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The use of administrative data to assess quality of care for bipolar disorder in a large staff model HMO

GENERAL HOSPITAL PSYCHIATRY 2000年第1期22卷 1-10页

作者： Unützer, J Simon, G Pabiniak, C Bond, K Katon, W Univ Calif Los Angeles Inst Neuropsychiat Ctr Hlth Serv Res Los Angeles CA 90024 USA Grp Hlth Cooperat Puget Sound Ctr Hlth Studies Seattle WA 98121 USA Univ Washington Dept Psychiat & Behav Sci Seattle WA 98195 USA

We examined patterns of care for 1246 adults treated for bipolar disorder in a large health maintenance organization. Computerized pharmacy and visit data were used to identify patients treated for bipolar disorder. Automated medical records for the following year were used to assess continuity and nosing of treatment with mood stabilizers, laboratory monitoring for adverse effects and therapeutic serum levels, and frequency of follow-up visits. Of our 1246 subjects 83% filled a mood stabilizer prescription during the 1-year study period, and doses were within recommended ranges 80% of the rime. Over 75% of the patients on mood stabilizers had at least one apparent interruption in medication use. Approximately half of the long-term users of mood stabilizers had at least one 7-month period without a recorded blood level and approximately half had a similar period without monitoring for adverse medication effects. Of the 116 subjects discharged from a psychiatric hospitalization 58% had a visit with a psychiatrist or a psychiatric nurse practitioner within 30 days. Of those discontinuing mood stabilizer treatment 68% made a mental health visit within 90 days. Our findings demonstrate the feasibility of using administrative data systems for population-based qualify of care assessment and suggest opportunities for improving the care of bipolar patients. (C) 2000 Elsevier Science Inc.

关键词：抗躁狂药/副作用抗躁狂药/药代动力学抗躁狂药/治疗应用双相情感障碍/血液双相情感障碍/药物疗法数据收集/统计学和数值数据药物监测/统计学和数值数据可行性研究健康维护组织/组织和管理病案系统计算机化/统计学和数值数据病人医疗小组/统计学和数值数据质量保证卫生保健/统计学和数值数据华盛顿青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Current understanding of clinical governance: a study of dental health care providers

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BRITISH DENTAL JOURNAL 1999年第10期187卷 555-556页

作者： Nicklin, PV Batchelor, PA Univ York Ctr Dent Serv Studies Innovat Ctr York YO10 5DG N Yorkshire England Univ London Kings Coll Dept Dent Publ Hlth & Community Dent Educ London SE5 9RW England

Objective To quantify what dental care providers understand by clinical governance and how it may impact on their activites Design A self-completed questionnaire administered to attendees at two postgraduate courses. Results A total of 71 forms were completed, a response rate of 88%. The majority of those responding recognised that clincial governance would impact in clinical areas of activity. However, nearly a third felt that any legislation would not affect receptionists or dental surgery assistants. Over 30% of respondents failed to keep records of any mistakes that occurred in their practices, a feature that is central to risk management. While overall the respondents felt that clinical governance would help to raise standards, there was also the fear that it would lead to increased litigation. Conclusion There is at present a lack of understanding of clinical governance and how it will impart on the profession. If GDPs are to sustain public and political confidence in their clinical practice the issue of clinical governance must be embraced by the profession.

关键词：临床工作能力/立法和法学临床工作能力/统计学和数值数据牙医师/立法和法学牙医师/统计学和数值数据牙医师女/立法和法学牙医师女/统计学和数值数据英格兰质量保证卫生保健/立法和法学质量保证卫生保健/统计学和数值数据女(雌)性人类男(雄)性

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Provision and quality assurance for head and neck cancer care

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BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY 2000年第5期38卷 543-545页

作者： Kerawala, CJ Campbell, A Middlesbrough Gen Hosp Dept Oral & Maxillofacial Surg Middlesbrough TS5 5AZ Cleveland England

In 1998, the British Association of Head and Neck Oncologists (BAHNO) published a report entitled 'Provision and quality assurance for head and neck cancer care in the United Kingdom. A nationally co-ordinated multidisciplinary approach'. This document considered, amongst other issues, operational policies for patient care. We audited three aspects of the care of 73 patients with head and neck cancer from initial referral to definitive treatment against standards set out in this report. Fifty-nine patients (81%) were seen within two weeks of initial referral, the maximum interval proposed by the BAHNO report. In 41 patients (56%), the diagnosis was confirmed and their treatment plan determined within the further two-week period suggested in the report. Of the 25 patients who required adjuvant radiotherapy, only 11 (44%) began treatment,within six weeks of their surgical phase;this represented the greatest variance from the BAHNO recommendations. These findings highlight the need for units active in the treatment of specific diseases to audit their activity against available minimum standards in an attempt to improve the quality of patient care. (C) 2000 The British Association of Oral and Maxillofacial Surgeons.

