Why it is Important to Demonstrate Linkages Between Outcomes of Care and Processes and Structures of Care

Hammermeister, Karl E.; Shroyer, A. Laurie; Sethi, G; Grover, Frederick L.

doi:10.1097/00005650-199510001-00002

Cited by 73 publications

(37 citation statements)

References 40 publications

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“…This explains why the most frequently examined outcome is hospital mortaliManagement and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study M This fact could explain the differences observed in some prospective studies with primary data (which enable the inclusion of a greater number of variables and have follow-ups which extend beyond the hospital period), in which the relationship between volume and outcomes is less consistent (8,9). Studies do not usually take into account other center-related factors that may influence outcomes, such as structure-related characteristics and process-related factors, as was suggested by A. Donabedian's approach for the assessment of health care quality (10,11) (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

“…Los estudios tampoco suelen tener en cuenta otros factores de las organizaciones que pueden influir en los resultados, además del volumen, como son las característi-cas relacionadas con la estructura y factores relacionados con el proceso siguiendo la aproximación planteada por A. Donabedian para la evaluación de la calidad asistencial (10,11) (Fig. 1).…”

Section: Introductionunclassified

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Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study

Espallargues

Almazán

Tebé

et al. 2009

Rev. esp. enferm. dig.

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Background: most studies that analyze the influence of structure factors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume.Objective: to study variations in the process and outcomes of oncologic surgery for esophagus, stomach, pancreas, liver metastases and rectum cancers in Catalonia, as well as the factors associated with these variations.Patients and method: a retrospective (2002) and prospective (2003-05) multicenter cohort study. Data forms were designed to collect patient, process, and care outcome characteristics before surgery, at hospital discharge, and at 3 and 6 months after discharge. Main outcome measures were hospital and followup mortality, complications, re-interventions, and relapse rates.Results: 49 hospitals (80%) participated in the retrospective phase, 44 of which (90%) also participated in the prospective phase: 3,038 patients (98%) were included. No differences were observed in the profile of operated patients according to hospital level of complexity, but clinical-pathological staging and other functional status variables could not be assessed because of over 20% of missing values. There was significant variability in the volume of interventions as well as in certain aspects of the healthcare process depending on type of cancer and center complexity. High rates of esophageal cancer mortality (18.2% at discharge, 27.3% at 6 months) and of complications and re-interventions for all cancers assessed, especially rectal cancer (18.4% re-interventions at 6 months), were identified.Conclusions: the study of the variability identified will require adequate risk-adjustment and should take into account different structure factors. It is necessary that information included in medical records be improved.Key words: Digestive cancer. Surgery. Medical practice variations. Structure, process, and outcomes of care. INTRODUCTIONOne of the aspects that is most debated in oncologic surgery and other fields (both surgical and medical procedures) is the relationship between the volume of patients having undergone surgery and clinical outcomes. It has been 30 years since the relationship between increased volume and improved outcomes was described (1). However, this relationship is not always observed, and the reasons why it occurs remain unknown. Several hypotheses, especially relating to surgeon-related technical factors (2-6), have been considered. However, if better outcomes are obtained in several different procedures or pathologies, healthcare organization and coordination factors should also be sought. This may be especially useful in the case of oncology, where it is necessary for professionals from different specialties to work together in tackling with diagnosis and treatment: surgery, oncology, as well as the site's central and general services.Most studies that have analyzed the influence of these physician-/center-related factors, particularly volume, on the variability of the process and outcome of cancer surgery are retrosp...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionunclassified

Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study

Espallargues

Almazán

Tebé

et al. 2009

Rev. esp. enferm. dig.

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“…3 Typically, quality of care is determined and measured by (1) structure, (2) process, and (3) outcome. 3 To clarify the issues in quality of care, I have differentiated surrogates from outcomes, and imputed governance and healthcare regulations (Figure 2). The definitions of quality of care and its components are difficult to determine, and several definitions have been reported, but one definition of quality care is "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge".…”

Section: Editorial Quality Of Care In Cardiovascular Medicinementioning

confidence: 99%

Investigating the Quality of Care in Cardiovascular Medicine

Morimoto

2015

Circ J

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“…Each domain was populated with items by using the overlying themes of structure, process, and outcomes, as described by Donabedian (21,22). This theoretical framework was used to capture how the structure of a DDMP affects patient satisfaction, how patients perceive their experiences navigating through the delivery of care, and how the process affects the patient' s health.…”

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confidence: 99%

Development and validation of a questionnaire to evaluate patient satisfaction with diabetes disease management.

et al. 2000

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OBJECTIVE: To develop a reliable and valid questionnaire to measure patient satisfaction with diabetes disease management programs. RESEARCH DESIGN AND METHODS: Questions related to structure, process, and outcomes were categorized into 14 domains defining the essential elements of diabetes disease management. Health professionals confirmed the content validity. Face validity was established by a patient focus group. The questionnaire was mailed to 711 patients with diabetes who participated in a disease management program. To reduce the number of questionnaire items, a principal components analysis was performed using a varimax rotation. The Scree test was used to select significant components. To further assess reliability and validity; Cronbach's alpha and product-moment correlations were calculated for components having > or =3 items with loadings >0.50. RESULTS: The validated 73-item mailed satisfaction survey had a 34.1% response rate. Principal components analysis yielded 13 components with eigenvalues > 1.0. The Scree test proposed a 6-component solution (39 items), which explained 59% of the total variation. Internal consistency reliabilities computed for the first 6 components (alpha = 0.79-0.95) were acceptable. CONCLUSIONS: The final questionnaire, the Diabetes Management Evaluation Tool (DMET), was designed to assess patient satisfaction with diabetes disease management programs. Although more extensive testing of the questionnaire is appropriate, preliminary reliability and validity of the DMET has been demonstrated.

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Why it is Important to Demonstrate Linkages Between Outcomes of Care and Processes and Structures of Care

Cited by 73 publications

References 40 publications

Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study

Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study

Investigating the Quality of Care in Cardiovascular Medicine

Development and validation of a questionnaire to evaluate patient satisfaction with diabetes disease management.

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