Monday, September 04, 2006

Special Eurobarometer on Medical Errors


The European Commission carry out the first analysis based on citizens’ perception of medical errors and use the results as a starting point for a more profound approach over the coming years.

This survey deals with the following themes:
• General perception of medical errors
• Experiences of medical errors: familiarity with the topic and concrete experiences
• Practical implications: trust in health care professionals and hospital treatment

This report presents the principal results obtained. Medical errors Eurobarometer 64.1 , 2006

Friday, September 01, 2006

EUROCHIP 2 - European Cancer Health Indicator Project (Phase 2) 2nd interim report

EUROCHIP-2 focuses on fighting inequalities in cancer. Its aim is to improve information and knowledge on cancer. It will add value to each country’s and all Europe’s action through data comparison.

The international group of experts engaged by EUROCHIP-2 is liaising with networks, international agencies, institutions, ministries of health and medical association to thus promote actions, with the aim to improve data collection, data analysis, and results dissemination.

2nd Interim report, June 2006, pdf (800 KB)

Thursday, August 31, 2006

MCHP - Defining and Validating Chronic Diseases: An Administrative Data Approach.

Lix L, Yogendran M, Burchill C, Metge C, McKeen N, Moore D, Bond R.

Winnipeg, Manitoba Centre for Health Policy, July 2006.


This study examines the validity of administrative data, including hospital separations, physician billing claims, and prescription drug records, for monitoring the prevalence of selected chronic diseases in Manitoba.

The specific objectives of this report are to:

1) Review the literature on the validity of administrative data for identifying chronic disease cases.

2) Evaluate the validity of multiple algorithms for identifying disease cases from Manitoba administrative data.

3) Test for differences in cross-sectional and longitudinal prevalence estimates for chronic disease algorithms.

Download the full report

Download the summary

Wednesday, August 30, 2006

Does Pay-for-Performance Improve the Quality of Health Care?

L. A. Petersen, L. D. Woodard, T. Urech, C. Daw and S. Sookanan
Ann Intern Med 2006; 265-272.

Abstract Full Text PDF Appendix Table

Tuesday, August 29, 2006

Tracking Rates of Patient Safety Indicators Over Time: Lessons From the Veterans Administration

Rosen AK, Zhao S, Rivard P, Loveland S, Montez-Rath ME, Elixhauser A, Romano PS.
Med Care. 2006 Sep;44(9):850-861.

Fulltext PDF (699 K)

Monday, August 28, 2006

Patients at Risk of Re-hospitalisation (PARR) case finding tool

Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patients

John Billings, Jennifer Dixon, Tod Mijanovich, David Wennberg
BMJ 2006;333:327

[Abstract] [Full text] [PDF] [extra: Appendix]


full report and tool

Friday, August 25, 2006

Volume and process of care in high-risk cancer surgery.

Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJ, Stukel TA.
Cancer. 2006 Jun 1;106(11):2476-81.

Abstract HTML PDF

Thursday, August 24, 2006

Accuracy of hospital report cards based on administrative data

Glance, LG; Dick, AW; Osler, TM; Mukamel, DB
HEALTH SERVICES RESEARCH, 41 (4): 1413-1437, Part 1; AUG 2006

abstract htm pdf

Wednesday, August 23, 2006

Pan-Canadian Primary Health Care Indicator Development Project


http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=GR_1489_E

A series of reports from the Canadian Institute for Health Information (CIHI) develops a list of Primary Health Care indicators. Report 1, Volume 1 presents the context and background for the 105 agreed upon indicators. Report 1, Volume 2 includes detailed technical specifications for each of the 105 indicators. A companion report outlining options for enhancing the pan-Canadian data collection infrastructure is also available.

PHC Indicator List - Labels
PHC Indicator List - Definitions

Primary Health Care Indicators : Pan-Canadian, Report 1, Vol 1 (PDF file)
Primary Health Care Indicators : pan-Canadian, Report 1, Volume 2 (PDF file)
Enhancing the Primary Health Care Data Collection Infrastructure in Canada, Report 2 (PDF file)

Tuesday, August 22, 2006

Effects of Quality Improvement Strategies for Type 2 Diabetes on Glycemic Control

A Meta-Regression Analysis
Kaveh G. Shojania; Sumant R. Ranji; Kathryn M. McDonald; Jeremy M. Grimshaw; Vandana Sundaram; Robert J. Rushakoff; Douglas K. Owens
JAMA. 2006;296:427-440.

ABSTRACT FULL TEXT PDF

Monday, August 21, 2006

IOM - Preventing Medication Errors

This report from the Institute of Medicine finds that medication errors are surprisingly common and costly, and it outlines a comprehensive approach to decreasing the prevalence of these errors.

