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Jt Comm J Qual Patient Saf ; 37(1): 38-44, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21306064


BACKGROUND: There has been increasing attention paid to quality assessment in hospice as the industry has grown and diversified. In response, policymakers have called for standardized approaches to monitoring hospice quality. The experiences of a set of hospices involved with the National Association for Home Care & Hospice (NAHC) Quality Assessment and Performance Improvement Collaborative, which was designed to test the use of a standardized patient symptom assessment tool as an exemplar of efforts to standardize symptom assessment in hospice, were examined. METHODS: Transcripts of semistructured telephone interviews with 24 individuals from eight of the nine participating hospices, which were conducted in July-August 2007, were analyzed using the constant comparative method. Interview questions centered on the collaborative's impact on the process of quality assessment at the hospices. FINDINGS: The collaborative activities influenced several hospices' quality assessment processes, most beneficially by prompting greater attention to quality assessment processes, by promoting the adoption of quality assessment tools, and by creating a supportive community. Challenges included the limits of distance communication technology, participants' misconceptions about data to be received, and potential lack of support and resources for quality assessment. CONCLUSIONS: The experiences of the participating hospices in the NAHC collaborative are intended to inform the design of future interorganizational learning efforts to promote quality assessment initiatives within hospice settings. Future hospice collaboratives should use multiple methods of communication to build a close participant network and be clear about collaborative goals and participant expectations and about the reciprocal relationship of the collaborative and the participants.

Conducta Cooperativa , Cuidados Paliativos al Final de la Vida/organización & administración , Calidad de la Atención de Salud/organización & administración , Benchmarking/normas , Cuidados Paliativos al Final de la Vida/normas , Humanos , Calidad de la Atención de Salud/normas
J Palliat Med ; 13(2): 155-9, 2010 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-19827961


BACKGROUND: Hospices are now mandated to perform routine quality assessment under the final Medicare Hospice Conditions of Participation, creating an opportunity to explore standardized approaches to monitoring hospice quality. OBJECTIVE: We report hospice staff experiences using a standardized symptom assessment instrument, the Edmonton Symptom Assessment System (ESAS), in a pilot study designed to develop and test quality measures on symptom management. Use of the ESAS illustrates the benefits and challenges arising with standardized symptom assessment for quality monitoring in hospice. METHODS: We interviewed 24 individuals representing 8 hospices involved with the National Association for Home Care & Hospice Quality Assessment Collaborative, which pilot tested the ESAS as a source of standardized data for quality assessment. Transcripts were analyzed using the constant comparative method. RESULTS: Participants reported benefits and challenges with the ESAS. Benefits were that the ESAS was a brief and easy tool that identified areas of concern, engaged patients in symptom assessment, and monitored symptom changes over time. Additionally, the ESAS was viewed as a useful teaching tool for less experienced staff. Challenges included lack of clarity about inclusion rules and frequency of assessments; difficulty interpreting the numeric symptom rating scale, difficulty incorporating patient preferences with symptoms, and a sense that the use of standard assessment instruments was "unnatural." DISCUSSION: Recommendations to promote effective use of ESAS data for quality monitoring of hospice care include standardizing implementation procedures, adding patients' preferences to the ESAS form, and staff education to enhance comfort with the instrument before implementation.

Indicadores de Salud , Hospitales para Enfermos Terminales/normas , Evaluación de Necesidades/normas , Humanos , Entrevistas como Asunto , Medicare , Proyectos Piloto , Estados Unidos
J Healthc Qual ; 24(5): 32-8, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12240541


Clinical pathways represent a strategy for responding to the current healthcare environment with a focus on managing care, reducing costs, increasing patient satisfaction, and improving quality. However, many healthcare organizations have found that implementing clinical pathways is not entirely successful even when they are based on sound evidence. The purpose of this case study was to describe and explain factors related to the success or failure of implementing a clinical pathway for congestive heart failure (CHF) patients in a 300-bed community hospital. The key factors involved in the nonadoption of the CHF pathway were inconsistencies in procedures and the work group culture.

Actitud del Personal de Salud , Vías Clínicas/organización & administración , Insuficiencia Cardíaca/terapia , Hospitales Comunitarios/normas , Recolección de Datos , Investigación sobre Servicios de Salud , Humanos , Entrevistas como Asunto , Medio Oeste de Estados Unidos , Estudios de Casos Organizacionales , Cultura Organizacional , Innovación Organizacional , Personal de Hospital/psicología