Surveillance for quality assessment: III. The critical assessment of quality indicators

Increased attention to healthcare quality issues by insurers, the public and providers has created the desire for quantitative indicators of high quality care. Attributes of quality indicators, including primary and secondary definitions, predictive accuracy and potential to define avoidable problems in care, have been discussed in an effort to allow the reader to critique suggested quality indicators as they appear through legislation and the literature. A continuous feedback process between reviewers and reviewees in the quality assessment process is mandatory to optimize the performance of quality indicators.     

Surveillance for quality assessment: I. Surveillance in infection control success reviewed

This review of the use of surveillance by infection control practitioners (ICPs) in nosocomial infection control programs has identified key components that have led to and supported its continued application and success. These include: Surveillance targeting of events (diseases); Early development of standardized definitions; Wide acceptance of these criteria; Advocacy, leadership and education of methodology and; A high level of effectiveness in program practice.     

医院信息采集质量监控方案的设计

就医院信息系统运行过程中出现的数据质量缺陷问题，提出了实时数据质量监控和终末数据质量监控方案。该方案实施的是以标准库为基础的服务器端数据质量监控模式，该模式的优点是尽可能快地发现可疑数据，发出预警提示，反馈给有关用户，且不影响客户端数据录入程序的使用。     

Selecting a hospital information system

The need for a hospital information system is relatively easy to establish. The process of selecting the system that is right for a particular hospital is another matter entirely. The author takes you through the selection process that led Fairfax Hospital Association to a choice that satisfied the Association's needs.     

Development of a hospital information system simulator for education

When teaching students the hospital information system, it is impossible to use an actual hospital information system because of security reasons. To overcome this problem, a simulator of the hospital information system for student education has been developed. The purpose of this system is to help students understanding a hospital information system from actual experience. The characteristics of this system are as follows: 1) Students can easily learn a hospital information system on the Web pages in the computer training room. 2) The present system is not as complete as a hospital information system, however, helpful explanations regarding the data processing have been inserted. 3) The fictional patient data have been prepared for the pages relating to the electronic medical chart. Consequently, students can understand what kind of data has been saved in this system. Through a questionnaire, students evaluated this system in terms of understandability. The result from four years between 1999 and 2002 showed that 70% of them evaluated it as good system. We therefore consider this system to be effective over a short period of time, and useful for medical education.     

医院信息化建设若干问题探讨

近年来,我国医院信息化建设取得了明显成效,但与国外发达国家的水平相比,无论是在应用的范围、软件质量还是标准化方面,仍然存在较大的差距。如何使医院信息系统在促进医院科学管理,提高医疗服务质量,减少差错,为公众提供更为安全高效的服务,是摆在我们面前的重要课题。     

Screening for lead exposure using a geographic information system.

Screening programs for lead overexposure typically target high-risk populations by identifying regions with common risk markers (older housing, poverty, etc.). While more useful than untargeted screening programs, targeted programs are limited by the geographic resolution of the risk-factor information. A geographic information system can make screening programs more effective and more cost-efficient by mapping cases of overexposure, identifying high-incidence neighborhoods warranting screening, and validating risk-factor-based prediction rules.     

利用医院信息系统做好疾病预防控制

自SARS爆发后,疾病预防控制工作已经引起各级各部门的高度重视,政府也出台了多项法律法规,对公共卫生事件和传染病上报工作进行规范。如何做好传染病、流行病的登记上报工作成为各医院的一项重要任务。作为重庆市的大型综合医院,我院年门诊病人在47万以上,门诊的传染病登记上报工作十分繁重,我们利用“军字一号”医院信息系统的完善的数据,辅之以自行开发的“传染病监控系统”使得我们很好的完成了门诊病人的疾病监控和登记上报工作。     

医院教员信息管理系统的研制

应用科学的理论方法和先进的计算机技术,开发研制了医院教员信息管理系统软件。文章介绍了该系统的基本设计思想、总体结构、主要功能、数据库设计等。该系统的成功研制在提高教学管理水平、加速医院教学管理现代化建设等方面具有重要意义。     

Developing a clinical information system: an interpretive case analysis within a UK hospital.

