This review demonstrates that there are significant gaps in the SS/L health care quality improvement literature and very weak evidence that SS/L improve health care quality.

We conducted a systematic review to identify studies on the effect of home telehealth on clinical care outcomes. The search was restricted to peer-reviewed publications (published between 2001 and 2007) about studies conducted in home or residential settings. The search yielded 154 potential articles and dissertations. A total of 29 articles met the inclusion criteria and were included in a meta-analysis. The weighted mean effect size for the overall meta-analysis was 0.50, and the z-statistic was 3.0, indicating that telehealth had a moderate, positive and significant effect (P < or = 0.01) on clinical outcomes. Subanalyses also indicated positive significant effects of telehealth for some disease categories (heart disease and psychiatric conditions), but not others (diabetes), patient populations and telehealth interventions. Overall, the meta-analysis indicated that telehealth positively affects clinical outcomes of care, even in different patient populations.

Organizational quality improvement practices have gained wide acceptance in manufacturing industries over the last several decades. A substantial number of books have been written on Lean and Six Sigma alone, which today are the leading improvement initiatives. The healthcare industry however has been slower to adopt these methods, although anecdotal evidence suggests they are now being gradually diffused throughout hospitals on an increasing basis. Yet, these new practices have been developed substantially without a theoretical foundation (Linderman et al. J Oper Manag 21:193-203, 2003) and the question of industry "fit" is the topic of debate for many physicians and administrators (Kassirer N Engl J Med 339: [1543][1544][1545] 1998). This article provides the descriptive results from our mixed methods research, combining survey questionnaire with semi-structured interviews, that examines implementation of two quality improvement initiatives (Lean and Six Sigma) in a cross-sectional sample of hospitals. We used correlations and non-parametric tests to examine relationships between goal attainment and quality management, and present descriptive findings about reported usage and adoption of quality initiatives. Importantly, we find that the efficacy of quality improvement initiatives in healthcare may be impeded by the lack of goal clarity and measurement. We build on these initial results by offering recommendations to improve results in practice, as well as an agenda for further research of quality initiatives in healthcare. The objectives of our research are to better understand how Lean and Six Sigma fit in the healthcare industry and to explore goal and value attainment from these projects.

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BackgroundThe access to and growth of percutaneous coronary intervention (PCI) has not been fully explored with regard to geographic equity and need. Economic factors and timely access to primary PCI provide the impetus for growth in PCI centers, and this is balanced by volume standards and the benefits of regionalized care.Methods and ResultsGeospatial and statistical analyses were used to model capacity, growth, and access of PCI hospitals relative to population density and myocardial infarction (MI) prevalence at the state level. Longitudinal data were obtained for 2003–2011 from the American Hospital Association, the U.S. Census, and the Centers for Disease Control and Prevention (CDC) with geographical modeling to map PCI locations. The number of PCI centers has grown 21.2% over the last 8 years, with 39% of all hospitals having interventional cardiology capabilities. During the same time, the US population has grown 8.3%, from 217 million to 235 million, and MI prevalence rates have decreased from 4.0% to 3.7%. The most densely concentrated states have a ratio of 8.1 to 12.1 PCI facilities per million of population with significant variability in both MI prevalence and average distance between PCI facilities.ConclusionsOver the last decade, the growth rate for PCI centers is 1.5× that of the population growth, while MI prevalence is decreasing. This has created geographic imbalances and access barriers with excess PCI centers relative to need in some regions and inadequate access in others.