Quality of care

I service volume I quality of care I user throughput... 

The needs of modem medicine require sophisticated measuring devices for a wide range of chemical species in very complex matricies. Due to fundamental breakthroughs in the 1950 s and 1960 s, electrochemical methods have proven to be extremely valuable in meeting such needs. This past success, coupled with the current trend in the United States and western Europe towards cutting medical costs while still maintaining quality of care is largely responsible for the present fast pace of research and development in the area ... 

Mikuls TR, MacLean CH, Olivieri J, et al. Quality of care indicators for gout management. Arthritis Rheum 2004 50 937-943. 

Segal, S. R, Bola, J. R. 8c Watson, M. A. (1996). Race, quality of care, and antipsychotic prescribing practices in psychiatric emergency services. Psychiatr. Serv., 47, 282-6. 

The primary goal of quality improvement (QI) is to continuously monitor and improve the quality of care delivered to MCO beneficiaries. Quality improvement... 

Another external response to concerns about MCOs has been an increased interest in measuring the quality of care they deliver [35]. This interest has resulted in the development of numerous quality indicators. One example, HEDIS (Health Plan Employer Data and Information Set), is a standardized set of performance indicators used to compare health plans. Developed by the National Committee for Quality Assurance, HEDIS measures allow employers and employees to evaluate different plans. Only a small number of HEDIS indicators are related to medication use, but more drug-related indicators are likely to be added in the future. The use of quality indicators likely will increase as the measures become more refined and tested. 

Physician payment system (even salaries can be translated into incentives if their level is adjusted according to criteria such as induced expenses, patient satisfaction and quality of care)... 

Abstract Quality of care is complicated, especially in the elderly. For a start we need drugs with evidence for the benefits and risks in the elderly, this is currently not always the case. Thereafter we need to use the drugs in an evidence based way, which may be difficult in the complex health care system. To achieve maximum benefit for the patient (outcome) and society (health-economy) a well planned process is needed. This includes identification, prevention and resolving of the patients drug-related problems decisions and selection of treatment, communication and decisions together with the patient, risk minimisation, and communication within health care. Several of these aspects are presented in this chapter. 

Quality assurance is defined by Donaobedian as all actions taken to establish, protect, promote, and improve the quality of health care (Donobedian 2003). He describes quality of care as an attribute of a system (structure), a set of organized activities (process), and an outcome that results from both. The definitions are described in Table 3.1. It should be noted that the efficacy of a drug (the ability for improvement under the most favourable circumstances) is included in the structure and that the effectiveness of a dmg (real improvement in the care) is included in the process. 

For improved quality of care in the elderly we must first define and measure the problem and the magnitude of the problem. We must also prioritise between problems and select the most important issue. Of course the aim must be improvement for the individual patient. But since quality in healthcare normally is complicated and multifactorial a systematic change in structures and processes is required. 

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

Below we have listed some very important aspects for improving quality of care in the elderly. We also list or explain some models or practical approaches for improvement. 

Figure 2.5. Improvements in the quality of care reduce healthcare expenses. [Source Institute of Medicine, 1999, p. 26 American Hospital Association, Hospital Statistics, Chicago, 1999.)...

By 1996 over 500,000 coronary interventions were performed annually, which has more than doubled to today s current standard. These pioneers have paved the way for interventional procedures that now serve as the standard of care for symptomatic coronary artery disease. While coronary intervention remains in its adolescent stage, the quality of care has increased substantially and the bar is ever increasing as to the extent coronary interventions play in our society s healthcare. 

The authors measure of quality of care was based on the Depression Guideline Panel (1993) recommendations and American Psychiatric Association (2003) guidelines. These state that if antidepressant medication is... 

Krumholz HM, Philbin DM Jr, Wang Y, Vaccarino V, Murillo JE, Therrien ML et al. Trends in the quality of care for Medicare beneficiaries admitted to the hospital with unstable angina. J Am Coll Cardiol 1998 31(5) 957-63. 

I feel a personal sense of achievement in contributing to the quality of care we give to our patients. I have also improved my self-esteem and feel that I have increased the staffs confidence in me as their manager. As a team we have... 

In a 2000 Harris Poll of cancer clinical trial participants, 76 percent of the respondents said they participated because they believed that the trial offered the best quality of care for their disease. Helping other people and receiving more and better attention for their own specific disease were other reasons cited. 

Lewittes LR, Marshall VW. Fatigue and concerns about quality of care among Ontario interns and residents. Can Med Assoc J January 1989 140. 

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