The role of clinical audit in the quality improvement of health care

The aim of clinical audit is continuous improvement of the quality of care through systematic and critical review of current practice against explicit criteria and the implementation of change if necessary. The audit is a regular multidisciplinary activity by which all participants of care including doctors, nurses and other health professionals carry out a systematic review of their own practice. Data collected during the process of audit should be handled with care, and individual data concerning care-givers, patients or health professionals must be treated confidentially. Clinical audit needs realistic timeframe and necessary resources as well as tolerant culture of learning organisations. Furthermore the success of clinical audit depends on the commitment and support of the management of the organisations. Clinical audit could relatively easily be embodied into the current practice of peer-review processes and other quality improvement initiatives in Hungary. Widespread and systemic application of clinical audit may improve the quality of patient care and maintain the trust of the population. However, clinical audit should be effective and cost-effective. The recently published methodological guideline by the Ministry intends to promote good practice in clinical audit.     

The effect of information systems architecture on health care data quality

A rapidly increasing number of health care provider institutions is dealing with data architecture design issues that directly affect the quality of data within their heterogeneous information systems. These problems result from a failure to recognize that they are actually managing a loosely distributed yet integrated database among their many information system platforms. Understanding the issues surrounding data integration, the application available interface standards, and the tools available for implementation is critical to operating a successful distributed health care information systems environment today.     

Organizationwide quality improvement in health care

Organizationwide quality improvement has offered many organizations in many different industries a new approach to work and leadership. The lessons learned can be applied to the health care setting. QA professionals can play an important role in this change by leading through example--first in their own departments and the work they currently perform and then throughout the entire organization.     

The role of quality standards--accreditation in redressing asymmetry of information in health care markets

Asymmetry of information presents major difficulties for the efficient operation of markets in health care. The use of accreditation schemes may reduce these difficulties by enhancing the availability of reliable, accessible information on aspects of service quality considered important by service users and their agents. The UK's Patients' Charter with its associated Charter Marks has the potential to perform such a function in respect of inpatient services. In as much as it refers to aspects of service valued by service users which are specified in contracts by service procurers and appear not to be negatively correlated with other aspects of service quality, it can be seen to provide unambiguous signals of service quality. Given the Charter is currently under review, it seems appropriate that such attributes are borne in mind by policy makers in their deliberations as to its future.     

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.     

The state of automated information systems in ambulatory health care

The development of moderately priced microprocessors has led to a new and complex set of information processing alternatives within the healthcare sector. Small group practices and some solo practitioners now find it technologically possible and economically feasible to automate some parts of their information system. With the introduction of this new and highly complicated technology comes a series of opportunities and problems for the healthcare consumer and provider. The article examines a number of the issues related to computer utilization in the ambulatory care setting.     

中国公共卫生科技工作者推广科研成果现状

  目的  了解中国公共卫生领域科技工作者推广科研成果的现状及其影响因素。  方法  于2022年1月对956名中华预防医学会、中国营养学会、中国防痨协会及中国性病艾滋病防治协会常务委员进行电子问卷调查,分析其从事科研工作程度、年限、学术论文发表、科研经费支持推广形式、接受相关培训、相关实践经验与其推广科研成果的关联。  结果  956名调查对象中737人从事科研工作,其中58.1 %的人推广过科研成果。主要或大部分时间从事科研者、从事科研20年以上者、3年内发表学术论文6篇以上者中推广科研成果的比例分别为64.3 %、64.4 %、67.8 %。科研经费支持开展多种形式的推广者（OR = 2.39,95 % CI = 1.61～3.54）、有相关培训经历者（OR = 2.05,95 % CI = 1.36～3.09）、有相关实践经验者（OR = 5.38,95 % CI = 3.75～7.73）更可能推广科研成果。  结论  我国公共卫生领域科技工作者推广科研成果的情况不容乐观。     

Leveraging quality improvement to achieve equity in health care

INEQUALITY IN QUALITY: Disparities in health care and quality for racial, ethnic, linguistic, and other disadvantaged groups are widespread and persistent. Health care organizations are engaged in efforts to improve quality in general but often make little attempt to address disparities. STANDARD VERSUS CULTURALLY COMPETENT QUALITY IMPROVEMENT (QI): Most QI interventions are broadly targeted to the general population-a "one-size-fits-all" approach. These standard QI efforts may preferentially improve quality for more advantaged patients and maintain or even worsen existing disparities. Culturally competent QI interventions place specific emphasis on addressing the unique needs of minority groups and the root causes of disparities. HOW QI CAN REDUCE DISPARITIES: QI interventions can reduce disparities in at least three ways: (1) In some cases, standard QI interventions can improve quality more for those with the lowest quality, but this is unreliable; (2) group-targeted QI interventions can reduce disparities by preferentially targeting disparity groups; and (3) culturally competent QI interventions, by tailoring care to cultural and linguistic barriers that cause disparities, can improve care for everyone but especially for disparity groups. GUIDELINES FOR CULTURALLY COMPETENT QI: A culturally competent approach to QI should (1) identify disparities and use disparities data to guide and monitor interventions, (2) address barriers unique to specific disparity groups, and (3) address barriers common to many disparity group. CONCLUSIONS: To achieve equity in health care, hospitals and other health care organizations should move toward culturally competent QI and disparities-targeted QI interventions to achieve equity in health care, a key pillar of quality.