Quality assurance monitoring and quality assurance programs: a system for improving patient care.
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Computers↗
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Quality assurance in dentistry: executive summary, part 1. ADA Quality Assurance Project.
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American Dental Association↗
Quality assurance in dentistry: executive summary, part 2. ADA Quality Assurance Project.
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American Dental Association↗
Quality assurance in dentistry: executive summary, part 3. ADA Quality Assurance Project.
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American Dental Association↗
Hospital screening for tuberculosis: a quality assurance trial.
A quality assurance trial which dealth with tuberculin testing and isoniazid prophylaxis for tuberculosis infection among hospitalized patients was undertaken at a short-term, general hospital of the Indian Health Service. Standards for care were developed by the hospital staff using questionnaire and Delphi process techniques. Following the demonstration of baseline deficiencies in clinical performance, tuberculin testing became a standing admission order. Subsequent changes in the completeness of tuberculosis screening and in physician response to a positive tuberculin skin test were demonstrated. Among hospitalized patients of unknown tuberculin reactivity, PPD screening coverage increased from 45 per cent to 87 per cent (p less that 0.005). Improvement in the appropriate initiation of isoniazid prophylaxis was demonstrated. The absence of simultaneous changes in other health surveillance activities suggests that the improvement in tuberculosis screening was attributable to the quality assurance intervention and not to the other intervening variables. An approach to selecting alternatives for remedial action when quality assessment has documented a deficiency is presented and disucssed.
Hospitals, Federal↗
Quality assurance for alcoholism treatment.
Mechanisms that seek assurance of quality care at reasonable cost include utilization review, accreditation, certification, licensure, and patient care audit. Within the social rehabilitative field, it is probably safe to say that only alcoholism has developed and implemented what might be considered the majority of the significant elements of a quality assurance program.
Accreditation↗
Formulating priorities for quality assurance activity. Description of a method and its application.
Quality assurance activity seems to have had little documented impact in terms of improving patient health or reducing care costs. One reason may be the lack of a practical and effective decision process for selecting priority areas where improvement of health or any other target outcome will most likely be achieved. This article describes a structured procedure for meeting this need. In addition, results of 14 years of quality assurance experience with structured and nonstructured topic selection procedures in 23 multispecialty group clinics and their associated hospitals are briefly reviewed. On the basis of this experience it is suggested that this priority method is both feasible and practical and can be recommended for application to most quality assurance systems. It is especially suited for planning medical care evaluation studies of the Professional Standards Review Organizations or the performance evaluation projects of the Joint Commission on the Accreditation of Hospitals.
Accreditation↗
Quality assurance strategies in U.S. and Canadian psychiatry.
Quality Assurance Strategies in Psychiatry and Medicine in general have developed rapidly and have been applied widely in the last few years, particularly in the United States. This paper reviews some of those developments both from a methodological and a socio-political point of view. The relevance to the Canadian scene is evaluated, and it is concluded that, although quality assurance is now accepted as an obligation of the health profession, some of the strategies being widely applied in the United States are of questionable value in themselves, and some, particularly cost control techniques, would seem to be irrelevant to the Canadian health field which already has a variety of checks and balances in its universal health insurance system. Though cost control and quality control logically overlap, at times they are allowed to merge and cause conceptual confusion. Finally, as systems are developed in Canada, it is suggested that a means of self-assessment be built in so that the validity and reliability are not in doubt.
Accreditation↗
Quality assurance in ambulatory care.
This article is one example of how a more simplified audit system for evaluating patient outcomes can be implemented and can be applied to an ambulatory care setting. Quality assurance activities are here to stay, either as a result of our feeling a professional obligation to monitor our own practice in relationship to the public we serve, or as a result of pressure from consumers and third-party payers. I prefer to believe that as professionals, we do recognize our obligation to be accountable for our actions, and that only we can set the standards of practice to which we will be held accountable. Through the development of criteria for care, we are able to establish these standards of practice. In complex care settings such as our Ambulatory Care Service, the CMA/CHA audit process is a reasonable approach to assuring quality by looking at patient outcomes. This process supports the team approach to patient care, is a less expensive method because less time is required to orient personnel to the audit process, and meets JCAH requirements for accreditation.
Ambulatory Care↗
Risk management and quality assurance: integration for optimal effectiveness.
The following is the second article in a two-part series examining the relationship between quality assurance and risk management functions. In part one, "Risk Management and Medical Malpractice: An Overview of the Issues," published in the April 1979 QRB, Dr. Fifer reviewed the problem of medical malpractice--the primary motivation for the present interest in risk management--and discussed the characteristics of current efforts in risk management, particularly their limitations in light of the facts about malpractice. In part two, Dr. Fifer first reviews the major quality assurance functions of the medical staff. He then focuses on methods for coordinating these quality assurance functions with the risk management function in a way that will utilize the expertise of the medical staff and create a unified, hospital-wide system intended to detect and prevent deviations from expected patient outcomes.
Education, Medical, Continuing↗
Evolution of quality assurance reflected in new standard. Staff, Joint Commission on Accreditation of Hospitals.
The new quality assurance standard, which should help hospitals to identify optimum methods for improving patient care and clinical performance and to be recognized for all rational and purposeful efforts at improvement, will take time to implement. In its continuing effort to help hospitals upgrade the quality of patient care, the JCAH is committed to implementing the new quality assurance standard in a manner that will not be disruptive to participating hospitals. The JCAH is also committed to ascertaining that hospitals are making every effort to comply with the standard. The degree to which a hospital does comply with the standard will be a persuasive factor in determining accreditation status.
