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Biomedical subjects

P M Schyve

Publications and source records attributed to P M Schyve.

At least 19 recordsLinked to original sources
PubMed2000

The evolution of external quality evaluation: observations from the Joint Commission on Accreditation of Healthcare Organizations.

The Joint Commission on Accreditation of Healthcare Organizations, the oldest health care accrediting body in the world, currently accredits almost 20000 organizations in the USA. Although continuing to be professionally-sponsored, accreditation's rapid growth in recent years has been driven by the external users of accreditation--government, purchasers, and public--rather than by the original users, the professionals themselves. This experience in the USA suggests that over time successful external quality evaluation mechanisms throughout the world will involve representatives of the public, purchasers, and government in establishing standards and setting policies. Without this involvement, these stakeholders are unlikely to find the mechanisms credible in addressing their needs, and will seek alternatives--adding cost and duplication to the external quality evaluation system. Successful mechanisms are also likely to provide more detailed information about an organization's performance to the public, purchasers, and the government, while creating evaluation processes that provide for innovation and support improvement in efficiency, as well as quality, through incorporation of aspects of the Baldrige and European Foundation for Quality Management approaches to organizational excellence. Finally, successful evaluation mechanisms are likely to create a special focus on the safety of care, incorporating aspects of the International Organization for Standardization's ISO 9000 approach to quality management. While the specific nature, priority, and timing of these changes will differ from country to country, they are likely to influence the evolution of external quality evaluation throughout the world. External evaluation of health care organizations' quality holds great promise, but its long-term success depends on responding to all those who will want to depend on it.

Diffusion of Innovation↗
PubMed1996

The evolving role of the Joint Commission for the Accreditation of Healthcare Organizations.

The Joint Commission on Accreditation of Healthcare Organizations, in collaboration with health professionals and others, is pursuing a process for assessing health care organizations that incorporates contemporary approaches to evaluating health care quality, while stimulating organizations to meet or exceed standards through recommendations for improvement and through education and consultation. To reach this goal, the Commission is currently evaluating various measurement systems that can be combined with a standards-based survey to accredit health care organizations. The Orion Project, an additional initiative of the Joint Commission, is concurrently striving to create a continuous accreditation process at the local level that supports a health care organization's efforts to improve its performance.

Data Collection↗
PubMed1994

Information management and quality improvement: the Joint Commission's perspective.

Health care is an information-intensive endeavor. Its improvement is even more information intensive. The core processes of health care and their improvement are dependent on effective and efficient management of information in health care organizations and integrated health care networks. The authors describe a framework for effective information management in health care organizations and discuss the implications of a framework for improving performance on information management.

Computer Communication Networks↗
PubMed1990

From quality assurance to quality improvement.

As we are learning to master the methods of quality assurance, a new conceptual approach focused on quality improvement is being advocated. But this new approach is not a derailment for health care practitioners committed to improve patient care quality. Rather, it is a progressive step that builds upon the concepts and methods of quality assurance. Whereas quality assurance tends to focus on correcting problems in patient care quality--especially individual practitioners' problems--quality improvement focuses on finding opportunities to improve quality by changing systems as well as individual practitioner behavior. Whereas quality assurance tends to rely primarily on standards or guidelines for the structures and processes of care and the intensive review of individual cases with undesirable outcomes, quality improvement also utilizes statistical profiles of outcomes, structures, and processes as baselines against which improvement can be measured. Whereas quality assurance may engender defensiveness in an individual practitioner, quality improvement is based on the health care practitioner's professional ethic and pride in providing even better care to patients tomorrow than is possible today. To improve patient care quality, it is necessary to examine the structures, processes, and outcomes of care. The structures and processes can be controlled by the practitioner and organization; the outcomes are the benchmarks against which the effectiveness of the structures and processes can be evaluated. Outcomes in health care are the effects of more than just the structures and processes controlled by the practitioner and organization. Therefore, outcomes are not direct and complete measures of the quality of the care provided. They are instead indicators of performance. These indicators can focus attention on care that lies outside the normal statistical parameters of performance and can provide baselines against which improvements can be measured. The monitoring and evaluation process described in Joint Commission standards is a method for establishing priorities and using indicators to improve the quality of patient care. This method can be used to focus case-based review of care and to establish baselines for continuous improvement. This conceptual approach that emphasizes quality improvement and the use of the monitoring and evaluation process is guiding the Joint Commission's development of clinical indicators and revision of its standards and survey process to help health care organizations in the transition from quality assurance to quality improvement.

