QUALITY & SAFETY: improvement

‏إظهار الرسائل ذات التسميات improvement. إظهار كافة الرسائل

الاثنين، 10 سبتمبر 2012

Improving primary care in Australia through the Australian Primary Care Collaboratives Program: a quality improvement report

Improving primary care in Australia through the Australian Primary Care Collaboratives Program: a quality improvement report -- Knight et al. -- BMJ Quality and Safety Search the BMJ BMJ BMJ Journals BMJ Careers BMJ Learning Evidence Centre doc2doc BMJ Group

Search this site

Advanced search

The international journal of healthcare improvement Online First Current issue Archive About the journal Submit a paper Subscribe Help Online First Current issue Archive Supplements eLetters Topic collections RSS Home > Online First > Article

BMJ Qual Saf doi:10.1136/bmjqs-2011-000165 Quality improvement report Improving primary care in Australia through the Australian Primary Care Collaboratives Program: a quality improvement report

OPEN ACCESS Andrew W Knight1, Claire Caesar2, Dale Ford2, Alison Coughlin2, Colin Frick2

1The Australian Primary Care Collaboratives Program, The Improvement Foundation (Australia), Katoomba, New South Wales, Australia

2The Improvement Foundation (Australia), South Australia, Australia Correspondence to Dr Andrew Walter Knight, The Australian Primary Care Collaboratives Program, The Improvement Foundation (Australia), PO Box 3645 Adelaide South Australia 5000 Australia; awknight{at}aapt.net.au Contributors AK wrote the article. CC, DF, AC and CF provided comments and edited during writing. All authors provided approval to publish.

Accepted 22 May 2012 Published Online First 12 July 2012 Abstract Problem Effective and affordable health systems have good primary care. Access, equity, care of chronic conditions and quality are key priorities in primary care in Australia.

Design A large-scale quality improvement collaborative addressing diabetes, coronary heart disease (CHD), access, chronic obstructive pulmonary disease (COPD), patient self-management, Aboriginal health and diabetes prevention.

Setting General practices and Aboriginal medical services across Australia.

Key Measures for Improvement Sample measures are reported.

Strategy for Change The Improvement Foundation (Australia) adapted collaborative strategies used in the UK. Health service teams attended three workshops, separated by activity periods and followed by 12 months of further work. Teams were supported by local collaborative program managers to make changes and report measures. Services received feedback about improvement compared with their wave.

Effects of Change 1185 health services participated in 13 waves between 2005 and 2011. 83% of Australian divisions of general practice participated, and 262 support staff received quality improvement training. Key measures show improvement in all topics except access. 397?111 patients were on the disease registers of participating health services.

Lessons learnt The collaborative methodology is transferable to primary care in Australia. Results may reflect improved data recording and disease coding, as well as changes in clinical care. Team dynamics and local support are important success factors. Collaboratives are a useful tool in a program of clinical quality improvement. The APCC will work with the new primary healthcare organisations which are part of health reforms in Australia to improve data reporting, improve diabetes care and entrench quality improvement in the emerging environment.

General practice quality improvement Footnotes Funding The Australian Primary Care Collaboratives Program is funded by the Australian Government Department of Health and Ageing and delivered by the Improvement Foundation (Australia) Ltd.

Competing interests None.

Provenance and peer review Not commissioned; externally peer reviewed.

Data sharing statement This article publishes a small indicative subset of the data collected by the APCC Program in the course of its improvement work. The complete dataset is held by the Improvement Foundation and is subject to agreements with participating health services which restrict its use. Researchers wishing to access the data may make direct contact with the Improvement Foundation (Australia).

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

CiteULike

Connotea

Delicious

Digg

Facebook

Google+

Mendeley

Technorati

Twitter What's this?

OPEN ACCESS This Article Abstract Full text PDF All Versions of this Article: bmjqs-2011-000165v1 bmjqs-2011-000165v2 most recent Services Email this link to a friend Alert me when this article is cited Alert me if a correction is posted Alert me when eletters are published Article Usage Statistics Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request permissions Add to portfolio Responses Submit a response No responses published Citing articles Load citing article information Citing articles via Scopus Google Scholar Articles by Knight, A. W. Articles by Frick, C. Search for related content PubMed PubMed citation Articles by Knight, A. W. Articles by Frick, C. Related Content Unlocked Load related web page information Social bookmarking Add to CiteULike

CiteULike

Connotea

Delicious

Digg

Facebook

Google+

Mendeley

Technorati

Twitter What's this?

Free sample

This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of BMJ Quality & Safety.
View free sample issue >>

Online survey

Take 2 minutes to complete this survey and be entered into a prize draw to win £100 in Amazon vouchers.

