Quality assurance in the health care industry

The purpose of this article is to explore the quality assurance methods commonly used in the health care industry. Factors that influence the delivery of quality patient care is explored as well as factors that affect implementation of quality control measures. The importance of quality patient care to the economic success of the health care industry is described. Quality improvement efforts that are utilized by health care institutions are described including: independent performance audits, internal audits, outcomes analysis, consumer reports, industry guidelines, and consumer satisfaction surveys. Highly effective hospital managers exhibit management roles, behaviors, and a range of activities that correlate strongly to institutional commitment to quality and improved patient care outcomes. By reinforcing their involvement in quality improvement efforts, hospital managers were able to enhance their effectiveness in promoting and sustaining quality care.     

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.     

A model for a culture-sensitive assessment of patients in health care settings

The need for a cultural formulation in the healthcare setting is demonstrated. A process is delineated for assessing the ethnically-diverse patient. A sensitive assessment provides recognition of how the patient's cultural roots affect their healing process. Cooperation and compliance to the advice given by healthcare professionals may be enhanced by understanding the patient's cultural perceptions. Case examples are given from Navajo, Laotian, and Cambodian cultures. The assessment and cultural formulation process can assist the social worker in their interventions with the patient and their recommendations to the other members of the treatment team.     

QUDOS: a quality assurance system for health care

Describes a system of quality assurance for use by either purchasers or providers of health care services. The system has been in operation since 1991 and is compatible with registration to BS 5750.     

Quality of care in mental health: the case of schizophrenia.

Scientific evidence supporting the efficacy of a range of treatments for persons with schizophrenia set the stage for the recent development of evidence-based quality-of-care indicators for this disorder. On the heels of these quality indicators, research has found that treatment services for many persons with schizophrenia are inadequate. Because most of these patients receive their care under public auspices (Medicaid, Medicare, and Veterans Affairs), public health policy can exert considerable influence to address these quality-of-care problems. Publicly funded managed care could promote evidence-based care. It also could coordinate specialty and primary care to improve early detection and general medical care for persons with schizophrenia.     

Considerations in predicting mental health care use: Implications for managed care plans

Managed care plans and other health care providers face a difficult task in predicting outpatient mental health services use. Existing research offers some guidance, but our knowledge of which factors influence use is confounded by methodological problems and sampling constraints. Consequently, available findings are insufficient for developing accurate predictions, which managed care plans need in order to formulate fiscally responsible service delivery contracts. This article reviews the primary data sources and research on ambulatory mental health services. On the basis of this review, the probability and intensity of outpatient visits are estimated. The primary predictors of use are also examined because they may help managed care plans forecast use by a given population or group of enrollees. Gender, age, race, education, health status, and insurance coverage are several variables surfacing as statistically significant predictors of use. The implications for planning capitated mental health services are discussed.     

Uses of ambulatory health/mental health utilization data in organized health care settings

A follow-up assessing uses of findings from NIMH-supported research on health and mental health services utilization in organized health care settings revealed a range of applications across the study sites. The research, conducted primarily for national policy purposes, had an impact on study sites in the following areas: clinician perceptions and attitudes about mental health services provided; program directions; fiscal policy; and further related research. Research team composition and dissemination of study findings are discussed in relation to the applications made.     

Primary eye care skills scores for health workers in routine and enhanced supervision settings

Introduction

Primary health care in Tanzania is provided at two types of health units, the dispensary and the health centre. Theoretically, primary health workers (with knowledge of primary eye care [PEC]) are ideally placed to identify people in need of eye care services. In Tanzania, they are expected to be able to identify, treat, or correctly refer a number of eye conditions including cataract, trauma, presbyopia, and the ‘red eye’. They are also expected to be able to measure visual acuity correctly and to educate the community about prevention.

Objectives

The objective was to determine the effect of enhanced supervision of health workers on PEC knowledge and skills in Kilimanjaro Region, Tanzania.

Study design

This was a quasi-experimental, cluster randomized intervention study of an enhanced supervisory method compared to a routine supervisory method; 36 dispensaries were randomly allocated into the two groups.

Participants

Health workers based at government dispensaries in Mwanga District.

Data collection

Participants were interviewed pre and post intervention and the information was recorded using a standardized pretested questionnaire.

Results

Mean scores of knowledge in healthcare workers was higher in the intervention group (score = 6.43, 80.4% improvement) compared to the non-intervention group (score = 4.71, 58.9% improvement). The ability to describe and demonstrate vision testing was better (score = 1.8) in the enhanced supervision group compared to the routine supervision group (score = 0.88, P = 0.03). There was a high level of attrition (24%) within one year from the time of baseline survey, especially amongst clinical officers (44%).

Conclusion

During the pilot study, enhanced supervision improved PEC knowledge and skills of health workers compared to health workers with routine supervision.

Recommendations

Training in PEC needs revision to become more practicum-based. There is need to revise supervision guidelines (to be skills-based) and the supervision skills of district eye coordinators (DECs) need to be enhanced. There is a huge need to improve governance (accountability and rule of law) of health staff.     

Quality indicators for primary care mental health services

Objectives: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement.

Design: Modified two-round postal Delphi questionnaire.

Setting: Geographical spread across Great Britain.

Participants: One hundred and fifteen panellists representing 11 different stakeholder groups within primary care mental health services (clinical psychologist, health and social care commissioner, community psychiatric nurse, counsellor, general practitioner, practice nurse/district nurse/health visitor, psychiatrist, social worker, carer, patient and voluntary organisations).

Main outcome measures: Face validity (median rating of 8 or 9 on a nine point scale with agreement by all panels) for assessing quality of care.

Results: A maximum of 334 indicators were rated by panels in the second round; 26% were rated valid by all panels. These indicators were categorised into 21 aspects of care, 11 relating to general practices and 10 relating to health authorities or primary care groups/trusts. There was variation in the total number of indicators rated valid across the different panels. Overall, GPs rated the lowest number of indicators as valid (41%, n=138) and carers rated the highest number valid (91%, n=304).

Conclusions: The quality indicators represent consensus among key stakeholder groups in defining quality of care within primary care mental health services. These indicators could provide a guide for primary care organisations embarking on quality improvement initiatives in mental health care when addressing national targets and standards relating to primary care set out in the National Service Framework for Mental Health for England. Although many of the indicators relate to parochial issues in UK service delivery, the methodology used in the development of the indicators could be applied in other settings to produce locally relevant indicators.

     

Moving an evidence-based intervention into routine mental health care: a multifaceted case example

Many evidence-based interventions fail to translate into routine care for individuals experiencing significant mental health disorders. Moving the evidence-based intervention from the controlled research settings to the broader mental health systems is an ongoing challenge for administrators and practitioners in the mental health delivery network. In the United States, the movement to bring evidence-based mental health interventions into the public mental health system to enhance consumer recovery and improve outcomes has been a major thrust of federal and state efforts over the past 10 years (IOM, 2006; New Freedom Commission on Mental Health, 2003; Michigan Mental Health Commission, 2004; U.S. Department of Health and Human Services, 1999). Using a multifaceted case example, this article will address one state's efforts to implement an evidence-based intervention, Family Group Psychoeducation (FPE), into routine care for individuals living with schizophrenia and their families. The Consolidated Framework for Implementation Research (CFIR) (Damshcroder et al., 2009) guides the discussion of the dissemination efforts. This CFIR framework involves examining five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation.     

Cultural competence in mental health care: a review of model evaluations

Background  

Cultural competency is now a core requirement for mental health professionals working with culturally diverse patient groups. Cultural competency training may improve the quality of mental health care for ethnic groups.