HISTORY AND THE QUALITY LANDSCAPE
HISTORY AND THE QUALITY LANDSCAPE
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I need u to read chapter 2 then answer question 5 clearly from chapter 2. also when u answer Q5 don’t forget to let me know from which page u get the answer.
CHAPTER 2 HISTORY AND THE QUALITY LANDSCAPE Norbert Goldfield Introduction The extraordinary developments in the measurement and management of healthcare quality need to be placed into historical context. This chapter will first briefly highlight the many advances that have occurred in quality control in industry, as a whole, and in the healthcare system specifically between 1850 and 1960. As this discussion is purposely brief, readers wanting to learn more can refer to the numerous articles and books that have been written about this period. The remainder of this chapter focuses on the most fertile period of quality measurement and management in healthcare in the United States–the time since the enactment of Medicare and Medicaid in 1965. Although many decry the profit motive that drives healthcare systems, the reality is that healthcare delivery is a critical part of the US economy, as it is in other countries. Many sectors–not just the insurance industry-enjoy substantial profits from the healthcare system. Healthcare spending represented 17.8 percent of the US gross domestic product (GDP) in 2015, and that figure is projected to rise to 19.9 percent by 2025-the highest of any country in the world (Advisory Board 2017). Financial incentives, such as those described in this chapter, are critical to the successful implementation of any quality mea. surement program. As numerous articles have documented, access to health insurance, the extent of its coverage, and socioeconomic disparities have a significant impact on quality of outcomes and important implications for the American healthcare economy. Typically, the people who suffer the most in terms of poor quality are the poor and nonwhite populations. Perhaps the best way to counter the profit motive that exists in our pres- ent healthcare system is to tie transparent financial incentives of quality outcomes to organizational (as opposed to individual health professional) behavior. These financial incentives should be one leg of the three-legged stool” of quality management. The other two legs are a focus on consumer empowerment, as discussed in detail later in this chapter, and payers’ regular release of transpar- ent, comparative outcomes data, which helps foster collaboration with payers, If we were to implement this three-legged stool approach throughout the entire healthcare system, we could make tremendous progress in one absolutely The Heart Chapter 2: History and the ctical intermediate outcome measure-namely, universal coverage sa chical ingredient to the provision of quality er that, thout murance coverage, clinical outcomes SC W of Mine 2001 Although we have made tremendous pogo ing access to cathcare coverage, those of us who believe that every deserves a decent minimum of healthcare coverage fre-world industrialized country that lacks universal insurance have a long way to go to achieve equity. The United SUMESTO in and protects for achieving that important goal of quality com father than ever, at least at the national level. less than 100 years ago. The beginning of healthcare measurement and man- gement can be attributed to the British nurse Florence Nightingale, who used statistics to document an improvement in the mortality rate after her sanitary interventions during the Crimcan War in the 1850s. According to many, she managerial practices based on results. paved the way for the first truly modern hospitals (McDonald 2014) with her focus on the most important quality measure (mortality), and her changes to In the carly twentieth century, decades before Deming, surgeon Ernest A. Codman (1914, 496) was an early supporter of outcomes research We must formulate some method of hospital report showing as nearly as possible what are the results of the treatment obtained at different institutions. This report must be made out and published by each hospital in a uniform manner, so that comparison will be possible. With such a report as a starting point, those interested can begin to ask questions as to management and efficiency Codman’s arguments led to a hospital standardization program by the American College of Surgeons (ACS); however, in a 1918 survey, only 89 of 692 hospi- tals met the basic minimum standards. The results were announced at an ACS Although Codman died a pauper, his research articles and short books Quality Measurement and Management Prior to 1914 The main themes of this chapter are an outgrowth of the period before the year that Congress passed Medicare and Medicaid into law. Once hal century, our quality measurement tools have become much more but the basic issues remain-we have reasonably good quality measums inadequate implementation Historically, the principal approaches to quality measurements descloped outside the healthcare system, in the manufacturing to come meeting at the Waldorf Astoria Hotel in New York City in 1919 W. Edwards Deming, Walter Shewhart (Deming’s teacher), and Joseph the public would not find out which