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Peruzzo E, Vainieri M, De Rosis S. Enhancing Learning Systems in Using Patient Experience Data: An Exploratory Mixed-Method Study in Two Italian Regions. Int J Health Plann Manage 2025; 40:688-700. [PMID: 39996465 PMCID: PMC12045758 DOI: 10.1002/hpm.3912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 01/23/2025] [Accepted: 02/03/2025] [Indexed: 02/26/2025] Open
Abstract
In the quest for healthcare systems enhancement, the improvement of patient experience plays a central role. The challenge lies in converting patient-reported experience data into actionable knowledge for quality improvement. This study aims to investigate the use of patient-reported data as knowledge base for actions and to identify and map actions derived from the use of patient-experience data within two Italian regional healthcare systems. Patient Experience Data are systematically collected in both systems, providing real-time updates accessible by professionals and managers through web-based reporting systems and including a collaborative network among practitioners. A sequential exploratory mixed-method study was carried out in several qualitative and quantitative phases. In the first phase, a qualitative method was conducted to discuss the actionability of patient-reported data and to design a tool for collecting the improvement actions based on these data. In the second phase, a quali-quantitative survey was performed to explore the professionals' use of patient-reported information and the types of actions implemented. Finally, a workshop was held to discuss, interpret and validate the results. The initial workshop identified key dimensions for improvement initiatives. After design and distribution of survey, a total of 189 responses was collected, respectively 96 from Region A and 93 from Region B. Both regions ensured widespread use of patient-reported data (89%). The establishment of a collaborative network seemed to reduce the learning curve in using patient-reported data and fostered a culture of using patient feedback effectively. The results reveal a difference between the two regions, with a more extensive patient-reported data use in Region A, attributed to its systematic joining the PREMs Observatory, prior experiences with patient-feedback collection and use, and patient-experience indicators integrated into the performance evaluation system. Regarding practices of data use, four themes emerged, namely, internal actions addressed to hospital staff (35.9%), external actions addressed to users (18.6%), comfort and hospitality aspects (34.7%) and review of processes and procedures (10.8%). The study highlights the importance of effectively using patient-reported data to achieve organisational goals, by combining different managerial strategies. It demonstrates how professionals use such data for improvement actions and underscores the significance of various forms of knowledge dissemination and sharing. It advocates for fostering a culture of continuous learning and improvement within and across healthcare organisations.
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Affiliation(s)
- Elisa Peruzzo
- Management and Health LaboratoryInstitute of ManagementSant'Anna School of Advanced StudiesPisaItaly
| | - Milena Vainieri
- Management and Health LaboratoryInstitute of ManagementSant'Anna School of Advanced StudiesPisaItaly
| | - Sabina De Rosis
- Management and Health LaboratoryInstitute of ManagementSant'Anna School of Advanced StudiesPisaItaly
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2
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Mehl C, Müller T, Nau T, Bachmann C, Geraedts M. [Development of an indicator set for the evaluation of the quality of routine ambulatory health care for common disorders in children and adolescents]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 186:69-76. [PMID: 38631959 DOI: 10.1016/j.zefq.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/28/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND In Germany, no consented quality indicator set (QI set) exists to date that can be used to assess the quality of pediatric care. Therefore, the aim of the project "Assessment of the quality of routine ambulatory health care for common disorders in children and adolescents" (QualiPäd) funded by the Innovation Committee of the Federal Joint Committee (grant no.: 01VSF19035) was to develop a QI set for the diseases asthma, atopic eczema, otitis media, tonsillitis, attention-deficit hyperactivity disorder (ADHD), depression and conduct disorder. METHODS For the observation period 2018/2019, quality indicators (QIs) were searched in indicator databases, guidelines and literature databases and complemented in part by newly formulated QIs (e.g., derived from guideline recommendations). The QIs were then assigned to content categories and dimensions according to Donabedian and OECD and reduced by removing duplicates. Finally, a panel of experts consulted the QIs using the modified RAND-UCLA Appropriateness Method (RAM). RESULTS The search resulted in a preliminary QI set of 2324 QIs. After the reduction steps and the evaluation of the experts, 282 QIs were included in the QI set (asthma: 72 QIs, atopic eczema: 25 QIs, otitis media: 31 QIs, tonsillitis: 12 QIs, ADHD: 53 QIs, depression: 43 QIs, conduct disorder: 46 QIs). The QIs are distributed among the following different categories: Therapy (138 QIs), Diagnostics (95 QIs), Patient-reported outcome measures/Patient-reported experience measures (PROM/PREM) (45 QIs), Practice management (31 QIs), and Health reporting (4 QIs). In the Donabedian model, 89% of the QIs capture process quality, 9% outcome quality, and 2% structural quality; according to the OECD classification, 61% measure effectiveness, 23% patient-centeredness, and 16% safety of care. CONCLUSION The consented QI set is currently being tested and can subsequently be used (possibly modified) to measure the quality of routine outpatient care for children and adolescents in Germany, in order to indicate the status quo and potential areas for improvement in outpatient care.
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Affiliation(s)
- Claudia Mehl
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland.
| | - Teresa Müller
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland
| | - Thorsten Nau
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland
| | - Christian Bachmann
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland
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Desai AD, Tolpadi A, Parast L, Esporas M, Britto MT, Gidengil C, Wilson K, Bardach NS, Basco WT, Brittan MS, Johnson DP, Wood KE, Yung S, Dawley E, Fiore D, Gregoire L, Hodo LN, Leggett B, Piazza K, Sartori LF, Weber DE, Mangione-Smith R. Improving the Quality of Written Discharge Instructions: A Multisite Collaborative Project. Pediatrics 2023; 151:e2022059452. [PMID: 37078242 DOI: 10.1542/peds.2022-059452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Written discharge instructions help to bridge hospital-to-home transitions for patients and families, though substantial variation in discharge instruction quality exists. We aimed to assess the association between participation in an Institute for Healthcare Improvement Virtual Breakthrough Series collaborative and the quality of pediatric written discharge instructions across 8 US hospitals. METHODS We conducted a multicenter, interrupted time-series analysis of a medical records-based quality measure focused on written discharge instruction content (0-100 scale, higher scores reflect better quality). Data were from random samples of pediatric patients (N = 5739) discharged from participating hospitals between September 2015 and August 2016, and between December 2017 and January 2020. These periods consisted of 3 phases: 1. a 14-month precollaborative phase; 2. a 12-month quality improvement collaborative phase when hospitals implemented multiple rapid cycle tests of change and shared improvement strategies; and 3. a 12-month postcollaborative phase. Interrupted time-series models assessed the association between study phase and measure performance over time, stratified by baseline hospital performance, adjusting for seasonality and hospital fixed effects. RESULTS Among hospitals with high baseline performance, measure scores increased during the quality improvement collaborative phase beyond the expected precollaborative trend (+0.7 points/month; 95% confidence interval, 0.4-1.0; P < .001). Among hospitals with low baseline performance, measure scores increased but at a lower rate than the expected precollaborative trend (-0.5 points/month; 95% confidence interval, -0.8 to -0.2; P < .01). CONCLUSIONS Participation in this 8-hospital Institute for Healthcare Improvement Virtual Breakthrough Series collaborative was associated with improvement in the quality of written discharge instructions beyond precollaborative trends only for hospitals with high baseline performance.
