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Discuss the Quality of Care within Hеаlth Care Orgаnisаtiоns under 3 Cаtеgоriеs Essay Example

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10QUALITY OF CARE WITHIN HEALTH CARE ORGANIZATIONS

Discuss the Quality of Care within Hеаlth Care Orgаnisаtiоns under 3 Cаtеgоriеs

Introduction

According to the Institute of Medicine, quality healthcare should be unbiased, effective, efficient, well-timed, safe, and patient-focused. It can also be defined as doing the right thing in the right way and time to the right patient to achieve the best possible outcomes. These two definitions prove that quality of care considers particular details of a patient’s life, and its primary role is to improve the health, as well as their life while under treatment. In Australia, for example, quality of care in health organizations has been identified to be a critical focus because of increased rates of unsuitable care, variations in the frequency of diseases, and high cost of treatment of medical errors and adverse events (ACSQHC, 2010). The quality of care is considered to be an essential element of the approach to global health. According to World Health Organization (WHO), report (2010) noted that there is control of wastage and inefficiencies through effective quality care, access to health services and financial management in achieving its global goals. Measuring the quality of health care is paramount as it enables us to understand how the health system is performing. By using data, we can evaluate the performance of health care systems against recognized quality standards. These measures fall into three broad categories namely structure, process and outcome. In this paper, we will discuss aims of health institutions, process and outcome data and their application in healthcare and nursing.

Aims and core business of health institutions

Health care systems have adopted safety and quality concepts, which are aimed at reducing or eliminating the risks or any unintended outcomes through evaluation of how the organization is performing. Health institutions have several objectives including promoting health, prevention of diseases, taking care of patients, support, as well as community development. Also, they should perform six core businesses. First, the health systems should always be safe for the patients. The safety standards should thus be maintained even during holidays, weekend, and night to ensure that the information delivered is not misplaced or overlooked. Second, it should provide sufficient care, after systematically analyzing available evidence to determine whether a preventive measure, diagnostic examination or therapy would be the most suitable to produce the best outcomes. According to Poon et al. (2010), a health institution should put more emphasis on the patient. In other words, the health system should respect the patient values, preferences, adequate information, good communication, and interaction with family and friends (Agosta, 2009). Care should be delivered at the right time by avoiding long waits that may aggravate the patient’s anxiety (Lowe et al., 2012). Fifth, it should be efficient in such a way that the resources that are utilized for providing care obtain the best outcome for the resources spent. Lastly, it should show equity irrespective of the patients’ gender, race, and status. In other words, it should be based on the patients needs to be related to their condition and reasons for seeking medical care rather than their personal characteristics.

Process data and Outcome data in the context of quality and safety in healthcare

The process is an activity that takes place when patient and care provider interacts, and it consists of two elements. First, technical performance refers to the skills used to come up with strategies of care and interpersonal excellence, which refers to a responsive feature of patient care. They are used to determine the degree to which health provider constantly delivers particular services that are consistent with the standards of care. They are linked to procedures that are known to improve a patient’s health status or prevent future complications. Process measures are therefore paramount because they give clear, actionable feedback, and direct way of improving performance. However, various studies have shown that to adequately measure the quality of care, individual process data is not sufficient but rather processes that can lead to a better outcome (Poon et al., 2011). For instance, in an intervention to prevent ventilator-associated pneumonia, several processes such as deep venous, disruption of sedation infusion on a daily basis, use of horizontal positioning, and prophylaxis for peptic ulcer disease (Berenholtz et al., 2011).

Krumholz & Lee (2008) noted that the appropriateness of medical intervention is evaluated to determine whether persons with particular characteristics, and thus the projected health benefits from undertaking intervention assessment is satisfactory so as to justify pursuing them. Appropriateness of intervention can be done using a list of a particular indication selected by experts, rating then and assessing their suitability. Alternatively, the process of quality care can be determined by studying the level in which care is equivalent to the practice standards. Furthermore, practice profiling can be used as it helps to compare the cost and quality of health providers against the set standards or guidelines. Customer ratings that are obtained during health users’ survey to measure the patients satisfaction of quality care can be used to evaluate the interpersonal quality of care process.

