Thursday, June 30, 2005

SISMEC - L'uso di database amministrativi per la valutazione di qualità delle attività sanitarie

http://events.orikata.it/sismec2/

Obiettivo del corso: fornire la capacità di leggere ed interpretare i valori degli indicatori proposti e considerare le modalità di aggiustamento per i possibili fattori di confondimento.

In particolare saranno affrontati gli aspetti relativi all'utilizzo congiunto delle informazioni reperibili da database diversi, alla costruzione ed interpretazione degli indicatori, alla presentazione efficace dei risultati.

Per scaricare la locandina in formato PDF clicca qui

AHRQ - The Value of Hospital Discharge Databases

The Agency for Healthcare Research and Quality (AHRQ) announces the availability of a new report, The Value of Hospital Discharge Databases , which focuses on the use and improvement of hospital discharge data and databases.

Drawing from multiple sources of information the report documents the ways in which hospital discharge databases are used and identifies ways to improve them.

Wednesday, June 29, 2005

CMS – Home Health Quality Initiative

Home health care is care provided to people who have a medical need for skilled care. A home health agency offers health care and personal care to patients in their own home, and in many cases, teaches them to care for themselves.

Home health care includes skilled nursing care, as well as other skilled care services, like physical and occupational therapy, speech-language therapy, and medical social services.

The Outcome and ASessment Information Set (OASIS) is a group of data elements that:

  • represent core items of a comprehensive assessment for an adult home care patient;
  • and form the basis for measuring patient outcomes for purposes of outcome-based quality improvement (OBQI).
The OASIS is a key component of Medicare's partnership with the home care industry to foster and monitor improved home health care outcomes.
The Home Health Quality Initiative (HHQI) aims to
  • empower consumers with public reporting of home health quality measures to make more informed decisions and
  • stimulate and support providers to improve the quality of health care.

The quality measures for the Home Health Quality Initiative are a subset of the OASIS outcome measures reported in the OBQI reports.

Consumers are able to view these measures on Home Health Compare website.

See also:

Home Health Quality Initiative Measures [Set]

Outcome-Based Quality Improvement (OBQI) Measures [Set]

Tuesday, June 28, 2005

Medical Care - Predicting Risk-Adjusted Mortality for CABG Surgery

Logistic Versus Hierarchical Logistic Models
Hannan, Edward L.; Wu, Chuntao MD; DeLong, Elizabeth R.; Raudenbush, Stephen W.
Medical Care. 43(7):726-735, July 2005.
Abstract HTML PDF

J Am Coll Cardiol

American College of Cardiology and American Heart Association methodology for the selection and creation of performance measures for quantifying the quality of cardiovascular care.

Spertus JA, Eagle KA, Krumholz HM, Mitchell KR, Normand SL;

Am Coll Cardiol. 2005 Apr 5;45(7):1147-56

http://www.ncbi.nlm.nih.gov/entrez/...

Monday, June 27, 2005

AHRQ Summit— Improving Quality of Care: At a Glance

http://www.ahrq.gov/qual/qsummit/

The Agency for Healthcare Research and Quality (AHRQ) held its first Summit on health care quality and disparities on April 4, 2005, in Washington, DC from both the public and private sectors came together to exchange information on "lessons learned" and address ways to improve health care quality and eliminate health disparities.

Contents

Summit Goal
The Quality Challenge
Turning the Corner on Quality
Quit Digging Your Grave With a Knife and Fork
Panel 1—Promising Quality Improvement Initiatives: Reports from the Field
Panel 2—Eliminating Health Care Disparities
Panel 3—Promising National Initiatives

BMJ - Where next with revalidation?

Self regulation should survive, but revalidation must offer education as well as performance review
John J Norcini
BMJ 2005:1458-1459
[Extract] [Full text] [PDF]

Friday, June 24, 2005

Ann Int Med – Special issue on systematic reviews

In this supplement authors from the North American Evidence-based Practice Centers offer detailed advice on doing systematic reviews, compiling evidence reports, and handling the methodologic challenges of systematic reviews.