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Affiliation(s)
- Arti D Desai
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | | | - Megan Esporas
- Children's Hospital Association, Washington, District of Columbia
| | - Maria T Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Karen Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Naomi S Bardach
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
| | - William T Basco
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Mark S Brittan
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - David P Johnson
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kelly E Wood
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Steven Yung
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin Dawley
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Darren Fiore
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
| | | | - Laura N Hodo
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett Leggett
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Kirstin Piazza
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Laura F Sartori
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Danielle E Weber
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Developing a quality measure to assess use of antibiotic medications for respiratory conditions. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e13. [PMID: 36714286 PMCID: PMC9879865 DOI: 10.1017/ash.2022.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 01/18/2023]
Abstract
Objective Antibiotics are essential medications for treating life-threatening infections. However, incorrect prescribing can lead to adverse events and contribute to antibiotic resistance. We sought to develop a utilization quality measure that could be used by health insurance plans to track overall prescribing for respiratory conditions. Design A consensus-based process that included evidence review, testing, and stakeholder input was used to develop a measure and assess its usefulness for the Healthcare Effectiveness Data and Information Set (HEDIS), a national quality measurement tool. Methods Guidelines and literature were reviewed to establish the rationale for the measure. The measure was tested in claims data for commercial, Medicaid and Medicare Advantage enrollees to assess feasibility of collecting and reporting needed information. The measure was vetted with multistakeholder advisory panels and posted for public comment to solicit wide input on relevance and usability. Results Respiratory conditions are frequent reasons for outpatient care in the data assessed. On average, across all lines of business, the measure revealed that approximately one-third of outpatient visits for respiratory conditions are followed by antibiotics. Stakeholders supported the measure as a tool for monitoring antibiotic prescribing across health plans alongside existing measures that assess inappropriate prescribing for specific conditions. The final measure assesses the number of antibiotic prescriptions dispensed across all outpatient respiratory-related encounters at a health-plan level. Conclusions The measure on antibiotic prescribing for respiratory conditions was relevant, feasible, and useful. Stakeholders strongly supported the newly developed measure and recommended its integration into HEDIS.
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Shunmuga Sundaram C, Campbell R, Ju A, King MT, Rutherford C. Patient and healthcare provider perceptions on using patient-reported experience measures (PREMs) in routine clinical care: a systematic review of qualitative studies. J Patient Rep Outcomes 2022; 6:122. [PMID: 36459251 PMCID: PMC9718906 DOI: 10.1186/s41687-022-00524-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patient-reported experience measures (PREMs) assess quality-of-care from patients' perspectives. PREMs can be used to enhance patient-centered care and facilitate patient engagement in care. With increasing quality improvement studies in clinical practice, the use of PREMs has surged. As a result, knowledge about stakeholder experiences of using PREMs to assess quality of care across diverse clinical settings is needed to inform PREM implementation efforts. To address this, this review examines the qualitative literature on patient and healthcare provider experiences of using PREMs in clinical practice. METHODS Medline, Embase and PsycInfo were systematically searched from inception to May 2021. Additional searching of reference lists for all included articles and relevant review articles were performed. Retrieved articles were screened for eligibility by one reviewer and 25% cross-checked by a second reviewer across all stages of the review. Full texts meeting eligibility criteria were appraised against the COREQ checklist for quality assessment and thematic analysis was used to analyze textual data extracted from the results. RESULTS Electronic searches identified 2683 records, of which 20 studies met eligibility criteria. Extracted data were synthesized into six themes: facilitators to PREM implementation; barriers to PREM implementation; healthcare providers' perspectives towards using PREMs; patients' perspectives towards using PREMs; advantages of using PREMs in clinical practice; limitations and practical considerations to reduce resistance of PREM usage. The primary factors facilitating and impeding the use of PREMs include organizational-, staff- and patient-related factors. CONCLUSION Results can be used to guide the usage and implementation of PREMs in clinical settings by addressing the identified barriers and building on the perceived benefits to encourage adoption of PREMs. Results around facilitators to PREM implementation and practical considerations could also promote appropriate use of PREMs by healthcare providers, helping to improve practice and the quality of care based on patient feedback.
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Affiliation(s)
- Chindhu Shunmuga Sundaram
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Rachel Campbell
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Angela Ju
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Madeleine T King
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia. .,Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Care Research Unit (CCRU), The University of Sydney, Sydney, Australia. .,The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.
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Blackburn J, Sharma P, Liu Y, Morrisey MA, Menachemi N, Sen B, Sanders T, Becker DJ. Characteristics and outcomes associated with two asthma quality of care measures. J Asthma 2021; 59:2283-2291. [PMID: 34669533 DOI: 10.1080/02770903.2021.1996602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We investigated asthma quality measures to understand patient characteristics associated with non-attainment of quality care and measure the association with asthma-related emergency department (ED) visits or inpatient hospitalizations (IPs). METHODS Using administrative data from ALL Kids, Alabama's Children's Health Insurance Program, from 2013 to 2019 we calculated non-attainment of the Medication Management for Asthma (MMA) and Asthma Medication Ratio (AMR) quality measures. Patient characteristics and asthma-related ED visits and IPs associated with non-attainment of the MMA and AMR measures were assessed using logit regression models and Marginal effects at the mean. RESULTS Among 2528 children with asthma, 53.2% failed to attain the MMA measure and 8.5% the AMR measure. Prior asthma-related ED visits or IP stays increased likelihood of non-attainment by 14.8 percentage points (95% CI 8.6-20.9) for MMA and 7.3 percentage points (95% CI 2.8-11.8) for AMR. Among 868 children (34.3%) with three years of continuous enrollment, AMR non-attainment was associated with a 6.1 percentage point increase in ED or IP utilization (95% CI 1.3-10.9), however MMA non-attainment was not associated with either outcome. Prior ED visit/IP stay was associated with a 17.2 percentage point (95% CI 8.3-26.1) increase in the likelihood of a subsequent ED visit/IP stay among those with non-attainment MMA and a 15.5 percentage point increase (95% CI 6.9-24.2) for non-attainment AMR. CONCLUSIONS Patient characteristics associated with non-attainment of asthma quality measures presents actionable evidence to guide improvement efforts as non-attainment AMR increases the risk of subsequent ED visits and IP stays.
