being made” (2).The National Clinical Effectiveness Committee (3) defines a standard as a definable measure against which existing structures, processes or outcomes can be compared. Donebedian (4) highlights structure, process and outcomes as three essential components of measuring good quality care. QCM focuses on ensuring the process measures adhere to standards.Targeted Population and Stakeholders: The project initiated in Donegal and grew expansively into a national initiative. QCM is now integrated nationally across nursing and midwifery services: Acute, Mental Health, Children, Midwifery, Older People, Public Health Nursing and Intellectual Disability Services.Timeline: The project commenced in 2012 involving two community hospitals in the North West. In 2013, it expanded to 2 acute hospitals and 9 community hospitals. In 2014, it expanded to Mental Health services, Intellectual Disability services, Midwifery and Children’s services and into two further regions of the HSE (Dublin North and Dublin North East).In 2015, the ONMSD took on the initiative as a national project and 30 acute hospitals around Ireland were involved. In 2016, 81% of acute hospitals are now collecting QCM (5).Highlights: QCM has resulted in more staff awareness of metrics and standards. Patient care has improved through greater adherence to standards. Documentation has improved in recounting care delivered. A standardised approach has led to positive measurement across services.Sustainability: The project has been built for sustainability through the ONMSD.Transferability The project has proved to have a high transferability factor. Expressions of interest have been made by other health care professionals and other services outside of nursing with a view to following this approach.Conclusion: QCM has been an exciting and invigorating project to participate in. It has given nurses and midwives a real method for measuring and improving care delivery.Lessons learnt: There has been great learning on this project. The benefits of the bottom up approach were evident as QCM grew exponentially. The top down approach is now in use to standardise across all services, managed centrally from the ONMSD. Guiding and keeping all stakeholders engaged at different stages (some beginning the journey, others well established) has been a crucial element.Compromise and negotiation have been key in order to ensure ownership by stakeholders is recognised. Many early adopters had to let go of metrics they used in order to standardise with other services.Ensuring services were using and understanding the same terms so that QCM was measurable across services.

Ability to Work among Patients with ESKD: Relevance of Quality Care Metrics

Enabling patient ability to work was a key rationale for enacting the United States (US) Medicare program that provides financial entitlement to renal replacement therapy for persons with end-stage kidney disease (ESKD). However, fewer than half of working-age individuals in the US report the ability to work after starting maintenance hemodialysis (HD). Quality improvement is a well-established objective in oversight of the dialysis program, but a more patient-centered quality assessment approach is increasingly advocated. The ESKD Quality Incentive Program (QIP) initiated in 2012 emphasizes clinical performance indicators, but a newly-added measure requires the monitoring of patient depression—an issue that is important for work ability and employment. We investigated depression scores and four dialysis-specific QIP measures in relation to work ability reported by a multi-clinic cohort of 528 working-age maintenance HD patients. The prevalence of elevated depression scores was substantially higher among patients who said they were not able to work, while only one of the four dialysis-specific clinical measures differed for patients able/not able to work. Ability to work may be among patients’ top priorities. As the parameters of quality assessment continue to evolve, increased attention to patient priorities might facilitate work ability and employment outcomes.

Specific Components of Pediatricians’ Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement

The development of attention-deficit/hyperactivity disorder (ADHD) care quality measurements is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of ADHD care best predict patient outcomes. Parents of 372 medication-naïve children in grades 1 to 5 presenting to their community-based pediatrician (N= 195) for an ADHD-related concern and who were subsequently prescribed ADHD medication were identified. Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at the time ADHD was raised as a concern and then approximately 12 months after starting ADHD medication. Each patient's chart was reviewed to measure 12 different components of ADHD care. Across all children, the mean decrease in VAPRS total symptom score during the first year of treatment was 11.6 (standard deviation 10.1). Of the 12 components of ADHD care, shorter times to first contact and more teacher ratings collected in the first year of treatment significantly predicted greater decreases in patient total symptom scores. Notably, it was timeliness of contacts, defined as office visits, phone calls, or email communication, that predicted more ADHD symptom decreases. Office visits alone, in terms of number or timeliness, did not predict patient outcomes. The magnitude of ADHD symptom decrease that can be achieved with the use of ADHD medications was associated with specific components of ADHD care.Future development and modifications of ADHD quality care metrics should include these ADHD care components.

Evaluating the impact of a quality care-metric on public health nursing practice: protocol for a mixed methods study.

