Quality Measurement Tools in Healthcare

Assignment 2: Tools for Measuring Quality

Quality measurement is important in nursing practice owing to the fact that it helps ensure successful assessment and hence delivery of quality health services. In the absence of quality measurement, there would be no way of finding out whether patients have access to meaningful and competent services. Essentially, information that is derived from quality measurements is used to determine what is appropriate in practice as well as what is not appropriate. Quality measures use various tools to quantify various aspects in the delivery of healthcare services. Towards this end, it would be prudent to note that there are various quality measurements that can be used in nursing practice. There are largely dependent upon certain aspects of healthcare which could be inclusive of, but they are not limited to; population and public health, patients perceptions in their care, patient engagement in their own care, care coordination, efficient use of healthcare services, patient safety, clinical processes, and patient outcomes. For the purposes of this assignment, I will focus on three rate-based measurements that relate to patient outcomes in healthcare settings. In particular, I will focus on smoking cessation for pneumonia risk reduction, restraints prevalence, and falls with injury measures.

Description of Measures

With regard to smoking cessation for pneumonia risk reduction as a measure to improve outcomes of care among patients, it would be prudent to note that worsening of outcomes among various pneumonia cases is associated with tobacco or cigarette smoking. During the annual measurement period in a control study that was population based, the risk of invasive pneumococcal disease among ex-smokers and those who have never smoked in the past 13 years was reduced by 14 out of 100 after smoking cessation was included (Baskaran et al., 2019). With regard to restraints prevalence, restraints prevalence measure was used as a measure to determine the level of knowledge as well as awareness on use of restraints among residents in nursing homes during the entire measurement period (Schnelle et al., 2004). Falls with injuries measure was used to determine the risk of falling among residents living in nursing homes (Hestekin et al., 2013). The main reason as to why I chose to focus on the said rate-based measurement is owing to the fact that it relates to the quality of services and clinical practices among nurses that relate to how patients are cared for, and their experiences regarding the said care. Essentially, the said indicators can be used to measure the quality of services that patients receive in healthcare facilities by adjusting other risk factors. For instance, smoking cessation for pneumonia risk reduction measure can be used to determine the likelihood of developing community acquired pneumonia when patients smoke or are exposed to smoke (Baskaran et al., 2019). Information gathered on this front would then be used to create or improve smoking cessation programs so as to reduce the said risks. With regard to the restraint prevalence measure, it is worthwhile noting that data on the prevalence of restraints in nursing homes will provide crucial information on settings that do not make use of restraints. This would provide an opportunity for knowledge dissemination, i.e. with regard to education or instruction on the importance/relevance of using restraints. On the other hand, information relating to falls with injuries measure would also be used to determine the prevalence and incidence of falls that are related to injuries in healthcare facilities. As a result, quality improvement measures would be put in place so as to reduce falls in the said facilities.

Definition of Measures

Smoking cessation measure is aimed at dealing with problems related to smoking. This is more so the case given that smoking has been associated with various health problems and concerns such as increased risk of community acquired pneumonia (Baskaran et al, 2019). For instance, the effect of smoking on patients with pneumonia was identified through a meta-analysis study that was conducted to gauge the role that cigarette smoking plays in as far as the development of community acquired pneumonia among adults is concerned (Baskaran et al., 2019). It would be prudent to note that as the authors further indicate, “undoubtedly, quitting smoking is among the most important steps smokers can take to lower the risk of respiratory infections and pneumonia” (81). Essentially, the study focused on smokers and ex-smokers who are aged between 18 years and 64 years of age. However, I am of the opinion that adults who are aged above 65 years ought to have also been included in the said analysis owing to the fact that that they are also at a risk of developing community acquired pneumonia. This is more so the case given that the said adults are in most cases passive smokers or are exposed to second hand smoke (Baskaran et al., 2019). The meta-analyses showed that adults who currently smoke are at the highest risk of developing community acquired pneumonia. Essentially, their likelihood of developing the said infection was found to be 53% more than for those who were ex-smokers. In addition, the said smokers possessed more than two times the risk of developing community acquired pneumonia in comparison to that those who had never smoked. The likelihood of developing CAP among ex-smokers was found to be approximately 49% higher than those who had never smoked (Baskaran et al., 2019). In a similar study, it was found that older adults were at a higher risk of developing community acquired pneumonia (Campagna, Amaradio, Sands, and Polosa, 2016, p. 132).