Reviews: Making Sense of an Often Tangled Skein of Evidence The Editors
Ann Intern Med.2005; 142: 1019-1020.
Full Text PDF

TABLE OF CONTENTS
21 June 2005 Volume 142 Issue 12 (Part 2)

Challenges of Summarizing Better Information for Better Health: The Evidence-based Practice Center Experience
A Guide to This Supplement
Mark Helfand, Sally Morton, Eliseo Guallar, and Cynthia Mulrow
Full Text PDF

Better Information for Better Health Care: The Evidence-based Practice Center Program and the Agency for Healthcare Research and Quality
David Atkins, Kenneth Fink, and Jean Slutsky
Abstract Full Text PDF

Challenges in Systematic Reviews of Complementary and Alternative Medicine Topics
Paul G. Shekelle, Sally C. Morton, Marika J. Suttorp, Nina Buscemi, and Carol Friesen
Abstract Full Text PDF

Challenges in Systematic Reviews of Diagnostic Technologies
Athina Tatsioni, Deborah A. Zarin, Naomi Aronson, David J. Samson, Carole R. Flamm, Christopher Schmid, and Joseph Lau
Abstract Full Text PDF

Challenges in Systematic Reviews: Synthesis of Topics Related to the Delivery, Organization, and Financing of Health Care
Dena M. Bravata, Kathryn M. McDonald, Kaveh G. Shojania, Vandana Sundaram, and Douglas K. Owens
Abstract Full Text PDF

Challenges in Systematic Reviews That Evaluate Drug Efficacy or Effectiveness
P. Lina Santaguida, Mark Helfand, and Parminder Raina
Abstract Full Text PDF

Challenges in Systematic Reviews of Economic Analyses
Michael Pignone, Somnath Saha, Tom Hoerger, Kathleen N. Lohr, Steven Teutsch, and Jeanne Mandelblatt
Abstract Full Text PDF

Challenges in Systematic Reviews of Educational Intervention Studies
Darcy Reed, Eboni G. Price, Donna M. Windish, Scott M. Wright, Aysegul Gozu, Edbert B. Hsu, Mary Catherine Beach, David Kern, and Eric B. Bass
Abstract Full Text PDF

Challenges in Systematic Reviews That Assess Treatment Harms
Roger Chou and Mark Helfand
Abstract Full Text PDF

Challenges in Systematic Reviews of Therapeutic Devices and Procedures
Lisa Hartling, Finlay A. McAlister, Brian H. Rowe, Justin Ezekowitz, Carol Friesen, and Terry P. Klassen
Abstract Full Text PDF

Challenges in Using Nonrandomized Studies in Systematic Reviews of Treatment Interventions
Susan L. Norris and David Atkins
Abstract Full Text PDF

Dissemination of Evidence-based Practice Center Reports
David B. Matchar, Emma V. Westermann-Clark, Douglas C. McCrory, Meenal Patwardhan, Gregory Samsa, Shalini Kulasingam, Evan Myers, Antonio Sarria-Santamera, Alison Lee, Rebecca Gray, and Katherine Liu
Abstract Full Text PDF

Thursday, June 23, 2005

AHRQ - HCUP Fact Books

AHRQ produces the HCUP Fact Books to highlight statistics about hospital care in the U.S. in an easy-to-use, readily accessible format. Each Fact Book provides information about specific aspects of hospital care.
These national estimates are benchmarks against which States and others can compare their own data.


Merrill CT, Elixhauser A. Hospitalization in the United States, 2002.
HCUP Fact Book No. 6. AHRQ Publication No. 05-0056. 2005.
Agency for Healthcare Research and Quality, Rockville, MD
http://www.ahrq.gov/data/hcup/factbk6/factbk6.pdf


Previously published HCUP Fact Books are available online:

Kruzikas DT, Jiang HJ, Remus D, et al. Preventable Hospitalizations. Window Into Primary and Preventive Care, 2000. HCUP Fact Book No. 5. AHRQ Publication No. 04-0056, September 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/hcup/factbk5/

Care of Children and Adolescents in U.S. Hospitals. HCUP Fact Book No. 4. AHRQ Publication No. 04-0004, October 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/hcup/factbk4/factbk4.htm

