Process and Outcome Data in Delivery of Safe and Quality Care - Literature review Example

Process and Outcome Data in Delivery of Safe and Quality Care Name Institutional Affiliation Process and Outcome Data in Delivery of Safe and Quality Care Introduction Quality of healthcare as well as safety in healthcare provision has become a major issue on both the national and international scene. Evidence-based research in the healthcare industry is aimed at improving the general quality and safety of healthcare services and processes. According to Donabedian (1988) assessing the quality of healthcare begins with the performance of physicians and other practitioners in the healthcare industry. Other levels on which healthcare quality can be assessed include the amenities, care as implemented by the patients and care received by the community in general (Marwick&Nathwani, 2013). This paper seeks to discuss the process and outcome data in the delivery of care in health institutions and describes one example of process and research data to show an understanding in its utilization in provision of safe and quality healthcare. The health issue utilized is Central line associated blood stream infections. Description What is Process and Outcome? Donabedian (1988) states that there are three categories from which information about the quality of healthcare can be drawn from. These categories include structure, process and outcome. Donabedian describes ‘process’ as the actual activities conducted in the provision and receipt of care. Process includes both the activities conducted by the practitioners and the patients. On the other hand, outcomes are described as the impact of care on the health of patients and the population in general. Changes in the patient behavior as well as the general improvement in knowledge fall under the outcomes(Gross, 2012) . Donabedian points out that there is a direct relationship between process and outcomes. He argues that outcomes are directly impacted by the processes. Additionally, he states that organizational sciences play a major role in the understanding of this relationship.Process measure makes it possible for the basic performance of various activities in healthcare to be measured while outcome measures the success of the systems in place. Rubin et al., (2001) points out that there have been an increasing need for evidence on the quality of healthcare from different stakeholders such as regulatory agencies, payers and consumers. Additionally, they point out that outcome measures are important in showing whether the desired end results of healthcare have been achieved and that process measures are equally important since they provide additional information on areas that need improvement, especially with regard to provider and patient action. There has been a constant need for the improvement of the quality of healthcare, hence continued growth in the need of process and outcome measures(Lilfford et al, 2004) . Process measure of the quality of healthcare, assesses the extent to which both the providers and patient perform the desired activities and the degree to which processes that result to under-achievement of healthcare aims are avoided(Werner, Konetzka& Kim, 2013) . Rubin et al., (2001) points that process measures that directly affect outcomes were previously considered too technical for regulatory and public use, but the need for continued improvement in the quality of healthcare has necessitated the sharing of this information. Process and Outcome Data Process data can be described as the information on the healthcare activities undertaken by both the patients and healthcare providers and practitioners. According to Donabedian (1988) information on the performance of healthcare practitioners can be broadly categorized into technical and interpersonal performance. On the other hand, outcome data can be described as the information on the effectiveness of care on the health and knowledge of the patients and the general population. Rubin et al., (2001) is of the view that different views have been raised on whether process or outcome data should be utilized in the assessment of quality and safety in healthcare. Fr both process and outcome data, Rubin et al., point out that there are bad and good measures. The good measures associated with process data includes the fact that it provides actionable information and that the information can be utilized as feedback for initiatives aimed at improving quality(Mant, 2001). On the other hand, some of the outcome data may be out of the practitioners’ control. Additionally, in outcome measures it is difficult for risk adjustment to be done(Donaldson, 1999). There are other significant differences between process data and outcome data. Process data takes less time to accumulate. Additionally, less time is needed when the processes being assessed occur during contact between the providers and the population (Parmanto et al, 2005). On the other hand, outcome data requires long periods of observation sue to the long-term nature of most outcome interests. Outcome measures also require larger sample sizes as a result of the need for risk adjustment compared to the process outcomes which require smaller sample sizes. Process measures can also be differentiated from the already recorded data meant for clinical and administrative use(Goeschel, 2011). Additionally, the collected data has the potential of being integrated into the information collected for these purposes. Outcome measures often require the recording of information not necessary for clinical or administrative reasons. Such information includes long-term patient related health and their survival(Lilford, Brown & Nicholl, 2007). Process data is commonly inaccessible to patients while process