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By F. Marik. Florida Memorial College.

PART II ORGANIZATION AND MICROSYSTEM This page intentionally left blank CHAPTER 5 THE SEARCH FOR A FEW GOOD INDICATORS Robert C cheap red viagra 200 mg free shipping. Lloyd Increasingly order red viagra 200 mg on-line, healthcare professionals are using Shewhart control charts to analyze the variation that resides within data. Yet, many still struggle with an essential aspect of quality measurement—identifying and developing appropriate indicators to be placed on control charts. Control charts based on inappropriate or poorly developed indicators are of no value; they merely provide chart junk. To obtain good data, therefore, it is necessary to approach its collection in a systematic way. This chapter provides a template and prac- tical recommendations for selecting and developing indicators. Seven milestones in the quality measurement journey are discussed, and recom- mendations for avoiding pitfalls along the way are offered. This chapter also reviews the leading national indicator initiatives and the data expectations related to each initiative. It may seem hard to believe, but there actually was a time when the only group that cared about measuring the efficiency and effectiveness of healthcare services was providers themselves. While providers are more focused than ever on performance meas- urement, they must balance their own measurement efforts against those being demanded by the following: • Purchasers of care (individuals and companies) • Business coalitions (representing companies within defined geo- graphical areas) • Insurance companies interested in structuring contractual agree- ments around quality outcomes • Accrediting organizations (e. This is a fundamental switch from how healthcare data have historically been treated. Prior to the early 1980s, the only way one could obtain data on hospitals or physicians was through the subpoena process. Such data can be obtained from various Internet sites, state data commissions, CMS, Consumer Reports, and various proprietary vendors. The basic theory behind such releases is that they will make providers more accountable for the outcomes they pro- duce, improve quality, and help to contain costs. National Indicator Initiatives Along with the growing interest in reporting healthcare performance data to the public has come a related challenge. Specifically, those who endorse the public release of provider data have quickly realized that the indicators being reported must be 1. Standardized across all providers (common definitions and data col- lection procedures); 2. Produced within reasonable time frames (which has been a widely debated issue); 3.

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The potential space between the rier that prevents leakage of water and other substances into layers is called the pleural cavity purchase red viagra 200 mg with mastercard. Second buy 200 mg red viagra free shipping, it participates in the transport of respi- allows the layers to glide over each other and minimizes ratory gases, water, and solutes. The lungs expand and relax in response to changes in pres- Nitric oxide also regulates smooth muscle tone in the sure relationships (intrapulmonic and intrapleural pressures). Elastic tissue in the bronchioles and alveoli allows the lungs When pulmonary endothelium is injured (eg, by endotoxins to stretch or expand to accommodate incoming air. This abil- or drugs such as bleomycin, an anticancer drug), these func- ity is called compliance. The respiratory center is stimulated orders may be caused by agents that reach the system through primarily by increased CO2 in the fluids of the center. A lesser tract secretions, asthma, and other chronic obstructive pul- stimulus to the respiratory center is decreased oxygen in monary diseases). The cough reflex is especially important edema, acute respiratory distress syndrome) is associated because it helps protect the lungs from foreign particles, air with the release of histamine and other biologically active pollutants, bacteria, and other potentially harmful substances. These mediators often A cough occurs when nerve endings in the respiratory tract cause inflammation and constriction of the airways. Once injured, cellular functions are impaired (eg, decreased mu- Musculoskeletal System cociliary clearance). Common signs and symptoms of respira- tory disorders include cough, increased secretions, mucosal The musculoskeletal system participates in chest expansion congestion, and bronchospasm. Normally, the diaphragm and external inter- treatment may lead to cell necrosis or respiratory failure. The abdominal and internal intercostal muscles are the muscles of expiration. DRUG THERAPY In general, drug therapy is more effective in relieving respira- SUMMARY tory symptoms than in curing the underlying disorders that cause the symptoms. Major drug groups used to treat respi- Overall, normal respiration requires: ratory symptoms are bronchodilating and anti-inflammatory 1. Ventilation, in turn, requires decongestants, antitussives, and cold remedies (see Chap. Adequate diffusion of O2 and CO2 through the alveolar– capillary membrane. Where does the exchange of oxygen and carbon dioxide and pressure differences between gases on each side of occur? What are common signs and symptoms of respiratory dis- orders for which drug therapy is often used?

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