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Affiliation(s)
- Justin Blackburn
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health at IUPUI, Indiana University, Indianapolis, IN, USA
| | - Pradeep Sharma
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ye Liu
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael A Morrisey
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nir Menachemi
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health at IUPUI, Indiana University, Indianapolis, IN, USA
| | - Bisakha Sen
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Teela Sanders
- Children's Health Insurance Program, Alabama Department of Public Health, Montgomery, AL, USA
| | - David J Becker
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Byron SC, Roth L, Acton RM, Shen A. Harnessing electronic clinical data to report adult and prenatal immunization quality measures. J Am Med Inform Assoc 2021; 28:2226-2232. [PMID: 34279653 PMCID: PMC8449614 DOI: 10.1093/jamia/ocab125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To explore the use of health plan quality measures specified for electronic clinical data to monitor immunizations. Materials and Methods We analyzed 2018 data submitted by health plans reporting 2 new Healthcare Effectiveness Data and Information Set measures assessing receipt of clinically recommended vaccines among pregnant women and adults. We analyzed the number of plans reporting a valid performance rate and electronic data source used. We consulted expert panels and reviewed coverage rates from other sources to understand the results. Results We received 136 data submissions across commercial, Medicaid and Medicare plans and 87 submissions across commercial and Medicaid plans for the adult and prenatal immunization measures, respectively. These submissions represent approximately 15% of possible submissions. Plans used claims, registries and electronic health records. Mean performance rates for adult immunizations were 21.2 (commercial), 14.0 (Medicaid) and 19.5% (Medicare). Mean rates for prenatal immunizations were 33.1 (commercial) and 16.7% (Medicaid). Discussion Results from the first year of reporting 2 electronic clinical data measures suggest health plans can feasibly report these measures and are seeking electronic data to supplement claims. Comparison of rates to other national results showed lower than expected rates for the adult immunization measure. However, prenatal immunization rates were on par with those from a national survey, suggesting this measure is closer to use for quality improvement. Conclusion Quality measure reporting that encourages connection to electronic data sources is a step forward in performance monitoring and improvement. The use of electronic sources may advance health information exchange for patient care.
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Affiliation(s)
- Sepheen C Byron
- National Committee for Quality Assurance, Washington, DC, USA
| | - Lindsey Roth
- National Committee for Quality Assurance, Washington, DC, USA
| | - Ryan M Acton
- National Committee for Quality Assurance, Washington, DC, USA
| | - Angela Shen
- Children's Hospital of Philadelphia and the Leonard Davis Institute University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mackie TI, Kovacs KM, Simmel C, Crystal S, Neese-Todd S, Akincigil A. A best-worst scaling experiment to identify patient-centered claims-based outcomes for evaluation of pediatric antipsychotic monitoring programs. Health Serv Res 2020; 56:418-431. [PMID: 33369739 PMCID: PMC8143685 DOI: 10.1111/1475-6773.13610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective This article employs a best‐worst scaling (BWS) experiment to identify the claims‐based outcomes that matter most to patients and other relevant parties when evaluating pediatric antipsychotic monitoring programs in the United States. Data Sources Patients and relevant parties, with pediatric antipsychotic oversight and treatment experience, completed a BWS experiment, including policymakers (n = 31), foster care alumni (n = 28), caseworkers (n = 23), prescribing clinicians (n = 32), and caregivers (n = 18). Study Design Respondents received surveys with a scenario on antipsychotic monitoring programs and ranked 11 candidate claims‐based outcomes as most and least important for program evaluation. Data Analysis Stratified by respondent group, best‐worst scores were calculated to identify the relative importance of the claims‐based outcomes. A conditional logit examined whether candidate outcomes for safety, quality, and unintended consequences were preferred over reduction in antipsychotic treatment, the outcome used most often to evaluate antipsychotic monitoring programs. Principal Findings Safety indicators (eg, antipsychotic co‐pharmacy, cross‐class polypharmacy, higher than recommended doses) ranked among the top three candidate outcomes across respondent groups and were an important complement to antipsychotic treatment reduction. Foster care alumni prioritized “antipsychotic treatment reduction” and “increased psychosocial treatment.” Caseworkers, prescribers, and caregivers prioritized “increased follow‐up after treatment initiation.” Potential unintended consequences of an antipsychotic monitoring program ranked lowest, including increased use of other psychotropic medication classes (as a substitute), increased psychiatric hospital stays, and increased emergency room utilization. Results of the conditional logit model found only caregivers significantly preferred other indicators over antipsychotic treatment reduction, preferring improvements in follow‐up care (5.78) and psychosocial treatment (4.53) and reduction in prescriptions of higher than recommended doses (3.64). Conclusions The BWS experiment supported rank ordering of candidate claims‐based outcomes demonstrating the opportunity for future studies to align outcomes used in antipsychotic monitoring program evaluations with community preferences, specifically by diversifying metrics to include safety and quality indicators.
