ποιοτητα στην-ορθοπεδικη

ΠΟΙΟΤΗΤΑ ΣΤΗΝ ΟΡΘΚΗKΩΝΝΟΣ Δ ΘΕΟΛΟΓΟΥ

Orthopaedic Surgeryand Healthcare Quality

Konstantinos D Theologou MD DSc MSc Οrthopaedic Surgeon

QUALITY DEFINITION

A MEASURE OF EXCELLENCE A STATE OF BEING FREE FROM DEFECTS

DEFICIENCIES AND SIGNIFICANT VARIATIONS STRICT AND CONSISTENT COMMITMENT TO

CERTAIN STANDARDS THAT ACHIEVE UNIFORMITY OF A PRODUCT IN ORDER TO SATISFY SPECIFIC CUSTOMER OR USER REQUIREMENTS

httpwwwbusinessdictionarycomdefinitionqualityhtmlixzz2OvFer6mb

)

IS IT TIME TO TAKE A HARDER LOOK AT THE QALY

HOW MUCH A PERSONrsquoS HEALTH ACTUALLY COST

HOW DO YOU DETERMINE THAT

SHOULD HIGH-PRICED BIOLOGICS BE COVERED IF THEY ARE NOT COST-EFFECTIVE

Amanda Brower Biotechnol Healthc v5(3) Sep-Oct 2008

PUTTING A PRICE ON TREATMENT

HEALTH CARE IS CHANGING RAPIDLY

ALL THINGS TO ALL PEOPLE-IMPOSSIBLE

MAKE CHOICES

HOW MUCH LONGER THE TREATMENT WILL ALLOW YOU TO LIVE

HOW IT IMPROVES THE LIFE YOU HAVE

J Bone Joint Surg Am 2005 Jun87(6)1253-9

ORTHOPAEDIC COMMUNITY UNDERSTAND AND APPLY ECONOMIC EVALUATIONS

IT CAN BE USEFUL FOR SETTING PRIORITIES AND GUIDING RESEARCH

Cost-utility analyses in orthopaedic surgery

Harvard Center for Risk Analysis Harvard School

HEALTH SYSTEMS IN THE UNION - EFFORTS TO ENSURE IMPROVING QUALITY AND SAFETY STANDARDS TAKING INTO ACCOUNT

ADVANCES IN MEDICAL SCIENCE

GOOD MEDICAL PRACTICES

NEW HEALTH TECHNOLOGIES

DIRECTIVE 201124EU OF THE EUROPEAN PARLIAMENT

WHERE ARE YOU GOING

THE FUTURE STARTS TODAY NOT TOMORROW

Pope John Paul II

ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE

rdquo Plutarch 46 ndash 120 AD

MEDICAL ERRORS

ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT

PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE

Council on Research and Quality AAOS

ERROR DEFINITION

OCCASIONS IN WHICH A PLANNED

SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES

FAILS TO ACHIEVE ITS INTENDED OUTCOME

AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY

Professor James Reason

ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES

(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)

WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS

A TYPE I ERROR IS A FALSE-POSITIVE

A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM

Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading

REDUCING MEDICAL ERRORS AND ADVERSE EVENTS

Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system

Annu Rev Med 2012 Johns Hopkins University School of Medicine

MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)

A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the

patient) This might include an inaccurate or incomplete

diagnosis or treatment of a disease

injury syndrome behavior infection

etc Zhang J Patel VL amp Johnson TR (2008)

MEDICAL ERROR

INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT

INCORRECTLY

CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND

BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE

PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE

MEDICAL NOTES

NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES

THE RECORDED DISCREPANCY EG BETWEEN

DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg

COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS

Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making

AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS

( most critical role here) NEXT LEVEL

INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY

AT THE NEXT LEVEL

INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY

AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL

FUNCTIONS NATIONAL REGULATIONS

MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])

(LACK OF SUPERVISION)

LACK OF TECHNICAL COMPETENCE ( [58])

Trainee errors appeared more complex than nontrainee errors

Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)

REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE

COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-

PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING

INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health

Sciences

COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN

COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON

POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common

REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE

J Hosp Med (2011)University of Tsukuba Japan

MODELS OF PHYSICIANndashPATIENT RELATIONSHIP

Number 395 January 2008

PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS

OF A PROCEDURE THAT THE PHYSICIAN THINKS

Indications Unconscious patients Patient is ill and unable to engage in a

discussion

INFORMATIVE MODEL

THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED

NOT IDEAL for patient care in most situations

INTERPRETIVE MODEL

PHYSICIAN ACTING AS AN INFORMATION SOURCE

HELPS THE PATIENT TO KNOW MORE CLEARLY

DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE

TO THE PATIENT HIS OR HER HEALTH VALUES

httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf

WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to

present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE

Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS

SUCH INFORMATION SHOULD INCLUDE

Alternative modes of treatment

Objectives

Risks and possible complications of treatment

Complications and consequences of no treatment

Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS

COUNCIL ON RESEARCH AND QUALITY -AAOS

EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING

evidenced-based medical practice orthopaedic devices

biologics regulatory pathways and standards development

patient safety occupational health

technology assessment and other areas of importance

The Patient Protection and Affordable Care Act (PPACA) -pressure on providers

to improve outcomes lower the cost of care

Market forces being exerted by both

consumers and businesses -demand for better healthcare at lower costs

httpwwwaaosorgnewsaaosnowjan13advocacy7asp

MEASURE QUALITY COST

QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE

PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY

Kevin J Bozic AAOS Council on Research and Quality

FUTURE QUALITY OBJECTIVES

ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES

MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE

EMPHASIS ON PATIENT OUTCOMES AND

PATIENT SATISFACTION AAOS Council on Research and Quality

DEFINITIONS OF QUALITY OF CARE

NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE

LACK OF A COMMON SYSTEMATIC FRAMEWORK

(from European Observatory of Health System and policies Odservatory studies No 12)

DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR

INDIVIDUALS AND POPULATIONS

INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES

CONSISTENT WITH CURRENT PROFESSIONAL

KNOWLEDGE

Doing the right things (what) bull

to the right people (to whom) bull

at the right time (when) bull

and doing things right first time

PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT

PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN

ORDER TO INCREASE THE EFFECTIVENESS

Centers for Disease Control and Prevention

httpwwwcdcgovstltpublichealthperformance

MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS

The Strategic Management of Health Care Organizations ndash

Peter M Ginter - 2013

UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM

CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION

INTEGRITY

DIVERSITY

PROFESSIONALISM

INDIVIDUAL OPPORTUNITY

TEAMWORK AND COLLABORATIONTRADITION

THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH

MEET THE NEEDS OF EVERYONE

FREE AT THE POINT OF DELIVERY

BASED ON CLINICAL NEED NOT ABILITY TO PAY

(July 5 1948-now)

COMPREHENSIVE SERVICE

AVAILABLE TO ALL

EXCELLENCE AND PROFESSIONALISM

NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS

BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES

Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)

GUIDING PRINCIPLES OF THE NHS

RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS

QUALITY OF CARE

INFORMATION

CONFIDENTIALITY

RIGHT TO COMPLAIN IF THINGS GO WRONG

PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT

OF THE PEOPLE THE NHS SERVES

httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx

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