Case study analysis methods and applications

Stroke

Stroke is identified as one of the leading causes of death and to decrease mortality rate a review of the causes is required. The importance of measuring and reviewing health care quality is no longer questioned. However quantifying quality is a difficult task one that involves a subjective element and judgment. Different methods are employed in measuring quality such as level of care provided, administration accuracy, staff sufficiency, hygiene level and therapies provided. The need to combine the facts and figures with judgments and evaluation is a complex process and needs to be done with utmost care. The quality measures need to be evaluated on a regular basis to ensure their relevance and validity in the given circumstances.

Measures used to monitor and review quality:

As the hospital administration began to realize the link between stroke patients death and the quality of service rendered the need to analyze data became inevitable. Quality can only be monitored when statistical data is interrelated and relationships are established between different variables.

The quality monitoring process can be broken down in to three distinct components namely structure, process and outcomes. Structure involves the assessment of the internal working system of the organization such as skills and training of the staff, efficiency and effectiveness of their equipment and the ability to utilize resources to its maximum. However in this case little importance is given to this component of monitoring quality. The organization simply reviews the number of patients that are admitted and are discharged from the hospital, breaking them down in the kind of treatment received to identify staffing needs and the need to invest in technical equipment. However, analysis based on only these factors might not be adequate and hospitals need to focus on other domains of care such as ensuring that there is appropriately trained staff for cardiovascular treatment, equipment is available for tests and procedures and there is follow up for patients (American Heart Association, 1999).

The process components has been slightly more focused on in hospitals and involves ensuring that accurate diagnose is done and the respective treatment is received. Quality monitoring was done by checking on the number of deaths in stroke patients. It was revealed that there were coding problems which led to distorted results. This was worked upon almost instantly. Another measure employed was by devising a formula which calculated the severity of different types of strokes. Monitoring was also done by grouping patient's deaths with similar diagnosis such as aspiration pneumonia. It was found out that correct therapy was not given and it was immediately rectified with improved results seen. Lastly the organization focused on the elements such as blood pressure and sugar level and changed the therapies resulting in lower death rates. Thus it can be said that process measures were much better used and results identified were then implemented so that better quality service was provided. The ultimate result was declining mortality rates.

The last step towards monitoring quality is the outcome component which involves analyzing the consequences of treatment such as mortality rates, readmission required, quality of life and cost. The hospital was successful to a certain extent in assessing quality in this respect. A database was created which showed patients history their by enabling the doctor to analyze the mortality rate. Moreover a regression technique was used showing the factors contributing to different patients deaths. These measures can help assessing in whether the organization is providing quality service overtime by analyzing decline in mortality rates. However, certain measures are missing such as number of readmissions in the hospital and the satisfaction of patients. These are important quality measures that would enable an organization in understanding the level of service they are providing. This can be done by using survey techniques (Ryan, Antman & Brooks, 1999).

The organization needs to place greater focus on quality improvement program by ensuring that sufficient data is collected and analyzed to identify areas for improvement.

Regulatory and Accredited Standards:

The governmental departmental departments such as National Center for Health Statistics (NCHS) and the Department of Health and Human Services have set certain guidelines that the hospitals need to follow. These include classifying and coding patients health status according to the diagnosis and the procedure used. The reason for such a rigorous standard is to maintain completeness and consistency of patient's medical records.

Accredited Standards such as those of Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the American Medical Association (AMA) Council require disclosure of the most severe adverse events within the hospital and also require that medical errors are disclosed and apologizes are offered to the patients and their families. The JCAHO also releases a hospital score cars that identifies areas for improvement such patient assessment excreta. The greater the need for improvement identified the lower would be the rating of the hospital (AHO, 2006).

A number of strategies have been employed by the hospital to meet these regulations. A complete database has been created that stores information of the patient's history starting from diagnosis to therapy treatments identified. In order to decrease the number of disclosure required for serious mistakes the hospital implemented safety procedures and preventive measures such as repetition of instructions by nurses to ensure they were not misheard. This reduces the chances of malpractices and also the insurance premiums.

The strategies employed for meeting these standards are not completely appropriate because there is always room for improvement. The organization has a number of problems in form of data management such as coding problems excreta. Moreover not all quality measures are implemented signifying that training and skills level for staff for example can be improved along with ensuring maximum output is obtained for the input. Strategies also need to be in place to ensure that all faults of the hospital are made public and apologizes are offered for mistakes made.

Barriers to improvement of quality measures and how to overcome them:

There are number of problems presented in improving quality. First is the need to have accurate data. Obtaining data can be expensive and difficult and errors are likely to occur at all levels. The better health service can only be provided when in dept assessment is done of patients with specific disease, the extent of their illness and what therapies might be employed. This could involve potential problems of accurate collection and also ensuring that risk adjustment factor are accounted for. Administrative records can be used but they are likely to be incomplete. Without electrical records data collection is expensive and requires substantial organization. Many results such as patient's health status would require direct input from patients and lack of their cooperation would make it impossible to collect all information. Moreover the time frame is important. Should the quality of service be measured over the initial hospitalization period or till the end of the treatment? The greater the time period the more complex the task becomes.

Risk adjustment also poses a problem. This is needed to allow interpretation of outcomes data among groups with different types of patients. Even though a range of sophisticated techniques are available many variables remain unexplained resulting in distorted results (Donabedian, 1988).