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Affiliation(s)
- Thomas I Mackie
- School of Public Health, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Katherine M Kovacs
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Cassandra Simmel
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Stephen Crystal
- School of Social Work, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Sheree Neese-Todd
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Ayse Akincigil
- School of Social Work, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Havers SM, Kate Martin E, Wilson A, Hall L. A systematic review and meta-synthesis of policy intervention characteristics that influence the implementation of government-directed policy in the hospital setting: implications for infection prevention and control. J Infect Prev 2020; 21:84-96. [PMID: 32494292 DOI: 10.1177/1757177420907696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 01/02/2020] [Indexed: 01/26/2023] Open
Abstract
Background Government-directed policy plays an important role in the regulation and supervision of healthcare quality. Effective implementation of these policies has the potential to significantly improve clinical practice and patient outcomes, including the prevention of healthcare-associated infections. A systematic review of research describing the implementation of government-directed policy in the hospital setting was performed with the aim to identify policy intervention characteristics that influence implementation. Methods A systematic search of four electronic databases was undertaken to identify eligible articles published between 2007 and 2017. Studies were included if published in the English language and described the implementation of government-directed policy in a high-income country hospital setting. Data on policy and implementation were extracted for each article and interpretive syntheses performed. Results A total of 925 articles were retrieved and titles and abstracts reviewed, with 69 articles included after review of abstract and full text. Qualitative synthesis of implementation data showed three overarching themes related to intervention characteristics associated with implementation: clarity; infrastructure; and alignment. Conclusion Better understanding and consideration of policy intervention characteristics during development and planning will facilitate more effective implementation although research describing implementation of government-directed policy in the hospital setting is limited and of variable quality. The findings of this study provide guidance to staff tasked with the development or implementation of government-directed policy in the hospital setting, infection prevention and control professionals seeking to maximise the impact of policy on practice and improve patient outcomes.
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Affiliation(s)
- Sally M Havers
- Queensland University of Technology Faculty of Health, Kelvin Grove, QLD, Australia
| | | | | | - Lisa Hall
- University of Queensland, Brisbane, QLD, Australia
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10
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Bentley N, Hartley S, Bucci S. Systematic Review of Self-Report Measures of General Mental Health and Wellbeing in Adolescent Mental Health. Clin Child Fam Psychol Rev 2020; 22:225-252. [PMID: 30617936 DOI: 10.1007/s10567-018-00273-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The assessment of general mental health and wellbeing is important within child and adolescent mental health services (CAMHS) for both clinicians and policy makers. Measurement tools are routinely relied upon to aid assessment and to monitor and evaluate treatment and service effectiveness. We conducted a systematic review using the COSMIN checklist to identify measures of general mental health and wellbeing for an adolescent mental health population. A systematic database search was performed using PsychINFO, MEDLINE, EMBASE, and CINAHL in accordance with PRISMA guidelines. Database searching produced 9587 records, with 27 papers meeting eligibility criteria and 16 measures identified and critically appraised. The Y-QOL-R and the Y-QOL.30.1 had the most robust psychometric properties. When considering the clinical utility of measures alongside psychometric properties of measures, the GHQ-12, ORS and YP CORE had the greatest clinical utility. The psychometric quality of measures reviewed overall, however, were generally poor in quality. Measuring outcomes in CAMHS and ensuring appropriate treatment pathways for young people is important. This review highlights the need for more robust testing of the psychometric properties of adolescent measures. When selecting measurement tools, clinicians should not only consider the purpose of the measure, (i.e., discriminative, predictive, and evaluative) and characteristics of the instrument (e.g., intended population, measure length), but should also the quality of the psychometric properties of the instrument.
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Affiliation(s)
- Natalie Bentley
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - Samantha Hartley
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.,Pennine Care NHS Foundation Trust, Manchester, M13 9PL, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK. .,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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A Primer on Understanding Pediatric Health Care Quality Measurement. J Pediatr Health Care 2019; 33:589-594. [PMID: 30878264 DOI: 10.1016/j.pedhc.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 11/23/2022]
Abstract
Advanced practice registered nurses implement evidence-based care guidelines and assess the quality of care delivered to pediatric and adolescent populations to ensure that the highest standards of care are provided to the patients and their families. Standardized health care quality measures allow for assessment of clinical competence, monitoring of equitable health care distribution, improvement of provider/institutional accountability, development of standards for accreditation and certification, informing of quality improvement efforts, and creation of criteria for provider incentive payments. The purpose of this article is to explain why health care quality measures are established, what agencies oversee the development of meaningful pediatric quality measures, and how these measures inform and improve the care provided by pediatric-focused advanced practice registered nurses.
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Desai AD, Starmer AJ. Process Metrics and Outcomes to Inform Quality Improvement in Pediatric Hospital Medicine. Pediatr Clin North Am 2019; 66:725-737. [PMID: 31230619 DOI: 10.1016/j.pcl.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article provides an overview of the selection, development, and use of process and outcome measures for pediatric hospital medicine quality improvement initiatives. It reviews commonly used categories of process and outcome measures and provides a list of common sources and repositories of previously validated measures. It also provides a blueprint for the development of novel measures. The relative merits of various data collection methods are discussed (eg, medical record abstraction, administrative, surveys), along with guiding principles for disseminating the results of quality improvement evaluations on a local and national level.
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Affiliation(s)
- Arti D Desai
- University of Washington, Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, Seattle, WA 98121, USA.
| | - Amy J Starmer
- Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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13
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Ronis SD, Kleinman LC, Stange KC. A Learning Loop Model of Collaborative Decision-Making in Chronic Illness. Acad Pediatr 2019; 19:497-503. [PMID: 31009759 PMCID: PMC8127066 DOI: 10.1016/j.acap.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/08/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022]
Abstract
Shared decision-making is a core attribute of quality health care that has proved challenging to implement and assess in pediatric practice. Current models of shared decision-making are limited, including their capacity to incorporate multiple stakeholders; to integrate downstream effects of subacute or minor decisions; and to account for the context(s) in which such decisions are being made and enacted. Based on a review of literature from organizational psychology, cognitive sciences, business, and medicine, we propose an iterative decision-making model of care planning and identify targets at several levels of influence warranting measurement in future studies. Our learning loop model posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that "meta-learning" from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians. We consider the model in light of the needs of children with special health care needs, for whom understanding the ongoing iterative effects of decision making and clinician-parent-child dynamics are likely to be particularly important in influencing outcomes.
