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Quality Management In Health Care Delivery HCA 450/550 - Course Syllabus

COLLEGE OF HEALTH AND HUMAN SERVICES

California State University, Long Beach

Health Care Administration Program

HCA 450/550 - Quality Management/Improvement in Health Care Delivery


Semester Spring 2010


Instructor: Rus Billimoria, MD, MPH, CPHQ

E-mail: rbillimo@csulb.edu
Office Hours: Mondays 6 - 7 pm
Phone: (213) 694 1250 ext. 4274


Class Numbers: 8534 (HCA 450) & 11177 (HCA 550)

Class Location: ET 105

Class Meets: January 25 - May 14, 2010

Mondays from 7 PM to 9:45 PM


Additional Contact Information:

HCA Program Administrative Coordinator: Deby McGill, dmcgill@csulb.edu

Tel. 562/985-5694; fax 562/985-5886





Catalog Description

Prerequisites: HCA 402, and 465. (Please refer to details below)

Basic elements of quality improvement and organizational responsibilities related to quality assurance. Data analysis for quality improvement, clinical practice guidelines, and future of healthcare quality.

Letter grade only (A-F). (Lecture)


ADA Accommodation will be provided to any student who requests such, as defined by the ADA act and CSU-LB. Please contact Dr. Billimoria or refer to your student handbook for further information.
Note: This syllabus is subject to change. Should there be any changes; students will be notified in class of the amendments.

 
COURSE PREREQUISITES:


For HCA 450 students: Prior to attending this course students are required to complete the following courses:

  • HCA 402 and

  • HCA 465

For HCA 550 Prerequisites, the following course must be completed:




  • HCA 502

Exemptions for the prerequisites are generally not entertained. However, these may be considered on a case-by-case basis.



COURSE OBJECTIVES
The purpose of this course is to familiarize the student with the concept of Quality and the process of Quality Improvement across the Health Care continuum. This course focuses on the history and evolution of quality, its terms, principles, theories, and practices. The student is introduced to a diverse collection of methods of improving quality, including but not limited to continuous Quality Improvement and Total Quality Management, and to the guidelines for implementing quality management and the continuous quality improvement processes. Additionally , the students will be asked to review the changes that a selected number of health care systems from across America have implemented in order to achieve the Institute of Medicine’s goals to make quality health care more safe, timely, effective, equitable, efficient, and patient-centered.

EXPECTED STUDENT LEARNING OUTCOMES

Upon completion of this course, the student will be able to:




  1. Describe the evolution of the health care systems and Quality Management/Improvement Programs and reflect on its future.




  1. Understand the reasoning and the importance of the requirements for Health Care Quality

Management/Improvement Programs.


  1. Describe the most current Quality Management/Improvement Program principles and techniques for health care in general. This includes the principles of Continuous Quality Improvement, Total Quality Management, and proactive versus reactive Quality Management programs.




  1. Understand the impact of federal and state legislation on Quality Management/Improvement Programs in Health care.




  1. Understand the need for and development of standards for accreditation of health care entities.




  1. Describe the recent impact of consumers on health care Quality Management/Improvement Programs and the development of health plan Report Cards (HEDIS etc.).




  1. Understand the use of data and statistics for an effective Quality Management/Improvement Program.




  1. Understand basic elements of provider credentialing, physician profiling and report cards, risk management and liability issues as they relate to Quality Management/Improvement Programs.




  1. Understand the effect of Patient Safety issues on Quality Management/Improvement systems.




  1. Understand the recent trends in Quality Management/Improvement and Continuous Quality and Continuity of Care issues in Assisted Living, Skilled Nursing, and Long Term Care.




  1. Health Care Report Cards, Pay For Performance and other strategies used for improving the quality of health care




  1. Demonstrate understanding of the principles in the development of a Quality Management/Improvement Program and Strategies for a health care entity via successful completion of class project.

 

REQUIRED TEXTS AND ANY OTHER REQUIRED MATERIALS AND INFORMATION.


This course does not prescribe a specific text, since no single text would cover the broad scope of this course. However, the following books and materials are strongly recommended for review:
HCA 450:


  1. Introduction to Quality Health Care Management, Patrice Spath, 2009, AUPHA, Health Administration Press, Chicago, Illinois




  1. Continuous Quality Improvement in Healthcare, Curtis McLaughlin and Arnold Kaluzy, 3rd Edition, 2006, Jones and Bartlett Publishers, Inc. Sudbury, Massachusetts (Optional for reference)


HCA 550:


  1. Continuous Quality Improvement in Healthcare, Curtis McLaughlin and Arnold Kaluzy, 3rd Edition, 2006, Jones and Bartlett Publishers, Inc. Sudbury, Massachusetts




  1. The HealthCare Quality Handbook- Elizabeth Ransom, Maulik Joshi, David Nash and Scott Ransom, 2nd Edition 2008, Health Administration Press, Chicago Illinois (Optional)




  1. The Quality Handbook for Health Care Organizations: A Manager's Guide to Tools and Programs by Yosef D. Dlugacz, Alice Greenwood, Andrea Restifo ISBN: 0787969214 Pub. Date: March 2004 Series: J-B AHA Press, #131 (Optional)

Lecture notes and handout materials. All lecture notes will be posted on Beach Board. Students need to print these. Some copies may be available for distribution by the instructor.


