Media Reviews

Lecia A. Albright, Media Editor

PAINReportIt

Diana J. Wilkes, eNursing llc, version 1, 1998, $500.00, CD ROM

Audience: healthcare quality professionals

Key Words: pain assessment, pain management, patient-centered healthcare

PainReportIt is an evidence-based electronic tool used to assess and document pain. This software program allows people with pain to self-report it, using a personal computer with a touch screen or mouse. The program is easy to install, and the clear instructions make it simple for people with pain—even sick patients and people who have little or no computer experience—to follow. This software application empowers the patient to take an active part in his or her own care and has the added advantage of requiring minimal staff time for the completion of pain assessments. This pain assessment tool requires about 15 minutes, the average time it takes a patient to complete a paper questionnaire. The answers are stored in a Microsoft Access database. When all the questions are answered, a summary report of the patient’s pain assessment is available both on screen and in written form. The summary is clear, well organized, and easy to follow.

The program is initiated by clicking on the eNursing PAINReportIt icon. The software includes a tutorial titled “Learn to Use PAINReportIt.” The simple on-screen instructions are easy to follow, and it is recommended that all first-time users, especially novice computer users, thoroughly review this section. Information may be entered either by using a keyboard or by touching the small gray “k” on the on-screen keyboard. The user enters some personal information, including first name, last name, ID number, visit number, gender, height, and weight. The program enables the user to create a unique system for “ID number.”

After the demographic information has been entered into the program, the user begins entering pain data. The first screen, “Pain Assessment Body Image,” permits the user to identify the location of his or her pain by using a special pen (on touch-screen computers) or by holding the left mouse button and moving the cursor to the pain’s location. The program makes it easy to correct mistakes. Following completion of the body-image drawings and other related data, the next three screens require the patient to measure and describe his or her pain using the pain intensity scale of 0–10. The user assesses pain “now” and then enters data representing the “least” and “worst” pain experienced in the previous 24 hours. After describing his or her pain, the patient then describes the “pattern” of the pain. The software provides nine choices for description of the pain’s pattern. The next portion allows the person to match his or her words describing the pain to the pain location identified on the anatomical body image.

The next few screens focus on pain relief and description of past pain. The individual is prompted to describe the interventions that best relieve the pain. In addition, the program allows the individual to identify activities and situations that increase the pain. The final portion of the program requires the individual to identify his or her goal for pain management, listing both an optimal goal and an acceptable goal for pain tolerance. The program includes some final demographic questions that may be useful in comparative studies.

This software program is innovative, well organized, and easy to use. For any healthcare organization with a philosophy that includes patient-centered care, this tool is worth a trial for inclusion in an ongoing pain management program.

Reviewed by J. Deborah Cicero, MPM RN CPHQ CMSC

Information Technology: Benefits Realized for Selected Health Care Functions

United States General Accounting Office, www.gao.gov, 2003, 124 pages

Audience: healthcare quality professionals, healthcare workers

Key Words: outcomes, performance improvement, performance measurement, performance monitoring, process improvement, program evaluation, quality assessment, quality of care, quality tools, quantitative studies, redesign and reengineering, resource utilization, strategic development,  systems.

This is a “must see” government document for anyone who works in healthcare and healthcare quality improvement. The document discusses results of a survey sent to 19 organizations recognized in the healthcare community for their use of information technology (IT). Data on the 14 organizations that responded and had data available to demonstrate cost savings and other benefits were obtained and analyzed. The respondents were 10 private and public healthcare delivery organizations, 3 healthcare insurers, and 1 community data network.

The document, written using a Microsoft PowerPoint slide approach, is extremely easy to follow, well written, and well organized. The objective, scope, and methodology of the study were included, along with a general overview of the participants and benefits of implementing IT. Specific examples of how IT is implemented in each participant’s organization were thoroughly discussed and included information pertaining to organizational structure, description of the IT environment, reported cost and cost-related benefits, and lessons learned. For example, in one medical center’s clinical carearea in 2002, the use of bar coding for patient bracelets, medications, nurse IDs, and charts resulted in the prevention of over 3,000 drug errors, with a value in prevented errors of over $800,000. A 33% reduction in Medicare disallowance of tests ordered was achieved as a result of other IT methods. Reduction of administrative costs, improved customer satisfaction and patient safety, improved productivity, and an overall documentation of outstanding financial savings for the organization were reported by all of the participants. The section “Lessons Learned” is invaluable to anyone who wants to avoid the barriers to IT implementation. I would strongly suggest reviewing this document to gain some insight into the creative options for IT that are being utilized by a variety of healthcare providers to maintain quality of care, be competitive in the field, and enhance delivery of services.

Reviewed by Rebecca Cohen, EdD MS MPA RN CPHQ

National Voluntary Consensus Standards for Hospital Care:  An Initial Performance Measure Set The National Quality Forum, 2003, 90 pages

Audience: healthcare quality and informatics professionals, health plan administrators, healthcare regulators, researchers, and other healthcare professionals interested in quality, measurement, and reporting.

Key Words: consensus-based standards, data measurement, public reporting, quality improvement

The report was published by the National Quality Forum (NQF), a private, not-for-profit membership organization whose mission is to improve healthcare through consensus-based national standards for data measurement and public reporting. NQF performed this work at the direction of the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality.

The substance of the report appears in the first seven pages, and the remaining pages contain appendixes describing processes used to develop the report, glossary, references, and NQF membership information.

The report describes the process that NQF used to develop a set of 39 measures in the priority areas of acute coronary syndrome, heart failure, patient safety, pediatric conditions, pneumonia, pregnancy/childbirth/neonatal conditions, smoking cessation, and surgical complications. The purpose of the measure set is to promote public accountability through the reporting of hospital data, thereby assisting patients and families in making healthcare decisions. Another purpose is to promote quality improvement, establish benchmarking, and facilitate the sharing of best practices among hospitals.

The process included soliciting candidate measures from the field, considering current measure sets, and using expert panels and a consensus process with final vote on measures by NQF board members. NQF also used the following criteria: measures should be reasonable and publicly available, should address high-volume populations, and should be able to be influenced by healthcare providers. NQF criteria also considered ease of data collection.

Development of standardized measure sets for hospital public reporting is a challenge JHQ that NQF has faced; however, although NQF’s work began in 2001 and was published in 2003, the measure set has not been widely adopted. Issues facing adoption of this measure set include disparate measures from varying data sources; inconsistency with measures already collected by many hospitals for regulatory and accreditation compliance; lack of a coordinating body to assist hospitals in data collection, analysis, and reporting; and implementation of the National Quality Initiative. This collaboration was launched in December 2002 by the American Hospital Association with the support of the Joint Commission on Accreditation of Healthcare Organizations and CMS to publicly report 10 quality measures in heart attack, heart failure, and pneumonia care.

Hospitals must prioritize data collection and reporting efforts to ensure that their limited resources are used efficiently and effectively. Hospitals are faced with pressure to report standardized measure sets other than the NQF set, particularly the 10 measures of the National Quality Initiative, including reimbursement incentives effective in 2005 that were part of the recently signed Medicare prescription bill. In the face of such pressure and limited resources, it is debatable what value NQF’s consensus set of measures will have on future hospital public reporting activities.

NQF’s work and the systematic process used to develop the measure set should be commended. This report is valuable because it furthers understanding of issues in defining measures for hospital public reporting and the process used to define such a measure set. The publication will be useful to individuals seeking to understand measure sets for hospital public reporting and issues involved in identifying and reaching consensus on such measure sets.

Reviewed by Jane Miller, MSN RN CPHQ FNAHQ

Help Identify Media for Review JHQ welcomes the opportunity to review various media potentially of benefit to healthcare quality professionals and the people they serve. Reviews are published in every issue of JHQ. To have your product reviewed by a healthcare quality expert, please send a nonreturnable copy to:

Media Editor
Media Reviews
Journal for Healthcare Quality
4700 W. Lake Avenue
Glenview, IL 60025-1485

Lecia A. Albright, CPHQ, is the principal and owner of
LARA Consulting, LLC, located in Fredericksburg, VA.
Her e-mail address is laraconsulting@adelphia.net.

JHQ welcomes the opportunity to review various media that could potentially be of benefit to healthcare quality professionals and the people they serve. Reviews are published in every issue of JHQ.

To have your product reviewed by a healthcare quality expert, please send a nonreturnable copy to Media Editor
Media Reviews
Journal for Healthcare Quality
4700 W. Lake Avenue
Glenview, IL 60025-1485

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