Care of Women in U.S. Hospitals, 2000. HCUP Fact Book No. 3. AHRQ Publication No. 02-0044, October 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/hcup/factbk3/factbk3.htm

Procedures in U.S. Hospitals, 1997. HCUP Fact Book No. 2. Elixhauser A, Klemstine K, Steiner C, Bierman A. February 2001, AHRQ Publication No. 01-0016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/hcup/factbk2/factbk2.htm

Hospitalization in the United States, 1997. HCUP Fact Book No.1. AHRQ Publication No. 00-0031, May 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/hcup/factbk1/

Wednesday, June 22, 2005

BMJ - Creative use of existing clinical and health outcomes data to assess NHS performance in England: Part 1

performance indicators closely linked to clinical care
Azim Lakhani, James Coles, Daniel Eayres, Craig Spence, Bernard Rachet
BMJ 2005:1426-1431, doi:10.1136/bmj.330.7505.1426
[Full text] [PDF] [extra: Extra technical details]

Ann Int Med - High and Rising Health Care Costs. Part 3

The Role of Health Care Providers
Thomas Bodenheimer
21 June 2005 Volume 142 Issue 12 (Part 1) Pages 996-1002
Abstract Full Text PDF

Tuesday, June 21, 2005

AHRQ - Quality Indicators Newsletter

The QI team publishes the first issue of the Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QI) e-Newsletter.

The purpose of the publication is to provide user community with updates on AHRQ activities related to the QIs, success stories from QI users, and tips on using the QIs.

http://www.qualityindicators.ahrq.gov/...

Monday, June 20, 2005

Epicentro - Qualità: Strategie di Formazione

http://www.epicentro.iss.it/focus/ocse/intro-qualita.htm

Nuova edizione dei manuali di formazione per la valutazione e il miglioramento della qualità professionale, un progetto nato dalla collaborazione tra l’Iss e l’Agenzia sanitaria regionale delle Marche.

Il corso si articola in cinque manuali:

Introduzione

Scelte terminologiche

Capitolo 1 - Gestione per processi e percorsi assistenziali
Esercizi
Risposte

Capitolo 2 - Indicatori in valutazione e miglioramento della qualità professionale
Esercizi
Risposte

Capitolo 3 - Medicina basata sulle evidenze
Esercizi
Risposte

Capitolo 4 - L’ufficio qualità nelle organizzazioni sanitarie

Appendice – Elenco dei partecipanti

Manuale completo (pdf 4.9MB)

Quest’ultima versione si differenzia da quella attualmente presente sul sito dell’Agenzia sanitaria della Regione Marche per una parziale riscrittura e alcuni aggiornamenti, principalmente del primo e del secondo manuale. Non comprende invece il manuale 5 sull’analisi statistica mediante Epi-info, consultabile soltanto sul sito citato. Il manuale 2 sugli indicatori professionali è stato pubblicato indipendentemente e in versione leggermente diversa come Rapporto Istisan 29 del 2004.

Il progetto, finanziato dal ministero della Salute, comprendeva anche la realizzazione di una banca dati degli uffici qualità delle aziende sanitarie pubbliche, banca dati che è stata realizzata con il determinante contributo operativo del ministero stesso e che è a disposizione sul sito dell’Agenzia sanitaria della Regione Marche.

Friday, June 17, 2005

Qual Saf Health Care

Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

Scott I, Youlden D, Coory M.

Qual Saf Health Care. 2004 Feb;13(1):32-9

http://qhc.bmjjournals.com/...

PHA - Discussing Unanticipated Outcomes and Disclosing Medical Errors

http://www.gha.org/pha/video/index.asp

55 minutes video from Georgia Hospital Association Research and Education Foundation & Agency for Healthcare Research and Quality.

The video was written and directed by Dr. John Banja, an Associate Professor at Emory University’s Center for Ethics.

The video consists of two parts. Part One features a panel discussion of three clinical vignettes involving medical error.

Part Two of the tape presents a host of empathic communication techniques that can be useful to health professionals when they conduct “bad news” conversations.
Please note: the file is 623mb in size.

