Quality of Care

Index - Major Sections
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Index - Same Level Subject

General Functions
Main Menu
Client, Household and the Social Unit
Sociological/Social Worker
Geographical Location
Triage
Registration and Admitting
Appointments
Cashier and Client Accounting
Medical
Case Management
Risk Management
Quality of Care
Nursing
Education
Hospital
Electronic Order Entry
Laboratory and Imaging
Nutrition
Gynecology and Obstetrics
Emergency Department
Surgery
Drugs and Pharmacy
Quality Assurance
Healthcare Intelligence
Management
Support Functions
Resource Management
Administration
Accounting and Finance
Human Resources
Monitoring and Research
Reporting and Distribution of Information
References

Index - Child Subjects

Introduction

Medical Audit Committee: Audits retrospectively examine the clinical application of medical knowledge and compares care rendered to the pre-set standards (De Geyndt 1995). The strategy developed by Williamson (1971) focuses on diagnostic categories or specific clinical procedures. Standards are set consensually by physicians for physicians.

The InHCc Information System is designed to determine the Quality of Care.

Data collection

The Screens are designed such that all data recommended by expert panels are captured as atomic units in the most efficient and effective manner.

Although duplications are eliminated, some redundancies are built into the system for several reasons:

To check the accuracy of the recorder
To check the accuracy of the Client

This duplication of information may be used in research to statistically test the accuracy of the data collected by testing the consistency of information taken from the same source and from difference sources over time and location. Where discrepancies exist, a follow up investigation may be implemented and population information can be obtained on a level more accurate than exists today.

Protocol Evidence Based Medicine

InHCc has extensive references to Evidence Based Medicine Protocols. Problems can be selected and the protocols for that problem will be displayed.

Social and Economic Evaluation

In order to manage, not only is data needed Internally but it is also needed from External Sources. Today, estimates of National Level statistical data are obtained through special surveys and questionnaires. It can be expected that with a large enough internal data base covering the population, these types of studies will not be necessary. The estimates of National Level statistics can be derived from the internal data.

Certain types of information can only be obtained at the National Level; for example, "All Registered Health Care Units" in the country with their statistics (however, even this can be collected electronically). This type of information should be made available at the National Level to be used by the Units for their individual analysis. This data can be "published" in an electronic form using either an Oracle or a MS SQL database. This data can also includes data such as economic statistics and population statistics as given below.

Elements of External Environment Analysis

Competition (other Service Centers or Organizations)
Population Statistics
Health Statistics
Economic Statistics
Political
Social

Education Systems

InHCc believes Education is the most important component of healthcare. InHCc has an extensive system for determining the requirements of the individual, their ability to learn, the best method for teaching, and a method of evaluation the outcomes.

Chronic Health Management

InHCc records all detail and maintains this data for immediate viewing over the life of the patient.

Audit and Monitoring of Care

Quality of Care will be determined though the use of regular medical procedures. This "Medical Knowledge Flow" (MKF) is as follows:

Client Syndromes
Client History
Client Family History
Client Physical Examination
Laboratory Results
Preliminary Diagnosis
Management (Treatment)
Outcomes
Reevaluation
Final Diagnosis

(see the design of the InHCc Database Information Flow)

The Quality of Care can be determined by answering the following questions based on the "Medical Knowledge Flow:"

Comparison between "Syndromes/Complains" and the actual Physical Examination given. Did the HCP examine the client thoroughly bases on the syndromes?
Comparisons between the Syndromes and results of the Physical Examination with the Laboratory tests requested. Were the laboratory tests request cost affective? Were the Laboratory tests requested of the type type that could determine the "additional" information needed to make a diagnosis? Could the results of the laboratory tests actually be used to determine "new information"?
Comparisons between Syndromes, Physical Examination, Laboratory Results, and “Preliminary Diagnosis:” Is the Diagnosis one that would be reasonably arrived at based on the information obtained from the following steps?
Comparisons between “preliminary diagnosis” and “standard treatments” given: Were the treatments correctly (both of type and cost) given to the Client based on the diagnosis?
Comparisons between “preliminary diagnosis” and “final diagnosis”: Was the correct medical history and examination performed?
Client “outcome:” Did the actual client outcome match what was expected based on the diagnosis and treatments given adjusted for severity of illness on admission?

Other Quality Control Data Examples

Comparisons between “expected number of days of care” and “actual” days of care: Did the patient stay longer in the unit then was normal for the diagnosis?
Number of patients not weighed: Does this improved examination taking?
Number of incomplete physicals given: Does this improved history taking?
Number of protocols items not followed.
Number of Revisits for same illness: Patient may have been discharged too soon, treatment was not appropriate, living conditions unsuitable, etc.
Standards met for fluid requirements: Are the paediatric patients receiving the correct amount of fluids for their diagnosis and physical?
Etc.

Outcomes

Patient outcomes will be measured by analysis data from the Medical Audit Committee. Outcomes will be divided into three types of outcomes:

Diagnostic outcomes
Therapeutic outcomes
Discharge condition

The diagnostic outcomes and the therapeutic outcomes will be measures against standards.

The discharge outcome will be measured also again standards. These standards will be that of

length of stay expected for condition vs. actual
discharge condition as determined by a 6 point scale vs. what was expected based on the condition the patient originally arrived to the clinic.

Resource Utilization

Utilization Review Committee: decides whether the clinic’s facilities are used appropriately in the provision of care. It reviews, for example, appropriateness of admissions and discharges, proper use of outpatient and emergency services, and the optimum utilization of diagnostic and therapeutic support services (De Geyndt 1995):

Examples:

Physician time spent with patient/ number of patients seen per physician:
Tracking of the time spent by physicians and nurses in patient care. Was it too little or too much based on the diagnosis? Do higher staff ratios per patient lead to lower morbidity/mortality?
Time spent by Nursing “teaching.”
Number of physicians, nurses as a % of the number of patients seen: It there a proper ratio of physicians and nurses for the patients
Utilization Rates of facilities: Where the facilities overused leading to poor sanitary and hospital? Does higher occupancy rates lead to higher morbidity/mortality?
Length of time for lab result return: Were the lab results returned in a timely manner?
Drug, Pharmacy or therapeutic committee: formulates and recommends policies and priorities which will ensure that the best use is made of available drugs and therapeutic agents in terms of optimal utilization and minimal potential for harm to the patient (De Geyndt 1995):
Drug available as a % of patient volume: Is there sufficient amount of drugs on hand? Are there too much and too many drugs in inventory leading to out-dated supplies?
Drugs available as a % of daily usage = # of days on hand: Are there sufficient amount of drugs on hand? Are there too much and too many drugs in inventory leading to out-dated supplies?
Tracking of drugs used by patient: Was the correct drug given for the diagnosis? Does higher drug use per episode lead to improved length of stay?
Comparison of drugs given with the results of the lab reports.
Tracking of important supplies used by patient: Are all the supplies in inventory per count?

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