MA PCMH Eval Week: Ann Lawthers on Triangulation Using Mixed Methods Appeals to Diverse Stakeholder Interests

Blog post to AEA365, a blog sponsored by the American Evaluation Association (AEA) dedicated to highlighting Hot Tips, Cool Tricks, Rad Resources, and Lessons Learned for evaluators. The American Evaluation Association is an international professional association of evaluators devoted to the application and exploration of program evaluation, personnel evaluation, technology, and many other forms of evaluation. Evaluation involves assessing the strengths and weaknesses of programs, policies, personnel, products, and organizations to improve their effectiveness. This blog post was posted to AEA365 during a week of posts featuring the team at the University of Massachusetts Medical School that helped to evaluate the Massachusetts Patient-Centered Medical Home Initiative

MA PCMH Eval Week: Ann Lawthers, Sai Cherala, and Judy Steinberg on How You Define Success Influences Your Findings

Blog post to AEA365, a blog sponsored by the American Evaluation Association (AEA) dedicated to highlighting Hot Tips, Cool Tricks, Rad Resources, and Lessons Learned for evaluators. The American Evaluation Association is an international professional association of evaluators devoted to the application and exploration of program evaluation, personnel evaluation, technology, and many other forms of evaluation. Evaluation involves assessing the strengths and weaknesses of programs, policies, personnel, products, and organizations to improve their effectiveness. This blog post was posted to AEA365 during a week of posts featuring the team at the University of Massachusetts Medical School that helped to evaluate the Massachusetts Patient-Centered Medical Home Initiative

Implementing Outcome-Based Quality Measures Using the MDS-HC

Data can be used to develop outcome-based measures to ensure the quality of home and community-based services (HCBS). Outcome-based measures are an essential but often missing puzzle piece in assuring HCBS quality, and promoting advanced payment models to include HCBS. The MDS-HC, or the Minimum Data Set Home Care, is a tool to help identify the needs of and services for older adults and people with disabilities who live in the community. Many validated outcome-based measures developed by interRAI may be constructed from the data collected in Massachusetts through the Long Term Services and Supports (LTSS) Policy Lab, a resource in partnership with Massachusetts state agencies to aid executive-level decision-makers in program planning, policy evaluation and fiscal forecasting in the LTSS arena

Rethinking quality in the context of persons with disability

OBJECTIVE: To review the current health services literature related to quality of care for persons with disabilities and to highlight the need for a unique framework for conceptualizing quality and patient safety issues for this population. DESIGN: Drawing on quality measurement theory, we formulate a multi-dimensional model of quality of care for persons with disability. This model is then used to identify and summarize findings from existing health services research that relate to the quality, of care for persons with disability. STUDY SELECTION: We searched MEDLINE and other databases for primary research and review articles containing the phrases \u27quality of care\u27, \u27patient safety\u27, \u27access\u27, \u27patient experience\u27, and \u27coordination of care\u27 in conjunction with the words \u27disability\u27 or \u27impairment\u27. RESULTS: A review of health services research suggests several potential issues in the areas of clinical quality, access, client experience, and coordination. Physical barriers, transportation, communication difficulties, and client and provider attitudes present barriers to receiving appropriate client-centered care. Communication difficulties between provider and client may increase risk for accidental injury and decrease the quality of the client experience. Frequent contact with the health care system and the complexity of an individual\u27s situation also increase the risk of accidental injury. Coordination, the \u27lubricant\u27 that facilitates links for all areas of quality for a person with disability, presents the most significant opportunity for improvement, because multiple medical and social providers are typically involved in the care of individuals with disabling conditions. CONCLUSION: Health care providers need to embrace a multi-disciplinary approach to quality to meet the needs of persons with disabilities. Funders and purchasers need to provide flexibility in funding to enable a comprehensive primary care approach, while health service researchers need to adopt a broad view of quality to capture issues of importance for persons with disabilities

Processing the tort deterrent signal: A qualitative study

Medical mistakes often are responsible for patient injury and suffering, but not all such mistakes are negligent. In the United States, injured patients have recourse to legal action under the common law. The medical malpractice tort trial system is intended to provide compensation for patients who have been negligently injured and to deter future negligent acts by physicians. The deterrent function of torts largely rests on practitioners' capacity and willingness to internalize, or 'process', the lessons of tort trials. However, physicians' willingness or ability to process the tort deterrent signal, while widely assumed in much contemporary legal writing on medical malpractice, has never been empirically verified. This study is a qualitative assessment of how practicing physicians process the tort deterrent signal. We interviewed a random sample of 47 internists, surgeons, and obstetrician/gynecologists from New York State as part of the Harvard Medical Practice Study. The interviews reveal three notable findings: physicians in our sample largely define medical negligence by reference to moral qualities of the practitioner; they claim that lawyers and the legal process of tort trials lack the moral authority to guide medical practice; and finally, while they consequently reject the lessons of lawyer-dominated, confrontational tort trials, they indicate that they would respond more favorably to hospital-based, physician-led, educational quality-control measures. Based on these findings, we identify several potential impediments to the receipt and processing of the tort deterrent signal by individual physicians and we suggest that the interview results support the notion of institutional liability for medical malpractice.medical mistakes malpractice physician attitudes qualitative analysis