How to Diagnose Solutions to a Quality of Care Problem

Harel, Ziv; Silver, Samuel A.; McQuillan, Rory; Weizman, Adam V.; Thomas, Alison; Chertow, Glenn M.; Nesrallah, Gihad; Chan, Christopher T.; Bell, Chaim M.

doi:10.2215/cjn.11481015

Cited by 55 publications

(56 citation statements)

References 7 publications

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“…The focus on value now optimizes the money spent and actual value added to patients receiving treatment. Exploring better ways of promoting quality improvement services in health care is important [13][14][15][16]. On the other hand, improving patient outcomes is usually promoted with limited healthcare providers and pharmacists [17].…”

Section: Resultsmentioning

confidence: 99%

Community Pharmacists and Health Promotion Activities in the 21st Century; Maximizing the Expanded Roles for Universal Health Coverage and Population Health Optimization

Brian¹

2017

MOJPH

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Background: Pharmacy practice has evolved with ever-increasing roles in patient care and providing medicine use information to the community. Efficient public health care services encourage the rapid attainment of universal health coverage in developing countries.Objective: This study was set to examine the role of health promotion activities in local community pharmacy practice. Methods:A narrative overview of health promotion activities among Nigerian pharmacists was described and qualitative syntheses of the findings were obtained from government documents and published articles. An electronic search of the literature was conducted in Embase, Medline and CINAHL using keywords, truncations terms for adjacency search and a logical combination of these search terms.Result: A survey of pharmacists' participation in health promotion activities within two cities in Nigeria showed a 90% participation among respondents, irrespective of whether financial incentives or remunerations were paid for performing these activities or not. Community pharmacists in Nigeria offered free consultation services at various identified pharmacy outlets, making them readily accessible and well placed for achieving wider coverage among the public. Overall, they respondents showed willingness and a positive attitude in all domains of health promotion activities examined. Conclusion:Community pharmacists now have the expanded and evolving roles of preventive and holistic care. The ease of access pharmacists have to patients, has positioned the profession towards the incorporation of advanced health promotion activities and involvement in various stages of awareness campaigns, especially in testing indicator sensitivity to specific targets set for community health in developing regions. The shortage of health care providers in public health facilities, especially in rural areas, could be leveraged by pharmacists who are adequately trained to educate or train the community towards a particular end or attaining set goals. Health promotion interventions driven by pharmacists, in addition to other health professionals, raise awareness levels about adverse effects of medicines and disease outbreaks. Active participation of community pharmacists in health promotion may serve as a needed link in the sustained global push towards providing increased access to essential medicines in developing communities and improving health coverage.

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Section: Resultsmentioning

confidence: 99%

Community Pharmacists and Health Promotion Activities in the 21st Century; Maximizing the Expanded Roles for Universal Health Coverage and Population Health Optimization

Brian¹

2017

MOJPH

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“…One example may be found in the ESRD networks: all networks engage in regular regional improvement activities and routinely set out to achieve important clinical goals using CQI toolkits, [38] but are not typically designed for research publication. Although the study of CQI implementation may not be thought of as traditional research in the past, its use is promoted in medical literature, including a very recent and lengthy series of nephrology-specific articles [12–16]. …”

Section: Discussionmentioning

confidence: 99%

“…There are a number of peer reviewed journals dedicated to publishing papers about CQI in healthcare--either as a primary or secondary focus of the journal (http://www.ihi.org/education/IHIOpenSchool/resources/Pages/WhereToSubmitYourWritingQIFriendlyPeerReviewedJournals.aspx) [11]. In addition, a recent series of articles promoted use of quality improvement tools in nephrology practice [12–16]. …”