This approach will require changes from doctors, nurses, pharmacists, and others in the health care industry, from government agencies, from hospitals and other health-care organizations, and from patients.

report

Report Brief. Preventing Medication Errors

Fact Sheet. What You Can Do to Avoid Medication Errors

Friday, August 18, 2006

Developing and implementing new safe practices

voluntary adoption through statewide collaboratives
Leape, L L, Rogers, G, Hanna, D, Griswold, P, Federico, F, Fenn, C A, Bates, D W, Kirle, L, Clarridge, B R
Qual Saf Health Care 2006 15: 289-295

[Abstract] [Full text] [PDF]

Thursday, August 17, 2006

AHRQ - DoD Medical Team Training Programs

Three medical team training programs based on aviation team training are evaluated under a contract from the Agency for Healthcare Research and Quality (AHRQ).

Results suggest that all three programs have desirable traits such as using active learning techniques and offering training to interdisciplinary health care teams. The researchers set out a framework for a successful medical team training program.

htm File PDF File

Wednesday, August 16, 2006

Developing the electronic health record: what about patient safety?

Boaden R, Joyce P.
Health Serv Manage Res. 2006 May;19(2):94-104.

pubmed

Monday, August 14, 2006

Fragmentation of care for frequently hospitalized urban residents.

Schrag D, Xu F, Hanger M, Elkin E, Bickell NA, Bach PB.
Med Care. 2006 Jun;44(6):560-7.

Abstract HTML PDF (673 K)

Friday, August 11, 2006

Review of performance assessment and improvement in ambulatory medical care.

Contencin P, Falcoff H, Doumenc M.
Health Policy. 2006 Jun;77(1):64-75.

Abstract Full Text + Links PDF (154 K)

Thursday, August 10, 2006

Tracking Progress in Patient Safety

An Elusive Target
Peter J. Pronovost; Marlene R. Miller; Robert M. Wachter
JAMA 2006 296: 696-699

EXTRACT FULL TEXT PDF

Wednesday, August 09, 2006

Tuesday, August 08, 2006

Monday, August 07, 2006

Hospital responses to pay-for-performance incentives.

Reiter KL, Nahra TA, Alexander JA, Wheeler JR.
Health Serv Manage Res. 2006 May;19(2):123-34.

pubmed

Friday, August 04, 2006

Thursday, August 03, 2006

Wednesday, August 02, 2006

Are Claims Data Accurate Enough to Identify Patients for Performance Measures or Quality Improvement?

The Case of Diabetes, Heart Disease, and Depression
Solberg, Leif I., Engebretson, Karen I., Sperl-Hillen, Joann M., Hroscikoski, Mary C., O'Connor, Patrick J.
American Journal of Medical Quality 2006 21: 238-245

[Abstract] [PDF]

Tuesday, August 01, 2006

Patient Safety: Solutions in Managed Care Organizations?

Nowinski, Caralynn V. ; Mullner, Ross M.
Quality Management in Health Care. 15(3):130-136, July/September 2006.

Fulltext PDF (80 K)

Monday, July 31, 2006

A safer place for patients: learning to improve patient safety.

House of Commons Committee on Public Accounts. London, England: The Stationary Office; July 6, 2006. Publication HC 831.

The Committee found that in 2004-05 some 974,000 patient safety incidents and near misses were recorded on NHS trusts' reporting systems. NHS trusts need to bring down the level of avoidable incidents, particularly those leading to serious harm and death, through rigorous implementation of safety alerts and adoption of high impact, evidence based solutions such as those promulgated by the National Patient Safety Agency and the Institute of Innovation and Improvement.

Free full text

Free full text (PDF)

Friday, July 28, 2006

Geographic Diversity of Low-Volume Hospitals in Total Knee Replacement: Implications For Regionalization Policies.

Losina E, Kessler CL, Wright EA, Creel AH, Barrett JA, Fossel AH, Katz JN.
Med Care. 2006 Jul;44(7):637-645.

Abstract HTML PDF (450 K)

Thursday, July 27, 2006

IOM - Hospital-Based Emergency Care: At the Breaking Point

The Institute of Medicine.s (IOM) Committee on the Future of Emergency Care in the United States Health System was formed in September 2003 to examine the emergency care system in the United States; explore its strengths, limitations, and future challenges; describe a desired vision of the system; and recommend strategies for achieving that vision.

Full Text
PDF Summary

Also of Interest:
Emergency Care for Children: Growing Pains
Emergency Medical Services: At the Crossroads

Wednesday, July 26, 2006

An Autocorrelation-corrected Nonparametric Control Chart Technique for Health Care Quality Applications.

Borckardt, Jeffrey J.; Pelic, Christopher ; Herbert, Joan ; Borckardt, Deza ; Nash, Michael R. ; Cooney, Harriet ; Hardesty, Sue.
Quality Management in Health Care. 15(3):157-162, July/September 2006.