Thursday, June 16, 2005

Wednesday, June 15, 2005

The Leapfrog Group Hospital Patient Safety Survey Results

The results of the Leapfrog Hospital Quality and Safety Survey are made publicly available on The Leapfrog Group Web site to be viewed and to support making informed decisions about where to receive care.

http://www.leapfroggroup.org/cp?form=cp_start


This hospital survey is based on a set of hospital patient safety practices that are the initial focus of The Leapfrog Group’s efforts to promote patient safety.
http://www.leapfroggroup.org/for_hospitals/...

These practices were intended to give a focus for recognition and rewards at the same time delivering significant ‘leaps’ in patient safety.

Research shows that if the first three leaps (Computer Physician Order Entry, Intensive Care Unit Physician Staffing and Evidence-Based Hospital Referral) were implemented in all urban hospitals U.S. could save up to 65,341 lives, prevent as many as 907,600 serious medication errors each year (Birkmeyer, 2004), and save $41.5 billion (Conrad, 2005).

Computer Physician Order Entry

Evidence Based Hospital Referral

ICU Physician Staffing


Example: State: MA

http://www.leapfroggroup.org/...

Tuesday, June 14, 2005

Inquiry - Quality report cards, selection of cardiac surgeons, and racial disparities

a study of the publication of the New York State Cardiac Surgery Reports

Mukamel DB, Weimer DL, Zwanziger J, Gorthy SF, Mushlin AI

Inquiry. 2004-2005 Winter;41(4):435-46

http://www.ncbi.nlm.nih.gov/entrez/...

Am Heart J - Impact of the choice of benchmark on the conclusions of hospital report cards

Austin PC, Alter DA, Anderson GM, Tu JV.

Am Heart J. 2004 Dec;148(6):1041-6

http://www.ncbi.nlm.nih.gov/...

Monday, June 13, 2005

The Care Transitions Program

http://www.caretransitions.org/index.htm

The term “care transition” refers to the movement patients make between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness.

Under the leadership of Dr. Eric Coleman, the aim of the Care Transitions Program is to address the negative consequences of fragmented care, including duplication of services, discontinuity, medication errors, patient and family caregiver distress, unnecessary utilization and higher costs of care.
http://www.caretransitions.org/definations.htm

Care Transitions Intervention was designed in response to the need for a patient-centered, interdisciplinary intervention that addresses continuity of care across multiple settings and practitioners.
http://www.caretransitions.org/...htm

Dr. Coleman and colleagues designed a 15-item uni-dimensional measure to assess the quality of care transitions: the Care Transitions Measure (CTM).
http://www.caretransitions.org/measures.htm

Assessing the quality of preparation for posthospital care from the patient's perspective: the care transitions measure.
Coleman EA, Mahoney E, Parry C.
Med Care. 2005 Mar;43(3):246-55

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?...

Lost in transition: challenges and opportunities for improving the quality of transitional care.

Coleman EA, Berenson RA.
Ann Intern Med. 2004 Oct 5;141(7):533-6

http://www.annals.org/cgi/reprint/141/7/533.pdf

BMJ - Dr Foster's case notes

Hospital waiting lists and pressures on the NHS

Brian Jarman, Steve Middleton

BMJ 2005;330:1352 (11 June)

http://bmj.bmjjournals.com/...

Friday, June 10, 2005

WebM&M - Perspectives on Safety

Interpreting the Patient Safety Literature

By Kaveh G. Shojania, MD

http://webmm.ahrq.gov/perspective.aspx?perspectiveID=5

Health Serv Manage Res - Towards an organization with a memory exploring

the organizational generation of adverse events in health care
Smith D, Toft B.
Health Serv Manage Res. 2005 May;18(2):124-40
http://www.ncbi.nlm.nih.gov/...

Ann Intern Med - High and Rising Health Care Costs

Part 2: Technologic Innovation
Bodenheimer T.
Ann Intern Med 2005 142: 932-937

http://www.annals.org/cgi/...

AHRQ - Ambulatory Care Quality Alliance

Third Invitational Meeting Summary

http://www.ahrq.gov/....html

To identify critical opportunities in ambulatory care performance measurement, the third in a series of meetings was held April 27-28, 2005.

