Health Care Quality Management

In today's challenging health care environment, health care organizations are faced with improving patient outcomes, redesigning business processes, and executing quality and risk management initiatives. Health Care Quality Management offers an introduction to the field and practice of quality management and reveals the best practices and strategies health care organizations can adopt to improve patient outcomes and program quality. * Filled with illustrative case studies that show how business processes can be restructured to achieve improvements in quality, risk reduction, and other key business results and outcomes * Clearly demonstrates how to effectively use process analysis tools to identify issues and causes, select corrective actions, and monitor implemented solutions * Includes vital information on the use of statistical process control to monitor system performance (variables) and outcomes (attributes) * Also contains multiple data sets that can be used to practice the skills and tools discussed and reviews examples of where and how the tools have been applied in health care * Provides information on root cause analysis and failure mode effects analysis and offers, as discussion, the clinical tools and applications that are used to improve patient care By emphasizing the tools of statistics and information technology, this book teaches future health care professionals how to identify opportunities for quality improvement and use the tools to make those improvements.

InhaltsangabeFigures and Tables xi Preface xix The Author xxvi Part 1: The State of Quality Management in Health Care Chapter 1 Quality in Health Care 3 Introduction 3 The Goal of Quality Management 5 Quality Pioneers in Health Care 12 Requisite Skills for Improving Health Care 19 Quality Control in Industry 23 System Thinking 27 Summary 33 References 35 Chapter 2 Error and Variation 37 Introduction 37 The Medical Decision-Making Process 37 Human Error and James Reason 40 Small Area Variations and John Wennberg 43 Practice Guidelines and Brent James 49 The Structure-Process-Outcome Paradigm 50 The Three Faces of Quality 51 Underuse, Overuse, and Misuse 55 Controlling Variation and Improving Outcomes 57 Summary 58 References 60 Chapter 3 Regulating the Quality and Quantity of Health Care 63 Introduction 63 Licensure, Accreditation, and Credentialing 65 Malpractice 71 The Economics of Health Care Markets 73 A Brief History of Health Care Financing in the United States 88 Pay for Performance and the CMS Quality Initiative 102 Summary 105 References 108 Part 2: Quality Management Tools Chapter 4 Process Analysis Tools 113 Introduction 113 Tools to Identify Problems 116 Tools to Identify Causes 137 Tools to Identify Solutions 146 Tool to Monitor Progress 152 Summary 155 References 159 Chapter 5 Root Cause Analysis 161 Introduction 161 Root Cause Analysis 162 SingleEvent Analysis 178 MultipleEvent Analysis 189 Prevention and Recovery 199 Cases and Applications 205 Summary 212 References 214 Chapter 6 Statistical Process Control for Monitoring System Performance 217 Introduction 217 Statistics Review 220 Types of Variation 226 Setting Performance Targets 228 Statistical Process Control for Continuous Data: X. and R Charts 231 Tinkering 255 Cases and Applications 257 Summary 261 References 264 Chapter 7 Statistical Process Control for Monitoring Failure Rates 265 Introduction 265 Statistical Process Control for Binomial Data: p and np Charts 266 Establishing Valid Control Limits 282 Constant and Variable Control Limits 284 Rebasing Control Limits and Monitoring Changes over Time 287 Cases and Applications 290 Improving Performance Using SPC 295 Summary 296 References 299 Chapter 8 Statistical Process Control for Monitoring Nonconformities 301 Introduction 301 Statistical Process Control for Counts: c and u Charts 302 Medicare Hospital Quality Initiative Example 312 Cases and Applications 317 Selecting a Control Chart 321 Benefits of SPC 323 Inhibitors of the Use of SPC 325 Summary 329 References 332 Chapter 9 Exploring Quality Issues with Statistical Tools 333 Introduction 333 ChiSquare Analysis 335 Analysis of Variance 344 Analysis of Means 350 Regression Analysis354 Quality Improvement and Research 362 Summary 365 References 370 Chapter 10 Failure Mode and Effects Analysis 373 Introduction 373 General System Theory 374 The Value Chain 383 Failure Mode and Eff ects Analysis 386 Designing Better Systems 398 Summary 403 References 406 Part 3: Medical Practice Management Chapter 11 Practice Policies 411 Introduction 411 Practice Policies 413 Computer Decision Support427 Cases and Applications 428 Summary 432 References 434 Chapter 12 Case, Disease, and Outcomes Management 437 Introduction 437 Case Management 440 Disease Management 449 Outcomes Management 463 Summary 468 References 470 Chapter 13 Profiling, Economic Credentialing, and Risk Adjustment 473 Introduction 473 Physician Profiling and Report Cards 476 Academic Detailing 485 Economic Credentialing 488 Risk Adjustment 490 Summary 505 References 507 Chapter 14 Benchmarking and Implementation 511 Introduction 511 Benchmarking