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Affiliation(s)
- Sarah D Ronis
- Department of Pediatrics, Case Western Reserve University, and UH Rainbow Center for Child Health and Policy, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio (SD Ronis).
| | - Lawrence C Kleinman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (LC Kleinman)
| | - Kurt C Stange
- Center for Community Health Integration, Department of Family Medicine & Community Health, Department of Population & Quantitative Health Sciences, Department of Sociology, Case Western Reserve University, Cleveland, Ohio (KC Stange)
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14
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Freed GL, deJong N, Macy ML, Van KD, Leslie LK. Pediatricians' Participation in Quality Improvement at the Time of Enrollment in MOC. Pediatrics 2018; 142:peds.2018-0712. [PMID: 30301817 DOI: 10.1542/peds.2018-0712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although national bodies have proclaimed the importance of incorporating quality improvement (QI) into the daily fabric of clinical care, the actual proportion of practicing pediatricians who participate in QI activities on an annual basis is unknown. Correspondingly little is known about pediatrician motivations for, attitudes about, and support received for QI participation. METHODS Pediatric diplomates enrolling in the American Board of Pediatrics' Maintenance of Certification program during calendar year 2016 were provided with the opportunity to complete a brief survey. A portion of the survey was focused on issues related to participation in QI programs. RESULTS Survey responses were received from 8714 of the 11 890 diplomates who enrolled in Maintenance of Certification in 2016 (response rate: 73.3%). Overall, 86.6% of respondents reported participation in at least 1 QI project in the previous year. There was variation in previous-year participation in a QI project by practice affiliation categories, ranging from 79.9% for nonacademic generalists to 92.4% for academic specialists. The extrinsic requirement for QI to maintain board certification was the dominant motivator among all respondents (50.7%), followed by 2 intrinsic factors: identify gaps in practice and implement change (40.3%) and opportunity to collaborate with others (36.9%). CONCLUSIONS Although the results are encouraging, despite almost 2 decades of national attention to the quality of health care and efforts to embed continual QI in health care delivery activities, ∼1 in 5 nonacademic pediatricians and 1 in 10 academic pediatricians did not report participating in any QI activities in the previous year.
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Affiliation(s)
- Gary L Freed
- Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, .,Department of Health Management and Policy, School of Public Health, and.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Neal deJong
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michelle L Macy
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan.,Division of Pediatric Emergency Medicine, Department of Emergency Medicine, School of Medicine
| | - Kenton D Van
- Division of General Pediatrics, Department of Pediatrics and Communicable Diseases.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, North Carolina; and.,School of Medicine, Tufts University, Boston, Massachusetts
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15
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Leckman-Westin E, Finnerty M, Scholle SH, Pritam R, Layman D, Kealey E, Byron S, Morden E, Bilder S, Neese-Todd S, Horwitz S, Hoagwood K, Crystal S. Differences in Medicaid Antipsychotic Medication Measures Among Children with SSI, Foster Care, and Income-Based Aid. J Manag Care Spec Pharm 2018; 24:238-246. [PMID: 29485947 PMCID: PMC10397713 DOI: 10.18553/jmcp.2018.24.3.238] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Concerns about antipsychotic prescribing for children, particularly those enrolled in Medicaid and with Supplemental Security Income (SSI), continue despite recent calls for selective use within established guidelines. OBJECTIVES To (a) examine the application of 6 quality measures for antipsychotic medication prescribing in children and adolescents receiving Medicaid and (b) understand distinctive patterns across eligibility categories in order to inform ongoing quality management efforts to support judicious antipsychotic use. METHODS Using data for 10 states from the 2008 Medicaid Analytic Extract (MAX), a cross-sectional assessment of 144,200 Medicaid beneficiaries aged < 21 years who received antipsychotics was conducted to calculate the prevalence of 6 quality measures for antipsychotic medication management, which were developed in 2012-2014 by the National Collaborative for Innovation in Quality Measurement. These measures addressed antipsychotic polypharmacy, higher-than-recommended doses of antipsychotics, use of psychosocial services before antipsychotic initiation, follow-up after initiation, baseline metabolic screening, and ongoing metabolic monitoring. RESULTS Compared with children eligble for income-based Medicaid, children receiving SSI and in foster care were twice as likely to receive higher-than-recommended doses of antipsychotics (adjusted odds ratio [AOR] = 2.4, 95% CI = 2.3-2.6; AOR = 2.5, 95% CI = 2.4-2.6, respectively) and multiple concurrent antipsychotic medications (AOR = 2.2, 95% CI = 2.0-2.4; AOR = 2.2, 95% CI = 2.0-2.4, respectively). However, children receiving SSI and in foster care were more likely to have appropriate management, including psychosocial visits before initiating antipsychotic treatment and ongoing metabolic monitoring. While children in foster care were more likely to experience baseline metabolic screening, SSI children were no more likely than children eligible for income-based aid to receive baseline screening. CONCLUSIONS While indicators of overuse were more common in SSI and foster care groups, access to follow-up, metabolic monitoring, and psychosocial services was somewhat better for these children. However, substantial quality shortfalls existed for all groups, particularly metabolic screening and monitoring. Renewed efforts are needed to improve antipsychotic medication management for all children. DISCLOSURES This project was supported by grant number U18HS020503 from the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS). Additional support for Rutgers-based participants was provided from AHRQ grants R18 HS019937 and U19HS021112, as well as the New York State Office of Mental Health. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ, CMS, or the New York State Office of Mental Health. Finnerty has been the principle investigator on research grants/contracts from Bristol Myers Squibb and Sunovion, but her time on these projects is fully supported by the New York State Office of Mental Health. Scholle, Byron, and Morden work for the National Committee for Quality Assurance, a not-for-profit organization that develops and maintains quality measures. Neese-Todd was at Rutgers University at the time of this study and is now employed by the National Committee for Quality Assurance. The other authors have no financial relationships relevant to this article to disclose. Study concept and design were contributed by Finnerty, Neese-Todd, and Crystal, assisted by Scholle, Leckman-Westin, Horowitz, and Hoagwood. Scholle, Byron, Morden, and Hoagwood collected the data, and data interpretation was performed by Pritam, Bilder, Leckman-Westin, and Finnerty, with assistance from Scholle, Byron, Crystal, Kealey, and Neese-Todd. The manuscript was written by Leckman-Westin, Kealey, and Horowitz and revised by Layman, Crystal, Leckman-Westin, Finnerty, Scholle, Neese-Todd, and Horowitz, along with the other authors.
