The Use of Three Strategies to Improve Quality of Care at a National Level
- 318 Downloads
Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial.
The purpose of this review was to address three questions: (1) does pay-for-performance improve the quality of care; (2) do surgical safety checklists improve the quality of surgical care; and (3) do practice guidelines improve the quality of care? These three strategies were chosen because there has been some research assessing their effectiveness in improving quality, and implementation had been attempted on a large scale such as entire countries.
We performed a literature review from 1950 forward using Medline to identify Level I and II studies. We evaluated the three strategies and their effects on processes and outcomes of care. When possible, we examined strategy implementation, patients, and systems, including provider characteristics, which may affect the relationship between intervention and outcomes with a focus on factors that may have influenced effect size.
Pay-for-performance improved the process and to a lesser extent the outcome of care. Surgical checklists reduced morbidity and mortality. Explicit practice guidelines influenced the process and to a lesser extent the outcome of care. Although not definitively showed, clinician involvement during development of intervention and outcomes, with explicit strategies for communication and implementation, appears to increase the likelihood of positive results.
Although the cost-effectiveness of these three strategies is unknown, quality of care could be enhanced by implementing pay-for-performance, surgical safety checklists, and explicit practice guidelines. However, this review identified that the effectiveness of these strategies is highly context-specific.
KeywordsPractice Guideline Financial Incentive Communication Failure Orthopaedic Care Partial Completion
- 5.Azoulay E, Rochard F, Chevret S, Vinsonneau C, Garrouste M, Cohen Y, Thuong M, Paugam C, Apperre C, de Cagny B, Brun F, Bornstain C, Parrot A, Thamion F, Lacherade JC, Bouffard Y, Le Gall JR, Herve C, Grassin M, Zittoun R, Schlemmer B, Dhainaut JF, for the PROTOCETIC Group. Compliance with triage to intensive care recommendations. Crit Care Med. 2001;29:2132–2136.PubMedCrossRefGoogle Scholar
- 11.Bodi M, Rodriguez A, Solé-Violán J, Gilavert C, Garnacho J, Blanquer J, Jimenez J, de la Torre MV, Sirvent JM, Almirall J, Doblas A, Badía JR, Garcia F, Mendia A, Jordá R, Bobillo F, Vallés J, Broch MJ, Carrasco N, Herranz MA, Rello J; for the Community-Acquired Pneumonia Intensive Care Units (CAPUCI) Study Investigators. Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of American guidelines on survival. Clin Infect Dis. 2005;41:1709–1716.PubMedCrossRefGoogle Scholar
- 14.Brignole M, Ungar A, Bartoletti A, Ponassi I, Lagi A, Mussi C, Ribani MA, Tava G, Disertori M, Quartieri F, Alboni P, Raviele A, Ammirati F, Scivales A, de Santo T; for the Evaluation of Guidelines in Syncope Study 2 (EGSYS-2) group. Standardized-care pathway vs usual management of syncope patients presenting as emergencies at general hospitals. Europace. 2006;8:644–650.PubMedCrossRefGoogle Scholar
- 19.Committee on Quality of Health Care in America Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21 st Century. Washington, DC: National Academy Press; 2001.Google Scholar
- 20.Cuspidi C, Michev I, Lonati L, Vaccarella A, Cristofari M, Garavelli G, Palumbo G, Meani S, Leonetti G, Magrini F, Zanchetti A; on behalf of the Lombardy Regional Section of Italian Society of Hypertension. Compliance to hypertension guidelines in clinical practice: a multicentre pilot study in Italy. J Hum Hypertens. 2002;16:699–703.PubMedCrossRefGoogle Scholar
- 21.Daly C, Clemens F, Lopez-Sendon JL, Tavazzi L, Boersma E, Danchin N, Delahaye F, Gitt A, Julian D, Mulcahy D, Ruzyllo W, Thygesen K, Verheugt F, Fox KM; Euro Heart Survey Investigators. The impact of guideline compliant medical therapy on clinical outcome in patients with stable angina: findings from the Euro Heart Survey of stable angina. Eur Heart J. 2006;27:1298–1304.PubMedCrossRefGoogle Scholar
- 22.de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, Schlack WS, van Putten MA, Gouma DJ, Dijkgraaf MG, Smorenburg SM, Boermeester MA; SURPASS Collaborative Group. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med. 2010;363:1928–1937.PubMedCrossRefGoogle Scholar
- 24.Fine MJ, Stone RA, Lave JR, Hough LJ, Obrosky DS, Mor MK, Kapoor WN. Implementation of an evidence-based guideline to reduce duration of intravenous antibiotic therapy and length of stay for patients hospitalized with community-acquired pneumonia: a randomized controlled trial. Am J Med. 2003;115:343–351.PubMedCrossRefGoogle Scholar
- 26.Gorecki W, Grochowska E, Krysta M, Wojciechowski P, Taczanowska A, Stanek B. A prospective comparison of antibiotic usage in pediatric surgical patients: the safety, advantage, and effectiveness of the Surgical Infection Society guidelines versus a common practice. J Pediatr Surg. 2002;37:1430–1434.PubMedCrossRefGoogle Scholar
- 31.Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–499.PubMedCrossRefGoogle Scholar
- 39.Johns Hopkins Medicine. Peter Pronovost’s Seemingly Simple Ideas Are Changing the Face of Patient Care. Available at: www.hopkinsmedicine.org/quality/safety/pronovost/. Accessed June 24, 2011.
