Framework for patient safety and quality research design
Chapter 24
Patient Safety and Quality Initiatives in Informatics
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Introduction
Definitions of “quality of care” and “patient safety”
Framework for patient safety and quality research design
Suggestions for further improvement
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Definitions
Quality of care
Is the extent that health services increase the likelihood for the desired health in a population.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Definitions (Cont.)
Six aims from the Institute of Medicine (IOM) state that healthcare should be:
Safe
Effective
Patient-centered
Timely
Efficient
Equitable
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Definitions (Cont.)
Patient safety
Is the freedom from accidental injury as a result of medical care or medical errors. An error is defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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National Initiatives Driving Adoption and Use of Health Information Technology
Federal Health Information Technology Strategic Plan: 2011–2015
Is a focus on the redesign of clinical processes and adoption and Meaningful Use of health information technology (IT).
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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National Efforts Related to Quality Data Standards
Working on mapping- or linking-specific quality concepts that are to be recommended terminologies
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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What is semantic interoperability?
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Evaluating Quality and Patient Safety
Conceptual framework for patient safety and quality
Medication safety
Chronic illness screening and management
Nursing-sensitive quality outcomes: Patient falls and pressure ulcers
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Framework for Patient Safety and Quality Research Design
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
9
Figure 20-1 from text
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Conceptual Framework for Patient Safety and Quality
Supports the understanding of the health IT intervention that is most likely to have an effect within the organizational causal chain of quality and safety events.
Provides a means to better explain why an health IT intervention was successful (or not).
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Quality and Safety Continuum
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Figure 20-2 from text
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Medication Safety
Health IT initiatives that have improved medication safety include:
Computerized physician (provider) order entry (CPOE) system
Clinical decision support (CDS) system
Electronic medication administration record (eMAR)
Barcode medication administration (BCMA) system
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Chronic Illness Screening and Management
Structural incentives for use of health IT to improve clinical processes include:
Screening for breast cancer
Screening for depression
Pay-for-performance measures
Centers for Medicare & Medicaid Services (CMS) core measures
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Nursing-Sensitive Quality Outcomes: Patient Falls and Pressure Ulcers
Deficit Reduction Act of 2006
CMS identified a list of preventable, hospital-acquired conditions for which hospitals would no longer receive additional payments.
Multifaceted response by healthcare organizations:
Use of clinical experts to improve the knowledge base of nurses and other providers
Use of a peer champion model
Use of health IT systems for decision support
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Success Factors and Lessons Learned
Success factors:
Are useful for exploring the relationships among the organization’s structural forces.
Incentives for the changes in clinical processes are supported by health IT interventions.
Include both management and clinical processes.
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Success Factors and Lessons Learned (Cont.)
Lessons learned:
Management interventions are effective in maximizing stakeholder support.
Management interventions improve overall adherence with practice changes and improve fidelity with health IT interventions.
Patient Safety and Quality Research Design (PSQRD) framework includes a focus on intervening variables that improve staff commitment to process changes such as incentive payments and morale.
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Conclusion and Future Directions
PSQRD framework is recommended as a guide for the implementation and evaluation of health IT interventions.
Supports:
Implementation
Performance improvement
Research projects
Organizations must have a comprehensive plan to implement the PSQRD framework.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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