To establish, implement and evaluate the impact of a quality care-metric developed to measure public health nursing practice. Measurement of care practices plays an integral role in quality improvement and promotes positive change in healthcare delivery. Quality care-metrics has been identified as a means of effectively measuring public health nursing practice. Public health nurses in Ireland are 'all-purpose' generalist community-based nurses caring for people across the lifespan, in defined geographical areas, employed by the Health Service Executive. In the public health nurse's child and maternal health role, the 'primary visit' (postnatal visit) has been identified as the most important contact a public health nurse has with a mother and her new baby. Mixed methods using a sequential multiphase design. This study involves three phases. The first phase will include focus group and individual interviews with key healthcare professionals and new mothers, using purposively chosen sampling. Thematic analysis of data will identify key components for the development of a quality care-metric. Phase two will be a RAND appropriateness survey with a panel of experts, to develop and validate the quality care-metric. The third phase will involve implementation and evaluation of the quality care-metric. Descriptive and inferential statistics will be completed using SPSS version 21. Funding for this research study was approved in December 2013. This study will evaluate the impact of introducing a quality care-metric into public health nursing practice. Results will illuminate the quality of public health nursing practice in relation to the primary visit.

Metrics of Quality Care in Veterans: Correlation Between Primary‐Care Performance Measures and Inappropriate Myocardial Perfusion Imaging

Approximately 10% to 20% of myocardial perfusion imaging (MPI) tests are inappropriate based on professional-society recommendations. The correlation between inappropriate MPI and quality care metrics is not known. Inappropriate MPI will be associated with low achievement of quality care metrics. We conducted a retrospective cross-sectional investigation at a single Veterans Affairs medical center. Myocardial perfusion imaging tests ordered by primary-care clinicians between December 2010 and July 2011 were assessed for appropriateness (by 2009 criteria). Using documentation of the clinical encounter where MPI was ordered, we determined how often quality care metrics were achieved. Among 516 MPI patients, 52 (10.1%) were inappropriate and 464 (89.9%) were not inappropriate (either appropriate or uncertain). Hypertension (82.2%), diabetes mellitus (41.3%), and coronary artery disease (41.1%) were common. Glycated hemoglobin levels were lower in the inappropriate MPI cohort (6.6% vs 7.5%; P = 0.04). No difference was observed in the proportion with goal hemoglobin (62.5% vs 46.3% for appropriate/uncertain; P = 0.258). Systolic blood pressure was not different (132 mm Hg vs 135 mm Hg; P = 0.34). Achievement of several other categorical quality metrics was low in both cohorts and no differences were observed. More than 90% of clinicians documented a plan to achieve most metrics. Inappropriate MPI is not associated with performance on metrics of quality care. If an association exists, it may be between inappropriate MPI and overly aggressive care. Most clinicians document a plan of care to address failure of quality metrics, suggesting awareness of the problem.

The unique contribution of community clinical nurse specialists in rural Wales.

To date, quality indicators that have been developed for nursing tend to focus on acute, secondary care settings. It remains unclear whether such quality indicators are applicable to community settings, particularly in rural environments. This research aims to identify the consensus view among specialist nurses regarding their unique nursing contribution within their rural community. Identifying agreed aspects of the unique role within the rural community area will enable quality care metrics to be developed, allowing specialist nurses to measure their unique contribution to rural health care in the future. The research used the Delphi technique to identify a consensus view among a population of specialist community nurses working in a designated rural area in Wales. The strongest area of consensus related to clinical and teaching expertise, where participants perceive educational expertise as being at the forefront of their role. In terms of care for individuals, consensus was focused on four main areas: developing appropriate criteria for referral in to the service, collaborative working, education, and advocacy roles. The findings highlight similarities to models of care provision elsewhere. Specific quality indicators are required for clinical nurse specialists working in rural areas. Current quality indicators may not be applicable across all clinical settings. Further work is required to explore the nature of rural nursing practice.

Abstract 186: Quality of Cardiovascular Care in Patients Subjected to Inappropriate Myocardial Perfusion Imaging

Background: Approximately 10-20% of myocardial perfusion imaging (MPI) is performed for inappropriate indications. Established metrics of quality outpatient care for coronary artery disease (CAD), hypertension, and diabetes mellitus (DM) have similar, or worse, failure rates. The extent to which inappropriate use of MPI is associated with failure to achieve quality care metrics has not been investigated. Methods: We conducted a cross-sectional investigation of MPI performed on outpatients at a single VA medical center between December 2010 and July 2011. Data were gathered from documentation of the visit when the MPI test was ordered, including metrics of quality care for outpatient management of hypertension, DM, CAD, and smoking. Goals of care were selected from established metrics of quality outpatient care. We also assessed whether the clinician documented a plan to bring the metrics to goal. Results: 516 MPI patients were included, 52 (10.1%) inappropriate (I) and 464 (89.9%) appropriate or uncertain (A/U). Hypertension (82.2%), DM (41.3%), CAD (41.1%), and tobacco use (23.1%) were common. No significant differences between A/U and I cases were observed for CAD quality metrics (aspirin use, p=0.22; beta-blocker use, p>0.99; statin use, p>0.99; lipids at goal, p=0.20). While hemoglobin A1c levels were significantly lower for I cases (6.6% versus 7.5% for A/U cases, p=0.04), no difference was observed in the percent of patients at goal (62.5% for I versus 46.3% for A/U, odds ratio [OR] 2.90, 95% confidence interval [CI] 0.55-15.27, p=0.258). Blood pressure at goal (p=0.36) was not different. Use of tobacco was not different between the two groups (23.2% versus 15.7%, p=0.29), and neither was the proportion without tobacco cessation planning (0.65% versus 3.9%, p=0.08) Overall achievement of quality metrics was poor but similar to other reports of these metrics (CAD 44.8%, DM 47.9%, hypertension 73.1%, smoking 77.5%). Most clinicians documented a reason for not achieving, or a plan to achieve the metrics (CAD 95.3%, DM 68.2%, hypertension 90.8%, smoking 99.0%). Conclusion: Overall, the inappropriate use of MPI is not associated with failure to achieve established metrics of quality outpatient care. On the contrary, most clinicians demonstrate awareness of these care deficiencies by documenting either a reason for not achieving, or a plan of care to achieve quality care metrics