TYPES OF ASSIGNMENTS
I Short Essays (20% of overall class Grade for 3 essays over the course of the semester)

To understand the latest trends around Quality Management/Improvement Programs it is necessary to review articles related to health care quality from various sources including professional medical or health care journals. Students will be expected to write short essays on specific prescribed topics (a maximum of two, doubled spaced and typed pages).


Examples of Journals that may be used for writing your essays are as follows:


  1. Journal of the American Medical Association (JAMA) - http://jama.ama-assn.org/

  2. New England Journal of Medicine - http://content.nejm.org/

  3. Annals of Internal Medicine - http://www.annals.org/

  4. Journal of Health Politics, Policy and Law - http://www.jhppl.org/

  5. Journal of HealthCare Quality - http://www.allenpress.com/jhq/

  6. Med Bio World - Hospital & Healthcare Management Journals - http://www.medbioworld.com/

The essays should be well thought out. The following is a suggested format for your essays.




  1. Introduction – Introduce the topic with a brief overview of sources used for the essay.

  2. Ideas or thoughts presented in the essay.

  3. Relevance and importance of the topic being discussed.

  4. Conclusions that may be derived from the essay.

The essays will be graded on a scale of zero – 10 points. Grading will be based on the following criteria:




  1. Introduction- Includes a brief overview of references used to write the.

  2. Clear presentation of the ideas and thoughts

  3. Your analysis of how the article corresponds to current issues and trends in Health Care Quality.

  4. Writing style.

  5. Clarity of presentation, grammar and spelling.

Three short essays will be due in the weeks assigned. Please see agenda on the following pages. Submit one copy to the instructor. The copy will be returned after review and scoring.



II Class Participation (10% of Overall Class Grade)
Active classroom participation is encouraged. Each student will have adequate opportunities to participate in classroom discussions. Students will be provided the opportunity to participate in small projects and pop quizzes to assess participation. Level of participation will contribute towards the overall course grade.
III PROJECT: Quality Management/Improvement Program Development
A major classroom project will be the development of a Quality Management/Improvement Program for a health care entity, to be assigned during the course. Students will form teams and develop a Quality Management/Improvement Program for their assigned entity. The program development will make use of principles and standards presented during the course. Each student within a team must make specific contributions to the program or project development and discussion.
The programs developed will be presented to the class by all members of each team. Each team member presents their specific contributions to the project. Please see course agenda below for timelines. Guest speakers may be present during presentations and will contribute to the discussions.
Grading For “The Quality Management/Improvement Program Development Project": (Constitutes 30% of the overall class grade)
Each student’s contribution towards the team project will be presented in form of a paper not less than three double-spaced type written pages. The paper shall comprise of the following elements:


  1. Introduction to the portion being contributed by the student. (10% of Mid term Grade)

  2. Presentation of the ideas and components the student is responsible for(10% of Mid term Grade)

  3. Discussion on the importance of the student’s contribution towards the team project using the principles and theories discussed in class as well as pertinent literature reviewed by the student. (40% of Mid Term Grade)

  4. Class Presentation by Team (40% of the Mid Term Grade)

IV Final Exam for HCA 450 (Constitutes 30% of the Overall Class Grade)
HCA 450 students will be administered a final exam equivalent to 30% of the overall class grade. The exam will comprise of four questions. Three questions will be essay type discussions from the topics discussed in class during the semester. The fourth question will be a series of short notes on specific topics discussed during the course. Each question will carry 25% of the final exam grade.
For each essay question, the student will be required to use the following format:


  1. Introduction (20% of the question grade)

  2. Factual presentation of the areas asked for in the question. (40% of the question grade)

  3. Brief Discussion of the topic (30% of the question grade)

  4. Conclusion. (10% of the question grade)

Length of the written answer is left to the discretion of the student. It is important to ensure that the above four points be taken into consideration for the answer.


