Issue Area - Ensuring Quality of Care
Adverse Drug Reactions in Hospitalized Patients: A Critique of a Meta-analysis by Marion Kvasz, MD, MPH, et al., Medscape General Medicine,
April 2000
A published meta-analysis of the incidence of adverse drug reactions (ADRs) in hospitalized patients concluded that ADRs rank as the fourth to sixth leading cause of death in the U.S. This conclusion generated considerable concern among health care providers, patients, and pharmaceutical manufacturers. To better understand the evidence behind this conclusion, a critical review of the source studies and the meta-analytic methods used to combine them was conducted. Findings suggest that the conclusions of the meta-analysis are invalid.
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Agitation and Depression in Frail Nursing Home Elderly Patients with Dementia: Treatment Characteristics and Service Use, by Stephen J. Bartels, MD, MS, et al., American Journal of Geriatric Psychiatry, Vol. 11, No. 2, March-April 2003
Agitation and depression are the two most common behavioral complications of dementia. Although the behavioral symptoms have received less attention than the cognitive symptoms of dementia, they have serious consequences, including caregiver stress, premature institutionalization, and compromised quality of life for patients and their families. This study suggests that dementia complicated by mixed agitation and depression is among the most clinically challenging problems in long-term care, and that effective interventions and services are needed to address the complex treatment needs of this high-risk group.
Complexities and Variations in Pharmaceutical Therapy for Cancer: Next steps toward achieving quality care, 2000
This white paper, authored by a collaboration of cancer organization in partnership with NPC, suggests cancer patients may not be receiving appropriate pharmaceutical care. The paper's findings also indicate that there is a slow transition of new knowledge into clinical practice.
This article was updated and published in October 2003 as a supplement to
the Journal of the National Comprehensive Cancer Network, Vol. 1, Suppl 2. The updated version is available from NPC in hard copy only. Click here to request a copy.
Executive Summary: Coordinated Pharmaceutical Therapy in Chronic Care: Five Innovative Programs, September 2000
Numerous studies indicate the limitations of a component-based, line item approach to the management of pharmaceuticals. A much greater potential for improved treatment and overall cost savings lies in the coordination of pharmaceutical care, especially for the elderly and other chronic care patients.
Coordinated Pharmaceutical Therapy in Chronic Care: Five Innovative Programs, September 2000
Successful models of coordinated pharmaceutical care for patients at high risk for suboptimal treatment must be identified. This collection of five diverse approaches illustrates that coordinated pharmacotherapy can be implemented effectively across a variety of health care organizations. Many of the programs have resulted in improved outcomes and/or reduced overall costs of
care. Fact sheet available.
Fraction of Nursing Home Admissions Attributable to Urinary Incontinence, by Alan Morrison, PhD, Richard Levy, PhD, Value in Health, Vol. 9, No. 4, July/August 2006
This brief article calculates the proportion of nursing home admissions of the elderly attributable to urinary incontinence (UI) and finds that estimates of the fraction of nursing home admissions attributable to UI exceed those previously assumed and show an imbalance between the sexes. Policies that support reimbursement for treatments of UI in the community might help prevent or delay institutionalization and offset some of the costs.
Improving and Measuring Osteoporosis Management, 2008
In the United States, an estimated 10 million people are living with osteoporosis, also called brittle bone disease. Although osteoporosis is responsible for the majority of hip fractures, and accounts for more than eighteen billion dollars in health care expenditures annually, on average only 20% of patients are ever screened or treated for the disease. A new monograph developed by The Joint Commission through an unrestricted educational grant by NPC, is now available. The monograph contains 10 voluntary measures of care, designed for a variety of healthcare settings. "Improving and Measuring Osteoporosis Management" is intended for a professional audience and contains clinical information and practical tips for implementing an osteoporosis improvement initiative, whether clinical care is given in a hospital, emergency department, rehabilitation facility, home health agency, or doctor's office.
Improving the Quality of Pain Management Through Measurement and Action, 2003
This monograph addresses the application of continuous quality improvement techniques to pain management and the implementation of performance
measurement processes. The use of a multidisciplinary systems point of view is described and the Cycle for Improving Performance, a structured approach to improvement activities, is outlined. Factors that influence an organization's ability to implement change and improve performance are also discussed. In addition, the real-world experience of four organizations in improving pain management is described. The examples provided encompass a diversity of settings and experience and suggest strategies for overcoming obstacles to pain management improvement initiatives.
Integrating Pharmaceutical Care: A Vision and Framework, 1999
Published in collaboration with the National Chronic Care Consortium, this concept paper outlines the principles and characteristics of integrated, patient-centered pharmaceutical care. Issues discussed include aligned incentives, optimal care for individual patients, the goal of lowest overall costs, and optimum outcomes and quality of life as the main drivers of medication choice.
NOTE: Since publication, the phone number for the National Chronic Care Consortium has changed. The correct number is (952) 858-8999. This is a change from the number given on page three of the publication.
An Overview of Two Monographs on Pain Management, 2003
In 2001, the Joint
Commission on Accreditation of Healthcare Organizations and the National Pharmaceutical Council began a collaborative effort to facilitate improvements in pain management. To date, this effort has produced a set of
monographs intended for those involved in pain management activities, including clinicians, quality management professionals, and others involved in pain management performance, assessment, improvement, education, and policy making.
Pain: Current Understanding of Assessment, Management, and Treatments, 2001
Pain is the most common reason individuals seek health care and about 9 in 10 million Americans regularly suffer from pain. Each year, an estimated 25 million Americans experience acute pain due to injuries or surgery and another 50 million suffer chronic pain. The adverse consequences of undertreated pain are considerable. Poorly managed acute pain may cause serious medical complications, impair recovery from injury or procedures, and can progress to chronic pain. Undertreated chronic pain can impair an individual's ability to carry out daily activities and diminish quality of life.
An addendum, published in May 2005, updates clinical advances in pain management since the publication of this monograph.
CE Credit for nurses and nurse practitioners is available through NP Central. (Lesson Expires:
1/31/06)
CE Credit for physician assistants is available through the AAPA. (Lesson Expires: 12/1/06)
CE Credit for pharmacists is available through the APhA. (Lesson Expires: 12/15/07)
CE Credit for physicians and psychiatrists is available through the APS. (Lesson Expires: 6/30/07)
Treatment of Depression in Older Primary Care Patients in Health Maintenance Organizations, by Stephen J. Bartels, PhD, et al., Psychiatry in Medicine, Vol. 27, No. 3, 1997
Older patients enrolled in managed care plans are being prescribed older anti-depressants, indicating that this issue is an important target for improving quality of care for depression in the elderly. Authors of this 1997 journal article found that the elderly who were prescribed anti-depressants received older varieties that have more side effects.
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