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The SF-36 Health Survey is the most widely used self-report measure of functional health. It is commonly used in both randomized controlled trials (RCT) and non-controlled evaluation of medical or other health services. However, determining a clinically significant change in SF-36 outcomes from pre-to-post-intervention, in contrast to statistically(More)
Clinicians can use data to improve daily clinical practice. This paper offers eight principles for using data to support improvement in busy clinical settings: 1) seek usefulness, not perfection, in the measurement; 2) use a balanced set of process, outcome, and cost measures; 3) keep measurement simple (think big, but start small); 4) use qualitative and(More)
Understanding the barriers to obtaining care that the population of people age 80 and older (80+) experiences is one of the first steps toward developing organizational and clinical strategies aimed at improving care. This article reviews the data from the 80+ Project's survey to assess the prevalence of barriers to care and identify the characteristics(More)
We have witnessed the separation of the care for an individual patient and the concern for the health of a population. As we anticipate the twenty-first century, we see the wisdom of reconnecting these concerns. The knowledge and skills that we will address can help bridge the gap. First, we offer background to seminal work during the twentieth century that(More)
This study demonstrates many of the important features and challenges of improving hospital care. The unique confluence of software technology advances and increasingly complex clinical needs have made possible a redesign of the process by which discharge documentation is generated and disseminated. Using knowledge of the patients' experience of hospital(More)
PURPOSE To provide guidance on using measurement to support the conduct of local quality improvement projects that will strengthen the evaluation of results and increase their potential for publication. TARGET GROUP Individuals leading quality improvement efforts who wish to enhance their use of measurement. PROCEDURES TO PROMOTE GOOD MEASUREMENT Eleven(More)
BACKGROUND Evidence that hand hygiene (HH) reduces healthcare-associated infections has been available for almost two centuries. Yet HH compliance among healthcare professionals continues to be low, and most efforts to improve it have failed. OBJECTIVE To improve healthcare workers' HH, and reduce healthcare-associated infections. DESIGN 3-year(More)
In 1998, the Veterans Health Administration invested in the creation of the Veterans Administration National Quality Scholars Fellowship Program (VAQS) to train physicians in new ways to improve the quality of health care. We describe the curriculum for this program and the lessons learned from our experience to date. The VAQS Fellowship program has(More)
The recent pressures on clinical medicine such as the attention to medical error and the challenges of interdisciplinary care have also exerted pressure on health professions education. Educators must now gauge how to redesign education systems to adapt quickly to these disruptions. Sometimes disruptions can be self-inflicted, such as the VA National(More)