Daniel van Leeuwen and Robert J. Rosati, Quality NETwork Editors

Featured Reviews

The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP)
www.nccmerp.org

Key Words: IOM priorities, medication errors, NCC MERP, patient safety

NCC MERP, an independent body addressing the interdisciplinary causes and prevention of errors, serves a nationwide audience of colleges,schools, and state associations of medicine, pharmacy, and nursing; national professional associations; managed care organizations; and third-party payers. The site contains a listing of recommendations (e.g., improving accuracy of prescription writing, promoting and standardizing bar coding, and reducing packaging errors). The accuracy in prescription writing contains the unapproved abbreviations now adopted by the Joint Commission on Accreditation of Healthcare Organizations. Although most of the recommendations were adopted between 1996 and 2003, NCC MERP began reviewing and revising some of the older recommendations in 2005. The site provides a link for consumers to report medication errors to the United States  Pharmacopeia or the Food and Drug Administration. This site should be bookmarked by anyone who requires succinct summaries of medication safety recommendations.

Substance Abuse and Mental Health Services Administration State Data
www.nationaloutcomemeasures.samhsa.gov

Key Words: behavioral healthcare, databases,outcomes, substance abuse

The Substance Abuse and Mental Health Services Administration recently launched a new service on its Web site. The goal of the National Outcome Measures is “to achieve a performance environment with true accountability. We are looking at the data we are collecting and asking why we are collecting it. And, we asked how we are using it to manage and measure performance. If we are not using the data collected, we are taking steps to stop collecting it. Our emphasis on a limited number of national outcomes and related national outcome measures is built on a history of extensive dialogue with our colleagues in state mental health and substance abuse service agencies and, most importantly, the
people we serve.” The data focuses on 10 domains, including abstinence from drug use and alcohol abuse or decreased symptoms of mental illness with improved functioning. Four domains focus on resilience and sustaining recovery (e.g., getting and keeping a job or enrolling and staying in school; decreased involvement with the criminal justice system; securing a safe, decent, and stable place to live; and social connectedness to and support from others in the community such as family, friends, co-workers, and classmates).
Two domains examine the treatment process itself, looking at available services and services provided. One measure is increased access to services for both mental health and substance abuse. Another measure is increased retention in services for substance abuse or decreased inpatient hospitalizations for mental health treatment. The final three domains examine the quality of services provided. These include client perception of care, cost-effectiveness, and use of evidenced-based practices in treatment.

The site is still in development. For example, the mental health and substance abuse data section contains only data from Texas about at-risk populations and the shortage of mental health professionals. The section on data sources provides links to National Survey of Substance Abuse Treatment Services, National Survey on Drug Use and Health,
Treatment Episode Data Set, Substance Abuse, Prevention, and Treatment Block Grant, Health Professional Shortage Areas, and the Center for Mental Health Statistics Uniform Reporting System.

Track this site over time to monitor the development of national measures and national benchmarks. We will.

The United States Pharmacopeial Convention, Inc.
www.usp.org

Key Words: IOM priorities, medication errors, medication therapy, patient safety

The United States Pharmacopeia (USP) is the official public standards-setting authority for all prescription and over-the-counter medicines, dietary supplements, and other healthcare products manufactured and sold in the United States. USP sets standards for the quality of these products and works with healthcare providers to help them reach the standards. An independent, science-based public health organization, USP operates two programs to promote safer care of patients who take medications and stay in hospitals. The Medication Errors Reporting Program allows healthcare professionals to report medication errors directly to USP. MEDMARX, an Internetbased medication error and adverse drug reaction
reporting program, is designed for use in hospitals and health systems. The United States Pharmacopeia–National Formulary (USP–NF) is a book of public pharmacopeial standards. It contains standards for medicines, dosage forms, drug substances, medical devices, and dietary supplements. USP–NF is available in English in print, online, and CD formats. The site contains a downloadable pdf catalogue of standards and instructions for reading the standards. The site is fairly dry, but medication safety aficionados will find it informative.