This paper seeks to adopt an interpretive case analysis for the study of the development of a clinical information system within a UK hospital. An initial literature review is outlined, which draws attention to the distinction between formal-rational and interpretive perspectives on information technology impacts. A case study is presented where a number of issues are identified which suggest that formal systems analysis techniques do not reflect the organizational realities within the hospital. The paper concludes with a brief discussion of the concerns for systems development, and notes the value of an interpretive perspective in this respect.     

The development of a quality information system: a case study of Mexico.

One of the primary obstacles in the implementation of continuous quality improvement (CQI) programmes in developing countries is the lack of timely and appropriate information for decentralized decision-making. The integrated quality information system (QIS) described herein demonstrates Mexico's unique effort to package four separate, yet mutually reinforcing, tools for the generation and use of quality-related information at all levels of the Mexican national health care system. The QIS is one element of the continuous quality improvement programme administered by the Secretariat of Health in Mexico. Mexico's QIS was designed to be flexible and capable of adapting to local needs, while at the same time allowing for the standardization of health care quality assurance indicators, and subsequent ability to measure and compare the quality performance of health facilities nationwide. The flexibility of the system extends to permit the optimal use of available data by health care managers at all levels of the health care system, as well as the generation of new information in important areas often neglected in more traditional information systems. Mexico's QIS consists of four integrated components: 1) a set of client and provider surveys, to assess specific issues in the quality of health services delivered; 2) client and provider national satisfaction surveys; 3) a sentinel health events strategy; and 4) a national Comparative Performance Evaluation System, for use by the Secretariate of Health for the quality assessment of state and provincial health care services (internal benchmarking). The QIS represents another step in Mexico's ongoing effort to use data for effective decision-making in the planning, monitoring and evaluation of services delivered by the national health care system. The design and application of Mexico's QIS provides a model for decentralized decision-making that could prove useful for developing countries, where the effective use of quality indicators is often limited. Further, the system could serve as a mechanism for motivating positive change in the way information is collected and used in the process of ensuring high quality health care service delivery.     

Surveillance for surgical site infection after hospital discharge: a surgical procedure-specific perspective.

OBJECTIVE: To estimate the rate of surgical site infection (SSI) occurring after hospital discharge, to evaluate whether limiting surveillance to inpatients underestimates the true rate of SSI, and to select surgical procedures that should be included in a postdischarge surveillance program. DESIGN: Prospective surveillance study. SETTING: A surgical ward at a university teaching hospital in Italy. PATIENTS: A total of 264 surgical patients were included in the study. RESULTS: The global SSI rate was 10.6% (28 patients); 17 (60.2%) of patients with an SSI developed the infection after hospital discharge. The overall mean length of postoperative stay (+/-SD) for patients who acquired a postdischarge SSI was 4.9+/-3.7 days, and SSI was diagnosed a mean duration (+/-SD) of 11.5+/-4.5 days after surgery. Among procedures with postdischarge SSIs, those classified by the National Nosocomial Infections Surveillance system (NNIS) as herniorrhaphy, mastectomy, other endocrine system, and other integumentary system were associated with a mean postoperative stay that was less than the mean time between the operation and the onset of SSI. Four (36%) of in-hospital SSIs occurred after procedures with an NNIS risk index of 0, and 7 (64%) occurred after procedures with an NNIS risk index of 1 or higher. Of the 17 SSIs diagnosed after discharge, 14 procedures (82%) had an NNIS risk index of 0, compared with 3 procedures (18%) with an NNIS risk index of 1 or higher. CONCLUSIONS: Our results revealed an increased risk of postdischarge SSI after some types of surgical procedures and suggest that there is an important need to change from generalized to NNIS operative category-directed postdischarge surveillance, at least for procedures locally considered to be high-risk.