Quality Health Care Nursing 870

Quality Health Care “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (IOM, 2000, p. 211).

How many glasses of water should I drink every day?

What is the best treatment for a cold?

Standard of Care Refers to the degree of attentiveness, caution and prudence that a reasonable person in the circumstances would exercise. Or: how similarly qualified practitioners would have managed the patient's care under the same or similar circumstances.

Standards of Care Standards of practice (care): A model of established practice commonly accepted as correct Resources to help NPs understand Standards of Care available at: http://www.aanp.org/practice/clinical-quality

Evidenced Based Practice “The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (Sackett, et al. 1996, p. 71).

Evidenced Based Practice Levels of evidence include: Systematic Reviews/Meta-analyses Randomized controlled trials (RCT) Individual research studies Studies without randomization Quasi-experimental designs Non-experimental designs Expert opinion

Clinical Practice Guidelines “Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Field & Lohr, 1990, p. 38).

Clinical Practice Guidelines: Purpose To promote efficient use of resources To act as focus for quality control, including audit To highlight shortcomings of existing literature and suggest appropriate future research

Clinical Practice Guidelines: Purpose To describe appropriate care based on the best available scientific evidence and broad consensus To reduce inappropriate variation in practice To provide a more rational basis for referral To provide a focus for continuing education

Clinical Practice Guidelines: Purpose To assist clinicians and patients make appropriate decisions about health care by Describing a range of generally accepted approaches for the diagnosis, management, or prevention of specific diseases or conditions. Defining practices that meet the needs of most patients in most circumstances.

Clinical Practice Guidelines Recommendations are not fixed protocols that must be followed. Clinicians and patients need to develop individual treatment plans that are tailored to the specific needs and circumstances of the patient

Clinical Practice Guidelines They define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. The statements contain recommendations that are based on evidence from a rigorous systematic review and synthesis of the published medical literature.

Clinical Practice Guidelines Designed to support the decision-making processes in patient care. The content of a guideline is based on a systematic review of clinical evidence - the main source for evidence-based care.

Clinical Guidelines Need to identify reliable resources More than 3,700 guidelines from 39 countries Additional 2,700 guidelines in National Guidelines Clearinghouse IOM developed recommendations for reliable Guidelines (2011) For now: Use up-to-date information Use reliable sites/resources Professional Organizations National Clearinghouse

Sample guidelines from the NIH’s National Heart, Lung & Blood Institute http://www.nhlbi.nih.gov/guidelines/index.htm

Clinical Guidelines Examples of Reliable Sites AAFP: http://www.aafp.org/online/en/home/clinical/clinicalrecs.html AHRQ : National Guidelines Clearinghouse http://www.guideline.gov/browse/by-topic.aspx Many others Look for guidelines specific to diseases at specialty organization web sites

Clinical Practice Guidelines Recommendations are not fixed protocols that must be followed. Clinicians and patients need to develop individual treatment plans that are tailored to the specific needs and circumstances of the patient

References Field MJ, Lohr KN (Eds). Clinical Practice Guidelines: Directions for a New Program, Institute of Medicine, Washington, DC: National Academy Press, 1990. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. Sackett, D. L., Rosenbert, M. D., Muir Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312, 71-72.

Additional Resources The Institute of Medicine of the National Academies. Available at: http://iom.edu/About-IOM.aspx U. S. Department of Health & Human Services. Agency for Healthcare Research and Quality (AHRQ). Measuring Healthcare Quality. Available at: http://www.ahrq.gov/qual/measurix.htm U. S. Department of Health & Human Services. Agency for Healthcare Research and Quality (AHRQ). National Quality Measure Clearinghouse. Available at: http://www.qualitymeasures.ahrq.gov/