Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-7479d7b7d-fwgfc Total loading time: 0 Render date: 2024-07-12T10:19:24.294Z Has data issue: false hasContentIssue false

8 - Commitment to Improving Quality of Care

Published online by Cambridge University Press:  25 February 2010

By
Christine Laine
Edited by
John Spandorfer ,
Charles A. Pohl ,
Susan L. Rattner  and
Thomas J. Nasca
Christine Laine
Affiliation:
Editor, Annals of Internal Medicine
John Spandorfer
Affiliation:
Jefferson Medical College, Philadelphia
Charles A. Pohl
Affiliation:
Jefferson Medical College, Philadelphia
Susan L. Rattner
Affiliation:
Jefferson Medical College, Philadelphia
Thomas J. Nasca
Affiliation:
Jefferson Medical College, Philadelphia
Get access

Summary

IMPROVING QUALITY OF CARE – ADULT PRIMARY CARE

A primary care physician who directs a large primary care clinic is notified of an insurance company audit that for the second consecutive year reports that a higher than predicted fraction of patients in that practice has cholesterol levels that are not at goal (Adult Treatment Panel III (ATP-III)). Following the audit last year, the physician notified his colleagues of these findings and spoke at a business meeting of the need to adhere to lipid-lowering recommendations. Despite the reminder given by the clinic director, the overall lipid results are slightly worse this year than last year.

A Perspective from an Internist and Quality of Care Scholar

Clinical Background

A strong body of evidence documents that elevated LDL cholesterol is a major risk factor for cardiovascular disease and that LDL-lowering interventions reduce the risk for cardiovascular disease events in both primary and secondary prevention settings. The effectiveness of cholesterol management in the prevention of cardiovascular morbidity and mortality has prompted many quality improvement efforts such as the Ambulatory Quality Alliance to develop quality measures related to cholesterol management.

The ATP-III recommends measurement of fasting lipoprotein levels (total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, and triglycerides) every five years, beginning at age twenty years.

Type
Chapter
Information
Professionalism in Medicine
A Case-Based Guide for Medical Students
 , pp. 309 - 360
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

