Kristy Gonzalez Morganti

A Retrospective Evaluation of the Perfecting Patient Care University Training Program for Health Care Organizations

This study evaluated how the Perfecting Patient Care (PPC) University, a quality improvement (QI) training program for health care leaders and clinicians, affected the ability of organizations to improve the health care they provide. This training program teaches improvement methods based on Lean concepts and principles of the Toyota Production System and is offered in several formats. A retrospective evaluation was performed that gathered data on training, other process factors, and outcomes after staff completed the PPC training. A majority of respondents reported gaining QI competencies and cultural achievements from the training. Organizations had high average scores for the success measures of “outcomes improved” and “sustainable monitoring” but lower scores for diffusion of QI efforts. Total training dosage was significantly associated with the measures of QI success. This evaluation provides evidence that organizations gained the PPC competencies and cultural achievements and that training dosage is a driver of QI success.

The State of Innovative Emergency Medical Service Programs in the United States

Abstract Background. The primary objective of this study was to determine how EMS organizations that are piloting patient-centered treatment and transport protocols are approaching the challenges of implementation, reimbursement, and quality assurance. We were particularly interested in determining if these pilot efforts have raised any patient safety concerns. Methods. We conducted a set of discussions with a small group of key EMS stakeholders regarding the status of pioneering efforts to develop and evaluate innovative approaches to EMS in the United States. Results. We had discussions with 9 EMS agencies to better understand their innovative programs, including: the history of their service policy and procedure for transports that do not require emergency department care; the impact of their innovative program on service costs and/or cost savings; any reimbursement issues or changes; patient safety; patient satisfaction; and overall impression as well as recommendations for other EMS systems considering adoption of this policy. Conclusions. In general, EMS systems are not reimbursed for service unless the patient is transported to an ED. Spokespersons for all nine sites covered by this project said that this policy creates a powerful disincentive to implementing pilot programs to safely reduce EMS use by directing patients to more appropriate sites of care or proactively treating them in their homes. Even though private and public hospitals and payers typically benefit from these programs, they have been generally reluctant to offer support. This raises serious questions about the long-term viability of these programs.

Should Payment Policy Be Changed to Allow a Wider Range of EMS Transport Options

The Institute of Medicine and other national organizations have asserted that current payment policies strongly discourage emergency medical services (EMS) providers from transporting selected patients who call 911 to non-ED settings (eg, primary care clinics, mental health centers, dialysis centers) or from treating patients on scene. The limited literature available is consistent with the view that current payment policies incentivize transport of all 911 callers to a hospital ED, even those who might be better managed elsewhere. However, the potential benefits and risks of altering existing policy have not been adequately explored. There are theoretical benefits to encouraging EMS personnel to transport selected patients to alternate settings or even to provide definitive treatment on scene; however, existing evidence is insufficient to confirm the feasibility or safety of such a policy. In light of growing concerns about the high cost of emergency care and heavy use of EDs, assessing EMS transport options should be a high-priority topic for outcomes research.

Measuring success for health care quality improvement interventions.

Background:The lack of a standard measure of quality improvement (QI) success and the use of subjective or self-reported measures of QI success has constrained efforts to formally evaluate QI programs and to understand how the various contextual factors impact QI success. Objectives:The objective of this study was to assess how best to measure “QI success” by comparing self-reported and externally rated measures of QI success. Research Design:We performed a retrospective evaluation that analyzed data on different measures of QI success for organizations after their staff completed the QI training. Subjects:The sample included 30 organizations whose staff had received QI training during 2006–2008, and who had used this training to carry out at least some subsequent QI initiative in their organizations. Measures:We developed 2 measures of self-reported QI success based on survey responses and 4 externally rated measures of QI success based on outcome data provided by the participating organizations in addition to qualitative data generated from the interviews. Results:We found some variation in the mean scores of the different QI success measures and only moderate to small correlations between the self-report and externally rated QI measures. Conclusions:This study confirms that there are important differences between self-reported and externally rated measures of QI success and provides researchers with a methodology and criteria to externally rate measures of QI success.