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Affiliation(s)
- Emily Leckman-Westin
- 1 New York State Office of Mental Health, Albany, New York, and State University of New York at Albany, School of Public Health, Rensselaer, New York
| | - Molly Finnerty
- 2 New York State Office of Mental Health, and New York University Langone Health, New York, New York
| | | | - Riti Pritam
- 4 New York State Office of Mental Health, Albany, New York
| | - Deborah Layman
- 4 New York State Office of Mental Health, Albany, New York
| | - Edith Kealey
- 4 New York State Office of Mental Health, Albany, New York
| | - Sepheen Byron
- 3 National Committee for Quality Assurance, Washington, DC
| | - Emily Morden
- 3 National Committee for Quality Assurance, Washington, DC
| | | | | | - Sarah Horwitz
- 6 New York University Langone Health, New York, New York
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16
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Bardach NS, Burkhart Q, Richardson LP, Roth CP, Murphy JM, Parast L, Gidengil CA, Marmet J, Britto MT, Mangione-Smith R. Hospital-Based Quality Measures for Pediatric Mental Health Care. Pediatrics 2018; 141:e20173554. [PMID: 29853624 PMCID: PMC6317537 DOI: 10.1542/peds.2017-3554] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with a primary mental health condition account for nearly 10% of pediatric hospitalizations nationally, but little is known about the quality of care provided for them in hospital settings. Our objective was to develop and test medical record-based measures used to assess quality of pediatric mental health care in the emergency department (ED) and inpatient settings. METHODS We drafted an evidence-based set of pediatric mental health care quality measures for the ED and inpatient settings. We used the modified Delphi method to prioritize measures; 2 ED and 6 inpatient measures were operationalized and field-tested in 2 community and 3 children's hospitals. Eligible patients were 5 to 19 years old and diagnosed with psychosis, suicidality, or substance use from January 2012 to December 2013. We used bivariate and multivariate models to examine measure performance by patient characteristics and by hospital. RESULTS Eight hundred and seventeen records were abstracted with primary diagnoses of suicidality (n = 446), psychosis (n = 321), and substance use (n = 50). Performance varied across measures. Among patients with suicidality, male patients (adjusted odds ratio: 0.27, P < .001) and African American patients (adjusted odds ratio: 0.31, P = .02) were less likely to have documentation of caregiver counseling on lethal means restriction. Among admitted suicidal patients, 27% had documentation of communication with an outside provider, with variation across hospitals (0%-38%; P < .001). There was low overall performance on screening for comorbid substance abuse in ED patients with psychosis (mean: 30.3). CONCLUSIONS These new pediatric mental health care quality measures were used to identify sex and race disparities and substantial hospital variation. These measures may be useful for assessing and improving hospital-based pediatric mental health care quality.
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Affiliation(s)
- Naomi S Bardach
- Department of Pediatrics, University of California San Francisco, San Francisco, California;
| | - Q Burkhart
- RAND Corporation, Santa Monica, California
| | - Laura P Richardson
- Department of Pediatrics, University of Washington, Seattle, Washington
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | | | - J Michael Murphy
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Courtney A Gidengil
- Harvard Medical School, Harvard University, Boston, Massachusetts
- RAND Corporation, Boston, Massachusetts
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Jordan Marmet
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; and
| | - Maria T Britto
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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17
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Measuring and improving comprehensive pediatric cardiac care: Learning from continuous quality improvement methods and tools. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Bender M, Spiva L, Su W, Hites L. Organising nursing practice into care models that catalyse quality: A clinical nurse leader case study. J Nurs Manag 2018; 26:653-662. [DOI: 10.1111/jonm.12596] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Miriam Bender
- Sue & Bill Gross School of Nursing; University of California; Irvine CA USA
| | - LeeAnna Spiva
- Nursing Operations and Practice; WellStar; Atlanta GA USA
| | - Wei Su
- Department of Health Care Organization and Policy; University of Alabama; Birmingham AL USA
| | - Lisle Hites
- Department of Health Care Organization and Policy; University of Alabama; Birmingham AL USA
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19
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Kilbourne AM, Beck K, Spaeth-Rublee B, Ramanuj P, O'Brien RW, Tomoyasu N, Pincus HA. Measuring and improving the quality of mental health care: a global perspective. World Psychiatry 2018; 17:30-38. [PMID: 29352529 PMCID: PMC5775149 DOI: 10.1002/wps.20482] [Citation(s) in RCA: 239] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.
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Affiliation(s)
- Amy M Kilbourne
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kathryn Beck
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brigitta Spaeth-Rublee
- Department of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
| | - Parashar Ramanuj
- RAND Europe, Cambridge, UK
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - Robert W O'Brien
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Naomi Tomoyasu
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Harold Alan Pincus
- Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian Hospital, New York, NY, USA
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20
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Mangione-Smith R. The Challenges of Addressing Pediatric Quality Measurement Gaps. Pediatrics 2017; 139:peds.2017-0174. [PMID: 28298483 DOI: 10.1542/peds.2017-0174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington; and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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21
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Lorch SA. Challenges to Measuring the Quality of Low-Risk Newborns. Pediatrics 2017; 139:peds.2016-4025. [PMID: 28188300 DOI: 10.1542/peds.2016-4025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Scott A Lorch
- Department of Pediatrics, Division of Neonatology, .,Center for Perinatal and Pediatric Health Disparities Research, and.,Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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22
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Adirim T, Meade K, Mistry K. A New Era in Quality Measurement: The Development and Application of Quality Measures. Pediatrics 2017; 139:peds.2016-3442. [PMID: 28025242 DOI: 10.1542/peds.2016-3442] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Quality measures are used for a variety of purposes in health care, including clinical care improvement, regulation, accreditation, public reporting, surveillance, and maintenance of certification. Most quality measures are 1 of 3 types: structure, process, or outcome. Health care quality measures should address the domains of quality across the continuum of care and reflect patient and family experience. Measure development for pediatric health care has a number of important challenges, including gaps in the evidence base; the fact that measures for most conditions must be age-specific; the long, resource-intensive development process; and the national focus on measure development for adult conditions. Numerous national organizations focus on the development and application of quality measures, including the Pediatric Quality Measures Program, which is focused solely on the development and implementation of pediatric-specific measures. Once a quality measure is developed for use in national measurement programs, the organization that develops and/or "stewards" the measure may submit the measure or set of measures for endorsement, which is recognition of the scientific soundness, usability, and relevance of the measure. Quality measures must then be disseminated and applied to improve care. Although pediatric health care providers and child health care institutions alike must continually balance time and resources needed to address multiple reporting requirements, quality measurement is an important tool for advancing high-quality and safe health care for children. This policy statement provides an overview of quality measurement and describes the opportunities for pediatric health care providers to apply quality measures to improve clinical quality and performance in the delivery of pediatric health care services.
