UNDERSTANDING AND DEFINING QUALITY Quality Academy – Cohort 6 April 8, 2013.
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Transcript of UNDERSTANDING AND DEFINING QUALITY Quality Academy – Cohort 6 April 8, 2013.
UNDERSTANDING AND DEFINING QUALITY
Quality Academy – Cohort 6 April 8, 2013
Defining Quality
History:– Institute of Medicine – 7 dimensions– OECD (Organisation for Economic Co-operation and
Development )– BC: Health Quality Network
Who’s perspective?– Patient– System
Dimensions of Quality
Acceptability Appropriateness Accessibility Safety Effectiveness Efficiency Equity
Acceptability
Care provided considers patient and family preferences Respecting cultural values and encouraging family
involvement in decision making Health care providers being empathetic to patients and
families, Following the wishes and expectations of patients and
families Empowering patients and families to be active in their
own care.
• Avoiding unnecessary visits with good communication (e.g. discharge instructions, case management)
• Improved adherence to treatment Time taken to deal with complaints
Appropriateness
Care provided is evidence-based and specific to individual clinical needs.
Care provided optimizes an individual‘s health outcome.
Appropriate care weighs the benefits and risks of care – aiming to provide maximum benefit (supporting best outcomes).
Practice variations– Overuse– Underuse– Misuse
What are the costs to patient?
Accessibility
Ease with which health services are reached Extend to which individuals can easily obtain the care
when and where it is needed Aims to ensure there are no physical, financial or
psychological barriers to receiving information, care and treatment
• Multiple visits due to access problems• Misuse of Emergency due to access
limitations• Costs of maintaining a wait list• Missed appointments due to poor access
(e.g. mental health appts)
Safety
Avoiding harm resulting from care. Involves designing and implementing processes to
prevent and minimize adverse outcomes or injuries that could unintentionally result from the delivery of care.
• Hospital acquired infections• Adverse drug events in Community• Pressure ulcers in LTC• Never events (e.g. wrong surgery)• Drug costs and length of stay due to
preventable complications
Effectiveness
Care that is known to achieve intended outcomes. Based on clinical evidence and best practices. A commitment to effectiveness is demonstrated by
continuously studying the results of care to find ways to improve care for all patients
• Avoidable hospital admissions/readmission• Early discharge• Errors in cancer screening leading to recalls• Failure to to provide accurate and timely
diagnose
Efficiency
Optimal use of resources to yield maximum benefits and results.
Maximizing capacity and eliminating/avoiding waste in the health system.
• Reduction of waste time spent looking for materials,
records, information• OR cancellations• Social impact
Equity
Distribution of health care and its benefits fairly according to population need.
British Columbians have equal access to the health services they need, regardless of gender, ethnicity, socioeconomic status, or where they live.
Areas of Care
Staying Healthy– Preventing injury, illness and disabilities.
Getting Better– Care for acute illness of injury.
Living With Illness and Disability– Care and support for chronic illness and/or disability.
Coping with End of Life– Planning care and support for life limiting illness and
bereavement.
How Is It Used?
• Program / Strategic Planning• Evaluation• Measurement Frameworks
An Example: Surgical Quality Framework
A framework to describe a comprehensive picture of surgical quality
BC Health Quality Matrix Dimensions acceptable, appropriate, accessible, safe, effective, efficient
+Segments along Surgical Pathway
REFER DECISION SURGERY RECOVER FOLLOW
ACCEPTABLE Patient Experience
Patient Experience
Experience Survey
Patient Experience
Patient Experience
APPROPRIATE Alignment of determination that benefits outweigh risks of care
Patient, primary care provider and surgeon
ACCESSIBLE Time to diagnostics
Time to specialist, diagnosis
Time to Surgery Time to follow-up care and treatment
SAFE Crude Infection Rates (PICNET)Adjusted Infection and
Complication Rates (NSQIP)
EFFECTIVE Risk Adjusted Mortality Rates, Return to OR (NSQIP)Patient Reported Outcome – functional status and quality of life
EFFICIENT Appropriate Referrals
Risk Adjusted LOS(NSQIP)Costs saved (lower LOS, fewer complications, fewer readmissions and return to OR)
Efficiencies in hospital and OR flow (e.g. cancelled procedures)
REFER DECISION SURGERY RECOVER FOLLOW
ACCEPTABLE Techniques for shared decision making and teamwork among providers and patients; opportunities identified from Patient Experience
APPROPRIATE Pathways, guidelines, decision aids, shared decision techniques
ACCESSIBLE Decision aids - when to refer
Advanced Access for Specialists and DI
MoH/PSAC work on prioritization, targeted funding, management of waitlists; Centre for Surgical Innovation
Advanced Access
SAFE Surgical Checklist, VTE Prophylaxis, SSI Protocol (SHN!, CPSI, Collective)
EFFECTIVE Focus on PROMs/QOL
EFFICIENT Flow in OR, Discharge Planning, Safety Initiatives
WHERE DOES YOUR PROJECT FIT?