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This book will provide clinicians, clinical managers and corporate managers with a practical guide to managing clinical processes and managing change in health services. It also provides the theory behind the practice.
This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.
From the Foreword: "[This book] provides a comprehensive overview of the fundamental concepts in healthcare process management as well as some advanced topics in the cutting-edge research of the closely related areas. This book is ideal for graduate students and practitioners who want to build the foundations and develop novel contributions in healthcare process modeling and management." --Christopher Yang, Drexel University Process modeling and process management are traversal disciplines which have earned more and more relevance over the last two decades. Several research areas are involved within these disciplines, including database systems, database management, information systems, ERP, operations research, formal languages, and logic. Process Modeling and Management for Healthcare provides the reader with an in-depth analysis of what process modeling and process management techniques can do in healthcare, the major challenges faced, and those challenges remaining to be faced. The book features contributions from leading authors in the field. The book is structured into two parts. Part one covers fundamentals and basic concepts in healthcare. It explores the architecture of a process management environment, the flexibility of a process model, and the compliance of a process model. It also features a real application domain of patients suffering from age-related macular degeneration. Part two of the book includes advanced topics from the leading frontiers of scientific research on process management and healthcare. This section of the book covers software metrics to measure features of the process model as a software artifact. It includes process analysis to discover the formal properties of the process model prior to deploying it in real application domains. Abnormal situations and exceptions, as well as temporal clinical guidelines, are also presented in depth Pro.
This open access book comprehensively covers the fundamentals of clinical data science, focusing on data collection, modelling and clinical applications. Topics covered in the first section on data collection include: data sources, data at scale (big data), data stewardship (FAIR data) and related privacy concerns. Aspects of predictive modelling using techniques such as classification, regression or clustering, and prediction model validation will be covered in the second section. The third section covers aspects of (mobile) clinical decision support systems, operational excellence and value-based healthcare. Fundamentals of Clinical Data Science is an essential resource for healthcare professionals and IT consultants intending to develop and refine their skills in personalized medicine, using solutions based on large datasets from electronic health records or telemonitoring programmes. The book’s promise is “no math, no code”and will explain the topics in a style that is optimized for a healthcare audience.
Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.
"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/
Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
It has been almost 20 years since the Institute of Medicine released the seminal report titled, Crossing the Quality Chasm. In it, the IoM identified six domains of care quality (safe, timely, effective, efficient, equitable, and patient-centric) and noted a huge gap between the current state and the desired state. Although this report received a great deal of attention, sadly there has been little progress in these areas. In the U.S., healthcare still has huge disparities, is inefficient, and is fragmented with delays in care that are often unsafe. Most U.S. citizens are expected to suffer from a diagnostic error sometime during their lifetime, not receive a large fraction of recommended care, and pay for one of the most expensive systems in the world. Much has been written about quality improvement over the years but many prominent quality and safety experts. Yet progress has been slow. Some have called on the healthcare professions to look outside of healthcare to other industries using examples in nuclear power and airlines for safety, the hotel and entertainment industry for a ‘customer’ focus, and the automotive industry, particularly Toyota for efficiency (Lean). This book by Dr. Oppenheim on lean healthcare systems engineering (LHSE) is a fresh approach that brings forth concepts that systems engineers have used in huge national defense projects. What’s unique in this book is that these powerful system engineering tools are modified to be able to address smaller sized healthcare problems that still involve similar problems in fragmentation and poor communication and coordination. This book is an invaluable reference for a new powerful process named Lean Healthcare Systems Engineering (LHSE) for managing workflow and care improvement projects in all clinical environments. The book applies to ambulatory clinics and hospitals of all types including operating rooms, emergency departments, and ancillary departments, clinical and imaging laboratories, pharmacies, and population health. The book presents a generic rigorous but not mathematical step-by-step process of integrated healthcare, systems engineering and Lean. The book also contains the first major product created with the LHSE process, namely tabularized summaries of representative projects in healthcare delivery applications, called Lean Enablers for Healthcare Projects. Each full-page enabler table lists the challenges and wastes, powerful improvement goals, risks, and expected benefits, and some useful descriptions of the healthcare system of interest. The book provides user-friendly solutions to major problems in healthcare delivery operations in all clinical environments, addressing fragmentation, wastes, wrong incentives, ad-hoc and stove-piped management, lack of optimized processes, hierarchy gradient, lack of systems thinking, “blaming and shaming culture”, burnout of providers and many others.
This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.
Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.