Nutrition assessment: a management tool for providing quality care.

When planning nutrition intervention programs in a health care facility or the community, an analysis of the service population is necessary to determine the levels of care than can be provided. The use of screening and monitoring techniques will maximize the resources that are available and increase the amount of care that can be given. By using baseline nutrition assessment data, health outcomes can be measured over time and cost-effectiveness of the program can be evaluated. Examples of studies that measure effectiveness of nutrition services and programs are reviewed. Specific steps are suggested to simplify the documentation of the process and outcomes of nutrition intervention.     

Methodologies for improving response rates in surveys of physicians: a systematic review

Although physician surveys are an important tool in health services and policy research, they are often characterized by low response rates. The authors conducted a systematic review of 66 published reports of efforts to improve response rates to physician surveys. Two general strategies were explored in this literature: incentive and design-based approaches. Even small financial incentives were found to be effective in improving physician response. Token nonmonetary incentives were much less effective. In terms of design strategies, postal and telephone strategies have generally been more successful than have fax or Web-based approaches, with evidence also supporting use of mixed-mode surveys in this population. In addition, use of first-class stamps on return envelopes and questionnaires designed to be brief, personalized, and endorsed by legitimizing professional associations were also more likely to be successful. Researchers should continue to implement design strategies that have been documented to improve the survey response of physicians.     

In Connecticut: improving patient medication management in primary care

Medications are a cornerstone of the management of most chronic conditions. However, medication discrepancies and medication-related problems-some of which can cause serious harm-are common. Pharmacists have the expertise to identify, resolve, monitor, and prevent these problems. We present findings from a Centers for Medicare and Medicaid Services demonstration project in Connecticut, in which nine pharmacists worked closely with eighty-eight Medicaid patients from July 2009 through May 2010. The pharmacists identified 917 drug therapy problems and resolved nearly 80 [corrected] percent of them after four encounters. The result was an estimated annual saving of $1,123 per patient on medication claims and $472 per patient on medical, hospital, and emergency department expenses-more than enough to pay for the contracted pharmacist services. We recommend that the Center for Medicare and Medicaid Innovation support the evaluation of pharmacist-provided medication management services in primary care medical homes, accountable care organizations, and community health and care transition teams, as well as research to explore how to enhance team-based care.     

Pay for performance: improving quality care

Pay-for-Performance (PFP) is becoming increasingly viewed as a viable means of responding to the ever increasing pressure for economy, continuity, and consistency in the delivery of health care. Pay-for-Performance is an important development in the move toward a more quality-driven health care system. The quality improvement mission of today's PFP programs is to provide realistic incentives encouraging physicians and hospitals to deliver quality health care in an efficient and cost-effective manner. Central to PFP is the enhancement of the essential patient-physician relationship. Existing guidelines developed by the American Medical Association, as well as guidelines published by the Joint Commission on Accreditation of Healthcare Organizations, describe how PFP programs work and how the various players in the health care system--physicians, patients, insurers, payers--are potentially affected by PFP. Several health plans have already adopted functional PFP programs. Overall, PFP programs show promise for improving the quality of care while helping to contain costs.     

学术期刊同行评议的问题及效率与质量提升策略

【目的】 调研期刊同行评议现状,分析评议专家审稿行为的影响因素,为提高我国科技期刊同行评议的效率与质量提供借鉴。【方法】 基于传统同行评议模式,以审稿专家为研究对象,对专家同行评议培训的需求、愿意参与期刊同行评议的原因、拒绝审稿的原因及认可的同行评议激励机制4个方面进行问卷调查。【结果】 目前我国科学家参与同行评议培训的程度低而专家的同行评议培训需求却较高,参与调研的88.03%的专家认为参加期刊同行评议是科学家的职责,专家拒绝审稿主要是因为研究领域不符、文章质量不高及没有时间等,专家认可的激励方式主要包括加入期刊候选编委团队、为他们搭建学术交流平台及优秀审稿人认证及表彰。【结论】 期刊编辑部可以从丰富同行评议培训方式、细分专家研究领域、多途径扩大审稿专家库、规范同行评议流程、健全同行评议激励机制及提高编辑学术社交能力6个方面来提升同行评议的效率及质量。     

Cost analysis as a management tool for improving the efficiency of primary care: some examples from Java.