For the short notes topic the student will be expected to write a short paragraph on each of the topics.
Please see agenda for timelines. The agenda is subject to change.
V Position Paper (HCA 550): Position Paper for HCA 550 only (30% of the overall class grade)
Students may select their own topic related to Health Care Quality Improvement with presentation of information as highlighted in the example below:
Example: Development of a Quality Management/Improvement Program may present organizational and process problems or issues that need to be reviewed and resolved if possible. The position paper will use the Quality Management/Improvement Program development exercise as its base. Develop your view of an idea or a problem related to the program development using professional literature and other resources from within or without the course materials. This position paper must have four major components.


  1. Description of the problem or idea. (20% of the Final Exam Grade)

  2. Description of the significance of the problem or issue arising out of the Quality Management/Improvement Program development. (30% of the Final Exam Grade)

  3. Your position, analysis and proposed solution if applicable. (40% of the Final Exam Grade)

  4. Literature support for your position and analysis. (10% of the Final Exam Grade)

The position paper will need to be written on a maximum of 10 double spaced pages. Your position paper may be presented to the class. Arrangements for your presentation are to be made at least a week prior to the desired date. The oral class presentation of your position paper should be 15 minutes in length, followed by a question & answer session. Grading will be based mainly on the written paper, however, oral presentations will only help enhance the overall final class grade.



AGENDA AND SEQUENCE OF ASSIGNMENTS
Week Objective


Week 1 – January 25 a) Introduction to the course.


b) Literature Review Guidelines.

c) Introduction to Terminologies.

d) Introduction to Health Care Systems.

Week 2 – February 1 a) The evolution of Health Care Quality Management with a

historic perspective.

b) Basic Elements of Quality Improvement



Readings: Review Chapters 1 (Prescribed Text Book)

Chapters 1 & 2 McLaughlin (Optional for 450)

Week 3 – February 8 a) Basic Elements of Quality Improvement continued.

b) The Deming approach to Quality Improvement.

c) Principles of Continuous Quality Improvement (CQI) and

Total Quality Management (TQM).

d) Outcomes needed of Quality



Readings: Chapter 2 (Prescribed ) ,

Chapter 1 (McLaughlin), Lecture Notes and Literature




Essay # 1 – Topic to be announced in class

Week 4 – February 15 a) Principles in developing a Quality Improvement Program

in health care (Part 1).

b) Quality Improvement and the Physician Factor.

c) Organizational Responsibilities in development of a

Quality Improvement Program.



  1. Selection of Team Leaders for the project.

Review: Chapters 1 & 3 (Prescribed Text Book)

Chapter 11 (McLaughlin, Optional), Lecture Notes




Essay # 1 to be submitted in class or electronic

Week 5 – February 22 a) Project on Quality Improvement .

b) Leadership and Quality Improvement Teams

Review: Chapter 7 (Prescribed)

Chapter 6 (McLaughlin), Lecture Notes & Literature


Week 6 – March 1 a) Use of Data for Quality Improvement.

b) Data Mining

c) Process capability and variations (Chapter 4 both books)

d) Tools for Quality

Review: Chapters 3,4 and 5 (Prescribed Text Book)

Chapters 4 & 5 (McLaughlin), Lecture Notes



Essay # 2 --- Topic will be announced in class

Week 7 – March 8 a) Progress Report and Updates on the Quality Improvement

Program development by each team.

b) Tools for Quality Continued

c) Six Sigma and Lean Theories

d) Data Analysis in Quality Management



Review: Chapter 5 (Prescribed Text Book) & Lecture Notes


Essay # 2 to be submitted in class or electronic

Week 8 – March 15 a) Health Plan Report Cards.



  1. Health Employer Data Information Set -2007 (HEDIS).

  2. ORYX systems (JC)


Review: Chapter 3 (Prescribed)

Chapter 2 (McLaughlin)

Lecture Notes & Literature

Week 9 – March 22 MID-TERM EXAM / PRESENTATIONS


Group Presentations of Quality Improvement Projects

Week 10 – March 29 SPRING BREAK




Essay # 3 ---- Topic to be announced in class

Week 11 – April 4 a) Introduction To Government Legislation in Health Care &

Understanding Regulatory Requirements (Guest Lecturer)

Review: Chapter 8 (Prescribed Text Book), Lecture Notes
Essay # 3 to be submitted in class

Week 12 – April 11 a) Health care Quality and Long Term care

b) Small Classroom project


Final Exam Question Paper will be distributed in class

Week 13 – April 18 a) Incentive Programs and improving Health Care Quality



  1. Safety, Leap Frog Initiatives

  2. Review: Chapter 8 (Prescribed Text Book and McLaughlin) & Lecture Notes


Week 14 – April 25 a) Understanding Accreditation

  1. Disease Management Programs.

Review: Chapter 2 (Prescribed)

