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2.
J Nurs Adm ; 51(1): 6-8, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33278194

RESUMO

This article describes the formation of a Regulatory Advisory Council to address regulatory preparedness. The council used quality improvement methods to address data and findings from previous mock surveys and created 2 categories of work, an environment of care and clinical standards group, with checklists and work streams to improve organizational success with regulatory readiness.


Assuntos
Melhoria de Qualidade/legislação & jurisprudência , Controle Social Formal/métodos , Humanos , Inovação Organizacional , Melhoria de Qualidade/normas , Melhoria de Qualidade/tendências , Inquéritos e Questionários
3.
Urol Clin North Am ; 48(1): 35-44, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218592

RESUMO

Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time.


Assuntos
Prostatectomia/história , Neoplasias da Próstata/história , Melhoria de Qualidade , Procedimentos Cirúrgicos Robóticos/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Laparoscopia , Masculino , Prostatectomia/instrumentação , Prostatectomia/métodos , Prostatectomia/normas , Neoplasias da Próstata/cirurgia , Melhoria de Qualidade/normas , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/normas
4.
Glob Health Sci Pract ; 8(4): 689-698, 2020 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-33361236

RESUMO

BACKGROUND: Providing professional development opportunities to staff working in clinical laboratories undergoing quality improvement programs can be challenged by limited funding, particularly in resource-limited countries such as Cambodia. Using innovative approaches such as video conferencing can connect mentors with practitioners regardless of location. This study describes and evaluates the methods, outputs, and outcomes of a quality improvement program implemented in 12 public hospital laboratories in Cambodia between January 2018 and April 2019. The program used mixed intervention methods including both in-person and remote-access training and mentorship. METHODS: Training outputs were quantified from the activity reports of program trainers and mentors. Program outcomes were measured by pre- and postimplementation audits of laboratory quality management system conformity to international standards. Variations in improved outcomes were assessed in relation to the time spent by laboratory personnel in video conference training and mentoring activity. An additional cross-sectional comparison described the difference in final audit scores between participating and nonparticipating laboratories. RESULTS: Laboratories significantly improved their audit scores over the project period, showing significant improvement in all sections of the ISO 15189 standard. Pre- and postaudit score differences and laboratory personnel participation time in remote mentoring activities showed a strong monotonic relationship. Average input per laboratory was 6,027±2,454 minutes of participation in video conference activities with mentors. Audit scores of participating laboratories were significantly higher than those of laboratories with no quality improvement program. CONCLUSION: Laboratories improved significantly in ISO 15189 conformity following structured laboratory quality management systems training supported by remote and on-site mentoring. The correlation of laboratory participation in video conference activities highlights the utility of remote video conferencing technology to strengthen laboratories in resource-limited settings and to build communities of practice to address quality improvement issues in health care. These findings are particularly relevant in light of the COVID-19 pandemic.


Assuntos
Laboratórios/organização & administração , Tutoria/organização & administração , Melhoria de Qualidade/organização & administração , Comunicação por Videoconferência/organização & administração , Camboja , Estudos Transversais , Humanos , Laboratórios/normas , Melhoria de Qualidade/normas , Desenvolvimento de Pessoal/organização & administração , Estados Unidos
5.
Methodist Debakey Cardiovasc J ; 16(3): 192-198, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133354

RESUMO

The American health care system has many great successes, but there continue to be opportunities for improving quality, access, and cost. The fee-for-service health care paradigm is shifting toward value-based care and will require accountability around quality assurance and cost reduction. As a result, many health care entities are rallying health care providers, administrators, regulators, and patients around a national imperative to create a culture of safety and develop systems of care to improve health care quality. However, the culture of patient safety and quality requires rigorous assessment of outcomes, and while numerous data collection and decision support tools are available to assist in quality assessment and performance improvement, the public reporting of this data can be confusing to patients and physicians alike and result in unintended negative consequences. This review explores the aims of health care reform, the national efforts to create a culture of quality and safety, the principles of quality improvement, and how these principles can be applied to patient care and medical practice.


