Health Care Quality Management E-Book

Thomas K. Ross

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1102

Veröffentlichungsjahr: 2013

Beschreibung

In today’s challenging health care environment, health care organizations are faced with improving patient outcomes, redesigning business processes, and executing quality and risk management initiatives. Health Care Quality Management offers an introduction to the field and practice of quality management and reveals the best practices and strategies health care organizations can adopt to improve patient outcomes and program quality.

• Filled with illustrative case studies that show how business processes can be restructured to achieve improvements in quality, risk reduction, and other key business results and outcomes
• Clearly demonstrates how to effectively use process analysis tools to identify issues and causes, select corrective actions, and monitor implemented solutions
• Includes vital information on the use of statistical process control to monitor system performance (variables) and outcomes (attributes)
• Also contains multiple data sets that can be used to practice the skills and tools discussed and reviews examples of where and how the tools have been applied in health care
• Provides information on root cause analysis and failure mode effects analysis and offers, as discussion, the clinical tools and applications that are used to improve patient care

By emphasizing the tools of statistics and information technology, this book teaches future health care professionals how to identify opportunities for quality improvement and use the tools to make those improvements.

Leseprobe

Table of Contents

Cover

Title

Copyright

FIGURES AND TABLES

PREFACE

THE AUTHOR

PART 1: THE STATE OF QUALITY MANAGEMENT IN HEALTH CARE

CHAPTER 1: QUALITY IN HEALTH CARE

Introduction

The Goal of Quality Management

Quality Pioneers in Health Care

Requisite Skills for Improving Health Care

Quality Control in Industry

System Thinking

Summary

References

CHAPTER 2: ERROR AND VARIATION

Introduction

The Medical Decision-Making Process

Human Error and James Reason

Small Area Variations and John Wennberg

Practice Guidelines and Brent James

The Structure-Process-Outcome Paradigm

The Three Faces of Quality

Underuse, Overuse, and Misuse

Controlling Variation and Improving Outcomes

Summary

References

CHAPTER 3: REGULATING THE QUALITY AND QUANTITY OF HEALTH CARE

Introduction

Licensure, Accreditation, and Credentialing

Malpractice

The Economics of Health Care Markets

A Brief History of Health Care Financing in the United States

Pay for Performance and the CMS Quality Initiative

Summary

References

PART 2: QUALITY MANAGEMENT TOOLS

CHAPTER 4: PROCESS ANALYSIS TOOLS

Introduction

Tools to Identify Problems

Tools to Identify Causes

Tools to Identify Solutions

Tool to Monitor Progress

Summary

References

CHAPTER 5: ROOT CAUSE ANALYSIS

Introduction

Root Cause Analysis

Single-Event Analysis

Multiple-Event Analysis

Prevention and Recovery

Cases and Applications

Summary

References

CHAPTER 6: STATISTICAL PROCESS CONTROL FOR MONITORING SYSTEM PERFORMANCE

Introduction

Statistics Review

Types of Variation

Setting Performance Targets

Statistical Process Control for Continuous Data: and R Charts

Tinkering

Cases and Applications

Summary

References

CHAPTER 7: STATISTICAL PROCESS CONTROL FOR MONITORING FAILURE RATES

Introduction

Statistical Process Control for Binomial Data: p and np Charts

Establishing Valid Control Limits

Constant and Variable Control Limits

Rebasing Control Limits and Monitoring Changes over Time

Cases and Applications

Improving Performance Using SPC

Summary

References

CHAPTER 8: STATISTICAL PROCESS CONTROL FOR MONITORING NONCONFORMITIES

Introduction

Statistical Process Control for Counts: c and u Charts

Medicare Hospital Quality Initiative Example

Cases and Applications

Selecting a Control Chart

Benefits of SPC

Inhibitors of the Use of SPC

Summary

References

CHAPTER 9: EXPLORING QUALITY ISSUES WITH STATISTICAL TOOLS

Introduction

Chi-Square Analysis

Analysis of Variance

Analysis of Means

Regression Analysis

Quality Improvement and Research

Summary

References

CHAPTER 10: FAILURE MODE AND EFFECTS ANALYSIS

Introduction

General System Theory

The Value Chain

Failure Mode and Effects Analysis

Designing Better Systems

Summary

References

PART 3: MEDICAL PRACTICE MANAGEMENT

CHAPTER 11: PRACTICE POLICIES

Introduction

Practice Policies

Computer Decision Support

Cases and Applications

Summary

References

CHAPTER 12: CASE, DISEASE, AND OUTCOMES MANAGEMENT

Introduction

Case Management

Disease Management

Outcomes Management

Summary

References

CHAPTER 13: PROFILING, ECONOMIC CREDENTIALING, AND RISK ADJUSTMENT

Introduction

Physician Profiling and Report Cards

Academic Detailing

Economic Credentialing

Risk Adjustment

Summary

References

CHAPTER 14: BENCHMARKING AND IMPLEMENTATION

Introduction

Benchmarking and Best Practice

Balanced Scorecards

Dashboards

Implementation Strategies

Summary

References

CHAPTER 15: THE FUTURE OF QUALITY MANAGEMENT IN HEALTH CARE

Introduction

