Lecture notes - Lecture -Quality of care delivery The importance of system changes in care delivery

10 important questions on Lecture notes - Lecture -Quality of care delivery The importance of system changes in care delivery

What is the main shift we need to do in health care systems in order to provide high quality care?

Shift from acute to chronic care

current systems are designed to address acute health problems (fragmented and reactive = care is provided when pt already experience problems)

What is the difference between acute VS chronic care roles for professionals as well as role of patients?

Bij chronic care role of patients => shared expertise

How can we improve quality of care by changing the system? What kind of changes?

Institute of medicine: More focus on changing the system instead of changing the people with the diseases within the system

Interventions indelen:
  1. behavior of health care professionals -> continuous medical education (increases providing evidence based medicine during practice)
  2. patient -> increasing knowledge and self-management
  3. design of health care practice -> reorganize practices including for example nurses with new responsibilities
  4. reorganise structure of care -> planed visits or follow-up
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What are the results of changing system interventions (4 delen)

In general On the whole it does improve the quality but NO single intervention seem to make a major difference of improvement on care quality


self-management seem to be necessary but not sufficient for improvement outcomes

What is the chronic care model (CCM)

Reorganization from system from a more fragmented reactive into a more proactive and integrated system


conclusion: all these levels need to change in order to improve quality and pt outcome

GOOD OUTCOMES AT THE BOTTOM RESULT FROM PRODUCTIVE INTERACTIONS BETWEEN HEALTH CARE PROFESSIONALS AND PTS

Why is Self-management support in the chronic care model in between health systems and community?

Because many programs who provided and support  self-management are also provided within community (peer support group)

self-management support = how we help patients live with their conditions

Why is a productive interaction between informed activated patient and prepared practice team essential for good chronic illnesses care?

More effected in meeting the needs of patients

improved patient outcome -> high quality care

interaction between the 2 = The hart of patient centered care delivery


What characterizes have an informed activated patient?

  • Motivation
  • information skills
  • and confidence


necessary of effectively make decisions about their health and mange it

How can you recognize productive interactions between informed activated patient and prepared proactive practice team?

Treatment should be tailored to the needs of patients and this is the essence of this productive interaction

What is 'decision support'?


what is the best care and how do we make it happen every time >
patients can understand the principles behind care and understand why a certain treatment is advised

Goal: promote clinical care that is consistent with scientific evidence and patient preferences

  • EBM guidelines into daily practice
  • integrate specialist expertise and primary care
  • use proven provider education methods
  • share guidelines and info with patients

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