#MEQAPI – Tweetchat May 31-2018 3:00ET Healthcare Resources

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

If you have been a patient or a healthcare professional in the developing world, the lack of healthcare resources will be familiar to you. On the other hand, if you are from a G7 country, work and live in a major metropolitan area, and don’t venture out much, it may have been somewhat hard to understand what it’s like to sometimes lack basic materials, expertise, and equipment.

However, venture just a little distance into rural America, and you may find some of the most basic resources in short supply, or have intermittent and sporadic availability. From dead=basic supplies like saline fluid, to complex capital-intensive equipment like MRI or PET cameras, lack of resources influence what medical services are available, and to what degree a patient can be supported.

Recent weather events, and ongoing market manipulation have brought resource shortages to the doorstep of even the biggest metropolitan hospitals, though. The disruption of supply chains due to extreme weather events in Puerto Rico, for example, have created shortage of IV Bags, pediatric amino acids, and synthoids.

Resources shortages area only likely to become a more familiar experience over time, due to political instability in offshore manufacturing regions, forced migration, economic shifts, climate change disruption, and a fifteen year human capital hiatus as the larger baby Boomer generation gives way to a smaller Generation X.

This chat topic was initiated by a physician with experience in the developing world, and who sees resource shortages on a daily basis, but her experience has real relevance to all clinicians.

Some areas in which resource shortages manifest, and have significant patient safety and care quality implications:

  • Expertise and human capital
  • Medications
  • Capital equipment
  • Ancillary and logistical equipment
  • Surgical tools and devices
  • Medical consumable materials

resources=b

Topics

  1. Policies: How do national policies, laws, and processes lead to medical resource shortages – which resources are you most worried about?
  2. Equipment: What risks, issues, and missed opportunities relate to medical equipment and device availability. What equipment is most at risk?
  3. Measurement: What measurements will be most effected by medical resource shortages. Which measurements will serve as early warnings?
  4. Environment: What environmental factors influence medical resource availability? How can we mitigate the risk?
  5. People: What people factors cause medical resource availability risks? What effects may medical resource availability have on people?
  6. Materials: What medical materials are most involved in medical resource availability? What is the effect?

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Accessibility, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.

 

 

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#MEQAPI – Tweetchat May 24-2018 3:00ET Drug Costs

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

We are in crisis with drugs.

There are people forced to choose between food and getting their medications, between paying the rent and staying alive, and there are people dying because they simply lack the money to pay for their medication.

The beliefs that market forces would bring drug prices to heel, spur innovation, and lead to more people getting better drugs at lower prices has not materialized. Instead, we we see examples such as a drug for infantile spasms going from $40 a vial to $40,000, and diabetic patients who die as a result of trying to stretch their insulin shots because of the high cost.

We have also seen numerous scandals of price fixing, market manipulation to create shortages, and just plain banditry, but the bigger problem is that US drug prices are typically multiples of the price of identical drugs in other countries – even for drugs developed and sold in the U.S.

This chat will cover several aspects of healthcare related to drug costs.

Some reading material from Physician’s Weekly and other sources:

drug prices

Topics

  1. Policies: How do drug policies, laws, and processes lead to drug price increases, or in controlling drug prices?
  2. Equipment: What risks, issues, and missed opportunities related to pharmaceutical equipment and devices influence drug prices
  3. Measurement: What measurements influence drug prices, and what measurements are still needed?
  4. Environment: What environmental factors influence drug prices?
  5. People: What people factors drive drug prices up or down?
  6. Materials: What pharmaceutical materials influence the price of drugs?

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Accessibility, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.

 

 

#MEQAPI – Tweetchat May 17-2018 3:00ET Women’s Health – A Quality Crisis

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

 

This is National Women’s Health Week #NWHW, so it is fitting to reflect on how women experience the healthcare system differently to men.

In many papers and articles, authors describe how healthcare policies, equipment, processes, measurements, etc. have been built (historically) by men, and one could say are custom-designed to suit the male experience of medicine. This would be fine if the two sexes experienced illness in the same way, had identical manifestations, and identical outcomes. However, there are significant differences between how men and women, for instance, experience heart failure. Because of historical male influence, the way heart failure is described, detected, treated, etc. have tended to under-diagnose heart failure in women, and have inferior outcomes.