关键词：综合疗法卫生保健提供/统计学和数值数据大不列颠头颈部肿瘤/治疗医学审核/统计学和数值数据质量保证卫生保健/统计学和数值数据回顾性研究时间因素成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Emergency medical care in rural America

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ANNALS OF EMERGENCY MEDICINE 2001年第3期38卷 323-327页

作者： Williams, JM Ehrlich, PF Prescott, JE W Virginia Univ Dept Emergency Med Morgantown WV 26506 USA W Virginia Univ Dept Surg Morgantown WV 26506 USA

The delivery of high-quality emergency care in a rural setting requires a conceptual framework quite different from that required in urban and suburban environments, given that available resources are limited in the rural setting. The intermittent and episodic nature of seriously ill and injured patients who present to rural emergency departments makes it difficult to plan, staff, and equip in order to provide emergency medical care at the same level seen at higher volume urban or suburban institutions. The objective of this article is to describe the distinctive nature and widely unrecognized features of emergency medicine in rural and remote areas, with a focus on clinical, workforce, and economic issues. We present recommendations for a shift in thinking and a call to action an behalf of all emergency medicine professionals that are based on a realistic assessment of the current status of emergency medicine and that are needed to develop and sustain high-quality emergency medical care in rural America.

关键词：急救医疗服务/利用急救医学/人力急诊室医院/利用卫生保健费用/统计学和数值数据需求估价/统计学和数值数据质量保证卫生保健/统计学和数值数据农村卫生/统计学和数值数据美国人类

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Ambulatory patient satisfaction: a systematic approach to collecting and reporting information.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1999年第6期21卷 12-17页

作者： Jackovitz, D.S. Summa Health System Akron OH United States

The importance of outpatient services to most hospitals continues to escalate. The number of ambulatory outpatients is much larger than the number of inpatients, and revenues from outpatient services are predicted to equal or exceed inpatient revenues in the near future. The ability to provide outpatient services with exceptional quality is paramount to long-term survival of hospitals. This article describes a methodology for systematically collecting and reporting patient satisfaction information from a wide array of hospital ambulatory care services. By systematically measuring satisfaction, hospitals can determine the outpatient areas and service dimensions in need of performance improvement.

关键词：门诊医疗/标准数据收集/方法教育继续卫生保健调查/方法门诊部医院/标准病人满意度/统计学和数值数据质量保证卫生保健/统计学和数值数据研究设计美国人类

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The Influence of the New York Quality Assurance System on Casemix in Nursing Homes

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Journal of Aging and Health 1994年第3期6卷 377-396页

作者： Ozminkowski, Ronald J. Cella, Margot A. Branch, Laurence G. Schwartz, Carolyn E. Abt Associates Inc. Frontier Science Inc.

The New York Quality Assurance System (NYQAS) was designed to assure high-quality nursing home care in New York. Among its many incentives, NYQAS may change the likelihood that elderly with heavy-care needs will be admitted to nursing homes. This article addresses that hypothesis. Data for descriptive and multivariate analyses come from the RUGs-Il Patient Review Instrument and the Medicare and Medicaid Automated Certification System files for 1986-1990. The descriptive analyses focus on functional ability in new nursing home residents before and after NYQAS. The multivariate analyses adjust for pre-NYQAS, RUGs-related trends in casemix, resident demographics, and nursing home characteristics that influence casemix. The results suggest a significant but small decrease in functional status at admission during the post-NYQAS era. © 1994, Sage Publications. All rights reserved.

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Quality management through statistics.

