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Arnold M Epstein - One of the best experts on this subject based on the ideXlab platform.
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the association between hospital margins Quality of Care and closure or other change in operating status
Journal of General Internal Medicine, 2011Co-Authors: Ashish K Jha, Arnold M EpsteinAbstract:BACKGROUND Hospitals face increased pressure to improve their Quality of Care in an environment of dwindling hospital payments. It is unclear whether lower hospital margins are associated with worse Quality of Care or closure.
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hospitalized patients participation and its impact on Quality of Care and patient safety
International Journal for Quality in Health Care, 2011Co-Authors: Saul N Weingart, Arnold M Epstein, Eric C Schneider, Junya Zhu, Laurel Chiappetta, Sherri O Stuver, Jo Ann DavidkasdanAbstract:Objective. To understand the extent to which hospitalized patients participate in their Care, and the association of patient participation with Quality of Care and patient safety. Design. Random sample telephone survey and medical record review. Setting. US acute Care hospitals in 2003. Participants. A total of 2025 recently hospitalized adults. Main Outcome Measures. Hospitalized patients reported participation in their own Care, assessments of overall Quality of Care and the presence of adverse events (AEs) in telephone interviews. Physician reviewers rated the severity and preventability of AEs identified by interview and chart review among 788 surveyed patients who also consented to medical record review. Results. of the 2025 patients surveyed, 99.9% of patients reported positive responses to at least one of seven measures of participation. High participation (use of .4 activities) was strongly associated with patients’ favorable ratings of the hospital Quality of Care (adjusted OR: 5.46, 95% CI: 4.15 – 7.19). Among the 788 patients with both patient survey and chart review data, there was an inverse relationship between participation and adverse events. In multivariable logistic regression analyses, patients with high participation were half as likely to have at least one adverse event during the admission (adjusted OR ¼ 0.49, 0.31 – 0.78). Conclusions. Most hospitalized patients participated in some aspects of their Care. Participation was strongly associated with favorable judgments about hospital Quality and reduced the risk of experiencing an adverse event.
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hospital cost of Care Quality of Care and readmission rates penny wise and pound foolish
JAMA Internal Medicine, 2010Co-Authors: Lena M Chen, Ashish K Jha, John E Orav, Stuart Guterman, Abigail B Ridgway, Arnold M EpsteinAbstract:Background Hospitals face increasing pressure to lower cost of Care while improving Quality of Care. It is unclear if efforts to reduce hospital cost of Care will adversely affect Quality of Care or increase downstream inpatient cost of Care. Methods We conducted an observational cross-sectional study of US hospitals discharging MediCare patients for congestive heart failure (CHF) or pneumonia in 2006. For each condition, we examined the association between hospital cost of Care and the following variables: process Quality of Care, 30-day mortality rates, readmission rates, and 6-month inpatient cost of Care. Results Compared with hospitals in the lowest-cost quartile for CHF Care, hospitals in the highest-cost quartile had higher Quality-of-Care scores (89.9% vs 85.5%) and lower mortality for CHF (9.8% vs 10.8%) ( P P = .002) and higher mortality for pneumonia (11.7% vs 10.9%, P P P = .20 for pneumonia). Nevertheless, patients initially seen in low-cost hospitals incurred lower 6-month inpatient cost of Care compared with patients initially seen in hospitals with the highest cost of Care ($12 715 vs $18 411 for CHF and $10 143 vs $15 138 for pneumonia, P Conclusions The associations are inconsistent between hospitals' cost of Care and Quality of Care and between hospitals' cost of Care and mortality rates. Most evidence did not support the “penny wise and pound foolish” hypothesis that low-cost hospitals discharge patients earlier but have higher readmission rates and greater downstream inpatient cost of Care.
