NR 451 Week 2: Homework Assignment 

NR 451 Week 2: Homework Assignment 

NR 451 Week 2: Homework Assignment 

This week the discussion topic asks you to describe a problem that you judge needs to experience a change in order to produce better patient outcomes. Your instructor will be giving you feedback that will guide you in the completion of Milestone 1, which is due at the end of Week 3. Be sure to read all of your instructor responses as advice provided to your peers will likely be applicable to you, too. And remember to post questions in the Q & A Forum. If you have a question, chances are your peers do, too! 

NR 451 Week 2 Discussion, The Clinical Question Week 2 Your capstone change project begins this week when you identify a problem that you judge needs to experience a change in order to produce better patient outcomes. • Formulate a significant clinical question that will be the basis for your capstone change project. • Relate how you developed the question. • Describe the importance of this question to your clinical practice. • Define meta-analysis, and explain how this relates to evidence -based practice (EBP). •

Describe what a research-practice gap is. Professor and class, The clinical question that will be the base of my capstone project is what can we do as a large healthcare system to prevent falls within the ambulatory clinic setting among the elderly population? I developed this question by doing an analysis on the amount of incidences of falls while the elderly population was stepping down off of the exam table and stepping off of the scales when seeing the provider during office hours. This problem is extremely important because it is a safety issue among our population as well as a patient satisfaction staple. CCN (2017) explains that safely delivering care to the patient must be essential within the work environment. The ANA (2015) describes that the registered nurse use the nursing process to form an individualized plan of care. Merriam-Webster (2017) defines meta-analysis as a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance.

This relates to evidence-based practice because in order to prove EBP, the gathered data needs to be pooled and use that pooled data to test the effectiveness of the results. The research practice gap is characterized as an area which is missing information that limits the ability to reach a goal or a conclusion. Variations of PICO (population, intervention, comparison, and outcomes) are used to determine gaps. References American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author Chamberlain College of Nursing Online Program (2017), Week 2, Lesson Merriam-Webster (2017)

Measuring healthcare quality

Wilm Quentin, Veli-Matti Partanen, Ian Brownwood, and Niek Klazinga.

3.1. Introduction

The field of quality measurement in healthcare has developed considerably in the past few decades and has attracted growing interest among researchers, policy-makers and the general public (Papanicolas & Smith, ; EC, ; OECD, ). Researchers and policy-makers are increasingly seeking to develop more systematic ways of measuring and benchmarking quality of care of different providers. Quality of care is now systematically reported as part of overall health system performance reports in many countries, including Australia, Belgium, Canada, Italy, Mexico, Spain, the Netherlands, and most Nordic countries.

At the same time, international efforts in comparing and benchmarking quality of care across countries are mounting. The Organisation for Economic Co-operation and Development (OECD) and the EU Commission have both expanded their efforts at assessing and comparing healthcare quality internationally (Carinci et al., ; EC, ). Furthermore, a growing focus on value-based healthcare (Porter, ) has sparked renewed interest in the standardization of measurement of outcomes (ICHOM, ), and notably the measurement of patient-reported outcomes has gained momentum (OECD, ).

The increasing interest in quality measurement has been accompanied and supported by the growing ability to measure and analyse quality of care, driven, amongst others, by significant changes in information technology and associated advances in measurement methodology. National policy-makers recognize that without measurement it is difficult to assure high quality of service provision in a country, as it is impossible to identify good and bad providers or good and bad practitioners without reliable information about quality of care. Measuring quality of care is important for a range of different stakeholders within healthcare systems, and it builds the basis for numerous quality assurance and improvement strategies discussed in Part II of this book.

In particular, accreditation and certification (see Chapter 8), audit and feedback (see Chapter 10), public reporting (see Chapter 13) and pay for quality (see Chapter 14) rely heavily on the availability of reliable information about the quality of care provided by different providers and/or professionals. Common to all strategies in Part II is that without robust measurement of quality, it is impossible to determine the extent to which new regulations or quality improvement interventions actually work and improve quality as expected, or if there are also adverse effects related to these changes.

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This chapter presents different approaches, frameworks and data sources used in quality measurement as well as methodological challenges, such as risk-adjustment, that need to be considered when making inferences about quality measures. In line with the focus of this book (see Chapter 1), the chapter focuses on measuring quality of healthcare services, i.e. on the quality dimensions of effectiveness, patient safety and patient-centredness. Other dimensions of health system performance, such as accessibility and efficiency, are not covered in this chapter as they are the focus of other volumes about health system performance assessment (see, for example, Smith et al., ; Papanicolas & Smith, ; Cylus, Papanicolas & Smith, ).