- 42.Kulkarni K, Castle G, Gregory R, Holmes A, Leontos C, Powers M, Snetselaar L, Splett P, Wylie-Rosett J; for the Diabetes Care and Education Dietetic Practice Group. Nutrition practice guidelines for type 1 diabetes mellitus positively affect dietitian practices and patient outcomes. J Am Diet Assoc. 1998;98:62–70.PubMedCrossRefGoogle Scholar
- 55.Noordzij M, Korevaar JC, Boeschoten EW, Dekker FW, Bos WJ, Krediet RT; for the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group. The Kidney Disease Outcome Quality Initiative (K/DOQI) Guideline for Bone Metabolism and Disease in CDK: association with mortality in dialysis patients. Am J Kidney Dis. 2005;46:925–932.PubMedCrossRefGoogle Scholar
- 57.Onat, A, Soydan I, Tokgozoglu L, Sansoy V, Koylan N, Domanic N, Ural D; on behalf of the Riskburn Study Group, Turkish Society of Cardiology. Guideline implementation in a multicenter study with an estimated 44% relative cardiovascular event risk reduction. Clin Cardiol. 2003;26:243–249.PubMedCrossRefGoogle Scholar
- 58.Palazzi M, de Tomasi D, D’Affronto C, Richetti A, Valli MC, Meregalli S, Asnaghi D, Arienti V, Cavallini D, Pradella R, Cafaro I, Baroncelli G, Di Lorenzo I, de Agostini A, Parrinello G, Bertoni F. Are international guidelines for the prescription of adjuvant treatment for early breast cancer followed in clinical practice? Results of a population-based study on 1547 patients. Tumori. 2002;88:503–506.PubMedGoogle Scholar
- 68.Schneider F, Marher M, Brand S, Sitta P, Menke R, Hammer-Filipiak U, Kudling R, Heindl A, Herold K, Frommberger U, Elmer O, Hetzel G, Witt G, Wolfersdorf M, Berger M, Gaebel W. Adherence to guidelines for treatment of depression in in-patients. Br J Psychiatry. 2005;187:462–469.PubMedCrossRefGoogle Scholar
- 69.Sellier E, Labarere J, Bosson J-L, Auvray M, Barrellier M-T, le Hello C, le Roux P, Sevestre M-A; for the Association our la Promotion de l’Angiologie Hospitaliere. Effectiveness of a guideline for venous thromboembolism prophylaxis in elderly post-acute care patients: a multicenter study with systematic ultrasonographic examination. Arch Intern Med. 2006;166:2065–2071.PubMedCrossRefGoogle Scholar
- 70.Sewell M, Adebibe M, Jayakumar P, Jowett C, Kong K, Vemulapalli K, Levack B. Use of the WHO surgical safety checklist in trauma and orthopaedic patients. Int Orthop. 2010 Aug 21 [Epub ahead of print].Google Scholar
- 71.Van der Sanden WJM, Mettes DG, Plasschaert AJM, Grol RPTM, Mulder J, Verdonschot EH. Effectiveness of clinical practice guideline implementation on lower third molar management in improving clinical decision-making: a randomized controlled trial. Eur J Oral Sci. 2005;113:349–354.PubMedCrossRefGoogle Scholar