CQI program

Measuring outcomes can seem to be a daunting task. This may have been why Anita s boss, pharmacist Pat (in the scenario), did not implement the corporate CQI program as recommended by his district manager. Thus the remainder of this chapter will present these concepts in an easy-to-understand manner and will include simple implementation tips. 

In the future, the accreditation process may become more focused on outcomes measurement. Eventually, health care report cards may be more accessible and easy to understand, thus helping to produce a market for quality. Some discussion of adjusting copayments to encourage patients to use providers that meet the standards purchasers have set has already occurred (Lovern, 2001). In some cases, pharmacy quality improvement may be mandated by state and local governments. For example, a new law in the state of Arizona requires that every pharmacy participate in a CQI program (Arizona Revised Statutes, 2007). 

L. M. Educational effort and CQI program improves ordering of serum digoxin levels. Hosp. Formul. 1994, 29, 657-659. 

Traditionally, infection control programs have played a major role in quality assessment. The shift of emphasis from QA to CQI methodology will require their continued involvement. How should an institution organize and implement a CQI program to reduce the occurrence of nosocomial pneumonia (Fig. 2)7 The first step is to form a dedicated, multidisciplinary committee to address this issue. Team members should include representatives from respiratory ther-... 

Once the CQI program is implemented, ongoing surveillance provides the data with which to measures its effectiveness (17). A standardized case definition should be used to ensure comparability between different abstractors. The CDC definition (Table 4) for nosocomial pneumonia is commonly used. The case definition differs for ventilated versus nonventilated patients and it depends on the age of the patient (18). Interinstitutional rates cannot be compared without standardization of the case definition. Surveillance for nosocomial pneumonia has typically been the domain of the hospital epidemiology and infection control department. It is a fundamental part of the specialized function of infection control practitioners (19,20). 

The press to increase practice activities may make it difficult to conduct all planned CQi activities in a short period of time. It may take 1, 2, or more years to complete evaluation efforts in the three areas. In most cases, then, it may be beneficial to conceptualize CQi programs as being conducted in phases and to consider implementing either one or some of the cqi activities over a period of time. This means that the process of CQi will be long term and developed in stages based on program funding and on the availability of staff to participate in evaluation activities. 

Table 1 presents key steps in developing continuous quality improvement activities in school mental health. We emphasize that implementation of a cqi program is a process that takes time, money, and effort from all who are involved in the program, including its leaders, staff, collaborating stakeholders, advisory board members, and funders. 

Develop and implement a Continuous Quality Improvement (CQi) Program. 

Develop and conduct educational programs at every level to promote CQI methodology. 

Focused case example using CQI to design a clinical pharmacy competency program... 

Pharmaceutical outcome data are also used to improve the quality of care, identify potential problems, and improve patient outcomes. These data are often used within a continuous quality improvement (CQI) cycle, where rate-based performance measures are tracked over time and used in conjunction with control charts to show changes in quality and assess the impact of programs or changes in process. Information can be fed back to front line health care practitioners, areas for possible improvement identified, appropriate changes made, and reassessments initiated. 

David Eddy at Duke University has written extensively on the problems and potential solutions related to pharmaceutical performance measurement systems. According to a U.S. survey, the most commonly perceived problems with pharmaceutical performance measurement systems are limitations with billing and administrative databases, lack of time to review summary data by physicians, and incomplete data. Other limitations include risk adjustment (what if my practice has sicker patients), overreliance on administrative (claims) data rather than clinical data (therefore lacking key patient outcomes), patient individuality and variation in medical practice, and lack of capacity for taking into account a discipline-specific rather than a whole programs-oriented CQI approach. There has also been some debate on the reliability of performance measurement systems to assess the true impact of physician care on the quality of health care.t ... 

Assessment is a key component of the outcomes-based accreditation system. Assessment is the systematic collection, review, and use of information for the purpose of improving smdent learning and development. Programs must be assessed to measure if and how well student outcomes are being attained. The information gathered during the assessment process must be used to improve the quality of the program as part of the Continuous Quality Improvement (CQI) process. 

CQI is the ongoing process to improve the quality of students educational experience. It is a systematic, documented and repeatable process which assesses the performance of the program against the relevant criteria. Accreditation is part of the CQI process as it verifies that programs meet certain level of quality. In order to obtain ABET accreditation, a program must have an established and effective CQI process. 

Initially, EC2000 was met with significant resistance from faculty, as it presented a fundamental change to the traditional process. The input-based system was perceived to be more direct and did not require a strong CQI process. However, after experienced the effect of the outcomes-based system on the quality of the programs was recognized by both faculty and ABET evaluators. 

OBE Implementation and Design of Continual Quality Improvement (CQI) for Accreditation of Biomedical Engineering Program University of Malaya... 

Select or recruit an Advisory Board (include multiple stakeholders) to guide program evaluation efforts and monitor CQi activities. 

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