AQA Web site. www.aqaalliance.org. Accessed June 24, 2008.
,National Heart, Lung, and Blood Institute. National Institutes of Health. Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III); Publication no. 01–3670. May 2001.
Grundy, S.M., Cleeman, J.I., Merz, C.N., et al. Implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. J Am Coll Cardiol. 2004;44(3):720–732.CrossRefGoogle ScholarPubMed
Flynn, J., Booth, B., Portelli, R.Professionalism and the quality framework. Aust Fam Physician. 2007;36(1–2):16–18.Google ScholarPubMed
Brennan, T.A., Rothman, D.J., Blank, L., et al. Health industry practices that create conflicts of interest: A policy proposal for academic medical centers. JAMA. 2006;295(4):429–433.CrossRefGoogle ScholarPubMed
McGlynn, E.A., Asch, S.M., Adams, J., et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–2645.CrossRefGoogle ScholarPubMed
Federman, A.D., Adams, A.S., Ross-Degnan, D., Soumerai, S.B., Ayanian, J.Z.Supplemental insurance and use of effective cardiovascular drugs among elderly Medicare beneficiaries with coronary heart disease. JAMA. 2001;286(14):1732–1739.CrossRefGoogle ScholarPubMed
Brown, L.C., Johnson, J.A., Majumdar, S.R., Tsuyuki, R.T., McAlister, F.A.Evidence of suboptimal management of cardiovascular risk in patients with type 2 diabetes mellitus and symptomatic atherosclerosis. CMAJ. 2004;171(10):1189–1192.CrossRefGoogle ScholarPubMed
,National Committee for Quality Assurance. The State of Health Care Quality, 2005. ACQA Web site. http://web.ncqa.org/tabid/447/ItemId/741/Default.aspx. Accessed July 31, 2008.
Majumdar, S.R., Lipton, H.L., Soumerai, S.B. Evaluating and improving physician prescribing. In: Strom, B., ed. Pharmacoepidemiology. New York: John Wiley and Sons; 2005:419–438.Google Scholar
Jamtvedt, G., Young, J.M., Kristoffersen, D.T., O'Brien, M.A.,Oxman, A.DAudit and feedback: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;(2)(2):CD000259.CrossRefGoogle Scholar
Soumerai, S.B., Avorn, J.Principles of educational outreach (“academic detailing”) to improve clinical decision making. JAMA. 1990;263(4):549–556.CrossRefGoogle Scholar
Thomson O'Brien, M.A., Oxman, A.D., Haynes, R.B., Davis, D.A., Freemantle, N., Harvey, E.L.Local opinion leaders: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2000;(2)(2):CD000125.Google Scholar
Bates, D.W., Gawande, A.A. Improving safety with information technology. N Engl J Med. 2003;348(25):2526–2534.CrossRefGoogle ScholarPubMed
Planas, R.I.Museu Picasso: Guide Français. Barcelona: Ajuntament de Barcelona, Institut; 1998.Google Scholar
,Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press; 2000.Google Scholar
Choudhry, N.K., Fletcher, R.H., Soumerai, S.B. Systematic review: The relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142(4):260–273.CrossRefGoogle ScholarPubMed
Chassin, M.R., Galvin, R.W.The urgent need to improve health care quality: Institute of Medicine national roundtable on health care quality. JAMA. 1998;280(11):1000–1005.CrossRefGoogle ScholarPubMed
,ABIM. Foundation. American Board of Internal Medicine, ACP-ASIM Foundation. American College of Physicians-American Society of Internal Medicine, European Federation of Internal Medicine. Medical professionalism in the new millennium: A physician charter. Ann Intern Med. 2002;136(3):243–246.CrossRefGoogle Scholar
,Institute of Medicine. Performance Measurement: Accelerating Improvement. Washington, D.C.: National Academy Press; 2004.Google Scholar
Baron, R.J. Personal metrics for practice – how'm I doing?N Engl J Med. 2005;353(19):1992–1993.CrossRefGoogle ScholarPubMed
Brennan, T.A. Recertification for internists – one “grandfather's” experience. N Engl J Med. 2005;353(19):1989–1992.CrossRefGoogle ScholarPubMed
Weisz, G. Divide and Conquer: A Comparative History of Medical SpecializationNew York: Oxford University Press; 2005.Google Scholar
Stevens, R. American Medicine and the Public Interest. New Haven: Yale University Press; 1971.Google Scholar