hospitals had failed his test (ACS 2018b). gants in the field of industrial quality measurement and management Wright 2017), but the leaders of the ACS burned Codman’s papers so that Juan (Deming 1982, Turan 1995). Deming pioneered the use of com chart, which had been developed by Shewhart Best and Neuhauser 200 remain among the most quoted in the healthcare quality measurement and Cool Charts Cably the most important tool in the quality management literature. Around the same time that Codman’s efforts failed, Dening famously said, “Look for the trouble and its explanation and by amentarium (though they are still not used enough in health Abraham Flexner was more accessful in reforming Ancrica’s medical schools to the cause every time a point goes out of control (Clarke 2005, physicians and medical staff Flexner 1910) We bere the Daw Atlas, which will be described later in this Set Derring who declared that “uncontrolled variation is the Belly began to reverse many of the perverse incentives of pusing Despite Derting’s pioneering work, it was not until the late 1990 pore quality outcomes is, hospital complications and we are still be them, and get paid for making them.” Deming clearly stated the die beginning! As Deming (1982, 11) said, “Defects are not free. Soms Colofficial risk from a payer to a provider means that the cand writerst in quality (Schiff and Gold cld 1994). toe dat between in the early twentieth century. General anesthesia Penders should keep in mind that effective medical intervention of the flessibiotics, and the discovery of insulin all quality King and Exam 2012, 19). and hospitals in general–by creating standards for education and licensure of In the 1930s through 1950s, rescarchers documented the validity of yet another of Deming’s beliefs, the presence of practice pattern variation in such procedures as tonsillectomies (Glover 1938) and hysterectomies (Doyle 1953). Leaders such as Mindel Sheps (1955), Cecil Sheps (Solon, Sheps, and Lee 1960), Leonard Rosenfeld (1957), Sam Shapiro (Berkowitz 1998), and Paul Lembcke (1956) developed new, preliminary approaches to quality mea. surement. Lemlacke, for example, described a quality measurement technique he called “medical auditing.” which is now called explicit chart review. In a remarkable article on the impact of medication on health and the importance of medication safety, Henry Becher (1955) summarized the then scant rescarch literature on the placebo effect. In an era with an unprecedented number of new medications and an increased focus on medication safety, Beecher summarized in a seminal article the 15 studies then extant documenting the placebo effect. The Healthcare Quality Book finding to improvement of particularly for the remembers of Ker White White Wams, and Greenberg 1961) Around the meme, LSF LOA the national and political aspects of quality the conction between quality and the one care. The most promide health in Suas merged in the 1930s–the same decade that will die Falk and his group of researches the best proaches to delivering quality care a Rong many years of research. F’s concluded that the XVI and The Social Security Act was the wife vice practice of the harded chic optice programin e today. The thelderly Evely evolved to a prototypical health antenance or room with the power another By the 1950s, some spectacu’cambiamento How to the American Medical Association, and that participate the lines for partic Mall 2014 her the cancer certy. The powered by we and local Medicare, Medicald, and subsequent Developments In 1965, the US Congrelished the Medicare and Medicaid program lativects in Swed to improved was the best approach for delivering quality medical care Medical Group started in the 1930, became a medical group in the in the 1970 (Cutting and Collen 1992) The dead began in 1900. Wedding with Senate We Mean Committee medie de wand Medicare Medical Actioned the American College of Surgeons of Como creditation of Hospitals (Roberts, Coale, and However, there were voluntary motion of professional organi government had minimal involvement in quality impenement were orient that only 1 percent of the directed benefits in 1964. deines John and candlegt victory Bury Galer, delivering a critical lector that the country wa Medicine and Medicaid. The lords Meie include hospital incended through Social Security Codman and Deming would be supported Ang with the income regry quality management bodies nagement with a come to the rapidly developing cold de implemented mumber of such as scheduled s finance culte Theming van propias de cuis sort the two interest in the car and even the one and an ockade tomatch with the expanded verbe and thus they did not the quality matched The Joint Condherde ofte er Millsted by the 50 Is the line and otherwise the whos Os and then caligy Freman lain und Reeder 1963). In 19 Lory of discharge planine. This profiling og pectoranews when the Road, Per RO PRO the 1950s. The the founding member of the Department oficial Science G1006) and healthcare insieme in place the quality management and with this piece Hein became the research the the precedereed purchasing medical cephewand between healthcare factors showing action calcud Quality Measure Development Following the