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Quality of Care in medicaid managed Care and commercial health plans
JAMA, 2007Co-Authors: Bruce E Landon, Eric C Schneider, Sharonlise T Normand, Sarah Hudson Scholle, Gregory L Pawlson, Arnold M EpsteinAbstract:ContextIn contrast to the commercially insured population, the proportion of Medicaid beneficiaries enrolling in health maintenance organizations continues to increase.ObjectiveTo compare Quality of Care within and between the Medicaid and commercial populations in 3 types of managed Care plans: Medicaid-only plans (serving predominantly Medicaid enrollees), commercial-only plans (serving predominantly commercial enrollees), and Medicaid/commercial plans (serving substantial numbers of both types of enrollees).Design, Setting, and ParticipantsAll 383 health plans that reported Quality-of-Care data to the National Committee for Quality Assurance for 2002 and 2003, including 204 commercial-only plans, 142 Medicaid/commercial plans (plans reported data for the Medicaid and commercial populations separately); and 37 Medicaid-only plans.Main Outcome MeasuresEleven Quality indicators from the HealthCare Effectiveness Data and Information Set (HEDIS) applicable to the Medicaid population.ResultsAmong Medicaid enrollees, performance on the 11 measures observed in this study were comparable for Medicaid-only plans and Medicaid/commercial plans. Similarly, among commercial enrollees, there was virtually no difference in performance between health plans that served only the commercial population and those that also served the Medicaid population. Overall across all health plan types, the performance for the commercial population exceeded the performance for the Medicaid population on all measures except 1, ranging from a difference of 4.9% for controlling hypertension (58.4% for commercial vs 53.5% for Medicaid; P = .002) to 24.5% for rates of appropriate postpartum Care (77.2% for commercial vs 52.7% for Medicaid; P = .001). Differences of similar magnitude were observed for commercial and Medicaid populations treated within the same health plan.ConclusionsMedicaid managed Care enrollees receive lower-Quality Care than that received by commercial managed Care enrollees. There were no differences in Quality of Care for the Medicaid population between Medicaid-only plans and commercial plans that also served the Medicaid population.
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racial disparities in the Quality of Care for enrollees in mediCare managed Care
JAMA, 2002Co-Authors: Eric C Schneider, Alan M Zaslavsky, Arnold M EpsteinAbstract:Context Substantial racial disparities in the use of some health services exist; however, much less is known about racial disparities in the Quality of Care. Objective To assess racial disparities in the Quality of Care for enrollees in MediCare managed Care health plans. Design and Setting Observational study, using the 1998 Health Plan Employer Data and Information Set (HEDIS), which summarized performance in calendar year 1997 for 4 measures of Quality of Care (breast cancer screening, eye examinations for patients with diabetes, -blocker use after myocardial infarction, and follow-up after hospitalization for mental illness). Participants A total of 305 574 (7.7%) beneficiaries who were enrolled in MediCare managed Care health plans had data for at least 1 of the 4 HEDIS measures and were aged 65 years or older. Main Outcome Measures Rates of breast cancer screening, eye examinations for patients with diabetes, -blocker use after myocardial infarction, and follow-up after hospitalization for mental illness. Results Blacks were less likely than whites to receive breast cancer screening (62.9% vs 70.9%; P<.001), eye examinations for patients with diabetes (43.6% vs 50.4%; P = .02), -blocker medication after myocardial infarction (64.1% vs 73.8%; P<.005), and follow-up after hospitalization for mental illness (33.2 vs 54.0%; P<.001). After adjustment for potential confounding factors, racial disparities were still statistically significant for eye examinations for patients with diabetes, -blocker use after myocardial infarction, and follow-up after hospitalization for mental illness. Conclusion Among MediCare beneficiaries enrolled in managed Care health plans, blacks received poorer Quality of Care than whites.
L Peters - One of the best experts on this subject based on the ideXlab platform.
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Quality of Care from the patients perspective from theoretical concept to a new measuring instrument
Health Expectations, 1998Co-Authors: H Sixma, C Van Campen, J J Kerssens, L PetersAbstract:INTRODUCTION: Patient views on Quality of Care are of paramount importance with respect to the implementation of Quality assurance (QA) and improvement (QI) programmes. However, the relevance of patient satisfaction studies is often questioned because of conceptual and methodological problems. Here, it is our belief that a different strategy is necessary. OBJECTIVE: To develop a conceptual framework for measuring Quality of Care seen through the patients' eyes, based on the existing literature on consumer satisfaction in health Care and business research. RESULTS: Patient or consumer satisfaction is regarded as a multidimensional concept, based on a relationship between experiences and expectations. However, where most health Care researchers tend to concentrate on the result, patient (dis)satisfaction, a more fruitful approach is to look at the basic components of the concept: expectations (or 'needs') and experiences. A conceptual framework - based on the sequence performance, importance, impact - and Quality judgements of different categories of patients derived from importance and performance scores of different health Care aspects, is elaborated upon and illustrated with empirical evidence. CONCLUSIONS: The new conceptual model, with Quality of Care indices derived from importance and performance scores, can serve as a framework for QA and QI programmes from the patients' perspective. For selecting Quality of Care aspects, a category-specific approach is recommended including the use of focus group discussions.
