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Quality improvement in health care - Conceptual and historical foundation

EVALUATION & THE HEALTH PROFESSIONS 2000年第1期23卷 7-42页

作者： Colton, D Mary Baldwin Coll Staunton VA 24401 USA

During the past decade, quality improvement (QI) has become the primary approach for health care organizations to measure performance and implement change. From a historical perspective, QI has multiple origins: in systems engineering, as a way of defining production processes;in quantitative analysis, as a methodological approach for collecting and analyzing data;and in organizational behavior as a way of understanding how el fits with an organization's structure and management philosophy. Although eland evaluation share similar goals, as modes of inquiry, they del eloped in very distinct and separate settings, to fulfill different needs. However these differences are now beginning to merge as el gains acceptance as a desirable and legitimate approach for health care organizations to enhance service delivery and outcomes. This article describes the conceptual foundations on which el is based and identifies historical events that have influenced the development of el and its adaptation by health care organizations. (C) 2000 Sage Publications, Inc.

关键词：全面质量管理/历史全面质量管理/组织和管理美国历史 19世纪历史 20世纪人类

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Research Priorities Project, year 2000: Establishing a direction for infection control and hospital epidemiology

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第2期29卷 73-78页

作者： Lynch, P Jackson, M Saint, S Epidemiol Associates Seattle WA USA Univ Calif San Diego Med Ctr Dept Educ Dev & Res San Diego CA 92103 USA Univ Michigan Sch Med Ann Arbor MI USA

Background: The field called "infection control" has expanded beyond hospitals to include many health care locations, some aspects of personnel health, elements of noninfectious complications, and occasionally the epidemiology of other problems that occur in care facilities. A research agenda that addresses these newer segments and provides a framework for answering fundamental questions is essential for the field and for the work of The Research Foundation for Prevention of Complications Associated with Health Care (formerly APIC Research Foundation). Methods: We used a multiple-round iterative consensus process (Delphi technique) with 50 experts and a validation round among participants at the 4th Decennial Conference. Results: The expert panel reduced 102 separate items to 21 high-ranked research priorities. The highest-ranked subject areas involved research to improve compliance 4 with excellent practices, to study antibiotic usage and resistance, to measure the financial impact of complications and value of interventions, to perform surveillance of infectious and noninfectious complications across the spectrum of care delivery, and to study effectiveness of interventions to prevent complications at specific sites. There were differences in education and discipline between the expert panel and the 4th Decennial participants and with respect to ranking some of the individual priorities Among respondents from outside the United States and Canada, occupational health issues were ranked more highly. Conclusions: The research priorities provide a blueprint for future progress and will require a collaborative, multicenter, multinational approach.

关键词：医务工作者的态度费用效益分析德尔菲技术流行病学/组织和管理预测基金会/组织和管理卫生工作重点卫生服务研究/组织和管理感染控制/组织和管理需求估价/组织和管理组织目标研究设计全面质量管理/组织和管理成年人老年人人类中年人

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The chain of survival

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ANNALS OF EMERGENCY MEDICINE 2001年第4期37卷 S5-S16页

作者： Jacobs, I Callanan, V Nichol, G Valenzuela, T Mason, P Jaffe, AS Landau, W Vetter, N Univ Western Australia Dept Emergency Med Nedlands WA 6907 Australia Townsville Gen Hosp Townsville Qld Australia Ottawa Civic Hosp Ottawa ON K1Y 4E9 Canada Univ Arizona Tucson AZ USA Natl Heart Fdn New Zealand Christchurch New Zealand SUNY Hlth Sci Ctr Syracuse NY 13210 USA Univ Washington Seattle WA 98195 USA UWCM Cardiff S Glam Wales

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A conceptual model of emergency department crowding

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ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 173-180页

作者： Asplin, BR Magid, DJ Rhodes, KV Solberg, LI Lurie, N Camargo, CA Reg Hosp Dept Emergency Med St Paul MN 55101 USA HealthPartners Res Fdn St Paul MN 55101 USA Univ Minnesota Sch Med Dept Emergency Med Minneapolis MN 55455 USA Univ Colorado Hlth Sci Ctr Div Emergency Med Denver CO USA Univ Colorado Hlth Sci Ctr Dept Prevent Med & Biometr Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Clin Res Unit Colorado Permanente Med Grp Denver CO 80262 USA Univ Chicago Hosp Sect Emergency Med Chicago IL 60637 USA HealthPartners Res Fdn Minneapolis MN USA RAND Corp Arlington VA USA Harvard Univ Sch Med Channing Lab Dept Med Boston MA 02115 USA Massachusetts Gen Hosp Dept Emergency Med Boston MA 02114 USA

Emergency department (ED) crowding has become a major barrier to receiving timely emergency care in the United States. Despite widespread recognition of the problem, the research and policy agendas needed to understand and address ED crowding are just beginning to unfold. We present a conceptual model of ED crowding to help researchers, administrators, and policymakers understand its causes and develop potential solutions. The conceptual model partitions ED crowding into 3 interdependent components: input, throughput, and output. These components exist within an acute care system that is characterized by the delivery of unscheduled care. The goal of the conceptual model is to provide a practical framework on which an organized research, policy, and operations management agenda can be based to alleviate ED crowding.

