Integrating Quality indicators into Research Strategy Third QPEM Conference 11-13 th of January 2019 Dr Ashok Aralihond Attending Physician
DISCLOSURE I do not have any relevant financial relationship with commercial interest to disclose.
Learning Objectives Explain with examples how quality indicators can be integrated into research strategies
Aims of Quality Indicators • Effective • Safe • Efficient • Timely • Equitable • Patient-centered Khan NS, Jain S. Quality initiatives in the emergency department. Curr Opin Pediatr 2010;22:262-7.
What are the methods used to improve quality? Quality assurance versus quality improvement
Quality Indicators and Research Quality Indicators Education Research De Vos et all Using quality indicators to improve hospital care: a review of the literature International Journal for Quality in Health Care, 2009
Quality Parameters In Alessandrini Et Al. • Academic Emergency Medicine 2011 Emergency Department • Length of stay • Patient and family satisfaction data • Care alignment with multiple clinical guidelines • 72-hour return visits • Morbidity and mortality • Data interpretation errors • Transfers out • Appropriate use of consultants • Procedural sedation
Quality Framework and LEAN principles Structure: Process Outcomes DONABEDIAN Model (Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs, 2006)
LEAN and ED • Redesign processes • Improve patient access and flow • Reduce wait times • ED overcrowding and errors Rutman et al; Improving Patient Flow Using Lean Methodology: an Emergency Medicine Experience Curr Treat Options Peds (2015)
The 4-hour standard is a meaningful quality indicator: correlation of performance with emergency department European Journal of Emergency Medicine 2017
Improving patient handovers from the ED to inpatient units Mahajan et al. Quality In Pediatric Emergency Medicine / • Vol. 12, No. 2 87
Other examples of Quality Indicators which help in Research Clinical Quality Indicators In The Children's Emergency Department - Why Do Children Re-attend? Hacking et al. Archives of Disease in Childhood, May 2012 Outcomes of Implementing Rapid Triage in the Pediatric Emergency Department Doyle et al Journal of Emergency Nursing, January 2012
Other examples of Quality Indicators which help in Research Development and Validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: The ED Prevention Quality Indicators for General Health Conditions Davies et al Health Services Research, October 2017 Prioritizing performance measurement for emergency department care: consensus on evidence-based quality of care indicators. Schull et al CJEM. 2011 Sep;13(5):300-9, E28-43.
Other examples of Quality Indicators which help in Research Patients who leave emergency departments without being seen: literature review and English data analysis. Clarey AJ, Cooke MW. Emerg Med J 2012 Evaluation of emergency department performance – a systematic review on recommended performance and quality-in-care Measures Sørup et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013.
Improving Adherence to PALS Septic Shock Guidelines- Enhances the patient care Process focused QI methodology Reduced mortality 4.8% to 1.7% Care bundles simplify & streamline the process thus speeding it up Paul et all, Pediatrics 2014;133:e1–e9
Integrating Quality in Development of Research Robert M Califf et al. JACC 2002;40:1895-1901
Take home messages How quality integrates in research ? • Alignment with existing pathways for busy clinician • Improving accuracy of medical data interpretation in practice • Morbidity and mortality review • Utilization and timeliness of consultations • Transfers of care • Regulatory compliance Knazik And De Baker Clinical Pediatric Emergency Medicine 2011
Questions?
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