Quality Improvement Basics in Healthcare

Study Notes

Medical errors cause between 44,000 and 98,000 deaths annually.
The Institute of Medicine outlined goals for improving U.S. healthcare quality and performance in 2001.
Quality improvement involves common definitions of quality, the importance of healthcare quality, and key figures in quality improvement.
Systems are assessed based on the Baldrige Award criteria.
Quality is evaluated through structure, process, and outcomes.
Structure is the material and human resources of the organization (e.g. staff, equipment).
Process is the actual delivery of care by healthcare workers.
Outcome involves the results of implementing care processes.
Donabedian's four aspects of health and illness include technical management, interpersonal relationships, care amenities, and ethical principles.
Effective healthcare delivery is both effective and efficient.
Effectiveness means actions are based on knowledge and benefit all patients who need the service while avoiding unnecessary service to those unlikely to benefit. Avoiding waste of resources (personnel, supplies, ideas, energy) defines efficiency.
Underuse involves failing to provide needed services while overuse involves providing services with excessive risks.
Misuse is delivering a poor-quality service that harms the patient, such as prescribing a drug to which they are allergic.
Healthcare quality is important for appropriate use of resources, underuse/overuse/misuse issues, as well as improving patients' health.

Health informatics combines information technology with healthcare to improve quality, efficiency, and reduce costs.
Health analytics uses quantitative data to support informed decision-making in healthcare.
Data mining analyzes large quantities of data to enhance healthcare outcomes.

Measurement in quality improvement involves definition, reliability, and validity of the metric being measured.
Process Variation and Statistical Process Control is a method for recognizing and dealing with common and special causes of variation within healthcare processes.
Special cause variation is due to unusual, infrequent, or unique events.
Common cause variation is due to the usual or normal causes of variation within a process.

Continuous Process Improvement (CQI) involves continuous improvements and is associated with the process part of Donabedian's description of healthcare quality. CQI uses TQM or CQI's five dimensions to assess healthcare delivery processes; the five dimensions are process focus, customer focus, data-based decision making, employee empowerment, and organizational scope.
FOCUS-PDCA (Find, Organize, Clarify, Understand, Select, Plan, Do, Check, Act) involves an iterative approach to solving healthcare process problems.

Tools like process mapping (flowcharts, workflow diagrams) and data collection (check sheets, chart abstractions/audits) are used for quality improvement. Processes include cause-and-effect (fishbone) diagrams and Pareto charts.

The assignment asks questions about EHR (electronic health records) and EMR (electronic medical records), requesting definitions, comparing and contrasting these, describing benefits, and outlining disadvantages.