The third meeting of the Ambulatory Care Quality Alliance was convened to review the activities of its three workgroups (on performance measurement, data sharing and aggregation, and reporting).

Thursday, June 09, 2005

Focus on: Surgery

The Commonwealth Fund: Case Study
By Douglas McCarthy
http://www.cmwf.org/...


ACS National Surgical Quality Improvement Program (ACS NSQIP)
https://acsnsqip.org/content/main/default.asp

The ACS National Surgical Quality Improvement Program (ACS NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care.

The program employs a prospective, peer-controlled, validated database to quantify 30-day risk-adjusted surgical outcomes, which allows valid comparison of outcomes among all hospitals in the program. Medical centers and their surgical staff are able to use the data to make informed decisions regarding their continuous quality improvement efforts.


Surgical Care Improvement Project (SCIP)
http://www.medqic.org/scip/scip_homepage.html

The Surgical Care Improvement Project (SCIP) is a national partnership of organizations committed to improving the safety of surgical care through the reduction of post-operative complications.
Quality improvement efforts will focus on reducing perioperative complications in four broad areas where the incidence and cost of complications are high:

  • Surgical site infections
  • Adverse cardiac events
  • Venous thromboembolism
  • Postoperative pneumonia

Although some surgical complications are unavoidable, surgical care can be improved through better adherence to evidence-based practice recommendations and more attention to designing systems of care with redundant safeguards.

Measures of surgical quality: what will patients know by 2005?

Broder MS, Payne-Simon L, Brook RH.

J Eval Clin Pract. 2005 Jun;11(3):209-17

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?...

Wednesday, June 08, 2005

AHRQ - National Resource Center

AHRQ established the National Resource Center for Health Information Technology to encourage adoption of health IT by sharing the findings and lessons from the real-world laboratory created in AHRQ's health IT initiative.

By disseminating new knowledge, providing technical assistance, and serving as a repository for best practices, the National Resource Center can help providers explore the adoption and use of health IT to improve patient safety and quality of care.

Focus on: Comorbidities

Complications and Comorbidities
http://www.umanitoba.ca/.../comp_comorb.html

Charlson Index

http://www.umanitoba.ca/.../charlson_index.html

http://www.measurementexperts.org/...


Elixhauser method

http://www.hcup-us.ahrq.gov/.../comorbidity.jsp


Comparison of the Elixhauser and Charlson/Deyo Methods of Comorbidity Measurement in Administrative Data.

Medical Care. 42(4):355-360, April 2004.Southern, Danielle A , Quan, Hude MD, Ghali, William A. MD
http://www.lww-medicalcare.com/...

Tuesday, June 07, 2005

JCAHO - National Patient Safety Goals

The Joint Commission on Accreditation of Healthcare Organizations announced the 2006 National Patient Safety Goals and related Requirements that will apply specifically to accredited hospitals and critical access hospitals.
Improve the accuracy of patient identification.

  • Improve the effectiveness of communication among caregivers.
  • Improve the safety of using medications.
  • Reduce the risk of health care-associated infections.
  • Accurately and completely reconcile medications across the continuum of care.
  • Reduce the risk of patient harm resulting from falls.
National Patient Safety Goals for 2006 and 2005
http://www.jcaho.org/accredited+organizations/.../npsg.htm

Epicentro - Diseguaglianze di salute in Italia

E' stato pubblicato il rapporto sulle Diseguaglianze di salute in Italia

Epidemiologia e prevenzione vol. 28 n.3, supplemento - maggio-giugno 2004

Giuseppe Costa, Carlo Perucci e Cesare Cislaghi

http://www.epicentro.iss.it/.../diseguaglianze.htm

Qual Saf Health Care - Crisis Management

Crises in clinical care: an approach to management
W B Runciman and A F Merry
Qual Saf Health Care 2005;14 156-163
http://qhc.bmjjournals.com/...

Monday, June 06, 2005

CMS - Hospital Compare

Hospital Compare has quality measures on how often hospitals provide some of the recommended care to get the best results for most patients. You will see some of the recommended care that an adult should get if being treated for a heart attack, heart failure, or pneumonia.

This website was created through the efforts of the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (DHHS) along with the Hospital Quality Alliance (HQA). The HQA is a public-private collaboration established to promote reporting on hospital quality of care.

http://www.hospitalcompare.hhs.gov

ECDC: Official launch

The European Centre for Disease Prevention and Control is a new EU agency that has been created to help strengthen Europe’s defences against infectious diseases, such as influenza, SARS and HIV/AIDS.

www.ecdc.eu.int

Qual Saf Health Care - Classic papers

Computerized surveillance of adverse drug events in hospital patients
D C Classen, S L Pestotnik, R S Evans, J P Burke, and J B Battles
Qual Saf Health Care 2005;14 221-226
http://qhc.bmjjournals.com/cgi/...

Commentary
J B Battles
Qual Saf Health Care 2005;14 225-226
http://qhc.bmjjournals.com/...

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Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I
T A Brennan, L L Leape, N M Laird, L Hebert, A R Localio, A G Lawthers, J P Newhouse, P C Weiler, and H H Hiatt
Qual Saf Health Care 2004; 13: 145-151
http://qhc.bmjjournals.com/...

Commentary
G R Baker
Qual Saf Health Care 2004; 13: 151-152
http://qhc.bmjjournals.com/...

Friday, June 03, 2005

Focus on: CSSP

The Clinical Support Systems Program (CSSP) has been a joint initiative of The Royal Australasian College of Physicians and the Australian Government Department of Health and Ageing.
http://www.racp.edu.au/bp/cssp.html

The CSSP investigated how best to facilitate the uptake of “best practice” by clinicians and, in particular, how improved clinical support systems including information systems could contribute to this.

It was fundamentally about processes of change in clinical practice and in the systems of care provision.

The CSS model to improve the quality of care combines two methodologies (Evidence-Based Medicine and Clinical Practice Improvement) to embed the best available evidence routinely in clinical practice.
http://www.improveyourpractice.com.au/...

The CSSP successfully tested the CSS model through four consortia around Australia.


New projects:
http://www.racp.edu.au/bp/newproj.html

The College has generated a unique web-based tool that provides a practical introduction to the CSS model and draws heavily on the experiences of clinicians involved in the CSSP.
http://www.improveyourpractice.com.au/

Learn more:

Medical Journal of Australia Supplement

Summary Report on the CSSP

Final Evaluation Report of the CSSP

Thursday, June 02, 2005

The Dartmouth Atlas of Health Care

The Dartmouth Atlas project is a funded research effort of the faculty of the Center for the Evaluative Clinical Sciences at Dartmouth Medical School.

The Atlas project brings together researchers in diverse disciplines - including epidemiology, economics, and statistics - and focuses on the accurate description of how medical resources are distributed and used in the United States.

www.dartmouthatlas.org/default.php

JAMA - Defensive Medicine

Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment

David M. Studdert, LLB, ScD, MPH; Michelle M. Mello, JD, PhD, MPhil; William M. Sage, MD, JD; Catherine M. DesRoches, DrPH; Jordon Peugh, MA; Kinga Zapert, PhD; Troyen A. Brennan, MD, JD, MPH
JAMA. 2005;293:2609-2617.

http://jama.ama-assn.org/...

JAMA - Tort Reform and the Patient Safety Movement

Seeking Common Ground
Peter P. Budetti, MD, JD
JAMA. 2005;293:2660-2662

http://jama.ama-assn.org/...

Wednesday, June 01, 2005

JCAHO - Quality Check

Quality Check is a comprehensive guide to the more than 15,000 Joint Commission-accredited health care organizations and programs throughout the United States.

http://www.jcaho.org/quality+check

As part of its new accreditation process, the Joint Commission will provide the public and health care professionals with relevant and useful information about the quality and safety of Joint Commission-accredited organizations in Quality Reports, which is available on Quality Check.

example: http://www.jcaho.org/qualitycheck/directry/...#

BMJ - Clinical leadership in the provision of hospital care

Must be improved to reduce basic errors in clinical care

Graham Neale
BMJ 2005;330:1219-1220 (28 May)

http://bmj.bmjjournals.com/...