Fulltext PDF (116 K)

Tuesday, July 25, 2006

Health Services Research - Special Issue on Health Care Reliability

August 2006 - Vol. 41 Issue 4p2 Page 1535-1720

Foreword to: Keeping our Promises: Research, Practice, and Policy Issues in Health Care Reliability. A Special Issue of Health Services Research
James L. Reinertsen, Carolyn Clancy

Organizational Silence and Hidden Threats to Patient Safety
Kerm Henriksen, Elizabeth Dayton

Sensemaking of Patient Safety Risks and Hazards
James B. Battles, Nancy M. Dixon, Robert J. Borotkanics, Barbara Rabin-Fastmen, Harold S. Kaplan

Teamwork as an Essential Component of High-Reliability Organizations
David P. Baker, Rachel Day, Eduardo Salas

Creating High Reliability in Health Care Organizations
Peter J. Pronovost, Sean M. Berenholtz, Christine A. Goeschel, Dale M. Needham, J. Bryan Sexton, David A. Thompson, Lisa H. Lubomski, Jill A. Marsteller, Martin A. Makary, Elizabeth Hunt

Struggling to Invent High-Reliability Organizations in Health Care Settings: Insights from the Field
Nancy M. Dixon, Marjorie Shofer

Enhancing Patient Safety through Organizational Learning: Are Patient Safety Indicators a Step in the Right Direction?
Peter E. Rivard, Amy K. Rosen, John S. Carroll

Improving Patient Safety in Hospitals: Contributions of High-Reliability Theory and Normal Accident Theory
Michal Tamuz, Michael I. Harrison

Making Noncatastrophic Health Care Processes Reliable: Learning to Walk before Running in Creating High-Reliability Organizations
Roger K. Resar

Fair and Just Culture, Team Behavior, and Leadership Engagement: The Tools to Achieve High Reliability
Allan S. Frankel, Michael W. Leonard, Charles R. Denham

Achieving a High-Performance Health System: High Reliability Organizations within a Broader Agenda
Anne K. Gauthier, Karen Davis, Stephen C. Schoenbaum

Monday, July 24, 2006

AHRQ - The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities

The Falls Management Program (FMP) is an interdisciplinary quality improvement initiative. It is designed to assist nursing facilities in providing individualized, person-centered care, and improving their fall care processes and outcomes through educational and quality improvement tools.

The manual addresses the following aspects of a fall management program:

  • Chapter 1: Introduction and Program Overview
  • Chapter 2: Fall Response
  • Chapter 3: Data Collection and Analysis Using TRIPS (Tracking Record for Improving Patient Safety)
  • Chapter 4: Long-Term Management
  • Chapter 5: Information and Training for Staff, Primary Care Providers, and Residents and their Families
  • Chapter 6: Environment and Equipment Safety
  • Appendix A: References and Equipment Sources
  • Appendix B: Forms and Training Materials
  • Appendix C: Case Study and Program Examples
  • Appendix D: Falls Engineer Instructions

full text pdf

Friday, July 21, 2006

The Association between Quality of Care and the Intensity of Diabetes Disease Management Programs

C. M. Mangione, R. B. Gerzoff, D. F. Williamson, W. N. Steers, E. A. Kerr, A. F. Brown, B. E. Waitzfelder, D. G. Marrero, R. A. Dudley, C. Kim, W. Herman, T. J. Thompson, M. M. Safford, J. V. Selby and for the TRIAD Study Group*
Ann Intern Med 2006; 107-116.

Abstract Full Text PDF Appendix Figure

What effect does physician "profiling" have on inpatient physician satisfaction and hospital length of stay?

Zemencuk, JK; Hofer, TP; Hayward, RA; Moseley, RH; Saint, S
BMC HEALTH SERVICES RESEARCH, 6: 45-45; APR 4 2006

Abstract Full Text PDF–265K

Thursday, July 20, 2006

Computers in Biology and Medicine - Special Issue on Medical Ontologies

Volume 36, Issues 7-8, Page 669-920 (July-August 2006)

The unexpected high practical value of medical ontologies
Pinciroli, F; Pisanelli, DM
COMPUTERS IN BIOLOGY AND MEDICINE, 36 (7-8): 669-673; JUL-AUG 2006
Abstract Full Text + Links PDF (118 K)


Ontologies supporting continuity of care: The case of heart failure
Eccher, C; Purin, B; Pisanelli, DM; Battaglia, M; Apolloni, I; Forti, S
COMPUTERS IN BIOLOGY AND MEDICINE, 36 (7-8): 789-801; JUL-AUG 2006
Abstract Full Text + Links PDF (799 K)


Building an ontology of adverse drug reactions for automated signal generation in pharmacovigilance
Henegar, C; Bousquet, C; Louet, ALL; Degoulet, P; Jaulent, MC
COMPUTERS IN BIOLOGY AND MEDICINE, 36 (7-8): 748-767; JUL-AUG 2006
Abstract Full Text + Links PDF (799 K)


A pilot ontological model of public health indicators
Surjan, G; Szilagyi, E; Kovats, T
COMPUTERS IN BIOLOGY AND MEDICINE, 36 (7-8): 802-816; JUL-AUG 2006
Abstract Full Text + Links PDF (237 K)


Building medical ontologies by terminology extraction from texts: An experiment for the intensive care units
Charlet, J; Bachimont, B; Jaulent, MC
COMPUTERS IN BIOLOGY AND MEDICINE, 36 (7-8): 857-870; JUL-AUG 2006
Abstract Full Text + Links PDF (333 K)

Wednesday, July 19, 2006

Ranking hospitals according to acute myocardial infarction mortality: should transfers be included?

