Brief history of quality movement in US healthcare

Marjoua, Youssra; Bozic, Kevin J.

doi:10.1007/s12178-012-9137-8

Cited by 106 publications

(69 citation statements)

References 28 publications

(23 reference statements)

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“…The CMS runs Medicare, a national social insurance program of the United States (19). The administrative CMS Medicare database can be utilized to conduct surgical research (20).…”

Section: Centers For Medicare and Medicaid Services (Cms) Medicare Damentioning

confidence: 99%

Surgical research using national databases

2016

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Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations.The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.

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“…The CMS runs Medicare, a national social insurance program of the United States (19). The administrative CMS Medicare database can be utilized to conduct surgical research (20).…”

Section: Centers For Medicare and Medicaid Services (Cms) Medicare Damentioning

confidence: 99%

Surgical research using national databases

2016

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“…The Centers for Medicare & Medicaid Services (CMS) runs Medicare, the national social insurance program that offers 7 . In 2009, the Medicare and Medicaid budget was nearly $500 billion, or 5.3% of the gross domestic product, and was expected to increase to 10% by 2035.…”

Section: Medicare Claimsmentioning

confidence: 99%

Database and Registry Research in Orthopaedic Surgery

Pugely

Martin

Harwood

et al. 2015

The Journal of Bone and Joint Surgery

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180

126

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The use of large-scale national databases for observational research in orthopaedic surgery has grown substantially in the last decade, and the data sets can be grossly categorized as either administrative claims or clinical registries. Administrative claims data comprise the billing records associated with the delivery of health-care services. Orthopaedic researchers have used both government and private claims to describe temporal trends, geographic variation, disparities, complications, outcomes, and resource utilization associated with both musculoskeletal disease and treatment. Medicare claims comprise one of the most robust data sets used to perform orthopaedic research, with >45 million beneficiaries. The U.S. government, through the Centers for Medicare & Medicaid Services, often uses these data to drive changes in health policy. Private claims data used in orthopaedic research often comprise more heterogeneous patient demographic samples, but allow longitudinal analysis similar to that offered by Medicare claims. Discharge databases, such as the U.S. National Inpatient Sample, provide a wide national sampling of inpatient hospital stays from all payers and allow analysis of associated adverse events and resource utilization. Administrative claims data benefit from the high patient numbers obtained through a majority of hospitals. Using claims, it is possible to follow patients longitudinally throughout encounters irrespective of the location of the institution delivering health care. Some disadvantages include lack of precision of ICD-9 (International Classification of Diseases, Ninth Revision) coding schemes. Much of these data are expensive to purchase, complicated to organize, and labor-intensive to manipulate--often requiring trained specialists for analysis. Given the changing health-care environment, it is likely that databases will provide valuable information that has the potential to influence clinical practice improvement and health policy for years to come.

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“…Their work regarding system change, first applied to business and industry, eventually made its way to the American health system as the need for improvement became evident. 6 In 1989, the Agency of Health Care Policy and Research was created, replacing the National Center for Health Services Research, with the charge to develop practice guidelines and conduct research on quality of care. These approaches included redesigning professional education, improving competition among provider organizations, requiring data on quality to be reported publicly, rewarding good performance, punishing bad performance, applying continuous quality improvement or total quality management tools, and measuring and improving the culture of health care organizations to facilitate the adoption of safer systems of care.…”

Section: Evolution Of Health Care Qualitymentioning

confidence: 99%

Physician-Led Sepsis Quality Improvement Team

Hampe

2015

Critical Care Nursing Quarterly

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Over the last decade, hospitalizations for sepsis have more than doubled and the incidence of postsurgical sepsis tripled between 1997 and 2006. This upward trend is expected to continue for several reasons, including population-specific characteristics (e.g., age, chronic disease status) and health care-specific characteristics (eg, lack of understanding of sepsis, medical treatments that leave patients susceptible). Highly effective, focused, quality improvement teams need to be established in order to successfully manage this condition. Quality improvement, and specifically quality improvement in health care, has evolved substantially over the past few decades. This evolution has been pushed by government initiatives and private accrediting bodies that have exposed concerns regarding quality of care. Hospitals have responded with not only corrective actions but also actions that improve quality despite a lack of noted deficiencies (i.e., taking quality from "good" to "better"). Key components of a successful quality improvement program have been identified, as have components of successful quality improvement teams. By applying these components to a physician-led sepsis quality improvement team, hospitals can successfully decrease sepsis mortality and increase compliance with the application of sepsis best practice in the emergency department, intensive care unit, or non-intensive care unit nursing units.

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Brief history of quality movement in US healthcare

Cited by 106 publications

References 28 publications

Surgical research using national databases

Surgical research using national databases

Database and Registry Research in Orthopaedic Surgery

Physician-Led Sepsis Quality Improvement Team

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