Table Of ContentJob #: 71342
Author name: Wan
Title of book: Monitoring the Quality of Health Care
ISBN number: 1402071000
MONITORING THE QUALITY OF HEALTH
CARE
Issues and Scientific Approaches
MONITORING THE QUALITY OF
HEALTHCARE
Issues and Scientific Approaches
by
Thomas T.H. Wan, Ph.D.
Virginia Commonwealth University
USA
and
Alastair M. Connell, M.D.
Virginia Commonwealth University
USA
.....
"
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
.....
" Electronic Services <http://www.wkap.nl>
Library of Congress Cataloging-in-Publication Data
Monitoring the Quality ofH ealth Care: Issues and Scientific Approaches
By Thomas T. H. Wan, Ph.D. and Alastair M. Connell, M.D.
ISBN 978-1-4613-5393-5 ISBN 978-1-4615-1097-0 (eBook)
DOI 10.1007/978-1-4615-1097-0
Copyright 2003 Springer Science+Business Media New York
Originally published by Kluwer Academic Publishers in 2003
Softcover reprint of the hardcover 1 st edition 2003
AII rights reserved. No part of this publication may be reproduced, stored in a retrieval
system or transmitted in any form or by any means, mechanical, photo-copying, recording,
or otherwise, without the prior written permission ofthe publisher, with the exception ofany
material supplied specifically for the purpose ofbeing entered and executed on a computer
system, for exclusive use by the purchaser ofthe work.
Permissions for books published in Europe: [email protected]
Permissions for books published in the United States of America: [email protected]
Printed on acid-free paper.
CONTENTS
List of Tables ......................................................... vii
List of Figures ........................................................ .ix
About the Authors ....................................................x i
Preface ................................................................. xiii
Acknowledgments ................................................... xv
PART I: Issues
Chapter 1
Health Care: An Industry in Transition .............................. 3
Chapter 2
The Historical Roots of Health Care Oversight: Cost
Containment ............................................................. 9
Chapter 3
Basic Definitions and Criteria for the Management and
Assurance of Quality in Health Care .............................. 23
Chapter 4
Complexities that Health Care Oversight Must Take into
Account ................................................................. 33
Chapter 5
The Necessity for Multifaceted Quality Management ........... 43
Chapter 6
Quality Improvement: Professional Initiatives ................... 47
Chapter 7
Quality Oversight in Health Care Institutions: Monitors and
Checklists .............................................................. 77
Chapter 8
Quality Oversight: Use of Administrative Data Bases .......... 91
Chapter 9
Quality Oversight: Medical Record Review ...................... 105
Chapter 10
Quality Oversight: Patient Satisfaction Surveys ................ 117
Chapter 11
Quality Accountability: External Oversight ..................... 123
Chapter 12
Total Quality Management and Continuous Quality Improvement
........................................................................... 143
Chapter 13
Approaches to Valid Quality Assistance .......................... 159
PART II: Scientific Approaches
Chapter 14
Measuring the Quality of Hospital Care: The Importance of
Identifying Principal Risk Factors for Adverse Health Events and
Using Risk Adjustment in Measures of Quality ................. 179
Chapter 15
Assessing a Quality Improvement Program: Study Design,
Causal Specification and Analysis ................................ 239
Chapter 16
Identifying the Roots Causes or Patterns of Adverse Health
Events: Statistical Methods ........................................ 269
Chapter 17
Conclusion: What Must Be Done .................................. 285
Appendix ............................................................ 291
Bibliography ........................................................ 295
Index .................................................................. 307
vi
LIST OF TABLES
Table 3.1a
Criteria for High Quality Health Plan .............................. 29
Table 3.1b
QuCI Five Steps to Safer Health Care ............................. 30
Table 7.1 Features of a Typical Hospital Quality Monitoring
Program ................................................................ 81
Table 7.2
Types of Adverse Occurrences ..................................... 82
Table 7.3
Quality Monitors Developed by the VA Management Science
Group (MSG) .......................................................... 83
Table 13.1
Behavioral and Education Guidelines to Reduce Errors in
Medical Care ......................................................... 168
Table 14.1
Univariate Analysis of Four Adverse Events, for Hospital Risk
Adjustments (N=223) ................................................ 195
Table 14.2
Bivariate Analysis of With- and Without Claim Groups, for
Hospital Risk Adjustment. . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . . . . . . . .. 196
Table 14.3
Bivariate Analysis of Single & Multiple Claim Groups for
Hospital Risk Adjustment .......................................... 197
Table 14.4
Bivariate Analysis of Low/High Incidence Rates for All Four
Adverse Events ....................................................... 198
Table 14.5
Bivariate Analysis ofLowlHigh Incidence Rates for Body Injury
.......................................................................... 199
Table 14.6
Logistic Regression of With & Without a Body Injury Claims for
Predicting Risk ...................................................... 202
Table 14.7
Multiple Regression Analysis of Predicting Total Events ..... 203
Table 14.8
Multiple Regression Analysis of Predicting Body Injury Events
...........................................................................2 06
Table 14.9
Multiple Regression Analysis of Predicting the Prevalence Rate
of Four Adverse Events ............................................ 208
Table 14.10
Multiple Regression Analysis of Predicting the Prevalence Rate
of Body Injury Events ............................................... 211
Table 14.11
Multiple Regression Analysis of Predicting Incurred Number of
F our Adverse Events ................................................ 214
Table 14.12
Multiple Regression Analysis of Predicting Incurred Number
Body Injury Events .................................................. 216
Table 14.13
Framework for Risk Factor Adjustment ......................... , 222
Table 15.1
Statistical Methods for Analyzing Program Performance, by
Intervention Design and Types of Outcomes ..................... 243
Vlll
LIST OF FIGURES
Figure 13.1
Berwick's Ten Concepts for Reducing Errors in Medical Care
........................................................................... 162
Figure 13.2
AHRQ's 20 Tips to Help Prevent Medical Errors ............. 164
Figure 14.1
Trend Analysis of Average Total Incurred Cost for Four Adverse
Events Combined .................................................... 192
Figure 14.2
Trend Analysis of Prevalence Rates for Four Adverse Events
Combined .............................................................. 193
Figure 15.1
An Outcome Measures and Intervention .......................... 250
Figure 15.2
Exploratory Approach .............................................. 257
Figure 15.3
Confirmatory Approach ............................................. 259
Figure 15.4
Temporal Orderings of the Events ................................. 260
Figure 15.5
Multiple Causes and Multiple Outcomes ........................ 260
Figure 15.6
Mutual Causation ................................................... 261
Figure 15.7
Causal Model ......................................................... 261
Figure 16.1
Path Analytic Model of Hospital Mortality ...................... 276
Figure 16.2
The Measurement Model of Adverse Patient Outcomes in
Hospitals ............................................................... 279
Figure 16.3
The Structural Equation Model of Adverse Patient Outcome .. 280
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