Using a summary measure for multiple quality indicators in primary care: the Summary QUality InDex (SQUID)

BACKGROUND: Assessing the quality of primary care is becoming a priority in national healthcare agendas. Audit and feedback on healthcare quality performance indicators can help improve the quality of care provided. In some instances, fewer numbers of more comprehensive indicators may be preferable. This paper describes the use of the Summary Quality Index (SQUID) in tracking quality of care among patients and primary care practices that use an electronic medical record (EMR). All practices are part of the Practice Partner Research Network, representing over 100 ambulatory care practices throughout the United States. METHODS: The SQUID is comprised of 36 process and outcome measures, all of which are obtained from the EMR. This paper describes algorithms for the SQUID calculations, various statistical properties, and use of the SQUID within the context of a multi-practice quality improvement (QI) project. RESULTS: At any given time point, the patient-level SQUID reflects the proportion of recommended care received, while the practice-level SQUID reflects the average proportion of recommended care received by that practice's patients. Using quarterly reports, practice- and patient-level SQUIDs are provided routinely to practices within the network. The SQUID is responsive, exhibiting highly significant (p < 0.0001) increases during a major QI initiative, and its internal consistency is excellent (Cronbach's alpha = 0.93). Feedback from physicians has been extremely positive, providing a high degree of face validity. CONCLUSION: The SQUID algorithm is feasible and straightforward, and provides a useful QI tool. Its statistical properties and clear interpretation make it appealing to providers, health plans, and researchers

Quality improvement in small office settings: an examination of successful practices

<p>Abstract</p> <p>Background</p> <p>Physicians in small to moderate primary care practices in the United States (U.S.) (<25 physicians) face unique challenges in implementing quality improvement (QI) initiatives, including limited resources, small staffs, and inadequate information technology systems 23,36. This qualitative study sought to identify and understand the characteristics and organizational cultures of physicians working in smaller practices who are actively engaged in measurement and quality improvement initiatives.</p> <p>Methods</p> <p>We undertook a qualitative study, based on semi-structured, open-ended interviews conducted with practices (N = 39) that used performance data to drive quality improvement activities.</p> <p>Results</p> <p>Physicians indicated that benefits to performing measurement and QI included greater practice efficiency, patient and staff retention, and higher staff and clinician satisfaction with practice. Internal facilitators included the designation of a practice champion, cooperation of other physicians and staff, and the involvement of practice leaders. Time constraints, cost of activities, problems with information management and or technology, lack of motivated staff, and a lack of financial incentives were commonly reported as barriers.</p> <p>Conclusion</p> <p>These findings shed light on how physicians engage in quality improvement activities, and may help raise awareness of and aid in the implementation of future initiatives in small practices more generally.</p

The ‘heritagisation’ of the British seaside resort: The rise of the ‘old penny’ arcade.

Amusement arcades have long been a key component of the British seaside resort. For almost a century, they enjoyed popularity and success and became established as a quintessential feature of the British seaside holiday. However, the advent of home-based video games along with recent gambling legislation has led to a decline of the seaside amusement arcade sector. Arcades gained a reputation as unsavoury places and their appearance and fortunes often mirrored those of the resorts in which they were located. However, over the past decade, a new variant of the seaside amusement arcade has appeared, featuring mechanical machines working on pre-decimal currency. Such ‘old penny arcades’ frequently describe themselves as museums or heritage centres and they offer an experience based on a nostalgic affection for the ‘traditional’ seaside holiday. They have appeared in the context of an increasing interest in the heritage of the British seaside resort and constitute one element of the ‘heritagisation’ of such resorts. This paper argues that such arcades can be important elements of strategies to reposition and rebrand resorts for the heritage tourism market

The Role of Clinical Information Technology in Depression Care Management

We examine the literature on the growing application of clinical information technology in managing depression care and highlight lessons learned from Robert Wood Johnson Foundation’s national program “Depression in Primary Care-Incentives Demonstrations.” Several program sites are implementing depression care registries. Key issues discussed about implementing registries include using a simple yet functional format, designing registries to track multiple conditions versus depression alone (i.e., patient-centric versus disease-centric registries) and avoiding violations of patient privacy with the advent of more advanced information technologies (e.g., web-based formats). Finally, we discuss some implications of clinical information technology for healthcare practices and policy makers.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44097/1/10488_2005_Article_4236.pd

Is it in the Game? Reconsidering play spaces, game definitions, theming and sports videogames

From the very first days of digital gaming, sport-themed videogames have been a constant and ever-popular presence. However, compared with many other genres of games, sports-themed videogames have remained relatively under-research. Using the case of ‘sports videogames’ this paper advocates a critical and located approach to understanding videogames and gameplay. Unlike many existing theorisations of gameplay, such as the ‘magic circle’ (Huizinga 1949 [1938]), which theorise play as a break from ordinary life, this paper argues for a consideration of play as a continuation of ‘the control of the established order’ (Lefebvre (1991 [1974]: 383). It argues that many videogames, and in particular sports videogames, can be understood as ‘themed’ spaces; which share similarities to other themed locations, such as fast-food restaurants and theme parks. These are ‘non-places’ (Augé 1995) themed to provide a sense of individuality, control and escape in a society that increasingly offers none