关键词：急性病/治疗病床利用率/统计学和数值数据拥挤效率组织急诊室医院/组织和管理健康计划/组织和管理卫生政策卫生服务易得程度/组织和管理卫生服务研究住院时间/统计学和数值数据模型组织管理需求估价/组织和管理运筹学结果与过程评价(卫生保健)/组织和管理病人入院/统计学和数值数据病人出院/统计学和数值数据研究设计全面质量管理/组织和管理伤病员分拣/组织和管理美国

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Practical hospital pharmacy management: management strategies and methods

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TROPICAL DOCTOR 2000年第1期30卷 3-5页

作者： Cranmer, A Holdsworth Mem Hosp Mysore 570021 Karnataka India

This review deals with the practical management of hospital pharmacies based on experience in Indian Christian hospitals with capacities ranging from about 30 to 500 beds. However the standards of pharmacy management should not depend on size;they should be kept under review and improved as staff and financial considerations allow.

关键词：基督教医院病床数 100张以下医院宗教印度库存清册医院/组织和管理药剂学管理/方法药剂科医院/组织和管理药学和治疗学委员会/组织和管理全面质量管理/组织和管理人类

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Organization of personnel and resources for airway management in the hospital and office environment

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CRITICAL CARE CLINICS 2000年第3期16卷 527-+页

作者： Showan, AM Sestito, JA Univ Penn Sch Med Dept Anesthesia Philadelphia PA 19104 USA

Good airway management depends on a system that emphasizes teamwork to expedite care and minimize errors. By understanding the accreditation and licensing requirements, appropriate personnel and equipment can be allocated along cost effective guidelines. Newer techniques for management of the difficult airway, such as the laryngeal mask airway (LMA;LMA North America, San Diego, CA) and flexible fiberoptic bronchoscope, provide alternatives to the emergency cricothyrotomy. A program of continuous quality improvement and clinical guidelines will enhance patient care and suggest intelligent use of airway resources.

关键词：气道阻塞/治疗麻醉科医院/组织和管理费用效益分析卫生人员/教育卫生人员/组织和管理在职培训/组织和管理插管法气管内/经济学插管法气管内/仪器和设备插管法气管内/标准办公室管理工作/组织和管理复苏术/经济学复苏术/教育复苏术/仪器和设备复苏术/标准全面质量管理/组织和管理人类

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Assessing the effectiveness of a clinical fellowship on diabetes in enhancing diabetes care in North Carolina

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DIABETES EDUCATOR 2000年第1期26卷 41-+页

作者： Bell, R Norman, M Lamb, B Holliday, J Leggett-Frazier, N Wake Forest Univ Bowman Gray Sch Med Dept Publ Hlth Sci Winston Salem NC 27157 USA

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Improving healthcare by perinatal mortality audit and feedback

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TROPICAL DOCTOR 2000年第2期30卷 94-97页

作者： Byaruhanga, RN St Francis Hosp Nsambya Kampala Uganda

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Turning information into knowledge to prevent health care-associated infections and other adverse events: The electronic ICP as an agent of change

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第6期28卷 389-391页

作者： Olmsted, RN St Joseph Mercy Hlth Syst Infect Control Serv Ann Arbor MI 48106 USA

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Formula for surgical practice resuscitation in an academic medical center

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AMERICAN JOURNAL OF SURGERY 2000年第5期179卷 417-421页

作者： Sinanan, M Wicks, K Peccoud, M Canfield, J Poser, L Sailer, L Stephens, K Edwards, D Univ Washington Sch Med Dept Surg Seattle WA 98195 USA Univ Washington Med Ctr Div Patient Care Serv Seattle WA 98195 USA Univ Washington Med Ctr Div Patient Admitting & Registrat Seattle WA 98195 USA Univ Washington Med Ctr Div Med Ctr Informat Syst Seattle WA 98195 USA

BACKGROUND: Managing patient referrals for surgical consultation in an academic practice has traditionally emphasized clinical rather than service expertise. However, assuring both efficiency and accuracy in the initial consultation have become critical early measures of quality care. METHODS: In partnership with the academic medical center administration, current practice was analyzed. Performance and communication standards were established around an ideal patient experience. A new ambulatory consultation process was developed;and flowcharting methods for resource allocation, statistical process control, and pre-visit data collection were used to reduce patient administrative time. Automated referral reports engaged referring physicians throughout the consultation, RESULTS: Accurate insurance and referral authorization have been provided for all patients, including the 4% who are underinsured. Patient, provider, and referring physician satisfaction has increased significantly. Staff time investment has progressively declined from 52 +/- 11 (95% confidence) minutes to 34 +/- 10 minutes for most patients. Realignment of tasks has reduced the administrative time spent by the patient by 32% without compromising clinical time. New patient volume increased by 29% per year, maintaining regional market share. CONCLUSIONS: Expertise in the process of consultation delivery is feasible and will be increasingly critical to the survival of academic surgical practice in a competitive market. (C) 2000 by Excerpta Medica, Inc.

关键词：诊疗工作管理医学/组织和管理方案评价质量指标卫生保健转诊和会诊/组织和管理软件设计外科学/组织和管理全面质量管理/组织和管理华盛顿

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