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Gleeson H, Calderon A, Swami V, Deighton J, Wolpert M, Edbrooke-Childs J. Systematic review of approaches to using patient experience data for quality improvement in healthcare settings. BMJ Open 2016; 6:e011907. [PMID: 27531733 PMCID: PMC5013495 DOI: 10.1136/bmjopen-2016-011907] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Explore how patient-reported experience measures (PREMs) are collected, communicated and used to inform quality improvement (QI) across healthcare settings. DESIGN Systematic review. SETTING Various primary and secondary care settings, including general practice, and acute and chronic care hospitals. PARTICIPANTS A full range of patient populations from (children through to the elderly) and staff (from healthcare practitioners to senior managers). METHODS Scientific databases were searched (CINAHL, PsycINFO, MEDLINE and Cochrane Libraries) as was grey literature. Qualitative and quantitative studies describing collection of PREM data and subsequent QI actions in any healthcare setting were included. Risk of bias was assessed using established criteria. Of 5312 initial hits, 32 full texts were screened, and 11 were included. RESULTS Patient experience data were most commonly collected through surveys and used to identify small areas of incremental change to services that do not require a change to clinician behaviour (eg, changes to admission processes and producing educational materials). While staff in most studies reported having made effective improvements, authors struggled to identify what those changes were or the impact they had. CONCLUSIONS Findings suggest there is no single best way to collect or use PREM data for QI, but they do suggest some key points to consider when planning such an approach. For instance, formal training is recommended, as a lack of expertise in QI and confidence in interpreting patient experience data effectively may continue to be a barrier to a successful shift towards a more patient-centred healthcare service. In the context of QI, more attention is required on how patient experience data will be used to inform changes to practice and, in turn, measure any impact these changes may have on patient experience.
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Affiliation(s)
- Helen Gleeson
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, London, UK
| | - Ana Calderon
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, London, UK
| | | | - Jessica Deighton
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, London, UK
| | - Miranda Wolpert
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, London, UK
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, London, UK
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24
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Leyenaar JK, Desai AD, Burkhart Q, Parast L, Roth CP, McGalliard J, Marmet J, Simon TD, Allshouse C, Britto MT, Gidengil CA, Elliott MN, McGlynn EA, Mangione-Smith R. Quality Measures to Assess Care Transitions for Hospitalized Children. Pediatrics 2016; 138:peds.2016-0906. [PMID: 27471218 PMCID: PMC9534577 DOI: 10.1542/peds.2016-0906] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Transitions between sites of care are inherent to all hospitalizations, yet we lack pediatric-specific transitions-of-care quality measures. We describe the development and validation of new transitions-of-care quality measures obtained from medical record data. METHODS After an evidence review, a multistakeholder panel prioritized quality measures by using the RAND/University of California, Los Angeles modified Delphi method. Three measures were endorsed, operationalized, and field-tested at 3 children's hospitals and 2 community hospitals: quality of hospital-to-home transition record content, timeliness of discharge communication between inpatient and outpatient providers, and ICU-to-floor transition note quality. Summary scores were calculated on a scale from 0 to 100; higher scores indicated better quality. We examined between-hospital variation in scores, associations of hospital-to-home transition quality scores with readmission and emergency department return visit rates, and associations of ICU-to-floor transition quality scores with ICU readmission and length of stay. RESULTS A total of 927 charts from 5 hospitals were reviewed. Mean quality scores were 65.5 (SD 18.1) for the hospital-to-home transition record measure, 33.3 (SD 47.1) for the discharge communication measure, and 64.9 (SD 47.1) for the ICU-to-floor transition measure. The mean adjusted hospital-to-home transition summary score was 61.2 (SD 17.1), with significant variation in scores between hospitals (P < .001). Hospital-to-home transition quality scores were not associated with readmissions or emergency department return visits. ICU-to-floor transition note quality scores were not associated with ICU readmissions or hospital length of stay. CONCLUSIONS These quality measures were feasible to implement in diverse settings and varied across hospitals. The development of these measures is an important step toward standardized evaluation of the quality of pediatric transitional care.
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Affiliation(s)
| | - Arti D. Desai
- Department of Pediatrics, University of Washington, Seattle, Washington,Seattle Children’s Research Institute, Seattle, Washington
| | | | | | | | | | - Jordan Marmet
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Tamara D. Simon
- Department of Pediatrics, University of Washington, Seattle, Washington,Seattle Children’s Research Institute, Seattle, Washington
| | | | - Maria T. Britto
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Courtney A. Gidengil
- RAND Corporation, Boston, Massachusetts,Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | | | - Elizabeth A. McGlynn
- Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, California
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington,Seattle Children’s Research Institute, Seattle, Washington
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25
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Chien AT, Kuhlthau KA, Toomey SL, Quinn JA, Houtrow AJ, Kuo DZ, Okumura MJ, Van Cleave JM, Johnson CK, Mahoney LL, Martin J, Landrum MB, Schuster MA. Development of the Children With Disabilities Algorithm. Pediatrics 2015; 136:e871-8. [PMID: 26416938 DOI: 10.1542/peds.2015-0228] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A major impediment to understanding quality of care for children with disabilities (CWD) is the lack of a method for identifying this group in claims databases. We developed the CWD algorithm (CWDA), which uses International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify CWD. METHODS We conducted a cross-sectional study that (1) ensured each of the 14,567 codes within the 2012 ICD-9-CM codebook was independently classified by 3 to 9 pediatricians based on the code's likelihood of indicating CWD and (2) triangulated the resulting CWDA against parent and physician assessment of children's disability status by using survey and chart abstraction, respectively. Eight fellowship-trained general pediatricians and 42 subspecialists from across the United States participated in the code classification. Parents of 128 children from a large, free-standing children's hospital participated in the parent survey; charts of 336 children from the same hospital were included in the abstraction study. RESULTS CWDA contains 669 ICD-9-CM codes classified as having a ≥75% likelihood of indicating CWD. Examples include 318.2 Profound intellectual disabilities and 780.72 Functional quadriplegia. CWDA sensitivity was 0.75 (95% confidence interval 0.63-0.84) compared with parent report and 0.98 (0.95-0.99) compared with physician assessment; its specificity was 0.86 (0.72-0.95) and 0.50 (0.41-0.59), respectively. CONCLUSIONS ICD-9-CM codes can be classified by their likelihood of indicating CWD. CWDA triangulates well with parent report and physician assessment of child disability status. CWDA is a new tool that can be used to assess care quality for CWD.
