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chapter 10 | Quality and Safety 149 CikguOnline
encourage changes in processes, structures, and ■ AHRQ Quality Indicators. Set of quality indi-
behaviors within the health-care community. cators used by organizations to highlight
■ Post–Acute Care Reform Plan. CMS is exam- potential quality concerns, identify areas that
ining post-acute transfers with the aim of reduc- need further study and investigation, and track
ing care fragmentation and unsafe transitions. changes over time
■ Hospital Quality Initiative. This is a major ini-
The U. S. Department of Defense (DoD) and the
tiative aimed at improving quality of care at the
Veterans Health Administration (VHA) have
provider and organization level. Organizations
taken leadership positions in developing tools,
provide data through public reporting of quality
resources, and programs aimed at improving safety,
measures that translate information to assist
promoting change, and promoting a culture of safety
consumers in health decisions. This initiative cre-
within the DoD and VHA. The VHA National
ates a uniform set of quality measurement by
Center for Patient Safety developed a toolkit for
which consumers can compare organizations and
fall prevention and management, tools for escape
by which organizations can benchmark progress
and elopement management, and cognitive aids for
toward achieving goals in specified areas of care,
root cause analysis and health failure mode and
such as acute myocardial infarct, congestive heart
effect analysis.
failure, pneumonia, and postsurgical infections.
These data feed the Hospital Compare Web site
Health-Care Provider Professional
(www.hospitalcompare.hhs.gov). Organizations
Organizations
are incentivized to participate with an offering of
increased reimbursement. Professional organizations directly address the mis-
sions and concerns regarding quality and safety of
Also under the HHS is the Agency for Healthcare the professionals they represent. Each organization
Research and Quality (AHRQ), which is the lead offers programs, access to evidence-based practices,
federal agency charged with improving the quality, toolkits, and newsletters to aid their members in
safety, efficiency, and effectiveness of health care for driving quality within their own practice and
all Americans (HHS, 2008).Through multiple ini- organization.
tiatives, the support of research, and evidence- The vital quality and safety initiative of the
based decision-making, the AHRQ aims to fulfill ANA is the National Database of Nursing Quality
its mission: Indicators (NDNQI), a database of unit-specific
■ Health IT. A multifaceted initiative that includes nurse-sensitive information collected at hospitals.
(a) research support of $260 million in grants and Data are collected and evaluated to improve quality.
contracts to support and stimulate investment The indicators reflect the structure, process, and
in health information technology (IT); (b) the outcomes of nursing care and lead to improved
newly created AHRQ National Resource Center, quality and safety at the bedside. The ANA also
which provides technical assistance and research has a strong focus on safe nurse staffing levels to
funding to aid technology implementation within promote safe, quality patient care.
communities; and (c) learning laboratories at
more than 100 hospitals nationwide to develop Nonprofit Organizations and Foundations
and test health IT applications With few exceptions, nonprofit organizations and
■ National Quality Measures Clearinghouse foundations are generally focused on consumer
(NQMC). Web-accessible database provides education, policy development, and research to
access to evidence-based quality measures and improve quality and safety within the health-care
measure sets; NQMC provides access for system. Many organizations serve multiple mis-
obtaining detailed information on quality sions. The Kaiser Family Foundation (2005) has a
measures and to further their dissemination, strong emphasis on U.S. and international nonpar-
implementation, and use in order to inform tisan health policy and health policy research. Self-
health-care decisions funded research and public opinion polling on
■ Medical Errors and Patient Safety. Web site topics related to quality and safety in the health-
providing access to evidence-based tools and care system contribute to policy and legislation
resources for consumers and providers development.