Reduction in restraint use in healthcare facilities has been associated to lack of adequate knowledge in the use of restraints and related care processes (Schnelle et al., 2004). The said concern largely relates to residents in nursing homes. To determine the prevalence of restraints, the authors utilized a cross-sectional study roping in 413 residents from fourteen nursing homes (Schnelle et al., 2004). Falls with injury cases are associated with high death rates and disabilities. Falls with injuries are caused by various risk factors which are inclusive of, but they are not limited to; severe or extreme sleep problems, grip strength, arthritis, and depression (Hestekin et al, 2013). The main population that is affected by falls with injuries happens to the older adults who are aged more than 50 years. In addition, problems related to falls with injuries tend to affect middle or low-income families (Hestekin et al, 2013). To determine the prevalence and risk factors associated with fall-related injuries, a longitudinal SAGE study was conducted using samples of older adults from South Africa, the Russia Federation, Mexico, India, Ghana, and China.

Numerical descriptions

With regard to the numerator measure counts for smoking cessation and pneumonia, the said counts relate to the number of adults who are current smokers, ex-smokers, and non-smokers or never smokers. The denominator count includes adults 15 years and above who had been diagnosed through radiology (or clinically) with community acquired pneumonia (Baskaran et al., 2019). To construct rate, there are various formulas that can be used. For instance, to construct the rate of smoking among adults, the study used percentages to come up with the rate of developing community acquired pneumonia among adults. In this case, the percentage of smokers, ex-smokers, and non-smokers who are at risk of developing community acquired pneumonia was calculated.

The numerical description for restraints prevalence showed that the numerical counts included restraint prevalence scores from 38 national health facilities. The denominator count for restraint prevalence includes all residents in the 38 national health facilities who are not in Medicare coverage or transitional care and had been identified as using restraints for seven days before the Minimum Data Set assessment (Schnelle et al., 2004). To calculate the rate of restraint prevalence, averages were used based on the Minimum Data Set (MDS) whereby the daily number of residents restrained was divided by the entire number of residents in the 38 health facilities that were used for the study (Schnelle et al., 2004). In falls with injury measures, the numerator count would relate to the socioeconomic, environmental, behavioral, and biological domains as fall determinants (Hestekin et al., 2020). The denominator count would include adults aged 50 years and above from 6 SAGE countries. To calculate the rate of falls with injury cases, Hestekin et al. (2020) indicates that the biological covariates were derived from WHO algorithms, behavioral covariates were calculated using the Global Physical Activity Questionnaire from WHO, environmental covariates were calculated using counts that were based on the 5-point Likert scale, while the social determinants were determined using household economic status indexes.

Data Collection Methods for the Measures

In smoking cessation for pneumonia, a population-based control study was conducted using English and non-English studies (Baskaran et al, 2019). In the English studies, data was independently collected by two authors (RM or TM, VB) while studies that were non-English were collected by single reviewer (MOB or KN, LB, TL) (Baskaran et al., 2019). The single reviewer was conversant with the said language whereby he used a standardized form. In the cross-sectional study that was carried out to determine restraint prevalence, data was collected from 38 nursing homes in Southern California whereby medical record reviews were assessed to determine restraint management, gait, and mobility for 183 participants (Schnele et al., 2004). In the SAGE longitudinal study that was conducted to determine risk factors related to falls with injuries, the SAGE data was collected through structured in-person interviews that were conducted between 2007 and 2010. In addition, data was also collected via two types of questionnaires which were administered separately (Hestekin et al., 2020). The said questionnaires were used to gather both household and individual information.