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Affiliation(s)
- Alyna T Chien
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Departments of Pediatrics, and
| | - Karen A Kuhlthau
- Departments of Pediatrics, and Center for Child and Adolescent Health Research and Policy, Department of General Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Sara L Toomey
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Departments of Pediatrics, and
| | - Jessica A Quinn
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Amy J Houtrow
- Division of Pediatric Rehabilitation Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dennis Z Kuo
- Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas; and
| | - Megumi J Okumura
- Division of General Pediatrics, Beinoff Children's Hospital, and Department of Pediatrics, Division of General Pediatrics, School of Medicine, University of California San Francisco, San Francisco, California
| | - Jeanne M Van Cleave
- Departments of Pediatrics, and Center for Child and Adolescent Health Research and Policy, Department of General Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Chelsea K Johnson
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Lindsey L Mahoney
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Julia Martin
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | - Mark A Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Departments of Pediatrics, and
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Desai AD, Popalisky J, Simon TD, Mangione-Smith RM. The effectiveness of family-centered transition processes from hospital settings to home: a review of the literature. Hosp Pediatr 2015; 5:219-31. [PMID: 25832977 DOI: 10.1542/hpeds.2014-0097] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The quality of care transitions is of growing concern because of a high incidence of postdischarge adverse events, poor communication with patients, and inadequate information transfer between providers. The objective of this study was to conduct a targeted literature review of studies examining the effectiveness of family-centered transition processes from hospital- and emergency department (ED)-to-home for improving patient health outcomes and health care utilization. METHODS We conducted an electronic search (2001-2012) of PubMed, CINAHL, Cochrane, PsycInfo, Embase, and Web of Science databases. Included were experimental studies of hospital and ED-to-home transition interventions in pediatric and adult populations meeting the following inclusion criteria: studies evaluating hospital or ED-to-home transition interventions, study interventions involving patients/families, studies measuring outcomes≤30 days after discharge, and US studies. Transition processes, principal outcome measures (patient health outcomes and health care utilization), and assessment time-frames were extracted for each study. RESULTS The search yielded 3458 articles, and 16 clinical trials met final inclusion criteria. Four studies evaluated pediatric ED-to-home transitions and indicated family-tailored discharge education was associated with better patient health outcomes. Remaining trials evaluating adult hospital-to-home transitions indicated a transition needs assessment or provision of an individualized transition record was associated with better patient health outcomes and reductions in health care utilization. The effectiveness of postdischarge telephone follow-up and/or home visits on health care utilization showed mixed results. CONCLUSIONS Patient-tailored discharge education is associated with improved patient health outcomes in pediatric ED patients. Effective transition processes identified in the adult literature may inform future quality improvement research regarding pediatric hospital-to-home transitions.
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Affiliation(s)
- Arti D Desai
- Department of Pediatrics, University of Washington, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
| | - Jean Popalisky
- Seattle Children's Research Institute, Seattle, Washington
| | - Tamara D Simon
- Department of Pediatrics, University of Washington, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
| | - Rita M Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
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Kuhlthau KA, Mistry KB, Forrest CB, Dougherty D. Advancing the science of measurement in pediatric quality of care. Acad Pediatr 2014; 14:S1-3. [PMID: 25169448 DOI: 10.1016/j.acap.2014.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Karen A Kuhlthau
- From the Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
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28
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Advancing children's health care and outcomes through the pediatric quality measures program. Acad Pediatr 2014; 14:S19-26. [PMID: 25169453 DOI: 10.1016/j.acap.2014.06.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 11/23/2022]
Abstract
In 2009 Congress passed the Children's Health Insurance Program Reauthorization Act (CHIPRA), which presented an unprecedented opportunity to measure and improve health care quality and outcomes for children. The Agency for Healthcare Research and Quality, in partnership with the Centers for Medicare & Medicaid Services, has worked to fulfill a number of quality measurement provisions under CHIPRA, including establishing the Pediatric Quality Measures Program (PQMP). The PQMP was charged with establishing a publicly available portfolio of new and enhanced evidence-based pediatric quality measures for use by Medicaid/Children's Health Insurance Program and other public and private programs and to also provide opportunities to improve and strengthen the Child Core Set of quality measures. This article focuses on the PQMP and provides an overview of the program's goals and related activities, lessons learned, and future opportunities.
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Kealey E, Scholle SH, Byron SC, Hoagwood K, Leckman-Westin E, Kelleher K, Finnerty M. Quality concerns in antipsychotic prescribing for youth: a review of treatment guidelines. Acad Pediatr 2014; 14:S68-75. [PMID: 25169461 PMCID: PMC4486323 DOI: 10.1016/j.acap.2014.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antipsychotic prescribing for youth has increased rapidly, is linked with serious health concerns, and lacks clear measures of quality for pediatric care. We reviewed treatment guidelines relevant to 7 quality concepts for appropriate use and management of youth on antipsychotics: 1) use in very young children, 2) multiple concurrent antipsychotics, 3) higher-than-recommended doses, 4) use without a primary indication, 5) access to psychosocial interventions, 6) metabolic screening, and 7) follow-up visits with a prescriber. METHODS We searched for clinical practice guidelines meeting the following criteria: developed or endorsed by a national body, published after 2000, and specific treatment recommendations made related to 1 or more of the 7 quality concepts. Sources included electronic databases, the American Academy of Child and Adolescent Psychiatry Web site, and stakeholder and expert advisory committee recommendations. Two raters reviewed the 11 guidelines identified, extracting treatment recommendations, including details that could support measure definitions, and ratings of strength of recommendation and evidence. RESULTS All 7 quality concepts were strongly endorsed by 1 or more guidelines, and 2 or more guidelines assigned their highest strength of recommendation ratings to 6 of the 7 concepts. Two guidelines rated evidence, providing high strength of evidence for 2 quality concepts: psychosocial interventions and metabolic monitoring. CONCLUSIONS Guidelines provide support for 7 quality concepts addressing antipsychotic prescribing for youth. However, guideline support is often based on strong clinical consensus rather than a robust evidence base.
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Affiliation(s)
- Edith Kealey
- New York State Office of Mental Health, New York, NY
| | | | | | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY
| | - Emily Leckman-Westin
- New York State Office of Mental Health, New York, NY; New York State Office of Mental Health and School of Public Health, State University of New York-Albany, Albany, NY
| | - Kelly Kelleher
- Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, Ohio
| | - Molly Finnerty
- New York State Office of Mental Health, New York, NY; Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
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