Bringing It All Together

Value and What an Employee (or Manager) Should Do

The Future of Health Care and Quality Management

Summary

References

INDEX

Guide

Cover

Table of Contents

Begin Reading

List of Illustrations

Chapter 1: Quality in Health Care

Figure 1.1 Evolution of Production Processes

Figure 1.2 The PDCA Cycle

Figure 1.3 Evolution of Quality Control

Figure 1.4 The System Model

Chapter 2: Error and Variation

Figure 2.1 The Medical Decision-Making Model

Figure 2.2 Treatment Selection

Figure 2.3 Donabedian’s Structure-Process-Outcome Paradigm

Figure 2.4 Nash’s Three Faces of Quality

Chapter 3: Regulating the Quality and Quantity of Health Care

Figure 3.1 Malpractice Suits, 2001–2010

Figure 3.2 Demand for Physician Visits

Figure 3.3 Demand for Physician Visits by Different Individuals

Figure 3.4 The Supply and Demand for Physician Visits

Figure 3.5 Overutilization of Physician Visits

Figure 3.6 The Effect of Third-Party Payment on Demand

Chapter 4: Process Analysis Tools

Figure 4.1 The Knowledge Hierarchy

Figure 4.2 Top 10 Medications in Adverse Events

Figure 4.3 Pareto Chart of Adverse Drug Events

Figure 4.4 Pareto Chart Examining Rate of Adverse Drug Events

Figure 4.5 Pareto Chart of Joint Commission Sentinel Events

Figure 4.6 Excel’s Frequency Function

Figure 4.7 Stratification Chart for Patient Falls by Age

Figure 4.8 Stratification Chart for Patient Falls by Level of Medication

Figure 4.9 Histogram for Baby Weights

Figure 4.10 Histogram for LOS by State

Figure 4.11 Histogram Distributions

Figure 4.12 Process Distribution Check Sheet

Figure 4.13 Process Distribution Check Sheet with Dates

Figure 4.14 Defective Item Check Sheet

Figure 4.15 Defect Factor Check Sheets

Figure 4.16 Defect Location Check Sheet

Figure 4.17 Cause and Effect Template

Figure 4.18 Cause and Effect Diagram for Wrong Medication

Figure 4.19 Scatter Diagrams

Figure 4.20 Scatter Diagram of LOS and Patient Volume

Figure 4.21 Common Flowchart Symbols

Figure 4.22 Word’s Flowchart Capability

Figure 4.23 Run Chart of Patient Falls

Figure 4.24 Run Chart of Patient Falls with Average

Figure 4.25 Run Chart of Patient Falls with Trendline

Chapter 5: Root Cause Analysis

Figure 5.1 The Heinrich Triangle

Figure 5.2 The Swiss Cheese Model of Error Occurrence

Figure 5.3 Root Causes of Sentinel Events, 2012

Figure 5.4 Why-Why Diagram

Figure 5.5 Is–Is Not Template

Figure 5.6 An Is–Is Not Example

Figure 5.7 Data Set of Adverse Events

Figure 5.8 Time between Registration and Patient Fall

Figure 5.9 Hierarchical Safeguards and Error Realization

Figure 5.10 Timeline of Events

Chapter 6: Statistical Process Control for Monitoring System Performance

Figure 6.1 Temperature and Response

Figure 6.2 The Normal Distribution

Figure 6.3 and R Charts

Figure 6.4 and R Charts: ER Wait Times

Figure 6.5 and R Charts: Rx Administration

Figure 6.6 Performance by Shift

Figure 6.7 Performance by Day

Figure 6.8 Cause and Effect Diagram

Figure 6.9 Blood Pressure after Tinkering

Figure 6.10 Shahian et al. SPC Chart

Figure 6.11 Johnson and Martin SPC Chart

Figure 6.12 Bonetti et al. SPC Chart

Chapter 7: Statistical Process Control for Monitoring Failure Rates

Figure 7.1 Indicators of Unstable Systems

Figure 7.2 p Chart for Surgical Coding Accuracy

Figure 7.3 np Chart for Nonconforming Surgical Claims

Figure 7.4 Breach of Lower Control Limit

Figure 7.5 Establishing Valid Control Limits

Figure 7.6 Constant Control Limits

Figure 7.7 p Chart for Aspirin Delivery to AMI Patients

Figure 7.8 Rebased Control Limits for Aspirin Delivery to AMI Patients

Figure 7.9 Duclos et al. SPC Charts

Figure 7.10 Fasting and Gisvold SPC Charts

Chapter 8: Statistical Process Control for Monitoring Nonconformities

Figure 8.1 c Chart for Medical Record Errors

Figure 8.2 u Chart for Medical Record Errors

Figure 8.3 u Chart for Dietary Concerns

Figure 8.4 Check Sheet for AMI Treatment

Figure 8.5 c Chart for AMI Treatment

Figure 8.6 Curran et al. SPC Chart

Figure 8.7 Walberg, Frøslie, and Røislien SPC Chart

Figure 8.8 Pollard and Garnerin SPC Charts

Figure 8.9 Selecting a Control Chart

Chapter 9: Exploring Quality Issues with Statistical Tools

Figure 9.1 Quality Management and Research

Figure 9.2 Selecting a Chi-Square Function

Figure 9.3 Create PivotTable

Figure 9.4 Drag and Drop

Figure 9.5 Data Analysis Functions

Figure 9.6 ANOVA: Single Factor Dialog Box

Figure 9.7 Number of Patients Prescribed Ritalin

Figure 9.8 ANOM Control Limits for Ritalin Prescription Rates

Figure 9.9 Scatter Diagram of Average Charge and Case Volume

Figure 9.10 Regression Dialog Box

Figure 9.11 Multiple Regression Dialog Box

Chapter 10: Failure Mode and Effects Analysis

Figure 10.1 The System View

Figure 10.2 A Production Process

Figure 10.3 Porter’s Value Chain

Figure 10.4 Health Care Value Chain

Chapter 11: Practice Policies

Figure 11.1 The Clinical Decision-Making Model

Figure 11.2 Ventilator Compliance and Practice Policies

Chapter 12: Case, Disease, and Outcomes Management

Figure 12.1 Distribution of U.S. Medical Spending across U.S. Population

Figure 12.2 Case, Disease, and Outcomes Management