Chest
Transparency in Health CareDesign and Measurement of Quality Improvement Indicators in Ambulatory Pulmonary Care: Creating a “Culture of Quality” in an Academic Pulmonary Division
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Materials and Methods
Beth Israel Deaconess Medical Center (BIDMC) is a 600-bed, full-service, adult teaching hospital with nearly 750,000 patient visits annually from persons in and around Boston, MA. The Division of Pulmonary, Critical Care, and Sleep Medicine at BIDMC delivers subspecialty services for patients with critical illnesses, thoracic diseases, and sleep-related disorders. The ambulatory services of the division account for > 5,000 pulmonary visits annually, with patients seen by attending physicians
Results
Since the implementation of the BIDMC pulmonary QI program in quarter 4 of 2006, performance has improved in many of the areas being tracked. Two main disease areas, asthma and COPD, were evaluated. Additionally, various measures for all patients were evaluated (Table 1).
For patients with asthma, a sample of 50 visits of approximately 250 visits were reviewed quarterly for the percentage of patients who had been appropriately prescribed inhaled corticosteroids. Treatment compliance prior to the
Discussion
Global guidelines and standards for the management and prevention of lung diseases have been developed and can lead to improved morbidity and mortality if implemented consistently and appropriately. By implementing programs that monitor adherence to evidence-based guidelines, we sought to improve quality of care, promote patient safety, and reduce medical errors through improved documentation of prior care and timely results notification.
Effectively implementing QI programs aimed at adherence
Acknowledgments
Author contributions: Dr. Roberts was responsible for designing and implementing the QI/PS within the Division of Pulmonary, Critical Care, and Sleep Medicine at BIDMC. He contributed to the development of QI measures, the program design, data collection, data analysis, and manuscript writing and editing. Dr. Gilmartin contributed to the program design, data analysis, and manuscript writing and editing. Ms. Neeman contributed to the design and implementation of the QI/PS, including working with
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Funding/Support: Stoneman Center for Quality Improvement and Patient Safety, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
All work was completed at Beth Israel Deaconess Medical Center, Boston, MA
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).