Process of care

Economic studies should consider the costs of all the resources and services used in the process of care. In addition, the outcomes that are a consequence of the health or social care interventions evaluated need to be included. For dementia, these include the costs of hospital inpatient and out-patient care, primary and community-based health-care services, social welfare services, and care provided by voluntary agencies or by femily and friends. Ideally, a broad perspective reflecting the costs and outcomes to society should be adopted. As a minimum, the perspective of the analysis should include the costs and outcomes to key health and social care providers or funders and to patients and their families. 

For quality of care in the elderly this put even higher emphasis on individualisation and on improving the structure and process of care delivery... 

Like Medical Care, Nursing Care etcetera PC consists of core components the philosophy, the patient care process, and the practical management system to support the practice. PC was developed from Clinical Pharmacy Services (see below) with more focus on the patients need and on the practitioners (pharmacist) responsibilities towards the patient and the outcome of the drug therapy. To be able to show the improved process of care a categorisation system for drug-related problems was developed. The taxonomy has been further developed into seven categories (Cipolle et al. 1998). This can be used for practice and in studies. 

The U.S. Office of Technology Assessment has defined the quality of medical care as evaluation of the performance of medical providers according to the degree to which the process of care increases the probability of outcomes desired by patients and reduces the probability of undesired outcomes, given the state of medical knowledge (Congress of the United States, Office of Technology Assessment, 1988). 

The process of careful, structured analysis and evaluation used to eliminate hazards during design and construction will also allow a chemical facility to accurately predict unplanned events that may create emergencies, and to effectively prepare to manage them should they occur. A comprehensive emergency preparedness program has all of these elements prevention, prediction, and preparation. 

The Early Use of Existing Preventive Strategies for Stroke (EXPRESS) study aimed to determine the effect of more rapid treatment after TIA and minor stroke in patients who were treated in a specialist neurovascular cUnic (Rothwell et al. 2007) within OXVASC. In a prospective, population-based, sequential comparison study, the effect on the process of care and outcome of either urgent access and immediate treatment in a dedicated neurovascular clinic or an appointment-based access and routine treatment initiated in primary care were compared for all patients with TIA or minor stroke who did not need hospital admission. The primary outcome was the risk of stroke during the 90 days after first seeking medical attention. 

The systematic process of caring for patients with drug-related needs... 

All health care professions have a unique philosophy, process of care, and practice management system. The commonly held purpose of a practice is its philosophy. The knowledge and expertise that a health care professional brings to care for a patient are done so within a common patient care process. The practice management system is vital to support the practice by facilitating application of the philosophy and process of care. By... 

When a patient has symptoms or signs of a health problem, the clinician establishes hypotheses about their etiology. Competing hypotheses must be resolved. After decisions are made about the nature of the condition, the process of care may then involve further decisions depending on the nature of the problem or disease. The services of laboratory medicine are one of the tools at the disposal of the clmician to answer the questions posed by the hypothesis generation and to help make decisions. ... 

The traditional system of providing patient care— wherein physicians initiate drug therapy, pharmacists dispense medications, and nurses administer medica-tion.s—is often run in a disjointed fashion. This results in potentially avoidable adverse drug events that contribute to poor patient outcomes and increased medical costs. Efforts aimed at modifying the current processes of care to enhance efficiency of workflow, improve patient outcomes, and reduce medication errors arc needed. 

If pharmacists were providing primary care for hypertensive patients and wanted to compare the results of an intervention, they should first provide interventions based upon established therapeutic guidelines for treating hypertension such as those outlined by the Fifth Joint National Committee on Detection, Evaluation, and Treatment of Hypertension (JNC-V). With each patient encounter, they would collect the data in Appendix 2. These two procedures would ensure that the pharmacist is providing an appropriate process of care. 

Appendix 2 Evaluating process of care Example quality assurance in primary care... 

Kocher MS, Mandiga R, Murphy JM, et al. A clinical practice guideline for treatment of septic arthritis in children Efficacy in improving process of care and effect on outcome of septic arthritis of the hip. J Bone Joint Surg 2003 85A 994-999. 

Next, it requires resource analysis. At local level, this may not be easy, e.g. the administration of an expensive drug at an early point in the process, may result in the re-engineering of the existing process of care, where an anticipated, subsequent admission to hospital for treatment becomes redundant. 

Hippocrates initiated a process of careful observation and experimentation. He separated myth and magic from rational therapy. Every natural event has a natural cause, he maintained. Hippocrates investigated symptoms and was able to predict the course of disease. But Asklepios s reliance on the... 

An example of how an evidence-based quality framework can be used to improve healthcare has been seen with improvements in stroke services in the United Kingdom following the implementation of the National Service Framework (NSF) for older people in 2001— The Biannual Sentinel Stroke Audit for 2008 has recently been published, and it demonstrates a continued significant improvement in stroke services. In terms of healthcare structure, 96% of hospitals in the United Kingdom now offer specialist stroke services, with an increasing number of specialist stroke unit beds 98% of hospitals employ a physician with a specialist interest in stroke. There also have been improvements in process of care measures, including the uptake of thrombolysis services and secondary prevention measures. A similar initiative has been beneficial for coronary heart disease and more recently has been broadly applied to cancer. 

Both measures of harm and assessments of failures in the process of care may reflect overall levels of safety. Failure to give appropriate care may or may not lead to harm, but it certainly seems reasonable to class these failures under the general heading of safety. These process measures however, seem similar if not identical to broader quality measures of effectiveness, reliability and efficiency captured in numerous studies of the quality of care. Does this mean that safety measures are nothing more than quality measures under another name Not exactly, though when we examine the level of process rather than outcomes, the same measures may reflect both safety (in the sense of potential for harm)... 

The first step in any analysis is to identify the care delivery problems. These are actions or omissions, or other deviations in the process of care which had a direct or indirect effect on the eventual outcome for the patient. 

For each care delivery problem identified, the investigator records the salient clinical events or condition of the patient at that time (e.g. bleeding heavily, blood pressure falling) and other patient factors affecting the process of care (e.g. patient very distressed, patient unable to understand instructions). 

Analyses of specific incidents, especially when systematic and thorough, can illuminate systemic weaknesses and help us understand how things go wrong. We have seen how there is frequently a chain of events leading to an incident and a variety of contributing factors. Having understood these principles, we are now able to approach the examination of system weaknesses from a different perspective. Rather than take a case, analyse it and see where it leads us, an alternative approach is to begin with a process of care and systematically examine it for possible failure points. This is the province of human reliability analysis. 

Incident analysis is usually seen as retrospective, while techniques such as FMEA, which examine a process of care, are seen as prospective and, therefore. 

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