Quality improvement tools in disease management

Disease management programs require constant monitoring to assure quality and address problems efficiently. To initiate continuous quality improvement in a disease management program, there are several methods available to identify potential problems within the program that may be affecting quality. Some common quality improvement instruments include the Plan-Do-Check-Act model, check sheets, and so forth. Whatever model is used, Statistical Process Control using flow charts, histograms, Pareto diagrams, scatter diagrams, control charts, and cause-and-effect diagrams provides a better understanding about how the organization\u27s processes are functioning. These tools facilitate problem recognition and allow an organization to meet established standards of quality in the most economical manner

Suicidality and hostility following involuntary hospital treatment

Background Psychiatric patients showing risk to themselves or others can be involuntarily hospitalised. No data is available on whether following hospitalisation there is a reduction in psychopathological indicators of risk such as suicidality and hostility. This study aimed to assess changes in suicidality and hostility levels following involuntary admission and their patient-level predictors. Methods A pooled analysis of studies on involuntary treatment, including 11 countries and 2790 patients was carried out. Suicidality and hostility were measured by the Brief Psychiatric Rating Scale. Results 2790 patients were included; 2129 followed-up after one month and 1864 after three months. 387 (13.9%) patients showed at least moderate suicidality when involuntarily admitted, 107 (5.0%) after one month and 97 (5.2%) after three months. Moderate or higher hostility was found in 1287 (46.1%) patients after admission, 307 (14.5%) after one month, and 172 (9.2%) after three months. Twenty-three (1.2%) patients showed suicidality, and 53 (2.8%) patients hostility at all time-points. Predictors of suicidality three months after admission were: suicidality at baseline, not having a diagnosis of psychotic disorder and being unemployed. Predictors of hostility were: hostility at baseline, not having a psychotic disorder, living alone, and having been hospitalized previously. Conclusions After involuntary hospital admission, the number of patients with significant levels of suicidality and hostility decreases substantially over time, and very few patients show consistently moderate or higher levels of these symptoms. In patients with psychotic disorders these symptoms are more likely to improve. Social factors such as unemployment and isolation could hamper suicidality and hostility reduction and may be targeted in interventions to reduce risk in involuntarily admitted patients