Assuntos
Procedimentos Cirúrgicos Cardíacos/normas , Reforma dos Serviços de Saúde/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Segurança do Paciente/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/legislação & jurisprudência , Procedimentos Cirúrgicos Cardíacos/mortalidade , Planos de Pagamento por Serviço Prestado/normas , Reforma dos Serviços de Saúde/legislação & jurisprudência , Política de Saúde , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde/legislação & jurisprudência , Segurança do Paciente/legislação & jurisprudência , Formulação de Políticas , Melhoria de Qualidade/legislação & jurisprudência , Indicadores de Qualidade em Assistência à Saúde/legislação & jurisprudência , Medição de Risco , Fatores de Risco , Resultado do Tratamento
6.
Methodist Debakey Cardiovasc J ; 16(3): 205-211, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133356

RESUMO

Cardiovascular registries play an integral role in providing real-world data on a number of cardiovascular conditions and allowing measurement of quality metrics across a large cohort of patients. Over the past 35 years, the number of cardiovascular registries has skyrocketed, and their use will only continue to grow as data on novel procedures and devices will need to be collected and analyzed. The American College of Cardiology and Society of Thoracic Surgeons Transcatheter Valve Therapy Registry is just one example of a modern registry that plays a crucial role in collecting data on patients undergoing transcatheter valvular procedures. Through public reporting registries, data can be shared on a hospital and provider level for many quality performance measures. There remains much work to be done on allowing automated data extraction from the electronic medical record directly into registries. No matter how sophisticated and complete a registry is, it can never overcome the problem of treatment selection bias that is inherent in observational data. This review discusses the growth, benefits, and limitations of national registries and their role in developing evidence for best clinical practice, measuring outcomes, providing feedback to clinicians, and improving quality of care.


Assuntos
Cardiologia/normas , Doenças Cardiovasculares/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Sistema de Registros/normas , Big Data , Doenças Cardiovasculares/diagnóstico , Humanos , Registros Públicos de Dados de Cuidados de Saúde , Resultado do Tratamento
7.
Surg Clin North Am ; 100(6): 1021-1047, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128878

RESUMO

Quality improvement is a dynamic process that requires continuously monitoring quality indicators and benchmarking these with national and professional standards. Endoscopists have formed societal task forces to propose quality indicators and performance goals. Institutions are now incentivized by payers and value-based reimbursement agreements to have processes in place to measure, report, and act on these quality metrics. Nationwide registries, such as the Gastrointestinal Quality Improvement Consortium, are used to report quality data to these merit-based incentive payment systems. Quality improvement processes such as these are instrumental to improve patient safety, health, and satisfaction while decreasing costs and medical errors.


Assuntos
Endoscopia do Sistema Digestório/normas , Guias de Prática Clínica como Assunto/normas , Melhoria de Qualidade , Benchmarking/normas , Competência Clínica , Endoscopia/normas , Endossonografia/normas , Humanos , Segurança do Paciente/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas
10.
Nurs Outlook ; 68(4): 523-527, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32896305

RESUMO

Patients with complex and chronic illnesses and those who have significant needs related to care coordination and transitions of care are dependent on access to healthcare providers who are skilled at meeting the distinct needs of these populations and are current in the latest evidence-based practices and guidelines. Clinical nurse specialists (CNSs) are uniquely qualified to care for patients with complex illnesses as well as having the skills to optimize care for entire populations with complex needs. The absence of consistent legislative advanced practice registered nurse recognition of CNSs prevents health care systems from optimal use of this advanced practice registered nurse role to improve and provide safe and quality care for these patients. Additional barriers in optimal utilization of CNSs include lack of consistency: in title protection and licensing from state to state; ensuring patient access through identification and tracking of CNS numbers across the United States in order to determine workforce and educational program requirements; and ensuring appropriate reimbursement for care provided by CNSs. Therefore, it is the position of the American Academy of Nursing that addressing public and private sector regulatory, legislative, and policy concerns related to CNSs is essential to achieving optimal population health outcomes across the nation.


Assuntos
Guias como Assunto , Enfermeiras Clínicas/estatística & dados numéricos , Enfermeiras Clínicas/normas , Melhoria de Qualidade/estatística & dados numéricos , Melhoria de Qualidade/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
11.
J Stroke Cerebrovasc Dis ; 29(10): 105151, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912531