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Quality of Care and patient satisfaction a review of measuring instruments
Medical Care Research and Review, 1995Co-Authors: C Van Campen, H Sixma, R D Friele, J J Kerssens, L PetersAbstract:Surveying the literature on the assessment of Quality of Care from the patient's perspective, the concept has often been operationalized as patient satisfaction. Patient satisfaction has been a widely investigated subject in health Care research, and dozens of measuring instruments were developed during the past decade. Quality of Care from the patient's perspective, however, has been investigated only very recently, and only a few measuring instruments have explicitly been developed for the assessment of Quality of Care from the patient's perspective. The authors consider patient satisfaction as an indicator of Quality of Care from the patient's perspective. This review is concerned with the question of whether any reliable and valid instruments have been developed to measure Quality of Care from the patient's perspective.
Eric C Schneider - One of the best experts on this subject based on the ideXlab platform.
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hospitalized patients participation and its impact on Quality of Care and patient safety
International Journal for Quality in Health Care, 2011Co-Authors: Saul N Weingart, Arnold M Epstein, Eric C Schneider, Junya Zhu, Laurel Chiappetta, Sherri O Stuver, Jo Ann DavidkasdanAbstract:Objective. To understand the extent to which hospitalized patients participate in their Care, and the association of patient participation with Quality of Care and patient safety. Design. Random sample telephone survey and medical record review. Setting. US acute Care hospitals in 2003. Participants. A total of 2025 recently hospitalized adults. Main Outcome Measures. Hospitalized patients reported participation in their own Care, assessments of overall Quality of Care and the presence of adverse events (AEs) in telephone interviews. Physician reviewers rated the severity and preventability of AEs identified by interview and chart review among 788 surveyed patients who also consented to medical record review. Results. of the 2025 patients surveyed, 99.9% of patients reported positive responses to at least one of seven measures of participation. High participation (use of .4 activities) was strongly associated with patients’ favorable ratings of the hospital Quality of Care (adjusted OR: 5.46, 95% CI: 4.15 – 7.19). Among the 788 patients with both patient survey and chart review data, there was an inverse relationship between participation and adverse events. In multivariable logistic regression analyses, patients with high participation were half as likely to have at least one adverse event during the admission (adjusted OR ¼ 0.49, 0.31 – 0.78). Conclusions. Most hospitalized patients participated in some aspects of their Care. Participation was strongly associated with favorable judgments about hospital Quality and reduced the risk of experiencing an adverse event.
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Quality of Care in medicaid managed Care and commercial health plans
JAMA, 2007Co-Authors: Bruce E Landon, Eric C Schneider, Sharonlise T Normand, Sarah Hudson Scholle, Gregory L Pawlson, Arnold M EpsteinAbstract:ContextIn contrast to the commercially insured population, the proportion of Medicaid beneficiaries enrolling in health maintenance organizations continues to increase.ObjectiveTo compare Quality of Care within and between the Medicaid and commercial populations in 3 types of managed Care plans: Medicaid-only plans (serving predominantly Medicaid enrollees), commercial-only plans (serving predominantly commercial enrollees), and Medicaid/commercial plans (serving substantial numbers of both types of enrollees).Design, Setting, and ParticipantsAll 383 health plans that reported Quality-of-Care data to the National Committee for Quality Assurance for 2002 and 2003, including 204 commercial-only plans, 142 Medicaid/commercial plans (plans reported data for the Medicaid and commercial populations separately); and 37 Medicaid-only plans.Main Outcome MeasuresEleven Quality indicators from the HealthCare Effectiveness Data and Information Set (HEDIS) applicable to the Medicaid population.ResultsAmong Medicaid enrollees, performance on the 11 measures observed in this study were comparable for Medicaid-only plans and Medicaid/commercial plans. Similarly, among commercial enrollees, there was virtually no difference in performance between health plans that served only the commercial population and those that also served the Medicaid population. Overall across all health plan types, the performance for the commercial population exceeded the performance for the Medicaid population on all measures except 1, ranging from a difference of 4.9% for controlling hypertension (58.4% for commercial vs 53.5% for Medicaid; P = .002) to 24.5% for rates of appropriate postpartum Care (77.2% for commercial vs 52.7% for Medicaid; P = .001). Differences of similar magnitude were observed for commercial and Medicaid populations treated within the same health plan.ConclusionsMedicaid managed Care enrollees receive lower-Quality Care than that received by commercial managed Care enrollees. There were no differences in Quality of Care for the Medicaid population between Medicaid-only plans and commercial plans that also served the Medicaid population.