Kosseim M, Mayo NE, Scott S, Hanley JA, Brophy J, Gagnon B, Pilote L.
Med Care. 2006 Jul;44(7):664-70.

Abstract HTML PDF (259 K)

Tuesday, July 18, 2006

Effects of the medical liability system in Australia, the UK, and the USA

Kessler DP, Summerton N, Graham JR
The Lancet 2006; 368:240-246

Summary Full Text

Monday, July 17, 2006

Friday, July 14, 2006

Thursday, July 13, 2006

Using routine data to define clinical case-mix and compare hospital outcomes in urology.

Mason A, Goldacre MJ, Bettley G, Vale J, Joyce A
BJU International 2006 97:6 1145

html pdf

Development of Measures of the Quality of Emergency Department Care for Children Using a Structured Panel Process

Guttmann, Astrid, Razzaq, Asma, Lindsay, Patty, Zagorski, Brandon, Anderson, Geoffrey M.
Pediatrics 2006 118: 114-123

[Abstract] [Full text] [PDF]

Wednesday, July 12, 2006

Quality Improvement Strategies for Hypertension Management: A Systematic Review

Walsh JM, McDonald KM, Shojania KG, Sundaram V, Nayak S, Lewis R, Owens DK, Goldstein MK.
Med Care. 2006 Jul;44(7):646-657.

Abstract HTML PDF (948 K)

Physician perception of hospital safety and barriers to incident reporting.

Schectman JM, Plews-Ogan ML.
Jt Comm J Qual Patient Safety. 2006;32:337-343.

Abstract

Tuesday, July 11, 2006

Hospital Volume and the Outcomes of Mechanical Ventilation

Kahn, Jeremy M., Goss, Christopher H., Heagerty, Patrick J., Kramer, Andrew A., O'Brien, Chelsea R., Rubenfeld, Gordon D.
N Engl J Med 2006 355: 41-50

Abstract Full Text PDF

Getting doctors to report medical errors: project DISCLOSE.

King ES, Moyer DV, Couturie MJ, Gaughan JP, Shulkin DJ.
J Comm J Qual Patient Saf. 2006;32:382-392.

Abstract

Monday, July 10, 2006

Correlates of Between-Surgeon Variation in Breast Cancer Treatments

Hawley ST, Hofer TP, Janz NK, Fagerlin A, Schwartz K, Liu L, Deapen D, Morrow M, Katz SJ.
Med Care. 2006 Jul;44(7):609-616
Abstract HTML PDF (300 K)


Editorial

Whither Quality of Breast Cancer Care?
Silliman, Rebecca A. MD
Medical Care. 44(7):607-608, July 2006.
HTML PDF (88 K)

Friday, July 07, 2006

IHI - Over 3,000 Hospitals Have Joined the 100,000 Lives Campaign

Institute for Healthcare Improvement (IHI) President and CEO Donald Berwick announces in Atlanta, GA, that hospitals in the 100,000 Lives Campaign have saved an estimated 122,300 lives, exceeding the original goal.

Read the June 14 press release.

Watch a recording of Don Berwick's June 14 plenary speech

Thursday, July 06, 2006

Hospital Quality for Acute Myocardial Infarction: Correlation Among Process Measures and Relationship With Short-term Mortality

Elizabeth H. Bradley; Jeph Herrin; Brian Elbel; Robert L. McNamara; David J. Magid; Brahmajee K. Nallamothu; Yongfei Wang; Sharon-Lise T. Normand; John A. Spertus; Harlan M. Krumholz
JAMA. 2006;296:72-78.

ABSTRACT FULL TEXT PDF


Editorial

Measuring Hospital Quality: What Physicians Do? How Patients Fare? Or Both?
Ashish K. Jha
JAMA. 2006;296:95-97.

EXTRACT FULL TEXT PDF

Wednesday, July 05, 2006

Tuesday, July 04, 2006

Public reporting of hospital outcomes based on administrative data: risks and opportunities

Ian A Scott and Michael Ward
Med J Aust 2006; 184 (11): 571-575.

HTML PDF

Monday, July 03, 2006

MCHP - Application of Patient Safety Indicators in Manitoba: A First Look

Given the potential contribution of administrative data to patient safetyrelated policy and practice, the Manitoba Centre for Health Policy (MCHP) set out to develop patient safety indicators using the MCHP Population Health Research Data Repository (Repository).

Indicators were selected and developed based on a review of the literature, the feasibility of using administrative data, and the input of physician Working Group members.
Based on these criteria the following indicators of compromised patient safety were selected for the report: (1) A selection of “Patient Safety Indicators” (PSIs) developed by AHRQ in the U.S., and (2) measures of complications related to laparoscopic cholecystectomy (removal of gallbladder).

Download the summary

Download the full report

Thursday, June 29, 2006

Alliance for Cardiac Care Excellence(ACE)

www.ofmq.com/ace.html

Twenty-nine leading healthcare organizations have joined forces to improve hospital care in the United States to ensure that all cardiac patients receive care consistent with nationally accepted standards.

The new coalition—the Alliance for Cardiac Care Excellence (ACE) — will help bridge the gap between clinical procedures and treatments proven to be most effective and the care many adult cardiac patients actually receive.

ACE Press Release

ACE Frequently Asked Questions

ACE Program Descriptions

Wednesday, June 28, 2006

The incidence and cost of adverse events in Victorian hospitals 2003–04

Jonathon P Ehsani, Terri Jackson and Stephen J Duckett
Med J Aust 2006; 184 (11): 551-555.

HTML PDF

Tuesday, June 27, 2006

AHRQ - Improving the Quality of Asthma Care

www.ahrq.gov/qual/asthmaqual.htm

The Agency for Healthcare Research and Quality (AHRQ) has developed Asthma Care Quality Improvement: A Resource Guide for State Action and its companion workbook, Asthma Care Quality Improvement: A Workbook for State Action. These materials were designed to help assess the quality of asthma care and create quality improvement strategies.

Asthma Care Quality Improvement: A Resource Guide for State Action (PDF File, 1.4 MB)

Asthma Care Quality Improvement: A Workbook for State Action (PDF File, 560 KB)

Monday, June 26, 2006

AHRQ Patient Safety and Health IT Conference

Conference Home and Agenda

The 2006 Patient Safety and Health IT Conference is an important meeting for anyone interested in new and emerging research around patient safety and health IT implementation; conference materials are now available.

Conference Themes and Topics

  • Track 1: Patient Safety and Health IT Across Settings and Populations
  • Track 2: Implementation Issues in Patient Safety and Health IT
  • Track 3: Improving the Health of Communities through Regional Health Information Exchange (HIE)
  • Track 4: Assessing Value and Evaluating Project Impact
  • Track 5: Achieving and Sustaining Improvements
  • Track 6: Using Reporting Systems for Safety and Quality Improvement
  • Track 7: Working Conditions Challenges in Patient Safety
  • Track 8: Patient and Family Centered Health IT and Safety
  • Track 9: Emerging Approaches to Drive Change in Healthcare

Friday, June 23, 2006

Does date stamping ICD-9-CM codes increase the value of clinical information in administrative data?

Glance, L.G., Dick, A.W., Osler, T.M., and Mukamel, D.B.
Health Services Research 41(1), pp. 231-251.
html pdf

Thursday, June 22, 2006

Expected and Unanticipated Consequences of the Quality and Information Technology Revolutions

Robert M. Wachter, MD
JAMA. 2006;295:2780-2783.

EXTRACT FULL TEXT PDF

Quality of Care for Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Peter K. Lindenauer, Penelope Pekow, Shan Gao, Allison S. Crawford, Benjamin Gutierrez, and Evan M. Benjamin
Ann Intern Med 2006;144 894-903

Abstract Full Text PDF

Wednesday, June 21, 2006

Tuesday, June 20, 2006

Understanding diagnostic errors in medicine: a lesson from aviation

H Singh, L A Petersen, and E J Thomas
Qual Saf Health Care 2006; 15: 159-164.
[Abstract] [Full text] [PDF]

Monday, June 19, 2006

Local clinical quality monitoring for detection of excess operative deaths.

Arrowsmith JE, Powell SJ, Nashef SA.
Anaesthesia. 2006 May;61(5):423-6.
html pdf

Friday, June 16, 2006

Linking community pharmacy dispensing data to prescribing data of general practitioners.

Florentinus SR, Souverein PC, Griens FA, Groenewegen PP, Leufkens HG, Heerdink ER.
BMC Med Inform Decis Mak. 2006 Apr 3;6:18.
pdf

Thursday, June 15, 2006

Are there better ways to determine wait times?

Schaafsma, Joseph
CMAJ 2006 174: 1551-1552

[Full Text] [PDF]

Wednesday, June 14, 2006

Persistence of unsafe practice in everyday work

an exploration of organizational and psychological factors constraining safety in the operating room
S Espin, L Lingard, G R Baker, and G Regehr
Qual Saf Health Care 2006; 15: 165-170.
[Abstract] [Full text] [PDF]

Tuesday, June 13, 2006

The Care of Patients with Severe Chronic Illness: An Online Report on the Medicare Program

A new study by the Dartmouth Atlas Project at the Center for the Evaluative Clinical Sciences (CECS) at Dartmouth Medical School report that:

  • The care of people with chronic illness accounts for more than 75% of all u.s. health care expenditures, but Medicare spends much more per enrollee in some states and regions than it does elsewhere.

