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67 Cards in this Set
- Front
- Back
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What does the quality in health care involve (IOM 1990)? |
Increasing the likelihood of desired health outcomes and being consistent with professional knowledge |
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What did Florence Nightingale say about hospitals? |
The very first requirement of a hospital is that it should do the sick no harm. |
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When was the NHS Outcomes Framework Domain created? |
2012 |
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How many domains are there? |
5 |
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What do the first 3 domains involve? |
Effectiveness |
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What does domain 4 involve? |
Patient experience |
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What does domain 5 involve? |
Safety |
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What is domain 1? |
Preventing people from dying early |
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What is domain 2? |
Enhancing quality of life for people with long-tern conditions |
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What is domain 3? |
Helping people to recover from episodes of ill health or following injury |
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What is domain 4? |
Ensuring that people have a positive experience of care |
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What is domain 5? |
Treating and caring for people in a safe environment and protecting them from avoidable harm |
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Why is finance a big problem for the quality of healthcare? |
Ageing population + more technologies = decreased amount of money |
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In the US, what % of people received the recommended health services? |
55% |
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What is an example of this variation in the UK? |
Knee replacements |
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In 2014, how many diabetes patients had said they had developed a care plan with their healthcare professional? |
39% |
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What is the average % of people that say they would like more involvement in decisions about their care? |
40-50% |
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Why are there challenges getting research into practice? |
There is an increasing amount of biomedical journals being published |
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What year was the high quality care for all NHS reform? |
2008 |
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What is quality improvement? |
An activity aimed to elicit information about clinical performance and based on that information to readjust the circumstances and processes of health care - getting evidence into practice. |
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What is the WHO definition of patient safety? |
Freedom, for a patient, from unnecessary or potential harm associated with healthcare. |
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What % of hospital admissions will have some adverse effect and how many of these are preventable? |
9.2% with 43.5% preventable |
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In the UK, how much of adverse effects leads to moderate or greater disability or death? |
A third |
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What are some examples of ways that the safety and quality pf patient care has been improved? |
Clean Your Hands campaign Surgical safety checklist (WHO) |
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What is the PDSA cycle? |
Plan Do Study Act |
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What is the concept of a sequence of improvement? |
1) developing a change 2) testing a change 3) implementing a change 4) change to other locations |
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What are unreconciled medicines? |
Patients forgetting what medications that they are on and therefore not telling the doctor the correct medications |
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What is shared decision making? |
It is an approach where clinicians and patients make decisions together using the best available evidence |
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What is SDM a balance between? |
Paternalistic approach and informed choice |
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What are examples of SDM situations? |
Breast cancer treatment - mastectomy or breast conserving therapy Repeat C-section or normal birth Statins or diet&exercise to reduce CVD risk |
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Why are healthcare reforms not always a good thing? |
They can be disruptive, costly and painful - not necessarily a good thing as may waste money |
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What are the 3 things that all healthcare systems face? |
1) Common pressures 2) Common determinants 3) The irreconcilable triumvirate |
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What are the common pressures faced by healthcare systems? |
Scarcity of resources |
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What does the irreconcilable triumverate involve? |
A triangle made up of: Quality Access Cost |
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What do we always want to do about the quality of healthcare systems? |
Maximise quality |
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What does access mean? |
Equality and fairness - people can access care when they need it |
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What is the problem in the irreconcilable triumverate? |
If you focus on one of these 3 things, the other 2 will be reduced |
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What happens if you increase quality? |
Usually result in an increased cost and also limited access as would have one specific clinic etc not many |
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What would the effect of decreasing cost do? |
Maybe decrease quality |
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What 4 factors determine what system is in place? |
1) historical factors 2) political pressures 3) wealth of the country 4) stage of economical and political development |
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How do political pressures determine what system is in place? |
Different attitudes to equality and definitions of equality and efficiency (different in Europe compared to the US) |
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How does the wealth of the country determine what system is in place? |
NHS is huge but less wealthy countries don't have the infrastructure for something like that |
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Why does the stage of economic and political development matter? |
UK is quite stable to maintain a complex system however many can't do this. |
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What are the 4 common drivers of change? |
1) restricted resources 2) increased need/demand 3) 'unacceptable' variation 4) regulatory framework |
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Why are resources restricted? |
Some countries have more wealth than others |
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What are 3 things that could cause an increased need/demand? |
1) demographic factors 2) disease patterns 3) changes in technology |
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What is an example of a disease that has changed and there is a decreased need for the specialist care of that now? |
Tuberculosis |
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What is the 'unacceptable variation'? |
That there is a lot of differences such as different life expectancies between different countries or between different places in the same country where everyone should have the same rights |
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What does regulatory framework involve? |
Changes in the law and licensure |
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What is an example in the US of regulatory framework? |
The role of a nurse practitioner (what they can do) differs in each state |
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What are 4 common policy options? |
1) commit more resource (spend more money) 2) get more healthcare for less money 3) ration healthcare 4) reform/incentives |
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How does the NHS ration healthcare? |
By availability of resources and having long waiting lists |
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How much of its economy does the UK spend on healthcare? |
About 9% |
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What are the 2 financial intermediaries that we use? |
1) Insurance company 2) Government - tax |
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What country uses direct payments? |
India |
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What countries use private insurance? |
US, Switzerland |
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What country uses social insurance? |
Germany |
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What country uses the Bismarck model? |
Germany |
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What country used national health insurance? |
Canada |
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What countries uses the national health service? |
UK, Scandinavia |
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What country uses the Beveridge model? |
UK |
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What is another way that healthcare can be paid for? |
Out-of-pocket payments |
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What is the demand for private insurance driven by (4)? |
1) wealth 2) premium level 3) level of risk aversion 4) income loss |
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However what is the problem with insurance companies? |
They select the people they want as they want to make a profit |
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What is the mix between public and private and finance and provision that leads to hospital care? |
Public finance and public provision |
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What is the mix between public and private and finance and provision that leads to GPs? |
Public finance and private provision |
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What are the 5 main objectives of a health system? |
1) maximising population health 2) reducing inequalities in population health 3) maximising health system responsiveness 4) reducing inequalities in responsiveness 5) financing healthcare equitability |