Accreditation↗
Quality assurance in a neighborhood health center: dental services.
A method for assessing the quality of dental care in neighborhood health centers has been presented. The audit uses implicit review for the evaluation of the overall process of dental care and explicit review for the technical component of the clinical audit and the evaluation of the dental record. This combined approach is favored over a totally explicit audit because it is more flexible and efficient and less threatening to the dentist. Although the "soft" structure of this audit could be criticized, the major issue is that a useable, simple quality assurance mechanism has been successfully used to improved the quality of dental care. Modifications of criteria will certainly evolve as quality assurance mechanisms improve.
Clinical Competence↗
Quality assurance of clinical data: internal monitoring: patient and study management at the clinic.
Adquate methods to assure the quality of data collected at the clinic need to be developed. A full understanding of the limitations of physicians as information processors and reasonable performance expectations for physicians during peak information periods will result in concentrated planning for patient visits and will limit the data that must be collected at the clinic. It is mandatory for each clinical research project that protocol treatment take into account the question of variable provider follow-up versus constant provider follow-up. It is also imperative that all clinical research providers receive special training, testing, and follow-up evaluation. The prime responsibility for the overall conduct of clinical research rests with the principal investigator. A monitoring tool that should be more fully used is the informed patient.
Clinical Trials as Topic↗
Priority setting in quality assurance: reliability of staff judgments in medical institutions.
A structured procedure using the judgments of a representative group of local providers for establishing priorities for quality assurance activity in diverse medical institutions was tested for reliability. Two independent matched teams of phy sicians, nurses, administrators, and other staff in eight separate medical facilities generated 320 topics which encompassed areas where quality assurance efforts would have either considerable or little impact in terms of improving health outcomes within reasonable costs. Concordance of judgment between teams in each facility was determined by analyzing the similarity of topics content, the agreement in scaling the health impact of similar topics generated by both teams independently, and the agreement by one team in scaling the health impact of topics generated by the other team. The findings revealed 44 per cent content agreement on topics independently generated, 93 per cent agreement on dichotomous scaling of similar topics, and 87 per cent agreement on five-point scaling of similar topics. Concordance of judgment by one team in scaling the other team's topics was highly significant (p less than .001). Preliminary analysis of topic content and scaling agreement among different facilities indicated low agreement both on the content areas and on the health impact of similar topics. It is concluded that the judgments of local providers in identifying cost-effective quality assurance priorities is highly relaible in the medical institutions studied.
Cost-Benefit Analysis↗
Validity of medical staff judgments in establishing quality assurance priorities.
The validation of a structured group judgment procedure to establish priorities for quality assurance activities was undertaken in six medical institutions in the United States. Validation focused on the extent to which health improvement could be documented by outcome-based projects focusing on priority topics. Predictive (criterion-related) validity was sought by analyzing five successively more stringent levels of evidence: 1) feasibility of implementing a quality assessment project within the topic areas selected by the prioity procedure; 2) accuracy of identifying health deficiencies or strengths; 3) verification of establishing correctable causes of health deficiencies; 4) capability of effecting significant improvement of health deficiencies; and 5) credibility of evidence that improvement achieved is directly attributable to corrective actions taken. Within the limits of generalizability, predictive validity was documented at every level of analysis. It is recommended that the structured group judgment process used in this study be more thoroughly evaluated and considered for quality assurance planning purposes.
Decision Making↗
Breast exposure: nationwide trends; a mammographic quality assurance program--results to date.
BENT (Breast Exposure: Nationwide Trends), a federal-state sponsored mammographic quality assurance program has demonstrated that unproductive radiation exposure can be reduced by identifying and correcting problems that result in poor image quality. BENT provides clinical personnel with knowledge on the performance of their mammographic system as a basis for possible improvements in image quality and for reductions in patient exposure.
Female↗
Quality Assurance in diagnostic radiology: an irreverent view of a sacred cow: annual oration in honor of Albert Soiland, M.D.
The problem of federal regulation of radiologic practice is examined via an in-depth analysis of the Proposed Recommendations for Diagnostic Radiology Facility Quality Assurance Programs as published in the Federal Register by the Commissioner of Food and Drugs. It is shown that the need for such recommendations is not established, that the program proposed by the Commissioner is potentially burdensome for the radiologist, that it does not address the most significant causes of unnecessary patient irradiation, and that the benefits expected to derive from it are, in fact, negligible. This is not to denigrate the value of well-conceived quality assurance efforts, and measures are suggested that might more reasonably be expected to reduce the radiation exposure of the public. The radiologist is urged to 1) conduct his practice in as faultless a manner as possible; and 2) exercise his right to respond to proposals of the federal regulatory agencies.
Cost-Benefit Analysis↗
A mammography quality assurance test program.
The design and implementation of a program to investigate remote quality assurance testing for film mammography is described. The measurements included tube output, x-ray machine and processor stability, and film quality. Mammography phantoms and film sensitometric strips were distributed monthly to 24 regional hospitals. Most of the hospital processors and x-ray machines performed in a stable manner during the 12-month test period. It was found that x-ray machine useful beams could be reliably measured using nonscreen films. The main utility of the phantom was to identify cases of poor image quality. The measurements performed on the phantom image could not be used to diagnose specific causes of poor images.
Mammography↗