Health information exchange: Using metrics to address quality of care and return on investment

Health Information Exchange (HIE) will play a key part in our nation’s effort to improve healthcare. The evidence of HIEs transformational role in healthcare delivery systems is quite limited. The lack of such evidence led us to explore what exists in the healthcare industry that may provide evidence of effectiveness and efficiency of HIEs. The objective of the study was to find out how many fully functional HIEs are using any measurements or metrics to gauge impact of HIE on quality improvement (QI) and on return on investment (ROI).^ A web-based survey was used to determine the number of operational HIEs using metrics for QI and ROI. Our study highlights the fact that only 50 percent of the HIEs who responded use or plan to use metrics. However, 95 percent of the respondents believed HIEs improve quality of care while only 56 percent believed HIE showed positive ROI. Although operational HIEs present numerous opportunities to demonstrate the business model for improving health care quality, evidence to document the impact of HIEs is lacking. ^

International comparison of wait times and quality of care: A pilot study

During the healthcare reform debate in the United States in 2009/2010, many health policy experts expressed a concern that expanding coverage would increase waiting times for patients to obtain care. Many complained that delays in obtaining care in turn would compromise the quality of healthcare in the United States. Using data from The Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries, this study explored the relationship between wait times and quality of care, employing a wait time scale and several quality of care indicators present in the dataset. The impact of wait times on quality was assessed. Increased wait time was expected to reduce quality of care. However, this study found that wait times correlated with better health outcomes for some measures, and had no association with others. Since this is a pilot study and statistical significance was not achieved for any of the correlations, further research is needed to confirm and deepen the findings. However, if future studies confirm this finding, an emphasis on reducing wait times at the expense of other health system level performance variables may be inappropriate. ^

The role of a nursing home administrator's education in influencing quality of care in US nursing homes

Nursing home literature links poor management practices to poor quality of care and resident outcomes. Since Nursing Home Administrators (NHAs) require an array of skills to perform their role, it is important to explore what makes a NHA effective. This research fills a gap in the literature and provides a possible option to improve the quality of care in nursing homes. Purpose of the study. The study examines whether NHAs with advanced education (defined as a Masters degree or more) are associated with better quality of care in licensed nursing homes (NHs). Design and Methods. Data was derived from the CDC’s 2004 National Nursing Home Survey, which is a representative sample of NHs across the US. A Donabedian- inspired structure-process-outcomes study model was created to explain how education relates to quality of care. Quality of care was defined as onsite oral care, employee influenza vaccination rates and staff recognition programs. Statistical analyses included multivariate logistic regression; covariates included facility-level variables used in similar peer-reviewed research but also included select measures from the Area Resource File to control for county-level factors. Results. Descriptive and analytical analyses confirm that NHAs with a Bachelor’s degree, Associate degree or high school diploma perform less well than NHAs with a Masters degree or more. NHAs with advanced education are more likely to have onsite dental care and recognition programs for staff than NHAs with a Bachelor’s degree (or less). Also NHAs with less than graduate education are more likely to provide off-site dental care. Employee vaccination rates are not impacted by education. Adding certification, tenure or years of experience to a NHA with advanced education gives them an advantage. In fact, certification and experience alone do not have a positive relationship to care indicators; however adding these to advanced education produces a significant result. Implications. This research provides preliminary evidence that advanced education for the NHA is associated with better quality of care. If future research can confirm these findings, there is merit in revisiting the qualifications. Education can be a legitimate option to support quality improvement efforts in US nursing homes. ^

Black/white disparities in infant mortality rates in the U.S.: A quality of care perspective

The infant mortality rate for non-Hispanic Black infants in the U.S. is 13.63 deaths per 1,000 live births while the IMR for non-Hispanic White persons in the U.S. is 5.76 deaths per 1,000 live births. Black women are 2 times as likely as White women to deliver preterm infants and Black women are 2 times as likely as White women to deliver low birth weight infants (weighing less than 2,500 grams at birth). Differential underlying risk factors among mothers of different racial/ethnic groups for delivering pre-term and low birth weight infants have been historically accepted as the cause of racial disparities in IMRs. However, differential underlying risk status may not be the only major causative factor. Differential or unequal access to and provision of care is widely speculated to be a leading contributing factor to the wide racial disparity in infant mortality.2 This paper conducts a systematic review of existing literature investigating racial disparities in obstetrical care provided by healthcare practitioners to evaluate whether inequities in healthcare services provided to pregnant mothers and their neonates exist. The search terms "racial disparities obstetrical care," "racial differences quality of prenatal care," and "infant mortality racial disparities" were entered into the EBSCO Medline, Ovid Medline, PubMed, and Academic Search Complete databases, and articles between years 1990–2011 were selected for abstract review. The only articles included were those that used statistical methods to assess whether racial inequalities were present in the obstetrical services provided to pregnant women. My literature search returned 5 articles. Four of the five studies yielded significant racial differences in obstetrical care. However, the one study that used a large, nationally representative valid sample did not represent significant differences. Thus, this review provides initial evidence for racial disparities in obstetrical care, but concludes that more studies are needed in this area. Not all of the studies reviewed were consistent in the use and measurement of services, and not all studies were significant. The policy and public health implications of possible racial disparities in obstetrical care include the need to develop standard of care protocols for ALL obstetrical patients across the United States to minimize and/or eliminate the inequities and differences in obstetrical services provided.^