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Improving Physician Decisions. Chapter 32 Code Blue Health Science Edition 4. Quality Control.

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improving physician decisions

Improving Physician Decisions

Chapter 32

Code Blue Health Science Edition 4

quality control
Quality Control

Although Wes has spent significant time trying to solve the financial problems of the hospital, the new administrator also recognizes the importance of correcting problems in the quality of healthcare offered by his facility.

outcomes management
Outcomes Management
  • Quality control has not always been a top priority of healthcare providers.
  • The reluctance to address the quality of care given by individual doctors on the medical staff can be illustrated by the history of outcomes management.
outcomes management1
Outcomes Management
  • Outcomes management focuses on measurable improvements in patient health due to specific procedures or treatments.
history of outcomes management
History of Outcomes Management
  • The approach was first proposed in 1913 by a Harvard surgeon named Emory Codman.
  • He called it the end results idea.
  • It consisted of tracking surgical patients for a year to see how their treatment turned out.

Early surgical center

history of outcomes management1
History of Outcomes Management
  • The goal of tracking surgical procedures was to discover their most likely cause of success or failure.
  • Codman planned to collect information into a database to improve treatment profiles.
history of outcomes management2
History of Outcomes Management
  • Unfortunately, his proposal to the American Medical Association was essentially ignored – it got only $500 in funding.
  • More important to Codman, other doctors stopped sending patients to him, his practice suffered and he abandoned the idea.
history of outcomes management3
History of Outcomes Management
  • In 1919, the concept was resurrected by the American College of surgeons to perform a study of 692 hospitals with 100 beds or more.
  • The study showed that only 89 met minimum standards.
history of outcomes management4
History of Outcomes Management
  • The response of the Board of Regents to the report was swift and uncompromising.
  • They collected all the copies, carried them to the basement of the hotel and burned them.
outcomes management2
Outcomes Management
  • Despite its rocky start, outcomes management is receiving attention again because of pressures from employers and consumers concerned with healthcare quality.
outcomes management3
Outcomes Management
  • One approach to outcomes management is to build clinical pathways, doctor guidelines, and treatment protocols.
clinical pathways
Clinical Pathways
  • A clinical pathway is a guide for physicians and nurses.
  • It is designed to provide decision paths to be followed in diagnosing and treating patients.
  • The goal is to standardize the practice of care so the providers use only those diagnostic and treatment options scientifically shown to provide the best medical outcomes.
treatment protocols
Treatment Protocols
  • A treatment protocol is a procedure that should be followed under specific conditions.
medical practice non uniformity
Medical Practice Non-uniformity
  • Research conducted by several medical schools shows there is a large geographical variation in treatment patterns among doctors.
  • Patients like to think their doctors’ approach is based on research, but unfortunately that’s not always true.
journal of strategic performance measurement
Journal of Strategic Performance Measurement
  • “Most practices in clinical medicine have never been tested in double-blind peer reviewed scientific studies, or even thoroughly for prospective statistical analysis. When practice techniques have been firmly established or debunked in such studies, the knowledge often does not affect clinical practice. Many doctors fail to hear of the new knowledge, others routinely ignore it, preferring to continue to practice the way they were taught in medical school.”

Flower, Joe. “Measuring Health,” The Journal of Strategic Performance Measurement, August/September 1998, Volume 2, Number 4.

why don t doctors always follow the best practice patterns
Why don’t doctors always follow the best practice patterns?
  • Some physicians don’t know what the best approaches are.
    • The best solution for this is education.
  • Some physicians get bogged down in dealing with the large volume of information needed to make decisions.
    • One tool to assist in solving this is decision-tree software.
what can hospitals do to improve physician decisions
What can hospitals do to improve physician decisions?
  • In-service education
  • Adoption of practice protocols that are shown to have the best outcomes
  • Use boundary guidelines that define medical practices beyond which doctors incur penalties