Introduction to Health Care Quality Theory, Methods, and Tools

Introduction to Health Care Quality explores the issues of quality management in today's health care environment, and provides clear guidance on new and perennial challenges in the field. The idea of 'quality' is examined in the context of a variety of health care situations, with practical emphasis on assessment, monitoring, analysis, and improvement. Students will learn how to utilize statistical tools, patient data, and more to understand new models of reimbursement, including pay for performance and value-based purchasing. They will also learn how to learn how to incorporate technology into everyday practice. Each chapter centers on an essential concept, but builds upon previous chapters to reinforce the material and equip students with a deeper understanding of the modern health care industry. Real-world situations are highlighted to show the intersection of theory and application, while cutting-edge methodologies and models prepare students for today's data-driven health care environment.

Health care quality is defined and assessed according to setting, with factors such as standards, laws, regulations, accreditation, and consumerism impacting measurement and analysis in tremendous ways. This book provides an overview of this complex field, with insightful discussion and expert practical guidance.

Health care today is worlds away from any other point in history. As the field grows ever more complex, quality management becomes increasingly critical for ensuring optimal patient care. Introduction to Health Care Quality helps students and professionals make sense of the issues, and provide top-notch service in today's rapidly changing health care environment.

List of Figures and Tables xvii

Preface xxi

Acknowledgments xxv

About the Author xxvii

Introduction xxix

PART I: QUALITY MANAGEMENT FUNDAMENTALS 1

1 Foundations of Health Care Quality 3

Defining Quality 4

Contributions of Quality Theorists—Nothing New under the Sun 5

Quality Management Methodologies 14

Organizations Making an Impact on Quality and Safety Standards 16

Centers for Medicare and Medicaid Services 21

Institute for Healthcare Improvement 24

Agency for Health Research and Quality 25

National Quality Forum 27

The Leapfrog Group 27

Data: The Foundation of Quality Management 28

Summary 32

Key Terms 33

Quality Concepts in Action 33

References 33

Suggestions for Further Reading 34

Useful Websites 35

2 Understanding the Impact of Health Care Reform 37

The Affordable Care Act 38

New Models of Payment 42

New Models of Providing Care 47

New Models for Collecting Data 53

Improving Interpersonal Communication 56

Summary 60

Key Terms 60

Quality Concepts in Action 61

References 61

Suggestions for Further Reading 62

Useful Websites 63

3 Making the Case for Change 65

What Is Involved in Change? 66

Managing and Measuring Quality in the Reform Environment 69

Who Is Involved in Change? 71

Changing Communication 77

The Role of Data in Promoting Change 86

Summary 89

Key Terms 90

Quality Concepts in Action 90

References 91

Suggestion for Further Reading 92

Useful Websites 92

4 New Challenges for Health Care Professionals 93

Meeting Statistical Expectations for Standards of Care 94

Meeting Patient Expectations 97

Role of Dashboards 100

Role of Data Analysis 104

Understanding Different Kinds of Data 105

Managing Care for Chronic Illness across the Continuum 109

Managing Aggregated Patient Care Issues 112

Improving Communication 121

Summary 127

Key Terms 127

Quality Concepts in Action 127

References 128

Suggestions for Further Reading 129

Useful Websites 130

5 Improving Patient Safety 133

Understanding Medical Errors and Adverse Events 134

High-Reliability Organizations 139

The Role of Quality Management in Promoting a Safety Culture 142

Prioritizing Improvements 147

Expanding Data Sources: Partnerships to Develop Best Practice 154

Leading Organizational Improvements 155

The Role of Nursing Leaders in Promoting Safety 158

The Role of the Medical Staff in Promoting Safety 162

Promoting Safety through Effective Communication 165

Summary 169

Key Terms 169

Quality Concepts in Action 169

References 170

Suggestions for Further Reading 170

Useful Websites 171

PART II: APPLYING QUALITY TOOLS AND TECHNIQUES 173

6 Working with Quality Tools and Methods 175

Identifying a Problem 176

Describing Information 183

Variability 185

Making Use of Data 188

Significance

Using Quality Tools and Techniques to Improve Safety 189

Clinical Pathways or Care Maps 195

Improving Performance: Plan-Do-Study-Act 201

Summary 206

Key Terms 206

Quality Concepts in Action 206

Suggestions for Further Reading 207

Useful Websites 207

7 Working with Quality Data 209

Working with Measurements 210

Understanding Issues in Data Collection 214

Using Data to Understand Appropriateness of Care 218

The Value of Aggregated Data in Performance Improvement 222

The Role of Data in Managing Chronic Disease 225

Using Data to Monitor Variability 230

Publicly Reported Data 234

Interpreting and Making Use of Data 237

Quality Management in the Future 239

Summary 240

Key Terms 241

Quality Concepts in Action 241

References 241

Suggestions for Further Reading 242

Useful Websites 242

8 Working with Quality and Safety Measures 245

Commitment to Quality 246

The Future of Quality

Using Measures to Understand Care 247

Defining the Measure 250

Process Measures 253

Pay for Performance 263

P4P Measures

Patient Satisfaction Measures 264

Monitoring Measures 268

Safety and Environment of Care Measures 273

Summary 277

Key Terms 277

Quality Concepts in Action 277

References 278

Suggestions for Further Reading 279

Useful Websites 279

9 Translating Information into Action 281

Maximizing Efficiency 282

Determining Appropriate Levels of Care 288

End-of-Life Care/Advanced Illness 289

The Reform Mandate

Understanding Mortality 291

Improving ICU Care 295

Analyzing Readmission 298

Case Example: Readmission

Using Data for Improvements 299

Patient-Centered Care 303

Delivering the Message 305

Summary 308

Key Terms 308

Quality Concepts in Action 309

References 309

Suggestions for Further Reading 310

Useful Websites 311

10 Preparing for the Future 313

The New Quality Management 314

The New Role of Administrators

The Business of Health Care 315

Measurements Are the Nuts and Bolts of Quality 319

Getting Everyone on Board 322

Challenges for the Future 324

Summary 326

Key Terms 327

Quality Concepts in Action 327

Suggestions for Further Reading 327

Useful Websites 328

Index 329

YOSEF D. DLUGACZ, PHD, is the Senior Vice President and Chief of Clinical Quality, Education and Research of the Krasnoff Quality Management Institute of the Northwell Health system. The goal of the Institute is to bridge the gap between theoretical knowledge learned in the academic setting and the realities of applying quality management methods in today's health care reform environment. Dr. Dlugacz's research focuses on developing models that link quality, safety, good clinical outcomes and financial success for increased value and improved efficiencies.