Health programs in developing countries increasingly face limited or even reduced budgets. More and better services might be produced from these resources by improving efficiency through better management and program design. Cost analysis at individual health units can help identify sources of inefficiency, and provide guidance to managers as to where they can achieve important gains in productivity. This paper presents several examples from health centers and sub-centers in rural Java. Indonesia, showing how inefficiencies in staffing patterns, personnel management, and drug management can affect cost-efficiency. Routine analysis of cost data could provide the basis for management incentives to local health units to increase both outputs and quality of care.     

Use of a customer satisfaction survey by health care regulators: a tool for total quality management.

OBJECTIVES: To conduct a survey of health care providers to determine the quality of service provided by the staff of a regulatory agency; to collect information on provider needs and expectations; to identify perceived and potential problems that need improvement; and to make changes to improve regulatory services. METHODS: The authors surveyed health care providers using a customer satisfaction questionnaire developed in collaboration with a group of providers and a research consultant. The questionnaire contained 20 declarative statements that fell into six quality domains: proficiency, judgment, responsiveness, communication, accommodation, and relevance. A 10% level of dissatisfaction was used as the acceptable performance standard. RESULTS: The survey was mailed to 324 hospitals, nursing homes, home care agencies, hospices, ambulatory care centers, and health maintenance organizations. Fifty-six percent of provider agencies responded; more than half had written comments. The three highest levels of customer satisfaction were in courtesy of regulatory staff (90%), efficient use of onsite time (84%), and respect for provider employees (83%). The three lowest levels of satisfaction were in the judgment domain; only 44% felt that there was consistency among regulatory staff in the interpretation of regulations, only 45% felt that interpretations of regulations were flexible and reasonable, and only 49% felt that regulations were applied objectively. Nine of 20 quality indicators had dissatisfaction ratings of more than 10%; these were considered priorities for improvement. CONCLUSIONS: Responses to the survey identified a number of specific areas of concern; these findings are being incorporated into the continuous quality improvement program of the office.     

The missing link: improving quality with a chronic disease management intervention for the primary care office

Bold steps are necessary to improve quality of care for patients with chronic diseases and increase satisfaction of both primary care physicians and patients. Office-based chronic disease management (CDM) workers can achieve these objectives by offering self-management support, maintaining disease registries, and monitoring compliance from the point of care. CDM workers can provide the missing link by connecting patients, primary care physicans, and CDM services sponsored by health plans or in the community. CDM workers should be supported financially by Medicare, Medicaid, and commercial health plans through reimbursements to physicians for units of service, analogous to California's Comprehensive Perinatal Services Program. Care provided by CDM workers should be standardized, and training requirements should be sufficiently flexible to ensure wide dissemination. CDM workers can potentially improve quality while reducing costs for preventable hospitalizations and emergency department visits, but evaluation at multiple levels is recommended.     

Effectiveness of a physician peer educator in improving the quality of immunization services for young children in primary care practices

OBJECTIVE: To determine if the addition of a physician peer educator would lead to improved immunization quality when compared to the traditional education provided as part of a vaccines for children (VFC) site visit. METHODS: A randomized controlled trial was conducted. Study participants were private pediatric and family medicine practices. Both the intervention and control groups received a VFC visit; in intervention practices this visit was augmented by a presentation by the physician peer educator. Data on immunization rates and quality of immunization services were collected prior to the VFC visits and approximately 1 year later. RESULTS: A total of 73 practices participated, including 37 in the intervention group and 36 in the control group. At follow-up there was no difference in practice immunization rates (PIR) between intervention and control practices (mean rates 71.4% and 69.6%, respectively, P=0.94). There were also no significant differences between groups for any of the quality measures except that significantly more intervention practices used the appropriate length needle for vaccine injections in 2-month-old infants at follow-up (P=0.02). When assessing the overall impact of VFC visits, no significant increase in PIR were noted from baseline to follow-up assessments. However, statistically significant improvements in several quality measures were found. CONCLUSIONS: The addition of a physician peer educator did not result in improved immunization quality when compared to VFC visits alone. The educational content of the VFC site visit was associated with improved quality of immunization services delivered by primary care practices.     

