| Contributors | vii |
| Foreword to the First Edition | ix |
| Foreword to the Second Edition | xi |
| Preface | xiii |
| Acknowledgments | xv |
| Chapter 1 | The Rationale for Quality Improvement in Health Care | 1 |
| Introduction | 1 |
| Changing Health Care Environment | 2 |
| Growth of QI in Health Care | 4 |
| Transition to Integrated Health Care Delivery Systems | 7 |
| Delicate Balance Between Quality and Access | 8 |
| Next Level: Systemwide | 10 |
| Discussion Points | 10 |
| Chapter 2 | Group Processes in Health Care Quality Improvement | 13 |
| Introduction | 13 |
| Teamwork Concepts | 14 |
| Use of Teams in Organizations | 17 |
| Group Process Techniques | 27 |
| Special Situations: Team-Building Approaches | 35 |
| Teamwork: The Key to Higher Quality | 39 |
| Discussion Points | 40 |
| Chapter 3 | Process Orientation in Health Care | 43 |
| Introduction | 43 |
| Process-Analysis Tools | 45 |
| Failure Mode and Effects Analysis--Prospective Process Review | 84 |
| Root Cause Analysis--Retropective Process Review | 88 |
| Continuous QI--Concurrent Process Review | 89 |
| Relationship of Quality Assurance Approaches | 90 |
| Data Requirements in Quality | 91 |
| Discussion Points | 99 |
| Chapter 4 | Statistical Process Control: Basic Principles | 103 |
| Introduction | 103 |
| Data Analysis Models | 103 |
| Process Problems and Statistical Process Control | 106 |
| Statistical Basis of SPC | 109 |
| Conclusion | 122 |
| Discussion Points | 122 |
| Appendix 4.A | 124 |
| Chapter 5 | Statistical Process Control Approaches: Basic Theory and Use of Control Charts | 127 |
| Introduction | 127 |
| Overview of Data Types | 127 |
| Charts for Categorical Attributes | 128 |
| Charts for Counts Attributes | 135 |
| Analysis of Variables Data | 144 |
| Runs Testing in Control Charts | 169 |
| The Power of Control Charts | 170 |
| Discussion Points | 170 |
| Appendix 5.A | 172 |
| Chapter 6 | Advanced Statistical Process Control | 173 |
| Introduction | 173 |
| Using the Control Chart Selection Diagram | 173 |
| Discussion Points | 237 |
| Chapter 7 | Advanced Statistical Applications in Continuous Quality Improvement | 239 |
| Introduction | 239 |
| Discrete Contributions | 239 |
| Continuous Distributions | 242 |
| Statistical Inference | 248 |
| ANOVA | 249 |
| Regression Analysis | 262 |
| Analysis of Means | 275 |
| Design of Experiments | 282 |
| Sources of Data for QI | 287 |
| Discussion Points | 292 |
| Chapter 8 | Clinical Processes: Clinical Practice Guidelines | 295 |
| Introduction | 295 |
| History of Clinical Practice Guidelines in Health Care | 295 |
| Use of CPGs in Health Care | 297 |
| Creation of CPGs | 302 |
| Discussion Points | 317 |
| Chapter 9 | Strategies for Implementing Quality Improvement | 321 |
| Introduction | 321 |
| Deming's 14 Principles Applied to Health Care | 321 |
| Approaches to Implementation | 337 |
| Phases of Organizational Change | 337 |
| Institutionalization of Change | 353 |
| Balanced Scorecard Approach to QI | 354 |
| QI Implementation in Complex Organizations | 362 |
| Discussion Points | 363 |
| Chapter 10 | Making Continuous Quality Improvement Work: Care Management | 365 |
| Introduction | 365 |
| Care Management: A Contemporary Approach | 366 |
| Care Management: Theoretical Framework | 367 |
| Key Elements of a Care Management Program | 369 |
| Development of a Care Management Program | 374 |
| Financial Analysis of Care Management Programs | 398 |
| Provider Involvement in Care Management | 414 |
| Partnerships Within the Industry | 416 |
| Future of Care Management | 419 |
| Discussion Points | 420 |
| Appendix 10.A | Quality Improvement and Health Statistics Data Sources | 425 |
| Chapter 11 | Legal and Regulatory Issues in Quality Improvement | 429 |
| Introduction | 429 |
| Federal Legislation and Regulation | 430 |
| The NCQA | 437 |
| Utilization Review Accreditation Commission | 445 |
| Joint Commission on Accreditation of Healthcare Organizations | 447 |
| Foundation for Accountability | 449 |
| Malcolm Baldrige National Quality Award | 452 |
| International Organization for Standardization 9000 | 454 |
| QI and Reducing Risk | 458 |
| Regulatory Agencies and the Growth of QI in Health Care | 459 |
| Discussion Points | 459 |
| Appendix 11.A | QISMC Domain 1 | 463 |
| Appendix 11.B | QISMC Domain 2 | 491 |
| Appendix 11.C | QISMC Domain 3 | 507 |
| Appendix 11.D | QISMC Domain 4 | 537 |
| Chapter 12 | The Future of Continuous Quality Improvement in Health Care | 541 |
| Introduction | 541 |
| Quality Milestone 1 | Improved Information Management | 542 |
| Quality Milestone 2 | Health Care System Integration | 548 |
| Quality Milestone 3 | Consumerism | 549 |
| Quality Milestone 4 | Education | 551 |
| Quality Milestone 5 | Federal and State Government Programs Emphasis on Quality | 552 |
| Quality Milestone 6 | Adoption of the Quality Philosophy | 554 |
| QI Is the Answer | 555 |
| Discussion Points | 556 |
| Glossary | 563 |
| Index | 575 |
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