Ludmerer, K.M. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed CareNew York: Oxford University Press; 1999.Google Scholar
Ludmerer, K.M. Learning to heal: The development of American medical education. 1985.
Angell, M. The Truth about the Drug Companies: How They Deceive Us and What to Do about It. New York: Random House; 2004.Google Scholar
Kassirer, J.P. On the Take: How Medicine's Complicity with Big Business Can Endanger Your HealthNew York: Oxford University Press; 2004.Google Scholar
Relman, A.S. Assessment and accountability: The third revolution in medical care. N Engl J Med. 1988;319(18):1220–1222.CrossRefGoogle ScholarPubMed
Kreimer, S. Patient safety. fragmented care heightens error risk for surgical patients. Hosp Health Netw. 2007;81(6):32.Google ScholarPubMed
Suhonen, R., Nenonen, H., Laukka, A., Valimaki, M. Patients' informational needs and information received do not correspond in hospital. J Clin Nurs. 2005; 14(10):1167–1176.CrossRefGoogle Scholar
Hofer, T.P., Hayward, R.A. Are bad outcomes from questionable clinical decisions preventable medical errors? A case of cascade iatrogenesis. Ann Intern Med. 2002;137(5 Part 1):327–333.CrossRefGoogle ScholarPubMed
Boosting Care Transitions Resource Room. Society of Hospital Medicine Web site. http://www.hospitalmedicine.org/ResourceRoomRedesign/RR_CareTransitions/CT_Home.cfm. Accessed July 23, 2008.
Astrup, K., Olivarius Nde, F. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstet Gynecol Scand. 2004; 83(2):203–207.CrossRefGoogle ScholarPubMed
MacMahon, B. Overview of studies on endometrial cancer and other types of cancer in humans: Perspectives of an epidemiologist. Semin Oncol. 1997;24 (1 Suppl. 1):S1–122-S1–39.Google ScholarPubMed
Goldstein, R.B., Bree, R.L., Benson, C.B., et al. Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in ultrasound-sponsored consensus conference statement. J Ultrasound Med. 2001;20(10):1025–1036.CrossRefGoogle ScholarPubMed
Doorn, H.C., Opmeer, B.C., Burger, C.W., et al. Inadequate office endometrial sample requires further evaluation in women with postmenopausal bleeding and abnormal ultrasound results. Int J Gynaecol Obstet. 2007;99(2):100–104.CrossRefGoogle ScholarPubMed
Fallowfield, L., Jenkins, V.Communicating sad, bad, and difficult news in medicine. Lancet. 2004;363(9405):312–319.CrossRefGoogle Scholar
Farber, N.J., Urban, S.Y., Collier, V.U., et al. The good news about giving bad news to patients. J Gen Intern Med. 2002;17(12):914–922.CrossRefGoogle ScholarPubMed
Arnold, L., Stern, D.T. What is medical professionalism? In: Stern, D.T., ed. Measuring Medical Professionalism. Oxford, England: Oxford University Press; 2006:15–37.Google Scholar
Pellegrino, E.D. Nonabandonment: An old obligation revisited. Ann Intern Med. 1995;122(5):377–378.CrossRefGoogle ScholarPubMed
,Institute of Medicine. Crossing the Quality Chasm. Washington, D.C.: National Academy Press; 2007.Google Scholar
Lown, B., Kalet, A.L. Patient advocacy: The clinician's experience: Incorporating advocacy into the 20-minute medical encounter. In: Earp, J.A., French, E.A., Gilkey, M.B., eds. Patient Advocacy for Health Care Quality: Strategies for Achieving Patient-Centered Care. Sudbury, MA: Jones and Bartlett; 2007.Google Scholar
Epstein, R.M. Mindful practice. JAMA. 1999;282(9):833–839.CrossRefGoogle ScholarPubMed
Blank, L., Kimball, H., McDonald, W., et al. Medical professionalism in the new millennium: A physician charter 15 months later. Ann Intern Med. 2003; 138(10):839–841.CrossRefGoogle ScholarPubMed
Lazarus, J.A., Sharfstein, S. Ethics in Mangaged Care:The Psychiatric Clinics of North America. Vol. 23.; 2000.CrossRefGoogle Scholar
Lazarus, J.A.Ethics in Entering Private Practice, A Handbook for Phsychiatrists. American Psychiatric Publishing Inc; 2005.Google Scholar
Lazarus, J.A. Ethical Issues in Divided Or Collaborative Treatment in Psychopharmacology and Psychotherapy. Arlington, VA: American Psychiatric Press; 1999.Google Scholar
