David B. Nash, MD, MBA, the Founding Dean of the Jefferson School of Population Health on the campus of Thomas Jefferson University in Philadelphia, Pennsylvania. Dr. Nash is also the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy Here, he discusses the main cultural barriers to quality in medical practice and how they can be overcome.
Dr. Richard Jacoby is a Clinical Associate Professor in the Department of Health Policy at Jefferson Medical College in Philadelphia, Pa. He is board certified in Dermatology, Dermatopathology and Anatomic Pathology. He has over 20 years experience as a dermatologist, dermatopathologist and administrator in academic, private and corporate settings.
This lecture and the post-test is worth 2.0 credit hours.
Here, they define inpatient hospital quality, asks what, why and how to measure quality of care in the hospital setting, touch on the limitations of quality reporting, and discuss the future of hospital quality.
The authors quote the Institute of Medicine definition of quality and traces the history of the quality movement. They describe the quality triad consisting of the structure (personnel, facilities), process (treatment plan) and outcome (optimal result) needed to achieve quality.
Quality measurement, Dr Nash and Dr Jacoby point out, includes documenting performance, and developing strategies for improving that performance, one of which is public disclosure of results. He refers to the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, and the National Quality Forum and their work in producing, in 2003, 39 national voluntary consensus standards for hospital care performance measures.
The lecture continues with a discussion of how quality measures are reported and analyzed giving examples from acute coronary syndrome, heart failure, patient safety, pediatric conditions, pneumonia, pregnancy, smoking cessation and surgical complications. The authors describe Pay for Performance incentive programs and the Plan-Do-Study-Act format for improving hospital performance. Noting that the major challenge to quality measurement is the lack of widespread standardization, they say that while most quality measurements are of process, they would prefer to see outcomes measures of quality predominate.
Turning to safety improvement, Dr Nash and Dr Jacoby first offer a definition of safety while noting that while safety has always been a concern in hospitals it was not until the 1999 publication of the Institute of Medicine report : To Err is Human: Building a Safer Health System, that the issues gained prominence. He describes the key areas of concern as Medication Errors, Hospital Acquired Infections, Surgical Errors and Communication Errors. Patient rights as well as the role of patients and their surrogates in participating in their own care as well as the need for communication between health care professionals and their patients are discussed in detail. As with the discussion of quality, the lecture lists the leading organizations involved in safety issues, and lists so-called sentinel events in safety. These include wrong site surgery, operative and postoperative complications, and treatment delay.