data often involves elements that patients and the general public cares about and is, therefore, largely accessible to the public (Porter, 2010) Who Collects the Data? Process and outcome data in the healthcare industry is collected by physicians and health practitioners. Donabedian (1988) states that the collection of data for both clinical and administrative use cannot be done in a rigorously controlled environment as other types of studies. Assessment of quality in healthcare is described as a device utilized by the administration to determine whether performance is still within the acceptable standards. Process and outcome measures are obtained for varying reasons. Technical care information is always available in the medical records, meaning that it can always be obtained in a timely manner while outcome data is always being delayed and obtained over long periods of time(Revees et al, 2008). Additionally, Donabedian points that data on outcomes that occur after delivery of data is often hard to obtain, but outcome measures have an advantage over process measures in that they show the contribution of both the practitioners and patients in the delivery care. One may choose any of the assessment approaches, but it is important to incorporate all the approaches in order for the weaknesses presented by each of the approaches to be supplemented. Outcome data can be obtained by practitioners by asking the patients whether they are satisfied with the services they have received or not(Taylor el at, 2013). Donabedian points out that the satisfaction of patients can be utilized as an indicator of the quality of care. Apart from question patient, data on outcomes may also be obtained by observing the patient behaviors that may indicate a lack of satisfaction with a certain service(Powell et al, 2003). The article goes on to point out that collectors of both process and outcome data are usually interested in obtained representativeinformation, but are mostly interested in identifying the mistakes and failures in care delivery and finding ways of correcting such mistakes(Raghupathi & Raghupathi, 2014). Health issue to demonstrate how data collection works in the provision of safe and quality nursing care The health issue utilized is Central line associated blood stream infections (CLABSI) Central line associated blood stream infections (CLABSI) has posed a problem to most clinicians over the past years. Research has been ongoing on various ways to prevent the infections. The surgical units in most Medical Center are usually faced with the problem of identifying the most effective way of preventing Central line associated blood stream infections, hence the need for both process and outcome measures to identify the most effective ways. Whited and Lowe (2013) mention that the infections can result in a great deal of harm or even death. Most healthcare facilities utilize the insertion and maintenance bundles in preventing CLABSI. Klieger & Potter-Bynoe et al., (2013) state that the insertion bundles are used to minimize the risk of infection during Cather placement while maintenance bundle reduces the risk of infection during the period of Cather use. A number of components are used as maintenance and insertion bundles. Klieger et al.,mention a number of components that make up the insertion bundles and they include hand hygiene, maximal sterile barriers and chlorohexidine gluconate–isopropyl alcohol. CLABSI is a preventable problem and over the past decade, a lot of efforts have been made to minimize the infection in ICU patients (Whited and Lowe, 2013). They attribute the reduced rate of CLABSI to a number of preventative measures that include safety culture improvement; adherence to best insertion practices guidelines and educational programs aimed at the staff. Whited and Lowe (2013) point out that how the infections still affect the patients outside the ICU despite the great strides made in preventing the same infections in the ICU. This shows how important this issue should be treated for the infections are still with us. It is,therefore, important to solve the problem facing Kendall Regional Medical Center since all the patients at the center are at risk of infection. Berenholtz & Lubomski et al., (2014) mentions the fact that in 2002, 250,000 patients were reported to have CLABSI and out of that, 31,000 died. This points to the fact that if the right measures are not taken, many patients will be at risk of acquiring more complicated infections or dying. Analysis Why it is necessary to collect data Data collection in healthcare is essential since it provides evidence on the effectiveness of the processes utilized in achieving the desired outcomes. Additionally, both process and outcome data provide information on whether the healthcare practices and systems being utilized have any errors and the best way that such error can be rectified. Assessment activities depend on the availability as well as accuracy of the information. It thus follows that collection of data is essential in determining the quality and safety of care. In his article, Donabedian (1988) is of the view that the medical record is an important source of information about care process and the outcomes that follow. However, the information in medical cannot be always relied on due to the inaccuracy in clinical recording as well as inadequate information on the personal processes. For quality assessment to be accurate and complete, it is therefore necessary to go beyond clinical records and include other sources of information. Donabedian points out that re-examination of the available clinical records may go to a great extent in reducing the inaccuracies that come with the clinical information. Additionally, interviewing both the practitioners and patients