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Table Of Contents

Executive Summary
The Purpose and Philosophy of Quality Management
The Purpose and Philosophy of Quality Management ■5
Implementing a Quality Improvement Project
Tools for Quality Improvement
Process Mapping
Flow Charts
Cause-and-Effect (Fishbone) Diagram
Brainstorming and Affinity Diagrams
Pareto Chart
Bar Chart
Scatter Diagram
Statistical Control Chart
Methods for Quality Improvement
Plan, Do, Study, Act (PDSA) Methodology
Six Sigma
Commonly Used Quality Improvement Strategies
Academic Detailing
Opinion Leaders
Audit and Feedback
Reminder Systems
Patient Education
Additional Resources–Further Reading
Types of Quality Measures
Structural Measures
Process Measures
Outcome Measures
Constructing a Measurement
Baseline Measurement
Trending Measurements
Desirable Characteristics of Quality Measurement
Reliability or Reproducibility
Interpreting Quality Measures
Criterion-Based Measures
Opportunity Model
Program Evaluation
Formative Evaluations
Summative Evaluations
Error as a Systems Issue
Human Factors as a Cause of Errors
Medication Errors
Pressure (Decubitus) Ulcers
Patient Safety Tools
Tools for Data Acquisition
Analytic Tools
Retrospective Event Analysis
Pareto Charts
Fishbone Diagrams
Prospective Event Analysis
Disclosure of Errors
Prevention of Errors
Systems Approach
Operational Interventions to Prevent Error
Decision Support Systems
Teamwork and Crew Resource Management
High-Reliability Organizations (HROs)
Organization Design and Management
Organizational Systems Thinking and Theories
1. Product and Technical Subsystem
2. Structural Subsystem
3. Psychosocial Subsystem
4. Managerial Subsystem
5. Organizational Culture
Responsibilities of a Leader in Quality Improvement
Advocacy and Spokesmanship
Policy, Planning, and Visioning
Delivery System Decision Support
Analysis and Control of Quality
External Liaison and Representation
Double Track
High-Performing Teams
Size and Structure
Shared Vision
Focused Objectives
Hoshin Planning
Learning Organizations
Knowledge Source: Internal–External
Product–Process Focus
Documentation Mode: Personal–Public
Dissemination Mode: Formal–Informal
Learning Focus: Incremental–Transformative
Value–Chain Focus: Design–Deliver
Skill Development Focus: Individual–Group
Coding Classification Systems
Data Transmission
Health Information Exchange (HIE)
Data Storage
Data Analysis
Disease Staging
Electronic Medical Record (EMR)
Computerized Physician Order Entry (CPOE) ■99
Computerized Physician Order Entry (CPOE)
EMR’s Impact on Quality and Safety
Personal Health Record
Evaluating an Information Infrastructure
Health Information Technology and Return on Investment
HIT Standards (Abbreviated)
Economics and Finance in Medical Quality Management
Historical Perspective
Basic Concepts in Business and Economics
Basic Concepts in Business and Economics ■113
Other General Business Principles
Making the Business Case for Quality Management
Government Mandates
Demands by the Business Community
Requirements for Quality Oversight
Demands of Business Partners
Financial Effect
Results of Estimates Using Mathematical Tools
Social Goals
Outcomes Categories
Pay-for-Performance (P4P) and Quality
Additional Resources–Further Reading ■143
Critical Components of Utilization Management Systems
The Utilization Management Process
The Nine Tasks Key to Effective Utilization Management
1. Determine Priority Areas
2. Identify Needed Information and Critical Stakeholders
The Nine Tasks Key to Effective Utilization Management ■147
3. Establish Appropriate Benchmarks
4. Design, Data Collection, and Data Management Procedures
5. Implement Data Collection and Management Procedures
6. Evaluate the Data and Present Results
7. Develop Guidelines, Policies, and Procedures
8. Implement Guidelines, Policies, and Procedures
9. Continuously Review the Task List
Processes, Procedures, and Timing of Utilization Management
Prior Authorization or Precertification
Concurrent Review and Discharge Planning
Retrospective Review
Interrater Reliability
Measuring the Effectiveness of UM Programs
Risk Management and Safety
Organizational Design of Utilization Management
Disease Management
Case Management
Care Plans
Demand Management
Peer Review
Criteria for Credentialing
Physician Profiles
Accreditation and Regulatory Oversight of Utilization Management
Models of Care
Chronic Care Model
Evidence-Based Medicine and Evidence-Based Management Model
Patient-Centered Medical Home Model
National Committee for Quality Assurance (NCGA)
Utilization Review Accreditation Commission (URAC)
The Joint Commission
The Leapfrog Group
International Organization for Standardization (ISO)
Healthcare Effectiveness Data and Information Set (HEDIS)
Healthcare Effectiveness Data and Information Set (HEDIS) ■177
Public Reporting
Certification, Licensure, Credentialing
Teaching Quality Improvement
Undergraduate Medical Education
Teaching Quality Improvement ■187
Graduate Medical Education
Continuing Medical Education
Additional Resources–Further Reading ■195
Role of Government
Rules, Regulations, Laws, and Acts
Regulation and Public Laws to Ensure Quality
Health Care Quality Improvement Act and Peer Review Protection
HIPAA and Its Multiple Titles
HIPAA and Its Multiple Titles ■205
The Privacy Rule
The Transactions and Code Sets Rule
Facilitated Health Care Fraud and Abuse Investigation and Reporting
Medical Errors and Transparency
Basics of Malpractice
Facility–Organizational Risk Management Issues
Antitrust in Medicine
Alternative Dispute Resolution: Arbitration–Mediation
Respect for Autonomy
Beneficence and Nonmaleficence
Human Subjects Research and QI
Institutional Review Boards
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Medical Quality

Medical Quality

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Published by emmanuelbamu

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Published by: emmanuelbamu on Sep 24, 2012
Copyright:Attribution Non-commercial


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