Question

In many cases, improvements in health care quality are incremental (evolutionary) changes and not necessarily breakthrough (revolutionary) changes. Discuss the value of multiple small variations in effecting long-term, sustained quality improvement.

Must be 250 words and must have a reference.

Answer 1

Ans) The adoption of uniform, clinically relevant patient information systems for both nursing homes and home health agencies has already begun to transform these industries. N

- Not only do they provide the basis for a common clinical language, they also form the groundwork for two interrelated initiatives designed to improve the care of long-term patients.

- By feeding back quality performance data to provider organizations, leaders at all levels can begin examining and changing their current practices to reduce the occurrence of undesirable clinical events and to increase the rate of functional improvement.

- This impetus, which may be willingly adopted by only a minority of providers in each industry, is reinforced by reporting the same information to the public and the providers’ local competition.

- Spurred by either competition or fear of what consumers might find out about them on public websites, providers have signed up for their state's quality improvement initiatives.

-;Nursing home chains also are using some of these quality improvement approaches internally and are using competition among their different subunits or facilities to stimulate action.

- This is not to say that all this will necessarily improve the care offered by the average NH or HHA, nor will it necessarily affect the bottom tier of facilities, since they are unlikely to be able to make the needed organizational change.

- But the providers, though worried, appear to be more energized and are beginning to feel that they have the tools to make the changes needed to improve the quality of their care.

- The research community and the government have a responsibility to make sure that the technical aspects of the quality measures being used to compare NH and HHA providers are up to the challenge of being used both to stimulate the organizational changes needed to redesign care processes and to allow for legitimate and valid comparisons across providers.

- The current crop of measures, albeit a great improvement over the limited validity of the admittedly idiosyncratic survey and certification process, continue to leave much to be desired. While they appear to be reliably measuring quality in certain areas, the measures cannot capture a global notion of quality.

- Furthermore, problems with the consistency of measurement across providers may undermine the legitimacy of the comparisons for which these measures were created.

- There is evidence that this is the case in nursing homes, but the research on home health care has not even begun. Nonetheless, we should not stop the public reporting or other uses of these quality measures simply because they continue to have significant deficits; rather, we should treat them as merely one other product that should be continuously improved.