Passage of Medicare baru Levine was the first people to che quality of life and happiness. In addition to making to rewarch understanding of the critical continued belowhancing the chance of watched and win Ahmadan (19) maally summadepanded upon the the placed many of the federal programs of the 1960s. 4 니 and Medicaid Around the time Medicare and Medicaid were enacted, a series of scientific ices had a dramatic impact on healthcare delivery in the United States mentre with is contributions. In a seminal Chapter History and the Quality Landscape Frating the Quality of Medical Care,” he the definition of it and approaches to the hele the danified the distinctions between om Danubedian/1966, 197) set forthouse management professor Bob Fetter and the public healthcare expert the moulin in terms of dimensions of care and the therm weder since: In addition to concept them. ancaldies are need of what are the preva the time, an article by Sidney Kate and thekent of the activities of daily living (ADL) me festival wasche of validated measures that cu mine mas from the perspective of either the patient the 1983 The ADL and LADL (instrumental activities elinyament to their durante of the and colleagues foreshadowed the enorm sem and the systems of many other countries throughout the world) emerged the late 1960s from a group at the Yale School of Management. At Yale, the John Thompson (a nurse by training) worked with two operations research pratite students-Rich Averill and Ron Mills to develop diagnosis related and wales in relevant population groups roup (DRGs). Averill focused on operationalizing the DRG concept, and Mille ficued building the analytic infrastructure (Mills et al. 1976, Thompson, Averill, and Fetter 1979, Fetter et al. 1980). In 1977, after completing the first version of the DRGs, Petter, Thomp w, and Arrillad a meeting with the senior staffof a major teaching hospital to present their findings on the significant variation (both within and between DRGs) in that hospital lengths of stay and costs. They expected that the affwould be made by the findings and want to take immediate action the measurement of health status “The index is proposed to decrease the rice and improve the efficiency of care being delivered they of prognosis and the effects of treatment, as a survey in However, the findings were simply ignored. Without a financial incentive, the ini hade interest in addressing variation in hospital lengths of stay tive guide in clinical practice, as a teaching device, and a and cont Arrill.com) afging more knowledge about the aging proces” (Katz et al. 190aned upon the Deming dictum that, without a financial stake in quali After this experience, Petter, Thompson, and Averill internalized and lataformas ater the pasage of Medicare and Medicaid, for medement, no craniration would be interested. This understanding led dampertunang to variation in medical practice patterns, noting the dead emerged quickly after the page of the program Thompson, Averil, and dan permasalt setjast between the East Coast and West Coast of the enter 1979), and they worked to influence state and federal government to fremsberg et al. 1980). The researchers not conly decametel led to national implementation of DRGs, also known as the Inpatient Pepe Saber es within metropolitan areas such as New Haven, Commentale stion. A succesful interim trial of the DRGs in New Jeney in the 1970 shut dowgreed was of dealing with variations fontse Payment System (1/5), in 1982, as federal government official sought die beste mai prin of iew. Over decades ortubeyener contatto content Medicare’s dramatic cost overruns Ruuell 1989). Ironically, the Hola metra lares, Banatsen, and Gold Members and cover for se encun implemented the most regulatory government intervention Center parte of researchers, including Werbung unter andere tenderal geneemment under the conservative adiministration of President Rom The IPPS had the objectives, as articulated in Public Law No. 98-21, the Social Security Amendments of 1983: “Restructure the economic incen prudent buyer of services, to identify the product being purchased on behalf of Medicare beneficiaries How were these objectives accomplished The (the DRG) that linked the clinical and financial aspects of care. Fosen DRGs represents clinically meaningful product with a price that was mentin full, there willing the strong financial incentive for efficiency Schweier 1982, 34). The program was so of the cont increases in However, although the established a far payment amount for hospital Cal 2017Robert Koller (1994), Ene Neandertaken in health Sinner Skinner and op 2017 and John pored the of the Dart And the per indagement approaches. Specifically, Fisher the Demphis applied to healthcare and may be testais maklike forces, to stash the Federalwerment need of the patient-centered media home trition (ACO), and Wohas worked to Dractured heal payment to be based on adinically credite Cose MarDiagnosis Related Groups, and Risk Adjustment des the scientific methodology of assigning like mcg The key is defining the dependent variable, which the DRG were made for everal years Russell and Manning 1989) dan de complications. The case mix me to with the best dramatic impact on the American Z