Physician response to surveys. A review of the literature

OBJECTIVE: Physician-specific surveys are a frequently used tool in health services research, but attempts at ensuring adequate response rates are rarely reported. We reviewed literature of survey methodology specific to physician surveys and report those found to be most effective. DATA SOURCES: Studies were identified by searching MEDLINE and PSYCHInfo from 1967 through February 1999. We included all English-language studies that randomized physician survey respondents to an experimental or control group. The authors independently extracted data from 24 studies examining survey methodology of physician-specific surveys. We included Mantel-Haenszel chi-squares comparing treatment groups, if present. If not, these were calculated from study data. RESULTS: Pre-notification of survey recipients, personalizing the survey mailout package, and nonmonetary incentives were not associated with increased response rates. Monetary incentives, the use of stamps on both outgoing and return envelopes, and short questionnaires did increase response rates. Few differences were reported in response rates of phone surveys compared with mail surveys and between the demographics and practice characteristics of early survey respondents and late respondents. CONCLUSIONS: We report some simple approaches that may significantly increase response rates of mail surveys. Surprisingly, the response rates of mail surveys of physicians compared favorably with those from telephone and personal interview surveys. Nonresponse bias may be of less concern in physician surveys than in surveys of the general public. Future research steps include specifically testing the more compelling results to allow for better control of confounders.     

Journal club: a tool for health care management and development

While the journal club concept has its roots in medical practice, the premise of the concept can easily and effectively be assimilated into health care management practice. Health care executives and managers can greatly facilitate the journal club process by establishing a solid methodology for article presentations that focuses on critical and timely issues related to health care management. With upper management support and member commitment, the journal club can be a powerful vehicle for ongoing management and personal career development.     

Do or die. Presents an initiative for improving the quality of patient care

Over the recent past, a number of different approaches to quality improvement have been introduced to the field of health-care delivery. Presents an overview of the approach developed at Brighton Health Care Trust. Outlines the strategic approach incorporating: the recognition of the need for staff education to enable them to participate fully in improving the quality of patient care; the identification of seven core components; the development of an educational package; and the development of a structure to support the implementation.     

The public's perception of quality hospitals II: Implications for patient surveys

Because there is growing consensus that monitoring quality care should be based, at least in part, on patients' perceptions (Davies and Ware 1988), this article expands earlier findings on how the public perceives the quality of hospitals and hospital care (Boscarino 1988b). In this study, the public's overall quality ratings of 155 short-term medical and surgical hospitals are analyzed by the type, size, staff ratio, mortality rate, case mix, and location. The hospitals in the study represented a national cross-section of institutions, with the results based on 20,000 adults surveyed in 40 U.S. market areas. Initial analysis shows that the public rates nonrural, larger, tertiary care, teaching, higher-patient census, better-staffed, and lower-mortality facilities higher in overall quality. Hospitals that are located in the Midwest or West, have higher average employee salaries, and that are more costly are also perceived to be of a higher quality. A multiple regression analysis reveals that combined these variables account for 50 percent of the public's quality perception, with the most important being tertiary care level, patient-census level, average employee salary, and teaching status (all positively related to higher quality). Using these variables in a discriminant function analysis, hospitals with high-perceived quality can be correctly identified 80 percent of the time. It is suggested that these findings have major significance for monitoring the quality of care, based on patients' perceptions. A practical model for doing this, one that minimizes patient biases and incorporates medical outcomes, is described in detail.     

北京肿瘤医院住院病人满意度连续性监测

目的发现医疗服务中存在的问题,提出针对性的改进措施,以改善医疗服务质量。方法澳大利亚住院病人满意度监测工具(VPSM),采取随机抽样的方法,在2006年4月和12月分别抽取某一周所有的出院病人进行院外调查,分析2次监测住院病人观点的变化。结果与第一次调查相比,第二次调查时病人的总满意度、住院服务有效性评价、各服务质量指数等均有显著性提高。通过监测提出了在医院服务可及性、入院服务、物理环境、出院服务和随访等方面需要提高质量的建议,并通过第二次监测对医院有针对性的质量改进措施的效果进行了评价。研究还指出,在解释病人调查结果的时候应该考虑到年龄、性别、付费方式、住院日数和病人居住地等因素的影响。结论利用VPSM可以评价医院质量改进措施的效果以及进一步质量改进的重点。VPSM所采用的分析方法简单直观,可为管理者提供持续质量改进的科学证据。