Section: Introductionmentioning

confidence: 99%

Continuous quality improvement in nephrology: a systematic review

et al. 2016

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BackgroundContinuous quality improvement (CQI) has been successfully applied in business and engineering for over 60 years. While using CQI techniques within nephrology has received increased attention, little is known about where, and with what measure of success, CQI can be attributed to improving outcomes within nephrology care. This is particularly important as payors’ focus on value-based healthcare and reimbursement is tied to achieving quality improvement thresholds. We conducted a systematic review of CQI applications in nephrology.MethodsStudies were identified from PubMed, MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, ProQuest Dissertation Abstracts and sources of grey literature (i.e., available in print/electronic format but not controlled by commercial publishers) between January 1, 2004 and October 13, 2014. We developed a systematic evaluation protocol and pre-defined criteria for review. All citations were reviewed by two reviewers with disagreements resolved by consensus.ResultsWe initially identified 468 publications; 40 were excluded as duplicates or not available/not in English. An additional 352 did not meet criteria for full review due to: 1. Not meeting criteria for inclusion = 196 (e.g., reviews, news articles, editorials) 2. Not nephrology-specific = 153, 3. Only available as abstracts = 3. Of 76 publications meeting criteria for full review, the majority [45 (61%)] focused on ESRD care. 74% explicitly stated use of specific CQI tools in their methods. The highest number of publications in a given year occurred in 2011 with 12 (16%) articles. 89% of studies were found in biomedical and allied health journals and most studies were performed in North America (52%). Only one was randomized and controlled although not blinded.ConclusionsDespite calls for healthcare reform and funding to inspire innovative research, we found few high quality studies either rigorously evaluating the use of CQI in nephrology or reporting best practices. More rigorous research is needed to assess the mechanisms and attributes by which CQI impacts outcomes before there is further promotion of its use for improvement and reimbursement purposes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0389-1) contains supplementary material, which is available to authorized users.

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“…Here, we use the example generated by our root cause analysis (1), that of the introduction of a dialysis nurse educator into a CKD clinic, to illustrate these stages.…”

Section: Pdsa Cycles and Rapid Cycle Change Methodologymentioning

confidence: 99%

How to Measure and Interpret Quality Improvement Data

McQuillan

Silver

Harel

et al. 2016

CJASN

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This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology. We will then discuss the selection of outcome, process, and balancing measures, and the practicalities of collecting these data in the clinic environment. We will also introduce the PDSA worksheet as a practical way to oversee the progress of a quality improvement project. Finally, we will demonstrate how run charts are used to visually illustrate improvement in real time, and how this information can be used to validate achievement, respond appropriately to challenges the project may encounter, and prove the significance of results. This article aims to provide readers with a clear and practical framework upon which to trial their own ideas for quality improvement in the clinical setting.Clin J Am Soc Nephrol 11: 908-914, 2016. doi: 10.2215/CJN.11511015 Clinical ScenarioIn the previous article in this Moving Points feature (1), the improvement team performed a root cause analysis to examine, by way of example, reasons why more patients were not dialyzing independently at home. The change idea that this analysis generated was the addition of a nurse educator into the CKD clinic. This change addressed the main causes of limited patient education by the nephrology staff and limited interdisciplinary communication between nephrology staff. Now, the improvement team needs to put this idea into practice and determine if the change is having the impact that was anticipated. Although the improvement team is familiar with Plan-DoStudy-Act (PDSA) methodology, they are unsure exactly how to conduct small tests of change and convey progress to the rest of the improvement team and stakeholders. In order to do so, the team needs to formulate a plan for how the nurse educator will be introduced into the clinic. The team must decide what parameters of success (or failure) are to be measured and identify a method whereby, in real time, they can tell if this change is having the desired effect and respond appropriately if it is not. PDSA Cycles and Rapid Cycle Change MethodologyTo do this, The Model for Improvement suggests using a series of PDSA cycles in a process called rapid cycle change (2,3). This is an iterative process, whereby one cycle yields results that inform the next, and so on, toward reaching the eventual goal (Figure 1). Rapid cycle change can be thought of as being analogous to building a wall out of bricks rather than pouring a concrete floor. In the case of the wall,...

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How to Diagnose Solutions to a Quality of Care Problem

Cited by 55 publications

References 7 publications

Community Pharmacists and Health Promotion Activities in the 21st Century; Maximizing the Expanded Roles for Universal Health Coverage and Population Health Optimization

Community Pharmacists and Health Promotion Activities in the 21st Century; Maximizing the Expanded Roles for Universal Health Coverage and Population Health Optimization

Continuous quality improvement in nephrology: a systematic review

How to Measure and Interpret Quality Improvement Data

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