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Quality improvement in health care has 2 aims; to continuously develop and improve services provided to patients and to improve the clinical outcomes of patients (Varkey, 2010).The questions I will try to answer are these: What are the desirable characteristics of quality measurement? How do we know that the measurement method being used is reliable? How do we know when improvement is achieved (Varkey, 2010)?
Relevance: is the measure relevant to consumers, providers, clinicians, payers and policy makers? Is it actually relevant to the project at hand (Use Jade’s M&M example from last week).Evidence-based: the measure must be based on scientific evidence, that link structure and process to the outcomes of the improvement effort.Reliability: the measure should be free from random error, to justify the use of the data as an indication of quality.Reproducibility: the same measurement process using the same data should produce the same results subsequent times.Validity: is the measurement method associated with its’ implied measure? Does it actually represent patient care?Feasibility: the measurement must be realistic in its collection and analysis of data. Obstacles to measurement feasibility are those requiring too much time, money and or effort (Varkey, 2010).
How do we know if we are meeting these criteria?Ask the question: Is the data answering the critical questions?If not, get rid of the old and test new measures. If improvement within a specific area is meeting practice goals or is not changing over long periods of time, rethink which measures make sense (Endsley, 2007).How do we know which measures make sense?Image taken from: Clipart, 2001.
The appropriateness model of quality interpretation is sometimes referred to as the "all-or-none" approach because it is calculated based on the number of patients who received all of the services they needed (AHQR, 2010). One example of this model is the diabetes composite, in which a patient is recommended to receives a lab test, eye exam and foot exam. Failure to receive any of these services results in failure of the composite and decline in quality according to the measure (Varkey, 2010).The appropriateness model reflects the proportion of patients who receive all of the care recommended to them (Varkey, 2010).
The opportunity model sums the number of opportunities with the number of cases in which indicated care is delivered which reflects the rate at which indicated care is delivered (Varkey, 2010).
QI programs can be evaluated to measure their success.Formative evaluations occur frequently and focus on key improvement initiatives, allowing for rapid intervention within the program. Summative evaluations occur less often, with a focus on measuring the overall effectiveness of the improvement program (Varkey, 2010).
I conclude by saying, there is no definite method of measurement interpretation to decree that quality improvement has been reached. As I stated earlier, the goal of quality improvement in healthcare is to continuously develop and improve. The process of improvement is a cycle and there is no summit to reach, so the goal should be to seek usefulness and not perfection (IHI, 2007).The most dependable way to do this in a healthcare setting is to make measurement a daily routine and encourage data collection and analysis of the system under improvement (IHI, 2007).
QI Measurement: Interpretation ASTRID GRGURICH
Importance of Interpretation Continuously develop and improve services Improve clinical outcomes of patients
Importance of Measurement “Measurement is a critical part of testing andimplementing changes; measures tell a team whether the changes they are making actually lead to improvement.” (IHI, 2011).
In conclusion... Improvement is a cycle, so there is no summit to reach Seek usefulness not perfection
References Agency for Healthcare Quality Research. (2010). National healthcare quality report 2010. Retrieved from http://www.ahrq.gov/qual/nhqr10/Chap1a.htm Endsley, S. (2007). Measure to improve. Retrieved from http://www.aafp.org/online/en/home/practicemgt/qual ity/qitools/perfmeasure/practmeas.html Institute for Healthcare Improvement. (2011). Measures. http://www.ihi.org/knowledge/Pages/Measures/default. aspx Varkey, P. (Ed.). (2010). Medical quality management: Theory and practice. Sudbury, MA: Jones and Bartlett Publishers.