| Design and measurement of quality improvement indicators in ambulatory pulmonary care: creating a "culture of quality" in an academic pulmonary division. | |
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MedLine Citation:
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PMID: 19809055 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Quality improvement (QI) measures often are cited as goals for individual practices and medical centers and may someday form a component of reimbursement guidelines. Relatively few QI metrics relevant to ambulatory pulmonary medicine have been published. We describe the development and implementation of a QI program in an academic pulmonary division, including progress to date and lessons learned. METHODS: Metrics for the pulmonary QI Dashboard were developed based on an extensive literature review. Patients were identified through International Classification of Diseases-based billing databases, and results data were obtained from a manual and automated review of the electronic medical record. The performance of the division was monitored and presented in regular faculty meetings. Quarterly, confidential, individual scorecards gave each clinician feedback about his or her performance and compared the feedback to that of the faculty of the entire division. RESULTS: Significant improvements were found in many QI measures during a 2-year period. The number of patients with asthma who received appropriately prescribed inhaled corticosteroids increased from a baseline of 76 to 92% to 98%. Flu shot and pneumococcal vaccine administration documentation for patients with COPD increased from baseline values of 11 to 32% and 11 to 34%, respectively, to 90% and 93%, respectively. The COPD Global Initiative for Obstructive Lung Disease pharmacotherapy guidelines adherence increased substantially for patients with all disease stages. Chest CT scan results notification documentation improved from a baseline of 67 to 76% to 98%. Comparison between baseline and QI periods yielded statistically significant increases for these indicators. CONCLUSIONS: QI measures for an ambulatory pulmonary practice can be designed, implemented, and monitored. Key components include a well-structured electronic medical record, measurable outcomes, strong QI leadership, and specific interventions, such as providing feedback through QI review meetings and individual "report cards." |
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Authors:
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David H Roberts; Geoffrey S Gilmartin; Naama Neeman; Joanne E Schulze; Sabrina Cannistraro; Long H Ngo; Mark D Aronson; J Woodrow Weiss |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Chest Volume: 136 ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-10-07 Completed Date: 2009-11-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: 1134-40 Citation Subset: AIM; IM |
Affiliation:
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Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center andHarvard Medical SchoolBoston, MA 02215, USA. dhrobert@bidmc.harvard.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Ambulatory Care
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standards* Data Collection Hospital Departments / standards Humans Lung Diseases / therapy* Medical Records Pulmonary Medicine / education, standards* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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