The cancer psychosocial care matrix: a community‐derived evaluative tool for designing quality psychosocial cancer care delivery

Although the Institute of Medicine provided a vision for effective psychosocial care for cancer survivors, limited guidance exists regarding the essential components of comprehensive care or progressive steps for implementing each component. This paper describes the development of a unique tool for assessing capacity to provide quality psychosocial care to cancer survivors and the results of the first implementation of this tool in community settings. The psychosocial working group of the National Cancer Institute Community Cancer Centers Program (NCCCP) developed the Cancer Psychosocial Care Matrix assessment tool. All NCCCP sites (n=30, enrolled in 2007 nd 2010) completed the matrix indicating their capacity for providing psychosocial care at entry into NCCCP ('baseline') after 2 years of NCCCP participation (2007 sites only) and within the coming year ('future aspirations'). At baseline, matrix responses reflected few or no systematic processes in place for most components of comprehensive psychosocial care. However, reported capacity to deliver specific components improved at 2 years post-NCCCP entry for the 2007 sites and in all NCCCP sites' future aspirations. With growing demand on cancer centers to meet new metrics of quality care, the psychosocial matrix can help centers systematically identify and develop steps to address gap areas in their capacity to meet these new standards. The Cancer Psychosocial Care Matrix appears to enable evaluation of psychosocial programs, may promote intentions to improve psychosocial services, and can facilitate communication of 'best practices' among cancer centers.

The psychosocial matrix: A community-derived evaluative tool for designing quality psychosocial cancer care.

250 Background: Although the Institute of Medicine provided a vision for effective psychosocial care for cancer survivors, guidance regarding the essential components of comprehensive care or progressive steps for implementing each component is limited. This abstract presents a unique tool for self-assessing capacity to provide quality psychosocial care to cancer survivors and results of the first full-scale implementation of this tool. Methods: The psychosocial workgroup of the National Cancer Institute Community Cancer Centers Program (NCCCP) developed the Psychosocial Care Matrix Assessment Tool which covers 7 domains (e.g., distress screening, patient-provider communication, evaluation of psychosocial programs). All NCCCP sites (16 enrolled in 2007, 14 enrolled in 2010) completed the matrix in 2010 regarding their capacity for psychosocial care at entry into NCCCP (baseline), after two years of NCCCP participation (2007 sites only), and within the coming year (future aspirations). Results: At baseline, matrix responses reflected few or no systematic processes in place for most components of psychosocial care. However, reported capacity to deliver specific components improved at two years post-NCCCP entry for the 2007 sites and in all sites’ future aspirations. For example, about 80% of all sites reported no or inconsistent distress screening at baseline. After two years, 48% of the 2007 sites reported consistent screening with a standardized tool or consistent screening plus a comprehensive interview. Nearly all 2007 sites (89%) aspired to provide consistent screening plus comprehensive interview with 50% also hoping to add systematic follow-up screenings. The majority of 2010 sites (71%) aspired to provide consistent screening with a standardized tool. Conclusions: The psychosocial matrix tool was found to be useable and valuable. At the NCCCP sites, some aspects of psychosocial care (e.g., communicating the importance of psychosocial care) are more readily implemented than others (e.g., follow-up after a positive distress screen). With growing demand on cancer centers to meet new metrics of quality care, the psychosocial matrix can help identify and develop steps to address gap areas.

Measuring quality: an evaluation of a nurse-led stoma care outpatient clinic

Evaluation of health services has traditionally been based on medical outcome measures such as mortality, morbity and length of hospital stay. The government's recent introduction of the NHS outcomes framework has introduced patient experience and quality of life as essential metrics of quality care. Changing how we measure the quality of healthcare paves the way for nursing services to be recognised as providing high-quality care that directly impacts on the patient's experience and the outcomes of care. In this article, Theresa Bowles describes the development of a tool designed to measure the patient-perceived experience, quality of service and nursing outcomes of a nurse-led stoma care outpatient clinic at one NHS trust.