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Information on Quality and Patient Safety

Addington, D., Kyle, T., Desai, S., & Wang, J. (2010). Facilitators and barriers to implementing quality measurement in primary mental health care: Systematic review. Can Fam Physician, 56(12), 1322-1331.
OBJECTIVE To identify facilitators and barriers to implementing quality measurement in primary mental healthcare as part of a large Canadian study (Continuous Enhancement of Quality Measurement) to identify and select key performances measures for quality improvement in primary mental health care.

Brown, A., Baker, G. R., Closson, T., & Sullivan, T. (2012). The journey toward high performance and excellent quality. Healthc Q, 15 Spec No, 6-9.  
Signalling the importance of healthcare quality and quality improvement plans in Ontario, the province's Excellent Care for all act requires all hospitals to publish quality improvement plans, conduct regular patient and staff surveys, and forge a clear link between hospital CEO compensation and quality improvement.

Cochrane, P., Ginzburg, A., Spencer, G., & Marani, F. (2011). Uniting board to bedside: the use of driver diagrams in quality monitoring and improvement at Trillium Health Centre. Healthc Q, 14(4), 54-59.
Boards of directors of healthcare organizations are increasingly being urged to extend their governance activities beyond financial matters to include the quality of patient care. Recently, Trillium Health Centre identified four big dot indicators and generated corollary driver diagrams aimed at helping its board understand and measure the organization's quality improvement plans, efforts and results.

Dobson, L. A., Jr., James, M. G., O'Kane, M. E., Salgo, P., & Weissberg, J. (2013). Module 3: measuring quality in the quality enterprise. Am J Manag Care, 19(9 Suppl), s174-179.

Dowding, D., Randell, R., Gardner, P., Fitzpatrick, G., Dykes, P., Favela, J., . . . Currie, L. (2015). Dashboards for improving patient care: review of the literature. Int J Med Inform, 84(2), 87-100. doi:10.1016/j.ijmedinf.2014.10.001
AIM: This review aimed to provide a comprehensive overview of the current state of evidence for the use of clinical and quality dashboards in health care environments.

Forster, A. J., & van Walraven, C. (2012). The use of quality indicators to promote accountability in health care: the good, the bad, and the ugly. Open Med, 6(2), e75-79.
In Canada, we place significant cultural and financial value on our healthcare system. As such, it is imperative we measure its quality. In this commentary, we highlight some of the potential benefits and harms associated with measuring quality using currently available indicators, such as hospital mortality rates, emergency department length of stays, and readmission rates.

Fram, N., & Morgan, B. (2012). Ontario: linking nursing outcomes, workload and staffing decisions in the workplace: the Dashboard Project. Nurs Leadersh (Tor Ont), 25 Spec No 2012, 114-125.
Research shows that nurses want to provide more input into assessing patient acuity, changes in patient needs and staffing requirements. The Dashboard Project involved the further development and application of an electronic monitoring tool that offers a single source of nursing, patient and organizational information.

Gorzkiewicz, V., Lacroix, J., & Kingsbury, K. (2012). Cardiac care quality indicators: a new hospital-level quality improvement initiative for cardiac care in Canada. Healthc Q, 15(1), 22-25.
Health system stakeholders at different levels are focused more than ever on improvements to quality of care. With heart disease continuing to be a top health issue for Canadians, quality improvement initiatives aimed at improving cardiac care are increasingly important.

Kraetschmer, N., Jass, J., Woodman, C., Koo, I., Kromm, S. K., & Deber, R. B. (2014). Hospitals' internal accountability. Healthc Policy, 10(Spec issue), 36-44.
This study aimed to enhance understanding of the dimensions of accountability captured and not captured in acute care hospitals in Ontario, Canada. Based on an Ontario-wide survey and follow-up interviews with three acute care hospitals in the Greater Toronto Area, we found that the two dominant dimensions of hospital accountability being reported are financial and quality performance.

Kromm, S. K., Baker, G.R., Wodchis, W. P., & Deber, R. B. (2014). Acute care hospitals' accountability to provincial funders. Healthc Policy, 10(Spec issue), 25-35.
Ontario's acute care hospitals are subject to a number of tools, including legislation and performance measurement for fiscal accountability and accountability for quality.