  • The differences in spending provide important insights into the causes of waste in the health care system – and the opportunities to improve both the quality and the efficiency of care.
Report: The Care of Patients with Severe Chronic Illness:An Online Report on the Medicare Program

Executive Summary

Interactive data tools and hospital performance reports by state

Printable copy of press release

Monday, June 12, 2006

What Do We Know about Health Care Team Effectiveness? A Review of the Literature

Louise Lemieux-Charles and Wendy L. McGuire
Med Care Res Rev 2006 63: 263-300.
[Abstract] [PDF]

Friday, June 09, 2006

Computer based medication error reporting: insights and implications

M R Miller, J S Clark, and C U Lehmann
Qual Saf Health Care 2006; 15: 208-213.
[Abstract] [Full text] [PDF]

Thursday, June 08, 2006

Procedures in U.S. Hospitals, 2003: HCUP Fact Book No. 7

www.ahrq.gov/data/hcup/factbk7/

Merrill CT, Elixhauser A.
AHRQ Publication No. 06-0039, May 2006.
Agency for Healthcare Research and Quality, Rockville, MD.

The report highlights statistics for 2003 on:

  • Number and types of procedures performed during a hospital stay.
  • Age and gender variation in receipt of procedures.
  • Sources of payment (i.e., who is billed) for various procedures.
  • Procedures associated with the:
  • Longest lengths of stay.
  • Highest charges.
  • Highest inpatient mortality.
In addition, information is presented on the share of the Nation's hospitals that were high-volume providers for specific procedures as well as on how various patient safety indicators changed between 1997 and 2003.

PDF File (9.7 KB)

Wednesday, June 07, 2006

The "To Err is Human" report and the patient safety literature

H T Stelfox, S Palmisani, C Scurlock, E J Orav, and D W Bates
Qual Saf Health Care 2006; 15: 174-178.
[Abstract] [Full text] [PDF]

Tuesday, June 06, 2006

CMWF - Mirror, Mirror on the Wall

An Update on the Quality of American Health Care Through the Patient's Lens
K. Davis, C. Schoen, S. C. Schoenbaum, A.-M. J. Audet, M. M. Doty, A. L. Holmgren, and J. L. Kriss.
The Commonwealth Fund, April 2006.

Overview

report (pdf)

Monday, June 05, 2006

Active surveillance using electronic triggers to detect adverse events in hospitalized patients

Szekendi, M K, Sullivan, C, Bobb, A, Feinglass, J, Rooney, D, Barnard, C, Noskin, G A
Qual Saf Health Care 2006 15: 184-190
[Abstract] [Full text] [PDF]


Editorial

Automated surveillance for adverse events in hospitalized patients: back to the future
Kilbridge, P M, Classen, D C
Qual Saf Health Care 2006 15: 148-149
[Extract] [Full text] [PDF]

Friday, June 02, 2006

AHRQ - Release of the Pediatric Quality Indicator Risk Adjustment Module

www.qualityindicators.ahrq.gov/pdi_download.htm

The Agency for Healthcare Research and Quality (AHRQ) announce the release of the AHRQ Pediatric Quality Indicator (PedQI) risk adjustment module in SAS (Version 3.0b)

Thursday, June 01, 2006

Physician reactions to quantitative individual performance reports

Beckman, H; Suchman, AL; Curtin, K; Greene, RA
AMERICAN JOURNAL OF MEDICAL QUALITY, 21 (3): 192-199; MAY-JUN 2006
[Abstract] [PDF]

Wednesday, May 31, 2006

AHRQ - Cancer Care Quality Measures

Cancer Care Quality Measures: Diagnosis and Treatment of Colorectal CancerEvidence Report
(Publication No. 06-E002)
(PDF file, 1.6 MB)

This evidence report from Agency for Healthcare Research and Quality (AHRQ) identify measures that are currently available to assess the quality of care provided to patients with colorectal cancer (CRC), and assess the extent to which these measures have been developed and tested.


Cancer Care Quality Measures: Symptoms and End of Life CareEvidence Report
(Publication No. 06-E001)
(PDF file, 1.7 MB)

This evidence report from Agency for Healthcare Research and Quality (AHRQ) identify quality measures and the evidence for them to support quality assessment and improvement in the palliative care of patients with cancer in the areas of pain, dyspnea, depression, and advance care planning (ACP), and identify important gaps in related research.