RESUMO

BACKGROUND: Understanding and improving EMS stroke care requires linking data from both the prehospital and hospital settings. In the US, such data is collected in separate de-identified registries that cannot be directly linked due to lack of a common, unique patient identifier. In the absence of unique patient identifiers two common approaches to linking databases are deterministic matching, which uses combinations of non-unique matching variables to define matches, and probabilistic matching, which generates estimates of match probability based on the degree of similarity between records. This analysis seeks to compare these two approaches for matching EMS and stroke registry data. METHODS: Stroke cases transported by EMS to Michigan hospitals participating in the Michigan Coverdell Acute Stroke Registry were linked to records from Michigan's EMS Information System (MI-EMSIS) between January 2018 and June 2019. Destination hospital, date-of-service, patient age, date-of-birth, and sex were used to perform deterministic and probabilistic linkages. Match rates and representativeness of the matched samples were compared between the two matching strategies. Multivariable logistic regression was used to identify characteristics associated with successful matching. RESULTS: During the 18-month study period there were 8,828 EMS transported confirmed stroke cases in the registry and 620,907 EMS transports to 38 Coverdell registry-participating hospitals. The probabilistic match linked 5985 (67.7%) strokes to EMS records; the deterministic match linked 4012 (45.5%). Within each strategy the characteristics of matched and unmatched cases were similar, with the exception that deterministically matched cases were less likely to be older than 89 (adjusted odds ratio [aOR]=0.3), white (aOR=0.8), and more likely to have subarachnoid hemorrhage (aOR=1.4) than unmatched cases. CONCLUSION: Probabilistic matching resulted in higher match rates and a more representative sample of EMS transported strokes, suggesting it may be superior in assessing EMS stroke care compared to a deterministic approach.


Assuntos
Mineração de Dados/métodos , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Registro Médico Coordenado , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/normas , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Probabilidade , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento
12.
Anesthesiology ; 133(5): 985-996, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32773686

RESUMO

Preparedness measures for the anticipated surge of coronavirus disease 2019 (COVID-19) cases within eastern Massachusetts included the establishment of alternate care sites (field hospitals). Boston Hope hospital was set up within the Boston Convention and Exhibition Center to provide low-acuity care for COVID-19 patients and to support local healthcare systems. However, early recognition of the need to provide higher levels of care, or critical care for the potential deterioration of patients recovering from COVID-19, prompted the development of a hybrid acute care-intensive care unit. We describe our experience of implementing rapid response capabilities of this innovative ad hoc unit. Combining quality improvement tools for hazards detection and testing through in situ simulation successfully identified several operational hurdles. Through rapid continuous analysis and iterative change, we implemented appropriate mitigation strategies and established rapid response and rescue capabilities. This study provides a framework for future planning of high-acuity services within a unique field hospital setting.


Assuntos
Betacoronavirus , Simulação por Computador/normas , Infecções por Coronavirus/terapia , Análise do Modo e do Efeito de Falhas na Assistência à Saúde/normas , Equipe de Respostas Rápidas de Hospitais/normas , Unidades de Terapia Intensiva/normas , Pneumonia Viral/terapia , Boston/epidemiologia , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Cuidados Críticos/normas , Análise do Modo e do Efeito de Falhas na Assistência à Saúde/métodos , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas/métodos , Desenvolvimento de Programas/normas , Melhoria de Qualidade/normas
13.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32817268

RESUMO

BACKGROUND: Although required for healing, sleep is often disrupted during hospitalization. Blood pressure (BP) monitoring can be especially disruptive for pediatric inpatients and has few clinical indications. Our aim in this pilot study was to reduce unnecessary overnight BP monitoring and improve sleep for pediatric inpatients. METHODS: The intervention in June 2018 involved clinician education sessions and updated electronic health record (EHR) orders that enabled the forgoing of overnight BP checks. The postintervention period from July 2018 to May 2019 examined patient-caregiver surveys as outcome measures. These surveys measured inpatient sleep and overnight disruptions and were adopted from validated surveys: the Patient Sleep Questionnaire, expanded Brief Infant Sleep Questionnaire, and Potential Hospital Sleep Disruptions and Noises Questionnaire. Uptake of new sleep-friendly EHR orders was a process measure. Reported patient care escalations served as a balancing measure. RESULTS: Interrupted time series analysis of EHR orders (npre = 493; npost = 1472) showed an increase in intercept for the proportion of patients forgoing overnight BP postintervention (+50.7%; 95% confidence interval 41.2% to 60.3%; P < .001) and a subsequent decrease in slope each week (-0.16%; 95% confidence interval -0.32% to -0.01%; P = .037). Statistical process control of surveys (npre = 263; npost = 131) showed a significant increase in sleep duration for patients older than 2, and nighttime disruptions by clinicians decreased by 19% (P < .001). Annual estimated cost savings were $15 842.01. No major adverse events in patients forgoing BP were reported. CONCLUSIONS: A pilot study combining EHR changes and clinician education safely decreased overnight BP checks, increased pediatric inpatient sleep duration, and reduced nighttime disruptions by clinicians.


