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HE210 Test 4 With Complete Solutions Graded A+
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HE210 Test 4 With Complete Solutions Graded A+QUALITY OF HEALTH CARE - ANSWER Using the model originally developed by Avedis
Donabedian, health care quality is assessed in terms of structure, process, and
outcomes (Donabedian, 1980- 1985). "Structure. .. is meant to designate the conditions
under which care is provided" (Donabedian, 2003, p. 46). It is based on material
resources, such as facilities and equipment; human resources, such as number and
qualities of professional and support personnel providing health care; and
organizational characteristics, such as, for individual facilities such as hospitals,
nonprofit status, academic affiliation, and governing structure. Examples of
structure-oriented questions are: What is the nurse-to-patient ratio on a hospital floor?
What is the age of the facility? What percentage of a hospital's patients are uninsured,
Medicaid recipients, or Medicare recipients? Are the physicians in a practice salaried or
paid on a fee-for-service basis? Process "is taken to mean the activities that constitute
health care— including diagnosis, treatment, rehabilitation, prevention, and patient
education— usually carried out by professional personnel, but also including other
contributions to care, particularly by patients and their families" (Donabedian, 2003, p.
46). For example a study of health care process might ask the following questions: Is
infection control policy followed by the hospital staff? How long does it take to obtain the
results of tests ordered by the primary care physician? How does a treating physician
communicate information related to a drug's side effects to the patient? How long does
it take to wait in the emergency room? On average, how many minutes does the
physician spend with a patient during an annual physical? What is the standard care or
course of treatment for a particular health condition, such as acute
POPULATION HEALTH OUTCOMES - ANSWER Health outcomes can be measured on
the population level and used to evaluate the quality of a healthcare system. Some
examples of population health indicators include measures of population mortality and
morbidity. These are utilized at the macro-level for performance measures across
regions, states, and nations. We assume the impact of health care on these rates even
though we are not directly measuring the use of health care amongst the population
considered. If, for example, a disease-specific mortality rate is higher in one region
compared to another, we assume that the health care system has not been optimal in
the region with higher mortality. Traditionally, population health indicators have
included age-adjusted death rates, disease-specific death rates, life expectancy,
premature death rate, time lost to prema ture death, and infant mortality rate (IMR).1
The United Nations International Children's Emergency Fund defines IMR as the
probability of dying between birth and exactly 1 year of age. This rate is expressed per
1,000 live births per year. IMR is a pertinent indicator as it reflects wellbeing in infants,
children, and pregnant women since it is related to maternal health and quality and
,access to care, along with public health in the specific population. WHO defines life
expectancy as the number of years of life which, on average, can be expected in a given
population. The premature death rate can be determined by using life expectancy. The
premature death rate is the death rate for persons who die before the expected age of
death for that population. Time lost to premature death, sometimes referred to as years
of potential life lost, YPLL, is based on the difference between the actual age at death
and the expected age at death. YPLL weights deaths at a younger age more heavily
CLINICAL OUTCOMES-ANSWER Specific health outcomes of care received that pertain
to the persons are often called clinical outcomes. We use the following as outcome
measures quite frequently in studies of health care quality for the patients: readmission
to the hospital following a surgical procedure; functional capacity following a medical
intervention; long-term pain and discomfort following medical treatment; infection
acquired during a stay in the hospital nosocomial; 5-year mortality among patients
treated for cancer, heart disease, and other diseases; development of comorbidities
after medical therapy; and satisfaction of the patient with health care treatment
outcomes. Clinical outcomes research refers to studies that focus on the persons who
receive care, the patients, and the outcomes of their treatment. Below is a discussion of
health care quality at the microlevel of clinical outcomes. We look at two aspects related
to microlevel evaluation of healthcare quality: clinical effectiveness and patient safety.
CLINICAL EFFECTIVENESS-ANSWER A major concept used in defining the quality of
health care in the present era is the evaluation of its effectiveness, that is, whether the
care produces the desired or intended result. This term is synonymous with efficacy.
Assessing the effectiveness, or efficacy, of health care at the microlevel of physician
practices, hospitals, and other health care settings is increasingly becoming evidence
based-that is, scientifically valid, empirical research. It has been given perhaps one of
the best and most popular definitions by an article entitled, "Evidence-based medicine:
what it is and isn't," appearing in the British Medical Journal: Evidence-based medicine
is the conscientious, explicit, and judicious use of current best evidence in making
decisions about the care of individual patients. The practice of evidence-based
medicine means integrating individual clinical expertise with the best available external
clinical evidence from systematic research. Sackett, Rosenberg, Gray, Haynes, &
Richardson, 1996. (p. 71) Thus, the standards against which quality is measured are
based upon clinical research. Clinical outcomes research forms the basis for
quality-improvement initiatives at the microlevel. Starting in the final decade of the 20th
century, and funded by the Agency for Healthcare Research and Quality (AHRQ), the
Centers for Disease Control and Prevention (CDC), the National Institutes of Health
(NIH) among others, researchers at the NCI have continually produced updated and
published the results of clinical outcomes studies. These studies have then been
synthesized by experts in the field, and the synthesized results are translated into
clinical practice guidelines (or alternatively, clinical practice protocols). A standard
, definition of clinical practice guidelines was developed by Field and Lohr (1992):
"systematically developed statements to assist practitione
PATEINT SAFETY - ANSWER Another aspect of health care quality is patient safety. This
interest in health care delivery quality improvement-primarily driven by the patient
safety movement of the 1990s-resulted in efforts to apply methods borrowed from other
industries and pioneered by W. Edwards Deming. Deming was an American statistician
considered the father of the modern quality assurance movement. He had developed his
system following the end of World War II. Unable to get a hearing in this country, he
went to Japan. His methods, designated Statistical Process Control SPC and Total
Quality Management TQM strongly influenced the rebirth and eventual massive
expansion of Japanese industry post - World War II. The Institute of Medicine, 2000, has
defined patient safety as "freedom from accidental injury; ensuring patient safety
involves the establishment of operational systems and processes that minimize the
likelihood of errors and maximizes the likelihood of intercepting them when they occur"
(p. 211). Thus, patient safety includes but is not limited to all events and circumstances
leading to unintentional harm to the patients as a result of medication errors, surgical
mistakes, falls, improper use of medical devices, and nosocomial infection. The Institute
of Medicine report To Err Is Human (2000) has played a major role in bringing national
attention to this issue of patient safety. The Report transformed what had been a matter
of growing professional concern, gradually accumulating over many years, into one of
widespread public concern in a way and at a speed that was, until then, unprecedented
in contemporary experience with the quality of health care. This was due to errors in
medical care that led to the epidemiologic finding of over one million injuries and close
to 100,000 annual deaths in the United States. While studies resulting in this finding
were almost a decade old, this was new to the public.
ORGANIZATIONS WITH MAJOR INFLUENCE ON HEALTH CARE QUALITY - ANSWER
The following section describes the efforts of public and private organizations to
improve the quality of health care in the United States. These efforts are increasingly
collaborative. Many businesses that pay for the health care of their employees have
banded together. Public initiatives are increasingly coordinated. And, private- public
partnerships have developed. It is difficult to point out, however, which ones have the
most influence. Evidently, The Joint Commission and the Centers for Medicare &
Medicaid Services are one of the largest payers in the country for health services,
hence extremely influential. However, the private organizations and other public
agencies do have very important roles as well. The effects of such efforts on quality in
U.S. health care remain to be seen.
THE JOINT COMMISSION AND OTHER HEALTH CARE ACCREDITING ORGANIZATIONS
- ANSWER Although accrediting organizations are private entities, they possess a good
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