quality in allied health care: is there a place for ... · saravana kumar. centre for allied health...

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

Centre for Allied Health Evidence

What is Quality?

• Considered since the 60’s• Multi-dimensional concept• Constructs of quality depend on

individual stakeholder’s perspectives

Centre for Allied Health Evidence

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

Centre for Allied Health Evidence

Dimensions of Quality

Structure Process

Outcome

Donabedian 1966

Centre for Allied Health Evidence

Components of Health Care Quality

Safety Effectiveness

Patient centerednessTimeliness

Efficient Equitable

IoM 2001

Centre for Allied Health Evidence

The question!!!!

• Is all health care, quality health care?

Centre for Allied Health Evidence

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

Centre for Allied Health Evidence

Quality monitoring

Structure Process

Outcome

Clinical guidelines

Influencing process,

improves outcomes

Accreditation guidelines

Donabedian 1966

Centre for Allied Health Evidence

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

Centre for Allied Health Evidence

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

Centre for Allied Health Evidence

Barriers to uptake

• Key barrier to uptake– Medical vs. allied health model

Centre for Allied Health Evidence

Medical vs. allied health model

Centre for Allied Health Evidence

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

Centre for Allied Health Evidence

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

Centre for Allied Health Evidence

Acknowledgment

• Assoc. Prof. Karen Grimmer, School of Health Sciences, University of South Australia

• Mr. Shaun Larkin, HCF Australia