Assuntos
Determinação da Pressão Arterial/normas , Criança Hospitalizada , Pessoal de Saúde/normas , Análise de Séries Temporais Interrompida/normas , Melhoria de Qualidade/normas , Sono/fisiologia , Adolescente , Determinação da Pressão Arterial/psicologia , Determinação da Pressão Arterial/tendências , Cuidadores/educação , Cuidadores/normas , Cuidadores/tendências , Criança , Criança Hospitalizada/psicologia , Pré-Escolar , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/tendências , Feminino , Pessoal de Saúde/educação , Pessoal de Saúde/tendências , Humanos , Lactente , Recém-Nascido , Análise de Séries Temporais Interrompida/tendências , Masculino , Projetos Piloto , Estudos Prospectivos , Melhoria de Qualidade/tendências
14.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32769199

RESUMO

OBJECTIVES: Multiple early childhood screenings are recommended, but gaps persist in implementation. Our aim for this project was to improve screening, discussion, referral, and follow-up of development, autism spectrum disorder (ASD), maternal depression, and social determinants of health (SDoH) to 90% by July 2018. METHODS: This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes. RESULTS: Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening. CONCLUSIONS: Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.


Assuntos
Colaboração Intersetorial , Programas de Rastreamento/normas , Atenção Primária à Saúde/normas , Melhoria de Qualidade/normas , Inquéritos e Questionários , Pré-Escolar , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Atenção Primária à Saúde/métodos
15.
Emerg Med Clin North Am ; 38(3): 633-646, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32616284

RESUMO

Lean engineering is based on a process improvement strategy originally developed at Toyota and has been used in many different industries to maximize efficiency by minimizing waste. Lean improvement projects are frequently instituted in emergency departments in an effort to improve processes and thereby improve patient care. Such projects have been undertaken with success in many emergency departments in order to improve metrics such as door-to-provider time, left without being seen rate, and patient length of stay. By reducing waste in the system, Lean processes aim to maximize efficiency and minimize delay and redundancy to the extent possible.


Assuntos
Eficiência Organizacional , Serviço Hospitalar de Emergência/organização & administração , Melhoria de Qualidade/organização & administração , Eficiência Organizacional/normas , Serviço Hospitalar de Emergência/normas , Humanos , Tempo de Internação , Satisfação do Paciente , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde
16.
Public Health Rep ; 135(4): 442-451, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639897

RESUMO

OBJECTIVES: Coordinated measurement strategies are needed to inform collaborative approaches to improve access to and quality of care for persons with sickle cell disease (SCD). The objective of our study was to develop a multilevel measurement strategy to assess improvements in access to and quality of care for persons with SCD in 4 US regions. METHODS: From 2014 through 2017, regional grantees in the Sickle Cell Disease Treatment Demonstration Program collected administrative and patient-level electronic health record (EHR) data to assess quality improvement initiatives. Four grantees-covering 29 US states and territories and an SCD population of 56 720-used a collective impact model to organize their work. The grantees collected administrative data from state Medicaid and Medicaid managed care organizations (MCOs) at multiple points during 2014-2017 to assess improvements at the population level, and local patient-level data were abstracted from site-level EHRs at regular intervals to track improvements over time. RESULTS: Administrative data were an important source of understanding population-level improvements but were delayed, whereas patient-level data were more sensitive to small-scale quality improvements. CONCLUSIONS: We established a shared measurement approach in partnership with Medicaid and Medicaid MCO stakeholders that can be leveraged to effectively support quality improvement initiatives for persons with SCD in the United States.


Assuntos
Anemia Falciforme/terapia , Assistência à Saúde/estatística & dados numéricos , Assistência à Saúde/normas , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/estatística & dados numéricos , Melhoria de Qualidade/normas , Humanos , Estados Unidos/epidemiologia
17.
J Clin Neurosci ; 78: 114-120, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32620474

RESUMO

The growing elderly population in Western societies has led to an increasing number of primary brain tumors occurring in patients beyond the age of 65. The purpose of this study was to assess and compare the safety, efficacy, and outcomes of oncological craniotomy procedures between patients above and below 65 years. We performed a retrospective analysis of the ACS-NSQIP database to identify patients undergoing supratentorial and infratentorial tumor excisions by neurosurgeons between 2008 and 2016. We stratified them based on a cutoff age of 65 years and analyzed for minor and major complications, reoperation, the total length of hospital stay, and mortality within a standardized 30-day follow-up. Among the 30,183 analyzed patients, 9,652 (32%) were elderly (age ≥ 65). The bivariate analysis demonstrated significantly increased risk of complications, including major and minor complications and mortality in patients with metabolic syndrome, preoperative steroid use, and ASA classification ≥3. (p-value ≤ 0.001***). After controlling for confounding variables in our logistic regression models, older age, metabolic syndrome, extended operative time beyond 5 h, dependent functional health status, ASA class ≥3, steroid use pre-operatively, and black/African American race were found to be significant predictors of major and minor complication. Our study provides a comprehensive analysis of perioperative risk factors and predictors of adverse outcomes following craniotomy for supratentorial and infratentorial tumors in elderly patients. We identified increased age as an independent risk factor for minor and major adverse events as well as extended hospitalization.