Tuesday, May 30, 2006

BMJ - NICE work

Review of NICE's recommendations, 1999-2005
James Raftery
BMJ 2006;332:1266-1268
[Full text] [PDF] [extra: Classification of the recommendations]

Resource allocation: NICE work
BMJ 2006;332:1266
[Full text]

How NICE may be outflanked
R E Ferner, Sarah E McDowell
BMJ 2006;332:1268-1271
[Full text] [PDF] [extra: References w1 - w36]

Monday, May 29, 2006

CMWF - Committed to Safety: Ten Case Studies on Reducing Harm to Patients



This report from The Commonwealth Fund presents 10 case studies of health care organizations, clinical teams, and learning collaborations that have designed innovations in five areas that hold great promise for improving patient safety:

  • promoting an organizational culture of safety,
  • improving teamwork and communication,
  • enhancing rapid response to prevent heart attacks and other crises in the hospital,
  • preventing health care–associated infections in the intensive care unit, and
    preventing adverse drug events throughout the hospital.

report pdf

Executive Summary

Friday, May 26, 2006

Development and Validation of a Psychiatric Case-Mix System

Kevin L. Sloan, Maria E. Montez-Rath, Avron Spiro III, Cindy L. Christiansen, Susan Loveland, Priti Shokeen, Lawrence Herz, Susan Eisen, James N. Breckenridge, Amy K. Rosen
Medical Care. 44(6):568-580, June 2006.
Abstract HTML PDF (711 K)

Thursday, May 25, 2006

Indices for Continuity of Care: A Systematic Review of the Literature

Sandra H. Jee and Michael D. Cabana
Med Care Res Rev 2006 63: 158-188.
[Abstract] [PDF]

Wednesday, May 24, 2006

HCUP Statistical Briefs

www.hcup-us.ahrq.gov/reports/statbriefs.jsp

The Agency for Healthcare Research and Quality (AHRQ) has launched a new series of Web-based publications, the HCUP Statistical Briefs containing information from its Healthcare Cost and Utilization Project (HCUP).

These publications will provide concise, easy-to-read information on hospital care, costs, quality, utilization, and access.

Tuesday, May 23, 2006

MJA - The safety and quality of health care: where are we now?

Key achievements of the Australian Council for Safety and Quality in Health Care
Med J Aust 2006; 184 (10): S37.
HTML PDF

The safety and quality of health care: from Council to Commission
Richard A Smallwood
Med J Aust 2006; 184 (10): S39-S40.
HTML PDF

Shared meanings: preferred terms and definitions for safety and quality concepts
William B Runciman
Med J Aust 2006; 184 (10): S41-S43.
HTML PDF

Sea change: public reporting and the safety and quality of the Australian health care system
Clifford F Hughes and Patricia Mackay
Med J Aust 2006; 184 (10): S44-S47.
HTML PDF

Health care safety and quality: where have we been and where are we going?
Bruce H Barraclough and Jim Birch
Med J Aust 2006; 184 (10): S48-S50.
HTML PDF

Measurement of the safety and quality of health care
Sarah Scobie, Richard Thomson, John J McNeil and Paddy A Phillips
Med J Aust 2006; 184 (10): S51-S55.
HTML PDF

Designing safer health care through responsive regulation
Judith Healy and John Braithwaite
Med J Aust 2006; 184 (10): S56-S59.
HTML PDF

Improving safety and quality: how can education help?
Merrilyn M Walton and Susan L Elliott
Med J Aust 2006; 184 (10): S60-S64.
HTML PDF

The development of the National Reporting and Learning System in England and Wales, 2001–2005
Susan K Williams and Sue S Osborn
Med J Aust 2006; 184 (10): S65-S68.
HTML PDF

The WHO World Alliance for Patient Safety: towards the years of living less dangerously
Liam J Donaldson and Martin G Fletcher
Med J Aust 2006; 184 (10): S69-S72.
HTML PDF

Monday, May 22, 2006

AARP - Home Care Quality: Emerging State Strategies to Deliver Person-Centered Services

assets.aarp.org/rgcenter/il/2006_07_hcc.pdf

Folkemer, Donna, and Barbara Coleman.
PPI Issue Paper #2006-07. February 2006

This paper reviews the quality improvement initiatives of three states (Wisconsin, Washington, and South Carolina) to ensure faster consumer access to services and supports, to guarantee that consumers receive prompt and competent assistance from care managers and providers, and to assess how well consumers are being served through feedback from the consumers.

Friday, May 19, 2006

Qual Manag Health Care - Why We Love Quality but Hate to Measure It

Quality Management in Health Care. 15(2):116-120, April/June 2006.
Peabody, John
Abstract HTML PDF (73 K)

Thursday, May 18, 2006

Am J Med Qual - Consumer Assessment of Health Providers and Systems (CAHPS)

Evolving to Meet Stakeholder Needs
Charles Darby, Christine Crofton, and Carolyn M. Clancy
American Journal of Medical Quality 2006 21: 144-147.
[PDF]

Wednesday, May 17, 2006

What Is the Empirical Basis for Paying for Quality in Health Care?