The outcome, on the other hand, refers to the impacts of care to the patients, as well as population. They are used to evaluate patient’s health after receiving care. More importantly, they look at the impacts both intended or unintended on function and health status after receive patient care. Outcome data will also tell us whether or not the goals of care have been accomplished, such as surviving illness and improving their health. This refers to the consequence of preventive measures, diagnosis, and treatment, which is the centerpiece quality health care assessment. Thus, they include mortality, morbidity, and other health-related quality of life issues. However, other impacts may be included such as progress in a patient’s understanding and productive changes in their behaviors as they show the degree of satisfaction. Health provider uses outcome data to identify specific areas that may require quality improvement, however, further assessment is necessary to determine whether structures or processes should be changed. For example, poor stroke outcomes can lead to a delay in realizing signs, delays in emergency services, and delay in treatment. Therefore, improvement efforts may target these areas to yield better results. In this case, a delay that has been attributed to emergency services can be improved through reorganization of emergency services and implementing training programs for technicians. First, a condition-specific approach is used to assess a patient outcome for a particular diagnosis. Second, the generic approach is used to evaluate individuals or population irrespective of their health problems, for example, satisfactory levels, functional status changes, and mortality. Lastly, adverse event approach is used to examine the results that have been triggered by poor quality and also tracks the likelihood of reoccurrence of that event.

Example of a clinical care activity for which process and outcome data is collected

Process data and Outcome data about Diabetes Care

Various studies have indicated that preventive cares, as well as treatment of people with diabetes, have been linked to slowing the progression of end-stage and slow the risk of diabetes-related diseases. Following, clinical practice guidelines have thus been prepared to define the standard care for patients with diabetes. However, Australia has a large integrated health care delivery data that may be collected for diabetes care. Also, there are reviews on acute care facilities that measure how providers follow the required guidelines and the results of patients with diabetes. In this case, we will describe what process data and outcome data will be collected and their significance in diabetes care.

Process refers to steps that result in particular care. There are many process measures exist for diabetes care. The specific actions included the percentage of people who have been diagnosed with diabetes and also their hemoglobin A1c had been measured in the last year. Second, the proportion of patients who had a lipid profile over the last one year. Thirdly, annual eye examination by an eye specialist to determine the percentage of diabetic patients who underwent a retinal eye test within one year. Fourthly, a foot exam to find out the percentage of adults diagnosed with diabetes who went for a foot inspection, palpation, and sensory evaluation in the last one year. Lastly, the proportion of patients who have had a flu vaccination within one year. These processes are easy to identify in health claims and medical records. However, the periodic performance of these processes is paramount for all patients, except elderly patients whose life span may prohibit the need for screening to prevent complications.

The outcome measures for diabetes care test results and avoidable hospitalization. The percent of those diagnosed with diabetes were classified into three categories. If the levels of HbA1c levels was greater than 9.5 percent, poor control; if the levels were higher than 9.0 percent, needs improvement; and if the levels were 7.0 percent, optimal control. Other measures included the examination of cholesterol levels, those diagnosed with LDL-C level greater than 130 mg/dL, needs improvement; and those with less than100, optimal. Another indication is that blood pressure less than 140/90 mmHg for those patients who have already been diagnosed with essential hypertension (Cushman, Evans & Byington, 2010). On the other hand, avoidable hospitalization measures include adults with uncomplicated, uncontrolled diabetes, short-term complications of diabetes, and long-term complications of diabetes per 100,000 populations. Data on these outcome measures have been included in most diabetes quality measurements sets. Control of these risk factors is associated with improved outcomes such as cardiovascular events, complications, and mortality. If a safe, evidence-based treatment is used the patients with greater improvement in risk factors over time will receive quality care and also benefit clinically.

It is clear that improvement in process measures of diabetes care will also result in progress in a related outcome measure. For instance, the process measure of HbA1c tests to monitor blood glucose levels. Ability to regulate blood glucose level among diabetes patients is associated with reduced complications. These complications, in most cases, increase hospitalization incidents. The outcome measures used in such cases is the number of admission for both uncontrolled long-term and short-term complications of diabetes. For this reason, if monitoring of HbAlc process improves, consequently the number of hospitalization decreases. However, research indicates that HbA1cexamination does not mean that people with diabetes can now manage it adequately, or the best intervention will be provided and the complications reduce (Oluwatowoju et al., 2010). According to Allnutt et al. (2010), patient and provider education is imperative to ensure that complications are reduced. Processes of care elements do not suggest quality unless there is a link to the desirable outcomes.

