| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
The Annals of Thoracic Surgery, Vol 58, 1815-1821, Copyright © 1994 by The Society of Thoracic Surgeons
KE Hammermeister
There are a number of limitations to current models of risk-adjusted
outcome, continuous quality improvement, the most important of which are
the reliance on chart abstraction for data collection, the focus on a
procedure rather than a disease with several treatment options, and the
emphasis on outcomes--particularly the identification of care providers
with high rates of adverse outcomes. In this article, I describe a paradigm
that combines clinical information management with quality of care
assessment and improvement and that emphasizes the participation of care
providers. This participatory continuous improvement model is a synthesis
of three existing concepts: (1) continuous quality improvement, (2)
intellectually and altruistically motivated self-examination and
self-improvement, and (3) a modern medical information system. Important
design elements of the participatory continuous improvement model to
overcome these limitations include (1) a patient population defined by a
disease, or diseases, rather than by a treatment to allow for assessment of
the appropriateness and access to care; (2) a database that includes all
important patient-level risk, treatment (process), and outcome information;
(3) data input by the care provider at the point of care; (4) timely
information feedback to care providers in a nonadversarial environment; and
(5) public accountability. I believe that participatory continuous
improvement models can provide the framework for psychologically sound ways
to positively influence practice behaviors, and that this will, in turn,
result in improved access to care, quality of care, and cost-effectiveness
of care.
ARTICLES
Participatory continuous improvement
Cardiology Section, Denver VA Medical Center, CO 80220.
This article has been cited by other articles:
|
|
 |
|
  D. M. Shahian, E. H. Blackstone, F. H. Edwards, F. L. Grover, G. L. Grunkemeier, D. C. Naftel, S. A.M. Nashef, W. C. Nugent, and E. D. Peterson Cardiac Surgery Risk Models: A Position Article Ann. Thorac. Surg., November 1, 2004; 78(5): 1868 - 1877. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Dehmer, J. W. Hirshfeld, W. J. Oetgen, K. Mitchell, A. Wells Simon, M. Elma, M. A. Kellett Jr, R. G. Brindis, on behalf of the American College of Cardiology Fo, CathKIT Task Force Members, et al. CathKIT: improving quality in the cardiac catheterization laboratory J. Am. Coll. Cardiol., March 3, 2004; 43(5): 893 - 899. [Full Text] [PDF]
|
|
|
|
|
|
D. M. Shahian, S.-L. Normand, D. F. Torchiana, S. M. Lewis, J. O. Pastore, R. E. Kuntz, and P. I. Dreyer Cardiac surgery report cards: comprehensive review and statistical critique Ann. Thorac. Surg., December 1, 2001; 72(6): 2155 - 2168. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Ripouteau, O. Conort, J. P. Lamas, G.-R. Auleley, G. Hazebroucq, and P. Durieux Quality improvement report: Effect of multifaceted intervention promoting early switch from intravenous to oral acetaminophen for postoperative pain: controlled, prospective, before and after study BMJ, December 9, 2000; 321(7274): 1460 - 1463. [Abstract] [Full Text]
|
|
|
|
 |
|
 P. Durieux, R. Nizard, P. Ravaud, N. Mounier, and E. Lepage A Clinical Decision Support System for Prevention of Venous Thromboembolism: Effect on Physician Behavior JAMA, June 7, 2000; 283(21): 2816 - 2821. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. L. Grover, K. E. Hammermeister, and A. L. W. Shroyer Quality Initiatives and the Power of the Database: What They Are and How They Run Ann. Thorac. Surg., November 1, 1995; 60(5): 1514 - 1521. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
