Healthcare Quality & System Overview

• MIDTERM

IOM's 6 Dimensions of Quality (STEEEP AIMS)

• These dimensions serve as guidelines for enhancing healthcare
• Safe: Avoid harming patients
• Timely: Reduce wait times
• Effective: Utilize evidence-based care
• Efficient: Minimize waste
• Equitable: Provide equal care regardless of demographics
• Patient-centered: Respect patient preferences and needs

Four Levels of the Healthcare System

• Environment (Level D): the broader social, economic, and regulatory factors
• Organization (Level C): Institutions like hospitals and clinics
• Microsystem (Level B): Smaller units within healthcare organizations, such as departments and teams
• Individual Patient-Clinician (Level A): covers direct patient care interactions

Wennberg's Three Categories of Care

• Effective Care: Treatments proven beneficial for nearly all patients, like vaccines
• Preference-Sensitive Care: Treatments where patient preference guides decisions (e.g., choosing surgery vs. therapy)
• Supply-Sensitive Care: Care dependent on resource availability rather than patient need (like hospitals admitting more patients because they have extra beds)

Three Categories of Quality Defects (Wennberg)

• Overuse: Providing unnecessary treatments such as prescribing antibiotics for viral infections
• Underuse: Failing to provide necessary care such as a lack of cancer screenings for at-risk populations
• Misuse: Errors in care lead to harm like medication errors

Access to Care Influenced By

• Cost of care
• Provider location
• Insurance coverage
• Cultural/language barriers
• Transportation availability
• Health literacy levels

Reports Sparking the Quality Improvement Movement

• The Urgent Need to Improve Healthcare Quality (1998): Highlighted quality issues
• To Err is Human (2000): Brought attention to medical errors and showed that medical mistakes kill thousands each year
• Crossing the Quality Chasm (2001): Introduced STEEEP aims and rules
• AHRQ National Healthcare Quality Report (2003-2011): Identified improvement areas for hospitals
• Improving Diagnosis in Health Care (2016): Focused on diagnostic errors

Unwarranted vs. Warranted Variation

• Warranted Variation is based on patient preferences and needs
• Unwarranted Variation is differences in care without medical justification

Random vs. Assignable Variation

• Random Variation is natural fluctuations that follow probability laws (like flu cases going up and down)
• Assignable Variation is caused by specific, identifiable factors (like a hospital infection outbreak)

Donabedian's Three Types of Quality Outcomes

• Structure: Healthcare facilities, equipment, and staff qualifications
• Process: Actions taken in providing care, such as tests performed
• Outcome: The final result of care, such as recovery rates

Major Stakeholders in Healthcare

• Clinicians such as doctors and nurses
• Patients are the recipients of care
• Payers include insurance companies and government programs
• Administrators include hospital and clinic management
• Society/Public includes regulatory bodies, policymakers, and communities

Data Collection Methods & Their Advantages/Disadvantages

• Retrospective Data Collection analyzes past records and uses existing data but may be outdated or incomplete
• Prospective Data Collection gathers real-time data and is more accurate but time-consuming
• Patient Surveys collect feedback on experiences and captures patient perspective but are subjective responses
• Administrative Data uses billing and coding data, where large dataset availability exists but may not capture clinical details

Data Collection Approach

• Collect data "just in time" rather than "just in case" to avoid unnecessary waste
• Quality of care can improve while decreasing costs

Functional Status Surveys (ADLs, IADLs)

• ADLs (Activities of Daily Living) are basic self-care tasks like bathing and dressing
• IADLs (Instrumental Activities of Daily Living) are more complex activities (managing finances, transportation).