is mentioned as one effective way through which the clinical records may be supplemented. Both outcome measures and process measures are utilized as indicators of performance in healthcare. Outcome data obtained may be different from each other as a result of the difference in data collection methods, chance, case mix and differences in the general quality of care. Health outcomes may also be impacted by other factors such as nutrition, lifestyle, poverty and environment, hence the need for the collection of different types of data (Mant, 2001). Both the process measures and the outcome measures have their advantages and the disadvantages and in order to minimize the errors that may be brought by these differences, it is always important for quality assessment to incorporate both types of data. The advantages associated with process measures include the fact that they are direct measures of quality and that they are more sensitive to differences that may arise in the quality of healthcare. It is important for outcome measures to be obtained since they show most aspects of healthcare, including those that are hard to measure such as the practitioner skills and their technical expertise. Outcome measures can be utilized as direct indicators of health. Reliable interpretation of data is necessary, especially when the processes have a direct impact on the outcomes. Collection of data in healthcare involves both the public and the health practitioners and includes billing records, health surveys and medical records. This information is utilized by many stakeholders such as hospitals, policy makers as well as the general public. This is why it is important for accurate and timely collection of this information to be done. How in general it assists in achieving good health outcomes Data on outcome as well as processes is useful to the general public as well as the policy makers and the healthcare providers. Process and outcome measures play a vital role in the policies that govern the delivery of healthcare. These policies in turn have a direct impact on the quality of healthcare. Information on certain may lead policy makers I arriving at certain conclusions about the utilization of certain drugs or health delivery equipment and systems. If findings indicate that certain processes or substances endanger the life of patients, policy makers may come up with rules that prohibit the utilization of such processes. Additionally, such information is important to the general public as it directs their decisions with regard to where to seek the most appropriate care. Process and outcome measures and information also govern the practices as well as attainment of skills by health practitioners. Outcome measures show most aspects of healthcare, including those that are hard to measure such as the practitioner skills and their technical expertise. Outcome measures can be utilized as direct indicators of health. Reliable interpretation of data is necessary, especially when the processes have a direct impact on the outcomes Example on how process and data outcome has been utilized in the health issue Berenholtz et al., discusses the effectiveness of one method that involves the utilization of evidence-based practice, culture change and performance feedback. This method is referred to as ‘On the CUSP: Stop BSI’ and according to Berenholtz & Lubomski et al., (2014), if properly utilized across the country, it can significantly reduce the infection rate of CLABSI. Whited and Lowe (2013) mention a number of methods that were found to be effective in reducing CLABSI infection in the ICU settings. They include using full barrier precaution during the insertion procedure, hand washing, use of chlorhexidine to clean the skin and removal of unnecessary Cather. Large scale prevention efforts are more effective since it presents methods that have already been tested for effectiveness. Educating the staff is also another effective way that reduces the rate of CLABSI.Education results to the staff being more compliant with the central line care protocols (Whited and Lowe2013). The findings of the effectiveness of the above mentioned methods depended on both the process and outcome measures. Differences in the quality of care as a result of differences in the methods they utilize at attaining certain outcomes are easy to observe. Utilization of different proven intervention processes makes it easy for the most effective approach to be identified. Process measure in the effective way of preventing CLABSI also proved easy to measure in the mentioned cases since differences in outcomes can be directly observed over a short period. Conclusion Process and outcome in the delivery of care are closely related with outcomes being largely impacted by process. There are three categories from which information about the quality of healthcare can be drawn from and they include structure, process and outcome. An increasing need for evidence on the quality of healthcare from different stakeholders such as regulatory agencies, payers and consumers has resulted to increased utilization of process and outcome measures. This paper discussed how both measures can be utilized in finding out the most effective way of preventing CLABSI. Process and outcome measures are important to the practitioners as well as the general public. References Berenholtz, S. M., Lubomski, L. H., Weeks, K., Goeschel, C. A., Marsteller, J. A., Pham, J. C., Sawyer, M. D., Thompson, D. A., Winters, B. D., Cosgrove, S. E. & Others (2014). Donabedian, A. (1988). The quality of care: How can it be assessed?. Jama, 260(12), 1743--1748. Donaldson, M. (1999). Measuring the quality of health care (1st ed.). Washington, D.C.: National Academy Press. 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