Research on quality assurance.

Psychology has not been sufficiently attentive to the need to demonstrate the effectiveness of mechanisms intended to ensure the quality of psychological services. The mechanisms are numerous, but peer review has been among the most prominent. Research is needed to justify reliance on peer review. Specifically, peer review must be demonstrated to be reliable in the decisions it produces, and those decisions must be valid in furthering more nearly optimal treatment outcomes. A peer review system must also be credible in the profession. Research can help to improve criteria for peer review, improve the processes by which it operates, and determine its effects on treatment outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Accreditation and associated quality assurance efforts.

Discusses accreditation programs and the quality assurance efforts associated with them. The demands of consumers and purchasers of services, expressed in governmental action, have forced more direct and systematic efforts to assess and assure service quality. Time- and cost-efficient methods for assessing quality are available, but their use is resisted by organized medicine, which controls most accreditation and quality assurance activities in health care. The involvement of psychologists in the programs is discussed. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A brief history of quality assurance and peer review.

Presents a historical overview of quality assurance. The following innovations are noted: (a) the establishment of professional schools directly linking training with practice, (b) credentialing, (c) the setting of minimum standards for facilities and faculty in training institutions, (d) assessment of outcome, (e) personal supervision, (f) peer review, and (g) continuing education as a requirement for maintaining licensure. Peer review at present seems most favored and looks most promising. Credentialing and continuing education recently have been subject to considerable criticism. Several national peer review programs presently in effect and functioning are cited. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cost of quality assurance

The relative importance of endothelial derived relaxing factor (EDRF)/nitric oxide (NO) in maintaining kidney function in normal condition and in acute renal failure (ARF) were evaluated in inactin anesthetized rats. ARF was induced by unilateral occlusion of the left renal artery (40 min) followed by reperfusion, with the contralateral kidney serving as normal control. This protocol resulted in marked reductions in renal plasma flow (RPF), glomerular filtration rate (GFR) and increases in fractional sodium excretion (FENa) and urinary protein excretion in the post-ischemic kidney in comparison to the contralateral normal kidney. Administration of the nitric oxide (NO) synthase inhibitor NG--monomethyl-L-arginine (0.25 mg/kg per min, L-NMMA) exacerbated the ischemia-induced changes in renal functions as reflected by further reductions in urine flow (V), GFR, marked sodium wasting and renal edema. Pretreatment of the animals with NO precursor L-arginine (2.5 mg/kg per min, L-Arg) abolished the detrimental effects of L-NMMA in ARF. In contrast, D-Arginine (2.5 mg/kg per min, D-Arg) failed to reverse the detrimental effects of L-NMMA. Infusion of L-Arg alone also resulted in improvements in RPF and GFR in the ischemic kidney. The results of the present study suggest that the function of the ischemic kidney is sustained by EDRF/NO and is thus more sensitive to NO synthase inhibition.     

Psychological and psychiatric peer review at CHAMPUS.

Considers professional reviews of psychological and psychiatric services, which have been conducted by 3rd-party payers for a number of years by various arrangements. It was not until 1979, however, that a major 3rd-party payer, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), developed a comprehensive operational peer review activity. This action was stirred by the need for the program to account for quality of services provided its beneficiaries and to ensure cost-beneficial care. The development of collaboration between the program and major professional organizations (American Psychological Association and American Psychiatric Association) is traced, as are the successes and problems encountered thus far. It is concluded that peer review should be a consistent aspect of future 3rd-party determinations. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alternatives in mental health care and criteria for quality assurance.