The chapter also provides examples of quality measurement systems in place in different countries. An overview of the history of quality measurement (with a focus on the United States) is given in Marjoua & Bozic (). Overviews of measurement challenges related to international comparisons are provided by Forde, Morgan & Klazinga () and Papanicolas & Smith (). NR 451 Week 2: Homework Assignment

3.2. How can quality be measured? From a concept of quality to quality indicators

Most quality measurement initiatives are concerned with the development and assessment of quality indicators (Lawrence & Olesen, ; Mainz, ; EC, ). Therefore, it is useful to step back and reflect on the idea of an indicator more generally. In the social sciences, an indicator is defined as “a quantitative measure that provides information about a variable that is difficult to measure directly” (Calhoun, ). Obviously, quality of care is difficult to measure directly because it is a theoretical concept that can encompass different aspects depending on the exact definition and the context of measurement.NR 451 Week 2: Homework Assignment 

Chapter 1 has defined quality of care as “the degree to which health services for individuals and populations are effective, safe and people-centred”. However, the chapter also highlighted that there is considerable confusion about the concept of quality because different institutions and people often mean different things when using it. To a certain degree, this is inevitable and even desirable because quality of care does mean different things in different contexts. However, this context dependency also makes clarity about the exact conceptualization of quality in a particular setting particularly important, before measurement can be initiated.NR 451 Week 2: Homework Assignment

In line with the definition of quality in this book, quality indicators are defined as quantitative measures that provide information about the effectiveness, safety and/or people-centredness of care. Of course, numerous other definitions of quality indicators are possible (Mainz, ; Lawrence & Olesen, ). In addition, some institutions, such as the National Quality Forum (NQF) in the USA, use the term quality measure instead of quality indicator. Other institutions, such as the NHS Indicator Methodology and Assurance Service and the German Institute for Quality Assurance and Transparency in Health Care (IQTIG), define further attributes of quality indicators (IQTIG, ; NHS Digital, ). According to these definitions, quality indicators should provide:

  1. a quality goal, i.e. a clear statement about the intended goal or objective, for example, inpatient mortality of patients admitted with pneumonia should be as low as possible;
  2. a measurement concept, i.e. a specified method for data collection and calculation of the indicator, for example, the proportion of inpatients with a primary diagnosis of pneumonia who died during the inpatient stay; and
  3. an appraisal concept, i.e. a description of how a measure is expected to be used to judge quality, for example, if inpatient mortality is below 10%, this is considered to be good quality.

Often the terms measures and indicators are used interchangeably. However, it makes sense to reserve the term quality indicator for measures that are accompanied by an appraisal concept (IQTIG, ). This is because measures without an appraisal concept are unable to indicate whether measured values represent good or bad quality of care.

For example, the readmission rate is a measure for the number of readmissions. However, it becomes a quality indicator if a threshold is defined that indicates “higher than normal” readmissions, which could, in turn, indicate poor quality of care. Another term that is frequently used interchangeably with quali ty indicator, in particular in the USA, is quality metric. However, a quality metric also does not necessarily define an appraisal concept, which could potentially distinguish it from an indicator. At the same time, the term qua l ity metric is sometimes used more broadly for an entire system that aims to evaluate quality of care using a range of indicators.NR 451 Week 2: Homework Assignment

Operationalizing the theoretical concept of quality by translating it into a set of quality indicators requires a clear understanding of the purpose and context of measurement. Chapter 2 has introduced a five-lens framework for describing and classifying quality strategies. Several of these lenses are also useful for better understanding the different aspects and contexts that need to be taken into account when measuring healthcare quality. First, it is clear that different indicators are needed to assess the three dimensions of quality, i.e. effectiveness, safety and/or patient-centredness, because they relate to very different concepts, such as patient health, medical errors and patient satisfaction.

Secondly, quality measurement has to differ depending on the concerned function of the healthcare system, i.e. depending on whether one is aiming to measure quality in preventive, acute, chronic or palliative care. For example, changes in health outcomes due to preventive care will often be measurable only after a long time has elapsed, while they will be visible more quickly in the area of acute care.

Thirdly, quality measurement will vary depending on the target of the quality measurement initiative, i.e. payers, provider organizations, professionals, technologies and/or patients. For example, in some contexts it might be useful to assess the quality of care received by all patients covered by different payer organizations (for example, different health insurers or regions) but more frequently quality measurement will focus on care provided by different provider organizations. In international comparisons, entire countries will constitute another level or target of measurement.

In addition, operationalizing quality for measurement will always require a focus on a limited set of quality aspects for a particular group of patients. For example, quality measurement may focus on patients with hip fracture treated in hospitals and define aspects of care that are related to effectiveness (for example, surgery performed within 24 hours of admission), safety (for example, anticoagulation to prevent thromboembolism), and/or patient-centredness of care (for example, patient was offered choice of spinal or general anaesthesia) (Voeten et al., ). However, again, the choice of indicators – and also potentially of different appraisal concepts for indicators used for the same quality aspects – will depend on the exact purpose of measurement.

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