Despite the availability of information on diabetes care and guidelines, there are gaps between processes of care and the actual outcomes (Centers for Disease Control and Prevention, 2008). However, processes data have demonstrated to improve the care of the patient with diabetes. For instance, better rates of HbA1c testing suggest that there will be higher rates of avoidable hospitalizations for both uncontrolled and uncomplicated diabetes. Therefore, the health providers should thus examine the adequacy of ambulatory care, perhaps HbA1c testing has not resulted in the improvement in the glycemic control of patients (Burrows, Li & Geiss, 2010). Whenever both process and outcome measures do not agree, further analysis of other interrelated factors is required.

Conclusion

Quality measurement is one of the strategies to improve health care. Process measures are can be used as a direct measure of quality healthcare provided that there is a link between process and outcome. They are used to show the extent to which services are delivered to improve the patient’s health. On the other hand, outcome data are used to assess the impact on the patient after receiving care such as surviving illness and health improvement. If such measures are available, they can be used in preference to outcome measures because they are easier to interpret. For instance, in diabetes care appropriate process and outcome data were used to increase the frequency of observing frequency and health outcomes. The process data included the results of hemoglobin A1c measurement, lipid examination, eye test, foot exam, and flu vaccination test. While the outcome data were the number of avoidable hospitalization, complications, and uncontrolled diabetes. Outcome data indicate that if monitoring of HbAlc process improves, consequently the number of hospitalization decreases. Therefore, process data that shows the analysis or investigation of an individual incident is effective in preventing the population from poor quality care.

References

ACSQHC. (2010). National safety and quality health service standards and their use in a model national accreditation scheme. Regulatory impact statement. Retrieved on 30 October 2015 from http://ris.finance.gov.au/files/2011/06/National_Safety_RIS.

Agosta, L. (2009). Patient satisfaction with nurse practitioner-delivered primary healthcare services. Journal of the American Academy of Nurse Practitioners 21, 610–617.

Allnutt, J., Allnutt, N., McMaster, R., O’Connell, J., Middleton, S., Hillege, S., Della, P., Gardner, G & Gardner, A (2010). Clients’ understanding of the role of nurse practitioners. Australian Health Review 34, 59–65.

Berenholtz, S., Pham, J. C., Thompson, D. A., Needham, D., Lubomski, L., Hyzy, R., et al. (2011). An intervention to reduce ventilator-associated pneumonia in the ICU. Infect Control Hospital Epidemiol, In Press.

Burrows, N.R., Li, Y& Geiss, L.S. (2010). Incidence of treatment for end-stage renal disease among individuals with diabetes in the U.S. continues to decline. Diabetes Care 33, 73–77.

Centers for Disease Control and Prevention. (2008). Centers for Disease Control and Prevention: National Diabetes Surveillance System. Retrieved on 30 October 2015 from http://www.cdc.gov/diabetes/statistics/index.htm.

Cushman,W.C., Evans, G.W & Byington, R.P.(2010). ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. North England Journal of Medicine 362,1575–1585.

Krumholz, H.M & Lee, T.H. (2008). Redefining quality—implications of recent clinical trials. North
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Lowe, G., Plummer, V., O’Brien, A.P & Boyd, L. (2012). Time to clarify–the value of advanced practice nursing roles in health care. Journal of Advanced Nursing 68, 677–685.

Oluwatowoju, I., Abu, E., Wild, S.H & Byrne, C.D. (2010). Improvements in glycaemic control and cholesterol concentrations associated with the Quality and Outcomes Framework: a regional 2-year audit of diabetes care in the UK. Diabetes Medicine 27, 354–359.

Poon, E. G., Wright, A., Simon, S. R., Jenter, C. A., Kaushal, R., Volk, L. A., et al. (2010). Relationship between use of electronic health record features and health care quality: Results of a Statewide Survey. Med Care, 48(3), 203-209.

Ryan, A.M & Blustein, J. (2011). The effect of the Mass Health hospital pay-for-performance program on quality. Health Services Results 46,712–728.

World Health Organization (WHO). 2010. Health systems financing. The path to universal coverage. World Health Report. Geneva: WHO. Retrieved on 30 October 2015 from http://www.who.int/whr/2010/en/index.html.