The present mental health delivery system is composed largely of hospital services and outpatient office-based services. Alternatives to traditional mental health services have been slow to develop, although their cost-effectiveness is well demonstrated. A major reason for this is that 3rd-party payers are reluctant to reimburse for these services. The present study reviews the development of nontraditional, or alternate, approaches to mental health care and suggest applicable quality assurance strategies. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training and quality assurance in ultrasound diagnosis

Medical ultrasound equipment is mainly used for diagnostic purposes. Examiner, patient, measuring equipment and ultrasound-based diagnosis form the ultrasound diagnostic system which is characterised by a multitude of internal and external relations. By extending the scope of the system, quality assurance of the ultrasound diagnostic procedures is improved with regard to the physical performance of the system. The performance standards should be established internationally. Even the best of equipment is only as good as the user's experience In this respect, the standards have to be met theoretically and practically on all levels of medical education. The most appropriate settings would be represented by national associations of ultrasound. The introduction of ultrasound diagnostic procedures on the level GP everyday work should lead to a decrease in cost and an increase in speed and efficiency by eliminating routine x-ray examinations.     

Making a transition from quality assurance to quality improvement

Health care leaders now recognize the importance of adding continuous quality improvement activities and the measurement of clinical outcomes to their longstanding quality programs. From other industry leaders, they have learned that there is great promise on quality/cost returns when quality programs focus on measuring performance outcomes rather than just using the longstanding process of measuring variation in staff and system capacity processes. The purpose of this article is to describe how one urban acute care hospital is taking steps to change its quality paradigm and therefore change its quality program, which until recently consisted largely of unrelated quality assurance activities and projects. The new system will be a truly coordinated hospital wide continuous quality improvement program that will align quality activities with the mission of the organization and focus on the measurement of outcomes.     

Mucoviscidosis quality assurance. Problems, success and prospects 1995-1998

The German project "quality assurance in cystic fibrosis" collects data from 97 CF centres with 4,306 patients. Project goals are improvement of quality of life and life expectancy catching up with international standards. Collection of data and evaluation are done anonymously. In Germany, most patients including adults are under care of paediatric institutions. Nutrition and lung function data with decisive prognostic significance (weight for height, one-second-capacity) exhibited less favourable results for patients treated by very small institutions (less than 20 patients). Between 1995 and 1997 some parameters could be improved particularly in pupils children and young adults. In Germany, mean cumulative survival was 29.3 years for 1997. This figure is comparable to other European countries. However, further improvement with respect to quality of structure has to be made.     

Developing an effective toxicology/quality assurance partnership. Improving quality, compliance, and cooperation

A novel approach to the synthesis of the orally active estrogen 14 alpha,15 alpha-methylene estradiol (8, J 824) is described, starting with 3-methoxy-estra-1,3,5(10),8,14-pentaen-17 alpha-ol (5). The 14 alpha, 15 alpha-methylene bridge was sonochemically introduced by regioselective and stereoselective Simmons-Smith methylenation of the 14-double bond. Birch reduction of the 8-double bond provided the desired 8 beta-H, 9 alpha-H steroid, whereas ionic hydrogenation afforded the 8 beta-H, 9 beta-H isomer, together with an epimerization of the 17 alpha-hydroxy group. Oxidation of the Birch product yielded the corresponding 17-oxo steroid, which gave the title compound by diborane reduction. For radioimmunoassay development the 6-(O-carboxymethyl)-oximino derivative of 8 was prepared as hapten and the 2-hydroxy derivative of 8 was synthesized as a potential metabolite of 8, and 8 was tritium labeled as well.     

Patient compliance with CHAMPUS mental health referrals.

Studied patients' willingness to use the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) for psychotherapy by conducting phone interviews with 96 patients referred to psychotherapists by clinicians through CHAMPUS. Therapist and clinician ratings were compared to patient ratings. Low socioeconomic Ss were as likely to comply with the referral as were higher socioeconomic Ss. Therapists underestimated the percentage of Ss who were disappointed at being referred, and clinicians vastly overestimated the number of Ss who actually kept their first psychotherapy appointment. The actual compliance rate was 45%. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Information technology applications in quality assurance and quality improvement, Part II

Many information technologies have been or could be applied to efforts to measure and improve health care quality. This article reviews the recent literature in medical informatics, quality assurance, and quality improvement to identify these and current, emerging, and potential technologies.     

Utilization review expanded into quality assurance program

An Army hospital was able to broaden and refine its extensive utilizaiton review efforts to establish a comprehensive quality assurance program that complies with JCAH standards.