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trends in the Quality of Care and racial disparities in mediCare managed Care
The New England Journal of Medicine, 2005Co-Authors: A Trivedi, Alan M Zaslavsky, Eric C Schneider, John Z AyanianAbstract:BACKGROUND: Since 1997, all managed-Care plans administered by MediCare have reported on Quality-of-Care measures from the Health Plan Employer Data and Information Set (HEDIS). Studies of early data found that blacks received Care that was of lower Quality than that received by whites. In this study, we assessed changes over time in the overall Quality of Care and in the magnitude of racial disparities in nine measures of clinical performance. METHODS: In order to compare the Quality of Care for elderly white and black beneficiaries enrolled in MediCare managed-Care plans who were eligible for at least one of nine HEDIS measures, we analyzed 1.8 million individual-level observations from 183 health plans from 1997 to 2003. For each measure, we assessed whether the magnitude of the racial disparity had changed over time with the use of multivariable models that adjusted for the age, sex, health plan, Medicaid eligibility, and socioeconomic position of beneficiaries on the basis of their area of residence. RESULTS: During the seven-year study period, clinical performance improved on all measures for both white enrollees and black enrollees (P<0.001). The gap between white beneficiaries and black beneficiaries narrowed for seven HEDIS measures (P<0.01). However, racial disparities did not decrease for glucose control among patients with diabetes (increasing from 4 percent to 7 percent, P<0.001) or for cholesterol control among patients with cardiovascular disorders (increasing from 14 percent to 17 percent; change not significant, P=0.72). CONCLUSIONS: The measured Quality of Care for elderly MediCare beneficiaries in managed-Care plans improved substantially from 1997 to 2003. Racial disparities declined for most, but not all, HEDIS measures we studied. Future research should examine factors that contributed to the narrowing of racial disparities on some measures and focus on interventions to eliminate persistent disparities in the Quality of Care.
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racial disparities in the Quality of Care for enrollees in mediCare managed Care
JAMA, 2002Co-Authors: Eric C Schneider, Alan M Zaslavsky, Arnold M EpsteinAbstract:Context Substantial racial disparities in the use of some health services exist; however, much less is known about racial disparities in the Quality of Care. Objective To assess racial disparities in the Quality of Care for enrollees in MediCare managed Care health plans. Design and Setting Observational study, using the 1998 Health Plan Employer Data and Information Set (HEDIS), which summarized performance in calendar year 1997 for 4 measures of Quality of Care (breast cancer screening, eye examinations for patients with diabetes, -blocker use after myocardial infarction, and follow-up after hospitalization for mental illness). Participants A total of 305 574 (7.7%) beneficiaries who were enrolled in MediCare managed Care health plans had data for at least 1 of the 4 HEDIS measures and were aged 65 years or older. Main Outcome Measures Rates of breast cancer screening, eye examinations for patients with diabetes, -blocker use after myocardial infarction, and follow-up after hospitalization for mental illness. Results Blacks were less likely than whites to receive breast cancer screening (62.9% vs 70.9%; P<.001), eye examinations for patients with diabetes (43.6% vs 50.4%; P = .02), -blocker medication after myocardial infarction (64.1% vs 73.8%; P<.005), and follow-up after hospitalization for mental illness (33.2 vs 54.0%; P<.001). After adjustment for potential confounding factors, racial disparities were still statistically significant for eye examinations for patients with diabetes, -blocker use after myocardial infarction, and follow-up after hospitalization for mental illness. Conclusion Among MediCare beneficiaries enrolled in managed Care health plans, blacks received poorer Quality of Care than whites.