Virtual Toolbox for Quality Pharmacy Practice
www.pharmacytoolbox.org/main.cfm

Key Words: medication therapy, QI toolbox This site enables pharmacy operators to view and create their own quality practice programs based on actual programs currently in use in community pharmacy. The site requires registration and password for entry. The step-by-step course begins with Quality Program Principles: three simple, concise pages on continuous quality improvement readable in a few minutes. The Sample Program section
links to 10 different downloadable, Microsoft Word–format quality improvement program descriptions from a variety of pharmacy types (huge chain, small stand-alone, one with robotics). The Build Your Own Program section provides a quick demonstration of their building process and then the very detailed walk-through and flow-charting of all dispensing and management processes. This site is highly recommended not just to pharmacists
but to anyone interested in modeling an exciting, user-friendly, meaningful course to build a quality clinical program.

Reviewed by Daniel van Leeuwen, MPH RN CPHQ CHE

Help Identify and Review Sites The JHQ team invites you to help identify and review Web sites. A review consists of the name of the site or sponsoring organization, a URL reference, key words, the intent of the site, and comments about ease of navigation, value, pertinence to the healthcare quality professional, timeliness, and cost, if any. Please forward—via e-mail—questions, sites for review, or, better yet, sites with reviews, to Quality NETwork co-editor Robert Rosati at robert.rosati@vnsny.org.

Robert J. Rosati, PhD, is director of outcomes analysis and research at the Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY. His e-mail address is robert.rosati@vnsny.org.

Daniel van Leeuwen, MPH RN CPHQ CHE, is director of professional and community standards at St. Peter’s Addiction Recovery Center in Guilderland, NY. 

Wisconsin Collaborative for Healthcare Quality
http://www.wchq.org

Key Words: benchmarking, collaboration, performance

Wisconsin Collaborative for Healthcare Quality, Inc., a nonprofit organization established in 2003, promotes healthcare quality improvement. Some of its activities include developing and implementing shared definitions of healthcare quality measures and standards; promoting the development, effectiveness, and quality of healthcare for patients and communities in the state of Wisconsin through uniform measurement; and publicly reporting outcomes and sharing best practices. Member organizations agree to openly share comparative quality performance data among members. They also agree to independent third-party auditing and data validation with publicly reported comparative quality-performance data.
This new and interactive Web-based program, the 2005 Performance and Progress Report, contains reports easily accessible to anyone who wants to learn more about the quality of healthcare in Wisconsin. The interactive function allows one to view the performance of the members’ healthcare organizations. Maneuvering through the reports section is easy, but opening the measurement reports involves a slight delay. The reporting section can be sorted by one of nine areas such as access, critical care, or patient satisfaction. The reports can also be viewed by “aims of improvement” (e.g., safety, timeliness, patient-centeredness, effectiveness) as identified by the Institute of Medicine. This site provides useful comparative data, so I added it to my list of favorites.

Reviewed by Toni L. Layer, MHCA RN CPHQ

Getting the Sample Size Right: A Brief Introduction to Power Analysis

http://www.jeremymiles.co.uk/misc/power/

Key Words: data analysis, research, statistical analysis

The name of this site accurately describes it. A lecturer in biostatistics in the Department of Health Sciences, University of York, sponsors this site. The sponsor, an author with publications as recent as 2001 listed, makes the case for understanding statistical power in designing research projects and interpreting research results. The explanation of effect, power, and sample size is clear. The writing style, however, is uneven, alternating between explanations that a novice (such as this reviewer) could grasp and information beyond this level. The sponsor succeeded in conveying enough information to prompt a search of related sites, which resulted in the location of another site that explained statistical power more clearly: Important Factors in Designing Statistical Power Analysis Studies (http://cc.uoregon.edu/cnews/summer2000/statpower.html). Both sites underscore the need to consider this complex and often overlooked concept in study design. With a set of data in hand, experimenting with a statistical calculator (see the following review of http://calculators.stat.ucla.edu/powercalc/) to determine power proved easy and interesting. The sponsor acknowledges limitations in some of the writings on the site and provides links to his publications and contact information. I do not recommend bookmarking this site. It could not be determined when the site was last updated.

