Development and Evaluation of an Information System for Quality Assurance

Abstract

The aim of this study was to develop and evaluate an information system for monitoring impact of acute hospital care on health status of elderly patients, burden on carers, and consumer satisfaction with care. The study was undertaken on four acute care wards of an elderly care unit of a teaching hospital. We used a consensus-building process to achieve within-and-between-team convergence of policy and practice in the use of structured assessments on three wards, with parallel data collection by a research nurse on one ward. We describe the changes to our working practices, the costs of data collection, staff attitudes to the system and the assessment instruments, using 5-point Likert Scales, with additional in-depth interviews with senior staff for their attitudes to the system. We found that only nursing staff were able to change their practice. On admission, it was feasible to undertake functional assessment of activities of daily living (ADL), depression, perceived life quality and carer strain. Discharge assessment was only feasible for ADL. Other discharge assessments and follow-up assessments including consumer satisfaction interviews required audit assistant support. The total annual cost per ward was 6,225 pounds for the adopted system, or 6,455 pounds to incorporate follow-up assessments by audit assistant in a random sample of 50 patients. Staff attitudes to the system were positive, especially for use of the Relatives' Stress Scale, and for the value of follow-up interviews. We conclude that the participatory approach to the introduction of the information system produced a system which was perceived to be beneficial for patient care.(ABSTRACT TRUNCATED AT 250 WORDS)

A systematic review of the cost of data collection for performance monitoring in hospitals

“…Equipment and installation costs are reported Total charges Total costs with workstations: $594 less (10.5% lower bed costs, 12.4% lower tests costs, 15.1% lower drug costs) Comparator: normal practice Type of study: cost- consequence analysis Population: inpatients, house officers, medical students, and faculty internists Hospital length of stay Hospital length of stay declined by 0.89 days Perspective: not stated Benefits speculated Philp et al . [ 9 ] UK Intervention: Information system for monitoring impact of acute hospital care on health status Develop a patient information system which could be used to evaluate the effectiveness of multidisciplinary hospital care Setting: Hospital Staff time, printing, statistical analysis, computing equipment and system administration. Nurse perspective: Total annual cost per ward £6,455 to incorporate follow-up assessments Comparator: normal practice Type of study: cost analysis Population: physicians, nurses, and junior physicians Decision-making Undecided if decision-making, teamwork, professional care, and performance was improved Perspective: not stated Teamwork Benefits for patient care can only be inferred, not proven Professional care Performance Willems et al .…”

“…Four studies focused on the costs and benefits of data collection using information communication technology (ICT) compared to normal practice (hand-written patient records) [ 6 - 9 ]. Two studies examined how already implemented ICT systems can be improved to collect better quality data [ 9 , 10 ], and the two remaining studies [ 11 , 12 ] investigated how information collected by ICT can be analysed for further performance monitoring purposes.…”

“…The included studies reported costs in various ways. Two studies [ 6 , 9 ] calculated the costs based on the differences between the computerised system and the manual system. Two studies [ 11 , 12 ] reported the differences in the total costs of a hospital-acquired medical event before and after the adoption of 1) basic electronic medical records (2011 paper) and 2) a quality indicator (2013 paper).…”

“…[ 13 ] reported changes in the average subsequent hospital care revenue per trauma service admission rather than focusing on costs. Of the eight included studies identified, five reported start-up costs or associated IT costs in their analysis [ 7 - 9 , 11 , 12 ]. However, it must be noted that technology has advanced rapidly since the mid-1980s and has become relatively less expensive over time.…”

Fit to care? A comparison of informal caregivers of first-generation Black Caribbeans and White dependants with advanced progressive disease in the UK

“…Despite this limitation, the present authors are not aware of any evidence that bereavement would result in different memories between the Black Caribbean and White populations. Lastly, since the present survey was retrospective, the authors were unable to measure and compare the experience of caregiver burden using one of the many scales specifically designed for the assessment of this area (Novak & Guest 1989, Philp et al . 1994).…”