Date of Award

2016

Embargo Period

8-1-2024

Document Type

Dissertation - MUSC Only

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Jillian B. Harvey

Third Advisor

Michael Kelley

Fourth Advisor

Lisa K. Saladin

Abstract

Quality improvement initiatives have been a focus for many healthcare providers, hospitals, and policy makers. These initiatives have become a daily routine and obligation within the healthcare profession, and have led to increased efforts to identify and measure adverse events. Tracking adverse event trends can help identify if and where preventable measures can be taken to avoid future complications. Benchmarking is a quality improvement tool that can be an effective method for improving clinical management, and allows organizations to compare outcomes against those of other organizations. This study assessed whether adverse events are stable enough to be used as a quality indicator and if reliable benchmarks can be made. This project also examined how many observations would be necessary to identify a stable indicator and how a sample practice’s adverse event rates compare to other practices performing thoracenteses. Using archival data from the Healthcare Cost and Utilization Project (HCUP) database in addition to electronic medical record (EMR) data collected by Charlotte Radiology, adults with pleural effusions who underwent a thoracentesis were evaluated. The pneumothorax rates were calculated and cross-referenced to evaluate trends, and benchmarks. The study concluded that adverse event rates are too unstable to be used as a quality marker due to random variation, and therefore, benchmarks cannot be determined based on adverse event rates alone. However, facilities that perform approximately 150 thoracenteses per year can look at their pneumothorax rates over time and evaluate trends. For facilities performing over 150 thoracenteses per year, facilities performing over a 4.5% pneumothorax rate should perform an in-depth analysis in order to determine the etiology for higher pneumothorax rates.

Rights

All rights reserved. Copyright is held by the author.

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