Introduction to Health Care Quality: Theory, Methods, and Tools

Introduction to Health Care Quality explores the issues of quality management in today's health care environment, and provides clear guidance on new and perennial challenges in the field. The idea of 'quality' is examined in the context of a variety of health care situations, with practical emphasis on assessment, monitoring, analysis, and improvement. Students will learn how to utilize statistical tools, patient data, and more to understand new models of reimbursement, including pay for performance and value-based purchasing. They will also learn how to learn how to incorporate technology into everyday practice. Each chapter centers on an essential concept, but builds upon previous chapters to reinforce the material and equip students with a deeper understanding of the modern health care industry. Real-world situations are highlighted to show the intersection of theory and application, while cutting-edge methodologies and models prepare students for today's data-driven health care environment. Health care quality is defined and assessed according to setting, with factors such as standards, laws, regulations, accreditation, and consumerism impacting measurement and analysis in tremendous ways. This book provides an overview of this complex field, with insightful discussion and expert practical guidance. Health care today is worlds away from any other point in history. As the field grows ever more complex, quality management becomes increasingly critical for ensuring optimal patient care. Introduction to Health Care Quality helps students and professionals make sense of the issues, and provide top-notch service in today's rapidly changing health care environment.

Table of Contents:
List of Figures and Tables xvii Preface xxi Acknowledgments xxv About the Author xxvii Introduction xxix PART I: QUALITY MANAGEMENT FUNDAMENTALS 1 1 Foundations of Health Care Quality 3 Defining Quality 4 Contributions of Quality Theorists—Nothing New under the Sun 5 Quality Management Methodologies 14 Organizations Making an Impact on Quality and Safety Standards 16 Centers for Medicare and Medicaid Services 21 Institute for Healthcare Improvement 24 Agency for Health Research and Quality 25 National Quality Forum 27 The Leapfrog Group 27 Data: The Foundation of Quality Management 28 Summary 32 Key Terms 33 Quality Concepts in Action 33 References 33 Suggestions for Further Reading 34 Useful Websites 35 2 Understanding the Impact of Health Care Reform 37 The Affordable Care Act 38 New Models of Payment 42 New Models of Providing Care 47 New Models for Collecting Data 53 Improving Interpersonal Communication 56 Summary 60 Key Terms 60 Quality Concepts in Action 61 References 61 Suggestions for Further Reading 62 Useful Websites 63 3 Making the Case for Change 65 What Is Involved in Change? 66 Managing and Measuring Quality in the Reform Environment 69 Who Is Involved in Change? 71 Changing Communication 77 The Role of Data in Promoting Change 86 Summary 89 Key Terms 90 Quality Concepts in Action 90 References 91 Suggestion for Further Reading 92 Useful Websites 92 4 New Challenges for Health Care Professionals 93 Meeting Statistical Expectations for Standards of Care 94 Meeting Patient Expectations 97 Role of Dashboards 100 Role of Data Analysis 104 Understanding Different Kinds of Data 105 Managing Care for Chronic Illness across the Continuum 109 Managing Aggregated Patient Care Issues 112 Improving Communication 121 Summary 127 Key Terms 127 Quality Concepts in Action 127 References 128 Suggestions for Further Reading 129 Useful Websites 130 5 Improving Patient Safety 133 Understanding Medical Errors and Adverse Events 134 High-Reliability Organizations 139 The Role of Quality Management in Promoting a Safety Culture 142 Prioritizing Improvements 147 Expanding Data Sources: Partnerships to Develop Best Practice 154 Leading Organizational Improvements 155 The Role of Nursing Leaders in Promoting Safety 158 The Role of the Medical Staff in Promoting Safety 162 Promoting Safety through Effective Communication 165 Summary 169 Key Terms 169 Quality Concepts in Action 169 References 170 Suggestions for Further Reading 170 Useful Websites 171 PART II: APPLYING QUALITY TOOLS AND TECHNIQUES 173 6 Working with Quality Tools and Methods 175 Identifying a Problem 176 Describing Information 183 Variability 185 Making Use of Data 188 Significance Using Quality Tools and Techniques to Improve Safety 189 Clinical Pathways or Care Maps 195 Improving Performance: Plan-Do-Study-Act 201 Summary 206 Key Terms 206 Quality Concepts in Action 206 Suggestions for Further Reading 207 Useful Websites 207 7 Working with Quality Data 209 Working with Measurements 210 Understanding Issues in Data Collection 214 Using Data to Understand Appropriateness of Care 218 The Value of Aggregated Data in Performance Improvement 222 The Role of Data in Managing Chronic Disease 225 Using Data to Monitor Variability 230 Publicly Reported Data 234 Interpreting and Making Use of Data 237 Quality Management in the Future 239 Summary 240 Key Terms 241 Quality Concepts in Action 241 References 241 Suggestions for Further Reading 242 Useful Websites 242 8 Working with Quality and Safety Measures 245 Commitment to Quality 246 The Future of Quality Using Measures to Understand Care 247 Defining the Measure 250 Process Measures 253 Pay for Performance 263 P4P Measures Patient Satisfaction Measures 264 Monitoring Measures 268 Safety and Environment of Care Measures 273 Summary 277 Key Terms 277 Quality Concepts in Action 277 References 278 Suggestions for Further Reading 279 Useful Websites 279 9 Translating Information into Action 281 Maximizing Efficiency 282 Determining Appropriate Levels of Care 288 End-of-Life Care/Advanced Illness 289 The Reform Mandate Understanding Mortality 291 Improving ICU Care 295 Analyzing Readmission 298 Case Example: Readmission Using Data for Improvements 299 Patient-Centered Care 303 Delivering the Message 305 Summary 308 Key Terms 308 Quality Concepts in Action 309 References 309 Suggestions for Further Reading 310 Useful Websites 311 10 Preparing for the Future 313 The New Quality Management 314 The New Role of Administrators The Business of Health Care 315 Measurements Are the Nuts and Bolts of Quality 319 Getting Everyone on Board 322 Challenges for the Future 324 Summary 326 Key Terms 327 Quality Concepts in Action 327 Suggestions for Further Reading 327 Useful Websites 328 Index 329

About the Author :
YOSEF D. DLUGACZ, PHD, is the Senior Vice President and Chief of Clinical Quality, Education and Research of the Krasnoff Quality Management Institute of the Northwell Health system. The goal of the Institute is to bridge the gap between theoretical knowledge learned in the academic setting and the realities of applying quality management methods in today's health care reform environment. Dr. Dlugacz's research focuses on developing models that link quality, safety, good clinical outcomes and financial success for increased value and improved efficiencies.