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Journal of quality assurance : a publication of the National Association of Quality Assurance Professionals 1991年第5期13卷 40-48页

作者： Bush, D.L. Kennedy Memorial Hospitals and University Medical Center Stratford NJ United States

One of the responsibilities of a quality assurance professional is to assess patient care data in an effort to meet "outcome" requirements as established by the institution, the patient, the patient's family, the Joint Commission, the Health Care Financing Administration, the state PRO, and other regulatory agencies. A major goal of effective quality management is to assure that patients treated in a similar diagnostic category achieve similar outcomes. To accomplish this, the QA manager must gain and maintain control over patient care processes. To obtain this control, the conditions of patient care processes must be measured. Over one hundred years ago, the English scientist Lord Kelvin said, "When you can measure what you are speaking about, and express it in numbers, you know something about it;but when you cannot express it in numbers, your knowledge is...unsatisfactory." This article will describe some of the statistical quality control techniques that will assist in measuring the performance of specific patient care processes and outcomes and expressing them in numbers. A review of the numbers will show whether a particular patient care process is running smoothly or needs further investigation or adjustments. Using statistical quality control techniques will enable the QA manager to predict how well patient care processes and outcomes will run in the future. The simple statistical techniques discussed in this article can be used to measure the performance of patient care processes and outcomes both before and after corrective actions have been taken. They apply both to attempts to bring a specific process or outcome into "control" or to break through to a new, improved level of quality performance.

关键词：数据说明统计模型统计学结果与过程评价(卫生保健)/方法质量保证卫生保健/统计学和数值数据美国

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Evaluating change: a simple technique for determining the statistical significance of proportional criteria.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1994年第1期16卷 14-17;quiz17,37页

作者： el-Mallakh, R.S. Cowdry, R. Pettigrew, I.E. Mood Disorders Research Programs University of Louisville KY.

A simple method to calculate statistically significant differences between proportions is presented to evaluate changes in quality assessment and utilization data. The authors believe that this calculation could be a valuable analytic method for evaluating changes in monitored criteria, particularly in the assessment of criteria measuring high-volume events.

关键词：数据说明统计误诊教育继续卫生服务研究/方法实验室医院/标准实验室医院/统计学和数值数据质量保证卫生保健/统计学和数值数据美国

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The hospital patient representative: a key player in quality improvement.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1993年第5期15卷 26-27页

作者： al-Assaf, A.F. Waters, M.E. Usnick, L.T. University of Oklahoma Health Sciences Center Oklahoma City United States

A national survey of hospital patient representatives was conducted to identify and analyze basic demographic and occupational data for patient representatives. A total of 387 randomly selected U.S. hospitals were surveyed with a response rate of 66% (256 hospitals). Only 172 responses were completed appropriately. Of those who responded appropriately, we found the typical patient representative to be a female between 30 and 50 years old, with a bachelor's degree and about 6 years of experience as a patient representative. The majority of the respondents held a positive view of their role as the liaison between the patient and the administration as well as a facilitator for patients, families, staff, and administration problem solving. Several of the respondents stated that patient representatives strive to meet the needs and expectations of patients through their role as liaison with the administration. This role has a positive and crucial impact on improving the quality of care in healthcare organizations.

关键词：人口统计学教育程度医院病人关系病人辩护/统计学和数值数据质量保证卫生保健/统计学和数值数据问卷调查美国妇女就业成年人女(雌)性人类中年人

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Summarizing changes in an entire population: extensions to the quality improvement ratio.

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The Joint Commission journal on quality improvement 1999年第12期25卷 641-650页

作者： Parker, R.A. Truth LtdSM Newton 02459 Massachusetts United States

BACKGROUND: In an earlier article the use of the Quality Improvement Ratio (QuIR) was proposed as a way to assess whether an intervention improves preventive health practices. With this method, only members of a health plan observed both before and after an intervention are analyzed. Members observed in only one of the two periods are not included in the QuIR analysis. However, since membership in health plans is constantly changing, the QuIR analysis may exclude a substantial proportion of the total number of members studied. METHOD: To overcome this problem, an extension to the QuIR analysis, termed the Extended QuIR method, has been developed. Members are classified into two separate groups: those with data in both periods and those with data in only a single period. Members providing data in both periods are analyzed using the QuIR. Members studied in only a single period are analyzed using single-period analysis, described in this article. If the results of the two separate tests are consistent, both suggesting an improvement over time or both suggesting a deterioration, then the results of the two tests can be combined into an overall test to assess whether a change over time occurred. CONCLUSION: The Extended QuIR method, which combines the results of two separate analyses, should help clarify the effect of an intervention on improving preventive health practices in the overall population.

关键词：信息服务干预性研究管理医疗规划/标准管理医疗规划/利用普查/利用马萨诸塞模型统计学病人接受卫生保健的程度/统计学和数值数据预防卫生服务/利用质量保证卫生保健/统计学和数值数据研究设计利用情况审核人类

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