Humans↗
PubMed1989

Hepatitis D virus infection in Illinois state facilities for the developmentally disabled. Epidemiology and clinical manifestations.

OBJECTIVE: To define the epidemiology and clinical manifestations of hepatitis D virus infection in an institutionalized population. DESIGN: A case-control study of hepatitis B carriers with and without serologic evidence of hepatitis D virus infection. Demographic, institutional, and medical data were obtained through questionnaires and chart review. Clinical status was assessed by liver function assays. SETTING: Thirteen Illinois state facilities for the developmentally disabled. PARTICIPANTS: Clients (238) who were hepatitis B carriers. RESULTS: Antibody to hepatitis D virus (anti-HDV) was detected in 71 of 238 (30%) hepatitis B carriers. Nine of thirteen facilities housed positive clients. Previous residence at one facility, designated B, was the strongest correlate of anti-HDV positivity; 85% of positive persons had lived there compared with 16% of negative controls (odds ratio 28.3 [95% CI, 13.2 to 60.7], P less than 0.001). Past hepatitis episodes were more common among anti-HDV-positive clients (37% compared with 7%) (odds ratio, 7.5 [95% CI, 3.0 to 19.1], P less than 0.001) and occurred mainly at facility B from 1950 to 1975. Liver function tests were infrequently abnormal among anti-HDV-positive clients. CONCLUSIONS: Results show widespread hepatitis D virus infection in our institutionalized population and suggest that transmission occurred mainly in the past at the overcrowded facility B. The low prevalence of laboratory evidence of chronic liver disease in the anti-HDV-positive clients may be explained by increased mortality among those originally infected from 1950 to 1975.

Acute Disease↗
PubMed1979

Extrapyramidal side effects and increased serum prolactin following fluoxetine, a new antidepressant.

Fluoxetine (Lilly 110140) is a potent, specific serotonin (5-HT) uptake blocker which is being tested in man for antidepressant activity. One of 9 depressed patients receiving this drug developed a dystonic reaction, parkinsonian rigidity, and increased serum prolactin levels, all signs of decreased dopaminergic activity. Homovanillic acid levels also decreased in the cerebrospinal fluid of this subject. We postulate that fluoxetine, via the increase in 5-HT activity resulting from 5-HT uptake blockade, inhibited both the nigro-striatal and tubero-infundibular dopaminergic neurons. These results provide additional evidence for a linkage between serotonergic and dopaminergic neurons in man.

Adult↗
PubMed1979

Effect of clozapine on human serum prolactin levels.

The authors determined serum prolactin levels in 13 patients receiving clozapine, an antipsychotic drug that does not produce extrapyramidal side effects. Morning serum prolactin levels, 11 hours after the last dose, were not elevated during chronic treatment with clozapine in any subject despite its therapeutic effects. Serum prolactin levels were moderately increased between 90 minutes and 4 hours after administration of very high doses of oral clozapine in 4 patients but were smaller than those produced by chlorpromazine in other subjects. The authors suggest that clozapine in other subjects. The authors suggest that clozapine may achieve its antipsychotic effect differently than do classical neuroleptics and that sustained prolactin increases are not essential for antipsychotic action.

Animals↗
PubMed1978

Neuroleptic-induced prolactin level elevation and breast cancer: an emerging clinical issue.

This article reviews the evidence that neuroleptics may increase the risk of breast cancer via their effects on prolactin secretion. All available neuroleptics, including reserpine, raise serum prolactin levels. Elevated serum prolactin level increases the incidence of spontaneously occurring mammary tumors in mice, and increases the growth of established carcinogen-induced mammary tumors in rats. Caution is necessary in extrapolating this relationship to human mammary tumors because human and rodent tumors differ in some important characteristics, including hormone responsiveness. Serum prolactin levels in women with, or at risk for, breast cancer have generally been normal, and only a minority of human mammary tumors respond to changes in serum prolactin levels. Epidemiologic studies have failed to demonstrate an increased risk of breast cancer associated with the use of neuroleptics or reserpine. Thus, although some human mammary tumors are prolactin dependent, the available evidence does not demonstrate an increased risk of breast cancer in women receiving neuroleptics. We conclude that (1) additional epidemiologic studies of the incidence of mammary tumors in women treated with neuroleptics are desirable; (2) it is premature to mandate warning patients of an unknown and undemonstrated increase in the risk of developing breast cancer associated with neuroleptic treatment; (3) detection of existing mammary tumors by breast examination prior to administration of neuroleptics is desirable; and (4) development of antipsychotic drugs that do not increase serum prolactin level may be indicated.

Animals↗