The collaborative method: an effective performance improvement tool for reducing inappropriate admissions.

TMF Health Quality Institute (TMF) is the Medicare quality improvement organization for Texas. Under its contract with the Centers for Medicare and Medicaid Services, an agency of the U.S. Department of Health and Human Services, TMF undertook an initiative to reduce unnecessary Medicare 1-day hospital admissions in Texas. The initiative used the Institute for Healthcare Improvement's collaborative model design for improvement. Hospitals in the collaborative focused on the admission process in combination with education of physicians, utilization managers, and case managers, resulting in a 19% decrease in 1-day stays among participant hospitals and demonstrating that the collaborative model can be used successfully to improve utilization management.

Aluminumoxyhydride: improved synthesis and application as a selective reducing agent.

Aluminumoxyhydride (HAlO) has been obtained by the reaction of aluminum hydride with the siloxane (Me2HSi)2O or the stannoxane (Bu3Sn)2O as an amorphous colorless insoluble powder. The highest-purity product resulted from the reaction of H3Al.NMe3 with (Me2HSi)2O. However, HAlO suspensions in tetrahydrofuran (THF) of sufficient quality for synthetic applications can be prepared from commercially available reagents with only minor precautions. A LiAlH4 solution in THF was treated successively with Me3SiCl and (Me2HSi)2O, followed by heating at 60 degrees C for 20 h. The resulting suspensions are 0.4-0.5 M in active hydride content and selectively reduce aldehydes and ketones to the respective alcohols in the presence of any other common nonprotic functional group.

Quality improvement in nursing homes in Texas: results from a pressure ulcer prevention project.

BACKGROUND: Pressure ulcer prevalence, cost, associated mortality, and potential for litigation are major clinical problems in nursing homes despite guidelines for prevention and treatment. OBJECTIVE: To improve the use of pressure ulcer prevention procedures at nursing homes in Texas through implementation of process of care system changes in collaboration with a state quality improvement organization (QIO). DESIGN: Preintervention and postintervention measurement of performance for process of care quality indicators and of pressure ulcer incidence rates. SETTING: Twenty nursing homes in Texas. PARTICIPANTS: Quality improvement teams at participating nursing homes. MEASUREMENT: Data were abstracted from medical records on performance measures (quality indicators) and pressure ulcer incidence rates between November 2000 and August 2002. Descriptive and inferential statistics were used. INTERVENTIONS: Process of care system changes consisting of tools and education to prevent pressure ulcers were introduced to participating nursing homes. RESULTS: Participating nursing homes showed statistically significant improvement in 8 out of 12 quality indicators. Pressure ulcer incidence rates also decreased, although not quite significantly. Furthermore, facilities with the greatest improvement in quality indicator scores had significantly lower pressure ulcer incidence rates than the facilities with the least improvement in quality indicator scores (S = 131.0, P = .03). This suggests that the interventions positively affected not only the process of care but also led to a decrease in pressure ulcer incidences. CONCLUSIONS: These results show that nursing homes in a collaborative effort with a QIO were able to improve their processes of care. Although significant improvement was noted on most of the quality indicators, opportunity remains for further improvement. Furthermore, these results suggest that implementation of process of care system changes by nursing homes in a collaborative relationship with a QIO may yield improvements in measures of patient outcome (eg, pressure ulcer incidence).