Assuntos
Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/cirurgia , Craniotomia/normas , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade/normas , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico , Estudos de Casos e Controles , Craniotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/diagnóstico , Melhoria de Qualidade/tendências , Reoperação/efeitos adversos , Reoperação/normas , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
18.
J Evid Based Soc Work (2019) ; 17(4): 457-468, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32498667

RESUMO

PURPOSE: The growing range and complexity of community care services require robust approaches to ensuring quality. METHOD: This review collated studies on the use of standards in regulating community health and social care using Social Care Online, MEDLINE and CINAHL databases. Studies were appraised by two reviewers and synthesized by study themes. RESULTS: Sixteen studies were synthesized under three themes: standards in quality assurance and quality improvement; effectiveness of standards; and design of regulatory standards. Standards facilitate providers in self-regulation and enable regulators to support and monitor improvement. Effectiveness of standards depends on their language and interpretation, and on organizational factors. There was little evidence of scales within quality standards. DISCUSSION: There is continuing debate about self-regulation versus external regulation. Social care service regulation requires more research. CONCLUSION: Regulatory organizations should take note of wider initiatives toward evidence-based practice in the design of quality standards.


Assuntos
Redes Comunitárias/normas , Assistência à Saúde/normas , Guias de Prática Clínica como Assunto , Saúde Pública/normas , Melhoria de Qualidade/normas , Seguridade Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Medicine (Baltimore) ; 99(21): e20333, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481320

RESUMO

Since its application in medical institutions in China, quality control circle (QCC) has gained achievements in medical care and thus earned more attention from the administrative department of health.In order to improve the quality of laboratory specimens, we launched a QCC activity to solve the problems and evaluate the effect of it. The data of 30,105 unqualified specimens in our hospital were collected from February to June 2017. After the QCC activity, the data of 43,125 specimens taken from July to December 2017 were collected.The defect rate of the specimens before the QCC activity was 0.98% (297/30105), and after the QCC activity, it was 0.45% (193/43125), showing a significant statistical difference (P < .05). The achievement rate and improvement rate were 108.2% and 54.1%, respectively.After the implementation of QCC, the defect rate of specimens in clinical laboratories was significantly decreased, and the intangible factors were also improved, which demonstrated the positive effects of QCC on the quality control of specimens.


Assuntos
Técnicas de Laboratório Clínico/normas , Hospitais/normas , Pesquisa Qualitativa , Controle de Qualidade , Melhoria de Qualidade/normas , Manejo de Espécimes/normas , China , Seguimentos , Humanos , Estudos Retrospectivos
20.
Neurology ; 95(3): e310-e319, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32591468

RESUMO

OBJECTIVE: To conduct a data quality improvement project to improve the quality measure data mapping and to measure key phrase logic in the Axon Registry.® METHODS: Prior validation analysis of the Axon Registry identified 2 main areas for remediation: methodology for mapping data from electronic health record (EHR) into the registry clinical data record (CDR) and key phrase logic for each measure. Practice groups participating in Axon Registry and 6 Axon Registry quality measures were selected for intervention. Mapping of measure elements and measure performances for each of the selected measures and practices were reviewed before intervention. The Data Accuracy Plan (DAP) was performed, and documentation data and visit data counts and data yield after intervention were calculated and analyzed. RESULTS: Documentation data and visit data counts and data yield increased for all 6 quality measures and all practices in the DAP. Increase in documentation data count ranged from 815 to 15,782 occurrences, while visit data count increase ranged from 519 to 16,383 visits. Average data yield range was 7.22% to 33.46% before intervention and increased to a range from 15.34% to 74.40% after intervention. CONCLUSION: There was substantial improvement in the accuracy of data extraction for quality measure elements after intervention to improve methodology for mapping EHR data into CDR and key phrase logic. Implementation of changes and continued review of data mapping and data dictionary are important to ensure accurate measure performance and to improve reliability and validity of Axon Registry data.


Assuntos
Axônios , Confiabilidade dos Dados , Coleta de Dados/normas , Registros Eletrônicos de Saúde/normas , Melhoria de Qualidade/normas , Sistema de Registros/normas , Coleta de Dados/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Humanos
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