Eddy, D.M. Performance measurement: Problems and solutions. Health Aff (Millwood). 1998;17(4):7–25.CrossRefGoogle ScholarPubMed
Iserson, K.V. Understanding the incomplete text: Interpreting the emergency department patient. Am J Emerg Med. 1992;10(4):361–363.CrossRefGoogle ScholarPubMed
Adams, J., Murray, R.. The general approach to the difficult patient. Emerg Med Clin North Am. 1998;16(4):689–700.CrossRefGoogle ScholarPubMed
Harrison, D.W., Vissers, R.J. The difficult patient. In: Marx, J.A., ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. New York: Mosby; 2006:2972–2982.Google Scholar
Waitzkin, H. Doctor-patient communication. Clinical implications of social scientific research. JAMA. 1984;252(17):2441–2446.CrossRefGoogle ScholarPubMed
Asplin, B.R., Magid, D.J., Rhodes, K.V., Solberg, L.I., Lurie, N., Camargo, C.A.. A conceptual model of emergency department crowding. Ann Emerg Med. 2003;42(2):173–180.CrossRefGoogle ScholarPubMed
Trotter, G. The loyal physician: Roycean ethics and the practice of medicine. 1997.
,American Medical Association. Principles of Medical Ethics. http://www.ama-assn.org/ama/pub/category/2512.html. Updated 2006. Accessed April 26, 2007.
Hussey, P.S., Anderson, G.F., Osborn, R., et al. How does the quality of care compare in five countries?Health Aff (Millwood). 2004;23(3):89–99.CrossRefGoogle ScholarPubMed
Reinhardt, U.E., Hussey, P.S., Anderson, G.F. Cross-national comparisons of health systems using OECD data, 1999. Health Aff (Millwood). 2002;21(3):169–181.CrossRefGoogle Scholar
Nolte, E., McKee, C.M. Measuring the health of nations: Updating an earlier analysis. Health Aff (Millwood). 2008;27(1):58–71.CrossRefGoogle ScholarPubMed
Mangione-Smith, R., DeCristofaro, A.H., Setodji, C.M., et al. The quality of ambulatory care delivered to children in the United States. N Engl J Med. 2007;357(15):1515–1523.CrossRefGoogle ScholarPubMed
,Institute of Medicine, ed. Crossing the Quality Chasm. Washington, D.C.: National Academy Press; 2001.Google Scholar
,The Dartmouth Atlas of Healthcare. The Dartmouth Institute for Health Policy and Clinical Practice Web site. www.dartmouthatlas.org. Accessed January 28, 2008.
Rowe, J.W. Pay-for-performance and accountability: Related themes in improving health care. Ann Intern Med. 2006;145(9):695–699.CrossRefGoogle ScholarPubMed
,Institute of Medicine. To err is human. 1999. http://www.iom.edu/Object.File/Master/4/117/ToErr-8pager.pdf. Accessed May 2, 2009.
Moskowitz, E.J., Nash, D.B. The quality and safety of ambulatory medical care: Current and future prospects. Am J Med Qual. 2007;22(4):274–288.CrossRefGoogle ScholarPubMed
Fuhrmans, V. Insurers stop paying for care linked to errors. The Wall Street Journal. 2008.Google Scholar
Martin, J. Hospital-acquired Infections in Pennsylvania 2005 – News Release. Pennsylvania Health Care Cost Containment Council Web site. http://www.phc4.org/reports/hai/05/nr111406.htm. Updated 2006. Accessed January 28, 2008.
Shannon, R.P., Patel, B., Cummins, D., Shannon, A.H., Ganguli, G., Lu, Y. Economics of central line – associated bloodstream infections. Am J Med Qual. 2006;21 (6 Suppl):7S–16S.CrossRefGoogle ScholarPubMed
Peng, M.M., Kurtz, S., Johannes, R.S. Adverse outcomes from hospital-acquired infection in Pennsylvania cannot be attributed to increased risk on admission. Am J Med Qual. 2006;21(6 Suppl):17S–28S.CrossRefGoogle ScholarPubMed
Wennberg, J.E., O'Connor, A.M., Collins, E.D., Weinstein, J.N. Extending the P4P agenda, part 1: How Medicare can improve patient decision making and reduce unnecessary care. Health Aff (Millwood). 2007;26(6):1564–1574.CrossRefGoogle ScholarPubMed
O'Connor, A.M., Wennberg, J.E., Legare, F., et al. Toward the “tipping point”: Decision aids and informed patient choice. Health Aff (Millwood). 2007;26(3):716–725.CrossRefGoogle ScholarPubMed
Holmboe, E.S., Lipner, R., Greiner, A. Assessing quality of care: Knowledge matters. JAMA. 2008;299(3):338–340.CrossRefGoogle ScholarPubMed
