ABSTRACT
CASE MANAGEMENT The patient’s primary care physician has placed the patient on beta-blockers. Prophylactic antibiotics (second generation cephalosporin) are ordered to be given within 1 hour of surgery. Pneumatic compression stockings are ordered for placement in the holding area. Unfractionated heparin (5,000 units subcutaneously) is ordered for 2 hours before start of the operation. The patient’s body hair is removed with a clipper. Efforts are made to keep the patient normothermic during and after surgery. Prophylactic antibiotics are not continued after surgery. Final pathology documents a T3N1M0 adenocarcinoma. The patient is referred to a medical oncologist for consideration of adjuvant chemotherapy. For the first time in its history, the United States is at an impasse in healthcare. Rising healthcare costs, an aging population, and a growing number of uninsured Americans are causing concern among payers and lawmakers. These concerns have led to a largescale effort to assess and improve the quality of healthcare delivered to Americans. A major impetus for quality improvement was the realization that continuing to increase healthcare expenditure was not feasible. In 2007, the United States spent approximately 16% of its gross domestic product, or $2.3 trillion on healthcare, with projections forecasting a rise to 20% of GDP by 2016.(1) While these numbers far exceed what other countries spend on healthcare, they do not ensure that Americans receive better healthcare than other countries. In fact, with over 46 million people who are uninsured, and an infant mortality that is ranked 37th in the world, Americans are arguably not getting the most value out of their healthcare dollar.(2) The focus on quality in healthcare is a reality that current and future physicians will have to acknowledge, as transparency via public reporting of physician performance is likely in the near future. Currently, most efforts remain at the hospital level. In this chapter, we explore the concept of quality, the various methodologies of quality improvement (including the use of performance measures), and examine some of the quality improvement efforts that are currently ongoing.