Levitt, C. A., Nair, K., Dolovich, L., Price, D., & Hilts, L. (2014). Refinement of indicators and criteria in a quality tool for assessing quality in primary care in Canada: a Delphi panel study. Fam Pract, 31(5), 607-621. doi:10.1093/fampra/cmu021
PURPOSE: Primary care is the cornerstone of the health care system and increasingly countries are developing indicators for assessing quality in primary care practices. The 'Quality Tool', developed in Ontario, Canada, provides a framework for assessing practices and consists of indicators and criteria. The purpose of this study was to validate the indicators and simplify the Quality Tool.

McFadyen, C., Lankshear, S., Divaris, D., Berry, M., Hunter, A., Srigley, J., & Irish, J. (2015). Physician level reporting of surgical and pathology performance indicators: a regional study to assess feasibility and impact on quality. Can J Surg, 58(1), 31-40. doi:10.1503/cjs.004314.
BACKGROUND: There is increased awareness that, to minimize variation in clinician practice and improve quality, performance reporting should be implemented at the provider level. This optimizes physician engagement and creates a sense of professional responsibility for quality and performance measurement at the individual and organizational levels.

McGlynn, E. A., Schneider, E. C., & Kerr, E. A. (2014). Reimagining quality measurement. N Engl J Med, 371(23), 2150-2153. doi:10.1056/NEJMp1407883. 

Meyer, G. S., Nelson, E. C., Pryor, D. B., James, B., Swensen, S. J., Kaplan, G. S., . . . Hunt, G. C. (2012). More quality measures versus measuring what matters: a call for balance and parsimony. BMJ Qual Saf, 21(11), 964-968. doi:10.1136/bmjqs-2012-001081.
External groups requiring measures now include public and private payers, regulators, accreditors and others that certify performance levels for consumers, patients and payers.

Santana, M. J., & Stelfox, H. T. (2012). Quality indicators used by trauma centers for performance measurement. J Trauma Acute Care Surg, 72(5), 1298-1302; discussion 12303. doi:10.1097/TA.0b013e318246584c
BACKGROUND: To describe the quality indicators (QIs) that trauma centers use for quality measurement and performance improvement. Measuring and reporting quality of care is a critical step to improve the quality of care. QIs compare actual trauma care against ideal criteria and identify patients in whom care may have been suboptimal and should be further reviewed.

Schwartz, R., Price, A., Deber, R. B., Manson, H., & Scott, F. (2014). Hopes and realities of public health accountability policies. Healthc Policy, 10(Spec issue), 79-89.
Holding local boards of health accountable presents challenges related to governance and funding arrangements.

Seow, H. Y., & Sibley, L. M. (2014). Developing a dashboard to help measure and achieve the triple aim: a population-based cohort study. BMC Health Serv Res, 14, 363. doi:10.1186/1472-6963-14-363. 
BACKGROUND: Health system planners aim to pursue the three goals of Triple Aim: 1) reduce health care costs; 2) improve population health; and 3) improve the care experience. Moreover, they also need measures that can reliably predict future health care needs in order to manage effectively the health system performance.

Serb, C. (2011). Effective dashboards. What to measure and how to show it. Hosp Health Netw, 85(6), 8 p following 40, 42.
Today, hospitals must measure not only financial health, but also operational efficiency and quality of care. Redesigned dashboards make the data more accessible.

Solomon, R., Damba, C., & Bryant, S. (2013). Measuring quality at a system level: an impossible task? The Toronto Central LHIN Experience. Healthc Q, 16(4), 36-42.
Quality is being measured and reported across healthcare organizations and sectors, but efforts are rarely made to connect the activity in one organization to quality experienced by patients and clients in another part of the healthcare system.

Wagner, C., Groene, O., Thompson, C. A., Dersarkissian, M., Klazinga, N. S., Arah, O. A., & Sunol, R. (2014). DUQuE quality management measures: associations between quality management at hospital and pathway levels. Int J Qual Health Care, 26 Suppl 1, 66-73. doi:10.1093/intqhc/mzu020.
OBJECTIVE: The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery.