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J E Ibrahim

Publications and source records attributed to J E Ibrahim.

11 recordsLinked to original sources
PubMed2000

Managed care.

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Australia↗
PubMed2000

A system for systems is required for quality health systems.

Improving quality of health-care requires a systematic approach at many different levels within a health system. The levels range from the interactions between individual patient-health provider to the international stage. The provision of care within and between each level needs to be systematically organised if the quality of our health-care is to improve. There is a need to develop a systematic approach to the multiple systems within health care. An organisational structure similar to the Cochrane Collaboration may provide the mechanism to better coordinate all our efforts to improve health-care quality.

Australia↗
PubMed1999

The extraction of quality-of-care clinical indicators from State health department administrative databases.

OBJECTIVE: To assess whether three proposed quality-of-care indicators (unplanned readmissions, hospital-acquired bacteraemia, and postoperative wound infection) can be accurately identified from State health department databases. DESIGN: Algorithms were applied to State health department databases to maximise the identification of individuals potentially positive for each indicator. Records of these patients were then examined to determine the percentage of cases that met the precise indicator definitions. SETTING: 10 public, acute-care hospitals from Victoria, South Australia and New South Wales. Data from the 1994-95 and 1995-96 financial years were collected. PARTICIPANTS: Individuals 18 years of age or older who were identified from State health department administrative databases as potentially meeting the indicator criteria. MAIN OUTCOME MEASURES: The proportion of screened cases that met the precise indicator definitions, and the elements of the indicator definitions which could not be extracted from the administrative databases. RESULTS: The proportions of cases confirmed by medical record review to be positive for the indicator events were 76.3% for unplanned readmissions within 28 days, 20% for hospital-acquired bacteraemia, 43.5% for wound infections after clean surgery, and 34.8% for wound infections after contaminated surgery. The clinical elements of each indicator definition were not easily extracted from the administrative databases. CONCLUSIONS: The three proposed clinical indicators could not be extracted from current State health department databases without an extensive process of secondary medical record review. If administrative databases are to be used for assessing quality of care, more systematic recording of data is needed.

Algorithms↗
PubMedDate not supplied

Phenomenon of quality and health-care: snowball or an avalanche?

The quality-of-care in health as a phenomenon is developing through small incremental steps. Some suggest this approach is too slow and more rapid change is warranted. It is possible to achieve more rapid change by reaching a 'tipping point' or a critical level. To reach a critical level requires (i) identifying key people, (ii) having an idea that sticks, and (iii) having the right context. Examples from selected aspects of quality in health-care including the use of report cards, recognition and remedial action for adverse events, the substantial reviews of health systems for quality-of-care suggest the critical level has been achieved. However, when the three rules for reaching the 'tipping point' are examined closely, it would seem that much more work is required to transform quality in health-care from a snowball into an avalanche.

Australia↗