Reviewed by Michele Horvath, MSN RN CPHQ

Association for Benchmarking Health Care™

http://www.abhc.org/

Key Words: benchmarking studies

The Association for Benchmarking Health Care (ABHC) is a service of the Benchmarking Network, Inc. The purpose, as defined on the site, “is to identify ‘best in class’ business processes, which, when implemented, will lead member companies to exceptional performance as perceived by their customers.” Each link on this page clearly identifies specific objectives, which focus on benchmarking studies and, through cooperative agreements, obtain best-in-class information. Remember that best-in-class benchmarks transcend specific industries to describe practices that will result in top performance across multiple sectors.
Currently, membership in ABHC is free; however, if the site offers studies to the membership, then costs are divided. It can’t be determined from the site how this cost structure will be implemented. The site is heavily market driven and contains frequent pop-up boxes that allow viewers to sign up for free newsletters and membership. Readers who are looking for an immediate source of benchmark comparisons for existing measures will not find it on this site. Rather, the site is geared toward organizations that want to actively conduct research on processes in order to identify best practices on a particular topic, such as human resource management, and then compare these processes with those followed in other industries.
Links on this site to roundtables or consortiums are not online discussions but specific meetings with industry groups (not necessarily healthcare groups). Therefore, networking will involve looking at practices and processes across industry for best-in-class information.
At this time, links offer little content but are similarly structured. Each key study area includes mission, objectives, membership, benefits, and type of research studies. Each link repeats the roundtables and consortiums. Unless one is actively involved in a research study, no traditional benchmarks are listed.

Reviewed by Susan V. White, PhD RN CPHQ FNAHQ

Statistical Quality Control Tools

http://deming.eng.clemson.edu/pub/tutorials/qctools/homepg.htm

Key Words: data analysis, data collection, data management

This Clemson University site provides explanations and tutorials for the tools used in quality control systems. These tools include checksheets, flow charts, histograms, Pareto charts, cause-and-effect diagrams, scatter diagrams, and control charts. Each tutorial contains an overview, instructions, examples, related software available on the market, and other sources and links. I believe this site would be useful for new staff and as material for quality improvement staff to share with team members.

Online Statistical Calculators

http://calculators.stat.ucla.edu/

Key Words: data analysis, data collection, data management

This site from the University of California, Los Angeles, provides links to statistical software and tools to accomplish specific calculations (e.g., random permutation tool, two sample test calculators, correlation and regression software, sample size software, statistical tables, plots, random numbers, a parallel box plot maker, a Q-Q Plot maker, a histogram maker, and many others). The ability to access free consulting is very cool. Bookmark this page.

Smith's Statistical Package

http://www.economics.pomona.edu/StatSite/SSP.html

Key Words: data analysis, data collection, data management

Smith’s Statistical Package is a very user-friendly statistics program. The program is saved as a self-extracting condensed file that will open automatically. Try it!

Reviewed by Daniel van Leeuwen, MPH RN CPHQ CHE

Help Identify and Review Sites

The JHQ team invites you to help identify and review Web sites. A review consists of the name of the site or sponsoring organization, a URL reference, the intent of the site, and comments about ease of navigation, value, pertinence to the quality professional, timeliness, and cost, if any.

Please forward—via e-mail—questions, sites for review, or, better yet, sites with reviews, to one of the editors listed below.

Daniel van Leeuwen, MPH RN CPHQ CHE, is director of professional and community standards at St. Peter’s Addiction Recovery Center in Guilderland, NY. His e-mail address is dvanleeu@nycap.rr.com.

Robert J. Rosati, PhD, is director of outcomes analysis and research at the Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY. His e-mail address is robert.rosati@vnsny.org.

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