Читать книгу Kelly Vana's Nursing Leadership and Management - Группа авторов - Страница 129

Groundbreaking research beginning in the 1970s and continuing into the 1990s demonstrated that there was significant variation in utilization of specific health care services associated with geographical location, provider preferences and training, type of health insurance, and patient‐specific factors such as age and gender (Adams, Fraser, & Abrams, 1973; Greenfield et al., 1992; Leape, 1992; Safran, Rogers, Tarlov, McHorney, & Ware Jr., 1997; Wennberg & Gittelsohn, 1973). Associations between utilization rates of health care services have been found with availability of services and technologies, for example, MRIs, hospital beds, practitioners (Joines, Hertz‐Picciotto, Carey, Gesler, & Suchindran, 2003), prevalence and severity of morbidities (Dunn, Lyman, & Marx, 2005; AHRQ, 2008b), race or ethnicity (AHRQ, 2008b), patient adherence, health‐seeking behaviors of patients (Calvocoressi et al., 2004), and many other factors. Variation in the delivery and quality of health services is also associated with socio‐demographics, hospital types (e.g., urban and rural, teaching and nonteaching), and clinical areas (e.g., heart disease, diabetes, pneumonia, and clinical preventive services). Regions of the country and health care providers with more resources had higher rates of use and cost. Efforts to decrease the variation of health care practices through standardization of care with quality, evidence‐based guidelines are important to improve clinical decision making, care delivery, health outcomes, and cost efficiency.

Achieving health care transparency or truth in reporting is the ability to discover information about health care costs, medical errors, or practice preferences, preferably before receiving the service. Transparency is being encouraged by the CMS, though transparency can be hampered by the fear of litigation or reprisal against the health care provider. The Patient Safety and Quality Improvement Act of 2005 addresses such concerns by encouraging health care providers to participate in developing and implementing evidence‐based improvement initiatives. The Act also highlights the importance of recognizing and responding to the underlying hazards and risks to patient safety. Establishing national health benchmarks, such as those in Healthy People 2020 (USDHHS, 2010), is another strategy by which to achieve and measure quality improvement.