Since the definition of quality is how well the outcomes fit the process customer’s goals the quality of medicine is lower for women than men if the outcomes are inferior.

Likewise, the access women have the health services, including OB/GYN, may be sub-optimal. In many states, there are entire zipcodes with no facilities offering OB/GYN services. Women may often encounter higher prices for the same healthcare products and services – the so-called “pink-tax”.

These factors may translate to lower healthcare quality, as seen from the perspective of women and the process-customer.

The major causes of death in women (figure 1)* are pretty much the same as men (figure 2)*, but there are differences in the rank order and rates, and perhaps more importantly, how the two sexes experience healthcare.

CoD WomenFigure 1. Leading causes of death in women 1999-2016 .

CoD MenFigure 2. Leading causes of death in men 1999-2016.

 

This chat will cover several aspects of healthcare as experienced by the female patient, and we look at several high-value areas of healthcare related to women’s health.

Some reading material from Physician’s Weekly and other sources:

 

 

Womens health

Topics

  1. Access: What assists and what hinders women’s access to care?
  2. Cost: What factors increase or decrease the cost of care to women? (“Pink Tax”?)
  3. Heart disease: What risks, issues, and missed opportunities exist in relation to Heart disease in women?
  4. Cancer: What risks, issues, and missed opportunities exist in relation to cancer in women?
  5. Stroke: What risks, issues, and missed opportunities exist in relation to cancer in women?
  6. Reproductive health: What risks, issues, and missed opportunities exist in relation to Reproductive health in women?

*Tables taken from Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on May 14, 2018

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Accessibility, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.

 

 

#MEQAPI – Tweetchat May 10-2018 3:00ET Loneliness

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

Loneliness is an unwelcome part of the experience of healthcare. From both sides of the care process, people frequently find themselves engulfed by a sense of loneliness – patients, carers, and clinicians alike have reported a wrenching sense of being alone, isolated, and vulnerable at times.

In this #MEQAPI chat, we will explore the topic of loneliness from the traditional Ishikawa cause & effect perspective, and see if we can cast some light on what causes are common for loneliness, and how it affects patient outcomes, and where it touches of the main quality aspects of healthcare – Safety, Timeliness, Effectiveness, Efficiency, Equitability, Patient-Centeredness, and Accessibility.

The health effects of loneliness and social isolation can be severe. The Campaign to End Loneliness puts it so:

… research shows that lacking social connections is as damaging to our health as smoking 15 cigarettes a day (Holt-Lunstad, 2015). Social networks and friendships not only have an impact on reducing the risk of mortality or developing certain diseases, but they also help individuals to recover when they do fall ill (Marmot, 2010

Loneliness and burnout are close cousins, and the two are often causally interrelated – burnout resulting in isolation and loneliness, and loneliness leading to increased stress, reduced resilience, and increased burnout. This crippling cycle can eat at clinicians, especially those in specialties and environments involving high emotional burden such as oncology, emergency medicine, and critical care, but can be seen across all specialties.

For patients, news of a positive diagnosis for a “dread illness”, an ongoing chronic illness, or suicidal feelings can spiral the person into isolation and loneliness – often at the very time that they most need social support. Some medical equipment and devices play a role in increasing isolation – ventilation equipment makes conversation difficult, stoma bags and devices may cause a patient to feel intensely self-conscious and be withdrawn, and many other visible or invisible barriers to socialization exist that may result in a patient becoming socially isolated.

Likewise, some conditions themselves make social situations and contact more difficult and result in increased loneliness and isolation. Often the stigma associated with a condition can force isolation on a patient.

Some reading material from Physician’s Weekly and other sources:

 

 

Loneliness

Topics

  1. Methods: What policies and procedures increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  2. Machines: What equipment or devices increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  3. Measurement: What measurement or surveillance increases or mitigates clinician or patient loneliness or social isolation – What effect does this have?
  4. Environment: What social, built, or clinical environmental factors increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  5. People: What people factors increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  6. Materials: What materials increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?

 

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Accessibility, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.