329Techniques in QI/PS
Surveys
Surveys are instruments used for a wide variety of research initiatives and have been
shown to be a useful method for gathering data from a large group of people to
assess feelings and attitudes that may otherwise be very challenging to assess. Data
may be applied qualitatively or quantitatively to answer research questions. Surveys
are extremely valuable in assessing patient satisfaction and quality of care, as evi-
denced by validated surveys like the SF-36 health outcomes survey and the Hospital
Consumer Assessment of Healthcare Providers and Systems (HCAHPS), among
others. In addition to research questions, surveys may also assess uptake of informa-
tion through pre- and post-intervention questionnaires.
An example includes Pringle et al. (2009), which used surveys to examine safety
reporting practices and perceptions across a variety of hospitals. Using data from
these surveys, they were able to identify which aspects of patient safety needed to
be reinforced and at which facility. Information from surveys then helped to guide
quality improvement changes across a variety of healthcare campuses [ 25 ].
Databases and Data Reporting
Collaborative databases are emerging as an important component of quality
improvement and patient safety initiatives. These databases exist in many forms,
including some federally supported programs, such as the AHRQ, and specialty-
specific organizations, such as the ACS NSQIP (surgery) and the AUA quality reg-
istry (American Urological Association’s AQUA). Physicians contribute data
regarding outcomes and other end points to generate data with statistically impact-
ful numbers of observations, which may otherwise be very difficult or impossible
to achieve. The Centers for Medicaid and Medicare Services (CMS) recognizes a
number of these databases through the Physician Quality Reporting System
(PQRS). Through this system, eligible physicians and/or group practices may be
subject to a reduction in payment for inadequate reporting of data for Medicare
patients [ 26 ].
Large databases and registries including ACS NSQIP and AHRQ may help
determine how rates of surgical complications, infections, or other outcomes
nationally compare with local rates to identify areas for improvement. These
results may drive quality improvement initiatives at the local level [ 5 ]. Results may
also be analyzed to perform retrospective analyses that can identify healthcare
system-wide problems that result in system-wide quality improvement initiatives.
Rowell et al. (2007) described how ACS NSQIP data was used to identify problem
areas at multiple institutions resulting in QI projects that led to significant improve-
ments in patient outcomes [ 27 ].
19 Quality Improvement and Patient Safety