Special Report: The Ethics of Using QI Methods to Improve Health Care Quality and Safety

Baily, Mary Ann; Bottrell, Melissa M.; Lynn, Joanne; Jennings, Bruce

doi:10.1353/hcr.2006.0054

Cited by 169 publications

(148 citation statements)

References 36 publications

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“…With consideration to these differences (the minimal risk for the patients involved in quality improvement programs, the demonstrable and immediate benefit to those directly concerned, the introduction of existing evidence-based practices, the flexible and not rigidly formalized protocols, the necessity and obligation for health care institutions to improve the of the quality of care practices, the indirect use of personal data, the absence of sponsors, the clear public interest, etc. ), the related international literature highlights the inadequacy of applying the strict protection procedures of clinical research, particularly informed consent, to quality-improvement programs, and favors the adoption of different informative/consent procedures and, where possible, a responsible and informed participation of patients [26]. …”

Section: The Lcp-i Programmentioning

confidence: 99%

The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial

Costantini¹,

Ottonelli²,

Canavacci³

et al. 2011

BMC Health Serv Res

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BackgroundMost cancer patients still die in hospital, mainly in medical wards. Many studies in different countries have shown the poor quality of end-of-life care delivery in hospitals. The Program "Liverpool Care Pathway for the dying patient" (LCP), developed in the UK to transfer the hospice model of care into hospitals and other care settings, is a complex intervention to improve the quality of end-of-life care. The results from qualitative and quantitative studies suggest that the LCP Program can improve significantly the quality of end-of-life care delivery in hospitals, but no randomised trial has been conducted till now.Methods and designThis is a randomized cluster trial, stratified by regions and matched for assessment period. Pairs of eligible medical wards from different hospitals will be randomized to receive the LCP-I Program or no intervention until the end of the trial. The LCP-I Program will be implemented by a Palliative Care Unit.The assessment of the end-points will be performed for all cancer deaths occurred in the six months after the end of the LCP-I implementation in the experimental wards and, in the same period of time, in the matched control wards. The primary end-point is the overall quality of end-of-life care provided on the ward to dying cancer patients and their families, assessed using the Global Scale of the Italian version of the Toolkit "After-death Bereaved Family Member Interview".DiscussionThis study can be interpreted as a Phase III trial according to the Medical Research Council Framework. In this study, the effectiveness of a fully defined intervention is assessed by comparing the distribution of the endpoints in the experimental and in the control arm.Research IDRFPS-2006-6-341619Trial registrationClinicalTrials.gov Identifier: NCT01081899

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Section: The Lcp-i Programmentioning

confidence: 99%

The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial

Costantini¹,

Ottonelli²,

Canavacci³

et al. 2011

BMC Health Serv Res

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“…Staff input is known to be highly valuable in the use of QI in the health care setting, as many QI projects involve active participation and buy-in from a multidisciplinary staff. [8][9][10] By engaging night staff when we expanded the program to all patients, we were able to begin the process on admission. During the asthma-only phase of the program, we were relying primarily on the daytime staff, which caused us to miss patients who were admitted late in the day and ready to be discharged the following day.…”

Section: Discussionmentioning

confidence: 99%

Local Pharmacy Partnership to Prevent Pediatric Asthma Reutilization in a Satellite Hospital

Sauers‐Ford¹,

Moore

Guiot³

et al. 2016

Pediatrics

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The World Health Organization 2003 report on medication adherence 1 quoted Haynes that "increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments." An obvious, yet critical, component to medication adherence is access to medications; consequently the failure either to fill new prescriptions or to refill existing ones is a critical point of failure in the postdischarge care of patients. 1, 2 Previous work at our institution has demonstrated a sustained reduction in hospital and emergency department (ED) reutilization in part due to efforts abstract OBJECTIVES: In our previous work, providing medications in-hand at discharge was a key strategy to reduce asthma reutilization (readmissions and emergency revisits) among children in a large, urban county. We sought to spread this work to our satellite hospital in an adjacent county. A key initial barrier was the lack of an outpatient pharmacy on site, so we sought to determine if a partnership with community pharmacies could improve the percentage of patients with medications in-hand at discharge, thus decreasing reutilization. METHODS:A multidisciplinary team partnered with community pharmacies. Using rapid-cycle improvement methods, the team aimed to reduce asthma reutilization by providing medications in-hand at discharge. Run charts were used to display the proportion of patients with asthma discharged with medications in-hand and to track 90-day reutilization rates. RESULTS:During the intervention period, the median percentage of patients with asthma who received medications in-hand increased from 0% to 82%. A key intervention was the expansion of the medication in-hand program to all patients. Additional changes included expanding team to evening stakeholders, narrowing the number of community partners, and building electronic tools to support key processes. The mean percentage of patients with asthma discharged from the satellite who had a readmission or emergency department revisit within 90 days of their index admission decreased from 18% to 11%. CONCLUSIONS: Impacting population-level asthma outcomes requires partnerships between community resources and health providers. When hospital resources are limited, community pharmacies are a potential partner, and providing access to medications in-hand at hospital discharge can reduce asthma reutilization.

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“…69 This raises taxing governance questions that need to be addressed about when improvement is improvement and when it is research. 22 iii. Help Educational Institutions and service providers to understand that although they have different expert roles they share the purpose of improving healthcare quality.…”

Section: Fig 1 About Herementioning

confidence: 99%

“…12,22 It is claimed that it has made enough progress to be considered a discipline in its own right 23 and can serve as a place in which these different sciences are brought together; each with their own focus, knowledge base and methodologies; creating a sum greater than the parts. 24 Education for quality improvement aims to equip practitioners and managers with the skills to:…”

Section: The Educational Context For Improvementmentioning

confidence: 99%

Health care improvement and continuing interprofessional education: Continuing interprofessional development to improve patient outcomes

Wilcock

Janes

Chambers

2009

Journal of Continuing Education in the Health Professions

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Health care improvement and continuing professional education must be better understood if we are to promote continuous service improvement through interprofessional learning in the workplace. We propose that situating interprofessional working, interprofessional learning, work‐based learning, and service improvement within a framework of social learning theory creates a continuum between work‐based interprofessional learning and service improvement in which each is integral to the other. This continuum provides a framework for continuing interprofessional development that enables service improvement in the workplace to serve as a vehicle through which individual professionals and teams can continually enhance patient care through working and learning together. The root of this lies in understanding that undertaking improvement and learning about improvement are co‐dependent and that health care professionals must recognize their responsibility to improve as well as complete their everyday work. We believe that significant opportunities exist for health care commissioners, service providers, and educational institutions to work together to promote continuing interprofessional development in the workplace to enhance patient outcomes, and we outline some of the opportunities we believe exist.

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Special Report: The Ethics of Using QI Methods to Improve Health Care Quality and Safety

Cited by 169 publications

References 36 publications

The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial

The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial

Local Pharmacy Partnership to Prevent Pediatric Asthma Reutilization in a Satellite Hospital

Health care improvement and continuing interprofessional education: Continuing interprofessional development to improve patient outcomes

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