Meredith B. Rosenthal and Richard G. Frank
Med Care Res Rev 2006 63: 135-157.
[Abstract] [PDF]

Tuesday, May 16, 2006

Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care

B. Chaudhry, J. Wang, S. Wu, M. Maglione, W. Mojica, E. Roth, S. C. Morton and P. G. Shekelle
Ann Intern Med 2006; 742-752.
Abstract Full Text PDF

Monday, May 15, 2006

Leapfrog Group - Designing incentives to improve care tools

Tools

The Leapfrog Group offer tools to design, implement, and evaluat financial and nonfinancial incentives to reward hospitals for providing high-quality care.

These tools include:

  • profiles of insurers, purchasers, and employers that have implemented incentive programs
  • models of potential incentives
  • strategies for determining the business case for such programs
  • how to communicate benefits
  • other practical materials

Friday, May 12, 2006

BMA - Reporting Adverse Drug Reactions

A guide for healthcare professionals
British Medical Association
May 2006

The BMA believes that effective reporting of adverse drug reactions (ADRs) is an important mechanism for post-marketing surveillance of medicines and is vital for maintaining drug safety.

This report includes significant changes to the Yellow Card Scheme through which suspected ADRs can be reported spontaneously.

Also in the report are recommendations about ways in which healthcare professionals can help improve reporting of ADRs.

Download the report in PDF format (493K)

Wednesday, May 10, 2006

Arch Surg - Incidence, Patterns, and Prevention of Wrong-Site Surgery

Mary R. Kwaan; David M. Studdert; Michael J. Zinner; Atul A. Gawande
Arch Surg 2006 141: 353-358
ABSTRACT FULL TEXT PDF

Tuesday, May 09, 2006

Qual Manag Health Care - Readmission Data for Outcomes Measurement

Identifying and Strengthening the Empirical Base
Quality Management in Health Care. 15(2):83-95, April/June 2006.
Landrum, Laurie ; Weinrich, Sally.
Abstract HTML PDF (100 K)

Health Econ - Cost inefficiency and mortality rates in Florida hospitals

Deily, ME; McKay, NL
Health Economics, 15 (4): 419-431; APR 2006
Abstract PDF

Monday, May 08, 2006

Pharmacy Quality Alliance (PQA)

www.pqaalliance.org

Centers for Medicare & Medicaid Services (CMS) announces the formation of the Pharmacy Quality Alliance (PQA).

The Mission of the PQA is to improve health care quality and patient safety through a collaborative process in which key stakeholders agree on a strategy for measuring performance at the pharmacy and pharmacist-levels; collecting data in the least burdensome way; and reporting meaningful information to consumers, pharmacists, employers, health insurance plans, and other healthcare decision-makers to help make informed choices, improve outcomes and stimulate the development of new payment models.

Friday, May 05, 2006

Ann Intern Med - Patients' Global Ratings of Their Health Care Are Not Associated with the Technical Quality of Their Care

John T. Chang, Ron D. Hays, Paul G. Shekelle, Catherine H. MacLean, David H. Solomon, David B. Reuben, Carol P. Roth, Caren J. Kamberg, John Adams, Roy T. Young, and Neil S. Wenger
Ann Intern Med. 2006 May 2;144(9):665-72.
Abstract Full Text PDF

NHS - Website on cardiac care

heartsurgery.healthcarecommission.org.uk

The Healthcare Commission has worked with the Society of Cardiothoracic Surgeons of Great Britain and Ireland to develop a website on cardiac care.

The website provides detailed information to help patients who need cardiac surgery to make informed decisions about their care and treatment.

Patients are able to see the performance of cardiac units and in many cases of their individual surgeons.

Thursday, May 04, 2006

AHRQ - Patient Safety Tools and Resources

www.ahrq.gov/qual/pstools.htm
April 2006.
Agency for Healthcare Research and Quality, Rockville, MD.

The information here summarizes AHRQ patient safety tools and resources designed for health systems, providers, and consumers.

JAMA - How the US Drug Safety System Should Be Changed

Brian L. Strom
JAMA. 2006;295:2072-2075.
EXTRACT FULL TEXT PDF

Wednesday, May 03, 2006

AHRQ - Pay for Performance: A Decision Guide for Purchasers

This Guide from Agency for Healthcare Research and Quality (AHRQ) is intended to be used by public and private purchasers of health care services who are considering sponsorship of a pay-for-performance (P4P) initiative.

Twenty questions are presented for consideration along with options and any available evidence for each.

The questions are grouped into four phases: contemplation, design, implementation, and evaluation.

PDF File, 320 KB

Tuesday, May 02, 2006

Am J Med Qual - National Quality Forum 30 safe practices

priority and progress in Iowa hospitals
Ward MM, Evans TC, Spies AJ, Roberts LL, Wakefield DS.
Am J Med Qual. 2006;21:101-108.
[Abstract] [PDF]