quality in allied health care: is there a place for ... · saravana kumar. centre for allied health...
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Centre for Allied Health Evidence
Quality in Allied Health Care: Is there a place for guidelines?
Saravana Kumar
Centre for Allied Health Evidence
Aims of this research• Identify key elements underpinning
allied health service quality from key stakeholders perspective– Patients– Providers– Funders
• Perception towards guidelines as a tool in assisting quality care and its place in allied health
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What is Quality?
• Considered since the 60’s• Multi-dimensional concept• Constructs of quality depend on
individual stakeholder’s perspectives
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What are guidelines?• Guidelines are
– Tools to assist clinical decision making
– Tools to improve health care – Integral to quality improvement
strategies• Guidelines (& quality movement) in
Allied Health is in its infancy
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Dimensions of Quality
Structure Process
Outcome
Donabedian 1966
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Components of Health Care Quality
Safety Effectiveness
Patient centerednessTimeliness
Efficient Equitable
IoM 2001
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The question!!!!
• Is all health care, quality health care?
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How Hazardous is Health Care? (Leape)How Hazardous is Health Care? (Leape)
100,000
10,000
1,000
100
10
1
Tota
l liv
es lo
st p
er y
ear
DANGEROUS REGULATED ULTRA-SAFE
(>1/1000) (<1/100K)Health Care
Driving
Bungee jumping
Mountain Climbing Chemical
Manufacturing Chartered
Flights
Scheduled Airlines
European RailroadsNuclearPower
1 10 100 1,000 10,000 100,000 1,000,000 10,000,000Number of encounters for each fatality
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Quality monitoring
Structure Process
Outcome
Clinical guidelines
Influencing process,
improves outcomes
Accreditation guidelines
Donabedian 1966
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Methodology• Grounded theory methodology of
qualitative research paradigm• Semi-structured interviews with
– Patients (n=75)– Physiotherapists (n=20)– Funders (n=15)
• Interviews were tape recorded, later transcribed and key themes identified
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Key findings• Patients believed
– All health care should be quality care– Physiotherapists should provide up-to-date,
best treatment• Physiotherapists believed
– They provide quality care– Guidelines helped to provide quality care
• Funders believed– Treatment not based on best evidence should
not be funded
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Barriers to uptake
• Key barrier to uptake– Medical vs. allied health model
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Medical vs. allied health model
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Other barriers to uptake• Lack of proper diagnostic indicators
within the profession• Impractical at times
– Not clinically reflective• Not applicable to all patients
(heterogenous population)• Reduced therapist-patient interaction,
which in itself was part of care• Loss of revenue
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Conclusion• While all stakeholders believed
guidelines improved quality of care, concerns were raised– regarding issues of applicability in
allied health care setting – costing issues – specific model for allied health
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Acknowledgment
• Assoc. Prof. Karen Grimmer, School of Health Sciences, University of South Australia
• Mr. Shaun Larkin, HCF Australia