Comparison of Measures to other External Settings

In the study on smoking cessation for pneumonia, the rate of smokers, ex-smokers, and non-smokers was compared. It is important to note that the actual rate was given for each of the said risk factors and then the percentile rate was used to compare one risk factor in relation to another. For instance, Baskaran et al. (2019) makes an observation to the effect that the actual risk rate or percentage of passive smokers was 64% while that of current smokers was 79% in secondary care, and 27.3% in primary care. On the other hand, the percentage rate was indicated as a comparison for the three risk factors. Essentially, the percentile rate of developing community acquired pneumonia for current smokers was found to be 53% compared to ex-smokers, while the percentile rate of ex-smokers risk rate was 49% more that those who had never smoked (Baskaran et al., 2019).

In the cross-sectional study for restraints prevalence, the rate of minimum data sets were used to compare scores in the lower and upper quartiles (Schnelle et al., 2004). In this case, the authors found the actual risk rate to be 73% for residents from lower quartiles while the percentage rate of residents who lived in high prevalence homes was found to be 81%. With regard to the percentile rates, Schnelle et al. (2004) suggest that the percentage of restraints prevalence owing to time spent in bed was 57% for the high prevalence homes compared to 46% in the lower prevalence homes. The percentile rate for residents who spent time in bed was found to be 33% versus 44% in low-restraint homes and high restraints homes respectively. In addition, the percentile rate of residents who spent time in bed including the use of partial and full side rails, Schnelle (2004) found the said rate to be 16% versus 22% for low restraint homes and high restraint homes respectively. Further, the authors found the percentile rate of restraint use with regard to the number of residents who used full side rail to be 64% and 74% in low prevalence and high prevalence homes respectively. On the other hand, the rate of prevalence and incidence of falls related with injuries was compared between developing and developed countries whereby the actual rate of falls with injuries was 34% in developed countries compared to 66% in the developed countries (Hestekin et al., 2013). Specifically, with regard to the actual rate of prevalence in the two developing countries that were included in the study (i.e. South Africa, and India), the results showed that the actual rate of prevalence was 1.4% and 9.1% respectively. On the other hand, the percentile rates for the prevalence of falls with injuries in the said countries was also compared with China which was the reference category. For instance, in a study that was conducted in China, results show that the percentile rate with regard to population distribution was found to be 56% in urban populations compared to 44.1% in rural populations. With regard to sex distribution, the percentile rate was similar for all countries which was 51.2% (male) and 48.8% (females) (Hestekin et al., 2013).

Risk Adjustment in Quality Measures

With regard to smoking cessation for pneumonia risk reduction, it is important to note that the risk can be adjusted. This is more so the case with regard to measures of effect such as sex and age. The said measures of effect can be adjusted by conducting a case control study whereby medical records or record linkage such as ICD codes and chest radiographs-independent blind assessments can conducted (Baskaran et al., 2019). In restraint prevalence measure, it should be noted that the prevalence rate can be adjusted. The said adjustment can be done by altering or modifying restraint prevalence out of bed whereby foot pedals can be adjusted for residents out of bed (Schnelle et al., 2013). On the other hand, the fall with injuries risk factor such as age can be adjusted. Essentially, age factor can be adjusted for other factors by higher mortality related to falls in older adults and declining memory in the said adults (Campagna, Amaradio, Sands, and Polosa, 2016). When other factors are adjusted in this case, results show an increased risk of falls in adults who are 60 years and above.

Goal Setting Strategies

The goals that should be set in any given organization that wishes to excel in the healthcare realm, with specific reference to the three risk measures highlighted in this text, should be SMART. This is to say that it should not only be Specific and Measurable, but also Achievable, Realistic, as well as Timely. For instance, in smoking cessation for pneumonia, an organization can set a goal such as; to reduce the risk of community acquired pneumonia among adults aged 15 years and above through smoking cessation programs within a period of two years. In as far as restraints prevalence is concerned, an organization can set a goal that is essentially aimed at reducing the prevalence of restraints in nursing homes by increasing resident’s knowledge on restraint use through education practices over a period of 6 months. It should also be noted that when it comes to setting SMART goals on falls with injury measure, an organization can come up with a goal of reducing the number of deaths associated with falls with injury risk among adults aged 50 years and above by embracing the relevant evidence-based practices and systems.