C Van Campen - One of the best experts on this subject based on the ideXlab platform.
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Quality of Care from the patients perspective from theoretical concept to a new measuring instrument
Health Expectations, 1998Co-Authors: H Sixma, C Van Campen, J J Kerssens, L PetersAbstract:INTRODUCTION: Patient views on Quality of Care are of paramount importance with respect to the implementation of Quality assurance (QA) and improvement (QI) programmes. However, the relevance of patient satisfaction studies is often questioned because of conceptual and methodological problems. Here, it is our belief that a different strategy is necessary. OBJECTIVE: To develop a conceptual framework for measuring Quality of Care seen through the patients' eyes, based on the existing literature on consumer satisfaction in health Care and business research. RESULTS: Patient or consumer satisfaction is regarded as a multidimensional concept, based on a relationship between experiences and expectations. However, where most health Care researchers tend to concentrate on the result, patient (dis)satisfaction, a more fruitful approach is to look at the basic components of the concept: expectations (or 'needs') and experiences. A conceptual framework - based on the sequence performance, importance, impact - and Quality judgements of different categories of patients derived from importance and performance scores of different health Care aspects, is elaborated upon and illustrated with empirical evidence. CONCLUSIONS: The new conceptual model, with Quality of Care indices derived from importance and performance scores, can serve as a framework for QA and QI programmes from the patients' perspective. For selecting Quality of Care aspects, a category-specific approach is recommended including the use of focus group discussions.
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Quality of Care and patient satisfaction a review of measuring instruments
Medical Care Research and Review, 1995Co-Authors: C Van Campen, H Sixma, R D Friele, J J Kerssens, L PetersAbstract:Surveying the literature on the assessment of Quality of Care from the patient's perspective, the concept has often been operationalized as patient satisfaction. Patient satisfaction has been a widely investigated subject in health Care research, and dozens of measuring instruments were developed during the past decade. Quality of Care from the patient's perspective, however, has been investigated only very recently, and only a few measuring instruments have explicitly been developed for the assessment of Quality of Care from the patient's perspective. The authors consider patient satisfaction as an indicator of Quality of Care from the patient's perspective. This review is concerned with the question of whether any reliable and valid instruments have been developed to measure Quality of Care from the patient's perspective.
Clive Bowman - One of the best experts on this subject based on the ideXlab platform.
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the relationship between nurse staffing and Quality of Care in nursing homes a systematic review
International Journal of Nursing Studies, 2011Co-Authors: Karen Spilsbury, Catherine Hewitt, Lisa Stirk, Clive BowmanAbstract:Abstract Background Nursing homes have an important role in the provision of Care for dependent older people. Ensuring Quality of Care for residents in these settings is the subject of ongoing international debates. Poor Quality Care has been associated with inadequate nurse staffing and poor skills mix. Objectives To review the evidence-base for the relationship between nursing home nurse staffing (proportion of RNs and support workers) and how this affects Quality of Care for nursing home residents and to explore methodological lessons for future international studies. Design A systematic mapping review of the literature. Data sources Published reports of studies of nurse staffing and Quality in Care homes. Review methods Systematic search of OVID databases. A total of 13,411 references were identified. References were screened to meet inclusion criteria. 80 papers were subjected to full scrutiny and checked for additional references ( n =3). of the 83 papers, 50 were included. Paper selection and data extraction completed by one reviewer and checked by another. Content analysis was used to synthesise the findings to provide a systematic technique for categorising data and summarising findings. Results A growing body of literature is examining the relationships between nurse staffing levels in nursing homes and Quality of Care provided to residents, but predominantly focuses on US nursing facilities. The studies present a wide range and varied mass of findings that use disparate methods for defining and measuring Quality (42 measures of Quality identified) and nurse staffing (52 ways of measuring staffing identified). Conclusions A focus on numbers of nurses fails to address the influence of other staffing factors (e.g. turnover, agency staff use), training and experience of staff, and Care organisation and management. ‘Quality' is a difficult concept to capture directly and the measures used focus mainly on ‘clinical' outcomes for residents. This systematic mapping review highlights important methodological lessons for future international studies and makes an important contribution to the evidence-base of a relationship between the nursing workforce and Quality of Care and resident outcomes in nursing home settings.