Waterman, A.D., Garbutt, J., Hazel, E., et al. The emotional impact of medical errors on practicing physicians in the United States and Canada. Jt Comm J Qual Patient Saf. 2007;33(8):467–476.CrossRefGoogle ScholarPubMed
Garbutt, J., Waterman, A.D., Kapp, J.M., et al. Lost opportunities: How physicians communicate about medical errors. Health Aff (Millwood). 2008;27(1): 246–255.CrossRefGoogle ScholarPubMed
Kaldjian, L.C., Jones, E.W., Wu, B.J., Forman-Hoffman, V.L., Levi, B.H., Rosenthal, G.E. Reporting medical errors to improve patient safety: A survey of physicians in teaching hospitals. Arch Intern Med. 2008;168(1):40–46.CrossRefGoogle ScholarPubMed
Campbell, E.G., Regan, S., Gruen, R.L., et al. Professionalism in medicine: Results of a national survey of physicians. Ann Intern Med. 2007;147(11):795–802.CrossRefGoogle ScholarPubMed
Jha, A.K., Ferris, T.G., Donelan, K., et al. How common are electronic health records in the United States? A summary of the evidence. Health Aff (Millwood). 2006;25(6):w496–507.CrossRefGoogle Scholar
,Office of the National Coordinator: Mission. Health Information Technology Web site. http://www.hhs.gov/healthit/onc/mission/. Accessed January 28, 2008.
Miller, R.H., West, C., Brown, T.M., Sim, I., Ganchoff, C. The value of electronic health records in solo or small group practices. Health Aff (Millwood). 2005;24(5):1127–1137.CrossRefGoogle ScholarPubMed
Asch, S.M., McGlynn, E.A., Hogan, M.M., et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med. 2004;141(12):938–945.CrossRefGoogle Scholar
Jha, A.K., Perlin, J.B., Kizer, K.W., Dudley, R.A. Effect of the transformation of the Veterans Affairs health care system on the quality of care. N Engl J Med. 2003; 348(22):2218–2227.CrossRefGoogle ScholarPubMed
Pronovost, P., Needham, D., Berenholtz, S., et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26): 2725–2732.CrossRefGoogle ScholarPubMed
Pham, H.H., Ginsburg, P.B., McKenzie, K., Milstein, A. Redesigning care delivery in response to a high-performance network: The Virginia Mason Medical Center. Health Aff (Millwood). 2007;26(4):w532–44.CrossRefGoogle ScholarPubMed
,Institute for Healthcare Improvement. www.ihi.org. Accessed January 28, 2008.
Bradley, E.H., Holmboe, E.S., Mattera, J.A., Roumanis, S.A., Radford, M.J., Krumholz, H.M. The roles of senior management in quality improvement efforts: What are the key components?J Healthc Manag. 2003;48(1):15–28; discussion 29.CrossRefGoogle ScholarPubMed
Carman, J.M., Shortell, S.M., Foster, R.W., et al. Keys for successful implementation of total quality management in hospitals. Health Care Manage Rev. 1996; 21(1):48–60.CrossRefGoogle ScholarPubMed
Joshi, M.S., Hines, S.C. Getting the board on board: Engaging hospital boards in quality and patient safety. Jt Comm J Qual Patient Saf. 2006;32(4):179–187.CrossRefGoogle ScholarPubMed
Weiner, B.J., Alexander, J.A., Baker, L.C., Shortell, S.M., Becker, M. Quality improvement implementation and hospital performance on patient safety indicators. Med Care Res Rev. 2006;63(1):29–57.CrossRefGoogle ScholarPubMed
Weiner, B.J., Alexander, J.A., Shortell, S.M., Baker, L.C., Becker, M., Geppert, J.J. Quality improvement implementation and hospital performance on quality indicators. Health Serv Res. 2006;41(2):307–334.CrossRefGoogle ScholarPubMed
Clough, J., Nash, D.B.. Health care governance for quality and safety: The new agenda. Am J Med Qual. 2007;22(3):203–213.CrossRefGoogle ScholarPubMed
Hansen-Turton, T., Ryan, S., Miller, K., Counts, M., Nash, D.B. Convenient care clinics: The future of accessible health care. Dis Manag. 2007;10(2):61–73.CrossRefGoogle ScholarPubMed
Valko, G.P. Open access scheduling. In: Nash, D.B., ed. Practicing Medicine in the 21st Century. Tampa, FL: American College of Physician Executives; 2006:243.Google Scholar
Ferris, T.G., Vogeli, C., Marder, J., Sennett, C.S., Campbell, E.G. Physician specialty societies and the development of physician performance measures. Health Aff (Millwood). 2007;26(6):1712–1719.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×