Take the survey >>

Email alerts

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Online ISSN 2044-5423

View the original article here

This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

الأحد، 29 يوليو 2012

Comparative economic analyses of patient safety improvement strategies in acute care: a systematic review

The international journal of healthcare improvement BMJ Qual Saf 2012;21:448-456 doi:10.1136/bmjqs-2011-000585 Edward Etchells1,3,6, Marika Koo2,3, Nick Daneman1,3,6, Andrew McDonald1,3,6, Michael Baker4,6, Anne Matlow1,5,6, Murray Krahn4,6, Nicole Mittmann2,3,6

1University of Toronto Centre for Patient Safety Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

2Health Outcomes and Pharmacoeconomics (HOPE) Research Centre HOPE Research Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

3Sunnybrook Health Sciences Centre, Toronto, Canada

4University Health Network Toronto, Ontario, Canada

5Hospital for Sick Children, Toronto, Ontario, Canada

6University of Toronto, Toronto, Ontario, Canada Correspondence to Dr Edward Etchells, 2075 Bayview Avenue H469, Toronto M4N 3M5, Ontario, Canada; edward.etchells{at}sunnybrook.caContributors EE contributed to the conception and design of the study, analysed and interpreted the data, and was one of the principle writers of the research article. MK contributed to the concept and design of the study, collected, analysed and interpreted the data, and contributed to the writing and editing of the research article. ND contributed to the concept and design of the analysis, edited and reviewed each draft of the research article. AMc contributed to the concept and design of the analysis, edited and reviewed each draft of the research article. MB contributed to the concept of the study and edited each draft of the research article. AM contributed to the methodology of the study and participated in editing the research article. MK contributed to the conception and design of the study and reviewed all drafts of the research article. NM contributed to the concept and design of the study and was one of the principle writers of the research article. All authors approved the final version of the research article.

Accepted 4 January 2012 Published Online First 22 April 2012 Background The objective was to systematically review comparative economic analyses of patient safety improvements in the acute care setting.

Methods A systematic review of 15 patient safety target conditions and six improvement strategies was conducted. The authors searched the published literature through Medline (2000–November 2011) using the following search terms for costs: ‘costs and cost analysis’, ‘cost-effectiveness’, ‘cost’ and ‘financial management, hospital’. The methodological quality of potentially relevant studies was appraised using Cochrane rules of evidence for clinical effectiveness in quality improvement, and standard economic methods.

Results The authors screened 2151 abstracts, reviewed 212 potentially eligible studies, and identified five comparative economic analyses that reported a total of seven comparisons based on at least one clinical effectiveness study of adequate methodological quality. Pharmacist-led medication reconciliation to prevent potential adverse drug events dominated (lower costs, better safety) a strategy of no reconciliation. Chlorhexidine for vascular catheter site care to prevent catheter-related bloodstream infections dominated a strategy of povidone-iodine for catheter site care. The Keystone ICU initiative to prevent central line-associated bloodstream infections was economically dominant over usual care. Detecting surgical foreign bodies using standard counting compared with a strategy of no counting had an incremental cost of US$1500 (CAN$1676) for each surgical foreign body detected. Several safety improvement strategies were less economically attractive, such as bar-coded sponges for reducing retained surgical sponges compared with standard surgical counting, and giving erythropoietin to reduce transfusion requirements in critically ill patients to avoid one transfusion-related adverse event.

Conclusions Five comparative economic analyses were found that reported a total of seven comparisons based on at least one effectiveness study of adequate methodological quality. On the basis of these limited studies, pharmacist-led medication reconciliation, the Keystone ICU intervention for central line-associated bloodstream infections, chlorhexidine for vascular catheter site care, and standard surgical sponge counts were economically attractive strategies for improving patient safety. More comparative economic analyses of such strategies are needed.

Funding Unrestricted grant from the Canadian Patient Safety Institute.

Competing interests None.

Provenance and peer review Not commissioned; externally peer reviewed.

Data sharing statement This research article is a literature review. All data presented in this article have been previously published.

This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of BMJ Quality & Safety.
View free sample issue >>

View the original article here

This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

What is "quality improvement" and how can it transform healthcare?

The international journal of healthcare improvement Qual Saf Health Care 2007;16:2-3 doi:10.1136/qshc.2006.022046 Paul B Batalden1, Frank Davidoff2

1Center for Evaluative Sciences, Dartmouth Medical School, Hanover, New Hampshire, USA

2Institute for Healthcare Improvement, Cambridge, Massachusetts, USA Correspondence to:? Dr P B Batalden? Center for Evaluative Sciences, Dartmouth Medical School, Hanover, NH 03755, USA Transformation of healthcare—quality improvement

Many in healthcare today are interested in defining “quality improvement”. We propose defining it as the combined and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning; fig 1). This definition arises from our conviction that healthcare will not realise its full potential unless change making becomes an intrinsic part of everyone’s job, every day, in all parts of the system. Defined in this way, improvement involves a substantial shift in our idea of the work of healthcare, a challenging task that can benefit from the use of a wide variety of tools and methods (table 1).

Table 1 Illustrative tools and methods in improvement

Figure 1 Linked aims of improvement.

Although all improvement involves change, not all changes are improvement. If healthcare is going to benefit fully from the science of disease biology, we need to be sure that the changes we make …

This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of BMJ Quality & Safety.
View free sample issue >>

View the original article here

This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.