Chapter 3 (McLaughlin), Lecture Notes

Week 15 – May 3 a) Health Information Technology, Information Management and quality of health care

(Guest Lecture)

Chapter 10 (McLaughlin)

Week 16- May 10 a) Course Summary

b) The Future of Health Care Quality

c) Job opportunities in Quality Improvement

Week 17 – May 17 FINALS WEEK



BASIS FOR ASSIGNING THE COURSE GRADE
This being a double numbered course, university policy requires greater expectations, additional work and different grading scales for graduate students. Due importance will be given to student participation in projects, papers, class work and exams. Letter Grades are assigned from A-F for level of achievement in the course. For final computation of the letter grades, following weights for each course component will be used:

Component HCA 450

Percent of Grade

Component HCA 550

Percent of Grade

Discussion Papers

30%

Discussion Papers

30%

Development of a Quality Management Program Project (Mid Term Exam)

30%

Development of a Quality Management Program Project (Mid Term Exam)

30%

Final Exam

30%

Position Paper

30%

Class Participation

10%

Class Participation

10%

TOTAL

100%




100%

STUDENT RESPONSIBILITIES AND EVALUATION
Attendance

Students are required to attend and to be prepared for each session by reading any assigned or referenced materials. Attendance is expected at each class session. However, if there are compelling circumstances, an absence may be excused. It then becomes the responsibility of the student to bring her/himself up to date in the class material.
Drops

It is the responsibility of the student to file for a drop status if he or she desires. No drops will be signed by the instructor after the third week.
Exams

A traditional grading system is required for evaluation of student performance in this course. There will be one mid-term and one final exam. Exam formats will be developed and announced by the Instructor. No make-up exams will be offered unless the student has made specific arrangements with the instructor prior to the exam.
ADDITIONAL INTERNET RESOURCES:


America’s Health Insurance Plans

www.ahip.org

American College of Medical Quality

www.acmq.org

American Health Information Management Association

www.ahima.org

American Health Information Management Association

http://www.ahima.org/

American Healthcare Association

www.aha.org

American Society for Healthcare Risk Management

www.ashrm.org

American Society For Healthcare Risk Management

http://www.ashrm.org/ashrm/index.jsp

Association for Quality

www.asq.org

association for quality

http://www.asq.org/

California Association for Healthcare Quality

www.cahq.org

California Code of Regulations

http://ccr.oal.ca.gov/

California Department of Corporations

www.corp.ca.gov

California Medical Association

www.cmanet.org

Joint Commission on Accreditation of Healthcare Organizations

www.jcaho.org

Medicare

www.cms.hhs.gov

National Guideline Clearinghouse

www.guideline.gov

National Library of Medicine

www.nlm.nih.gov

National Network of Libraries of Medicine

www.nnlm.gov

Quality Indicator Project

www.qiproject.org

 


CHEATING AND PLAGIARISM


The following is excerpted from the California State University, Long Beach Policy Statement 85-19, dated December 13, 1985.

It is the policy of the faculty and administration to deal effectively with the student who practices cheating or plagiarism. These acts are fundamentally destructive of the process of education and the confident evaluation of a student's mastery over a subject. A University maintains respect and functions successfully within the larger community when its reputation is built on honesty. Similarly, each student benefits in helping to maintain the integrity of the University. This policy, therefore, provides for a variety of faculty actions including those, which may lead to the assignment of a failing grade for a course and for administrative actions, which may lead to dismissal from the University. It is the intent to support the traditional values that students are on their honor to perform their academic duties in an ethical manner.



GENERAL:
The following definitions of cheating and plagiarism shall apply to all work submitted by a student.
DEFINITION OF PLAGIARISM:
Plagiarism is defined as the act of using the ideas or work of another person or persons as if they were ones own, without giving credit to the source. Such an act is not plagiarism if it is ascertained that the ideas were arrived at through independent reasoning or logic or where the thought or idea is common knowledge.
Acknowledge of an original author or source must be made through appropriate references, i.e., quotation marks, footnotes, or commentary. Examples of plagiarism include, but are not limited to, the following: the submission of a work, either in part or in whole, completed by another; failure to give credit for ideas, statements, facts or conclusions with rightfully belong to another; in written work, failure to use quotation marks when quoting directly from another, whether it be a paragraph, a sentence, or even a part thereof; close and lengthy paraphrasing of another writing or paraphrasing should consult the instructor.
Students are cautioned that, in conducting their research, they should prepare their notes by (a) either quoting material exactly (using quotation marks) at the time they take notes from a source; or (b) departing completely from the language used in the source, putting the material into their own words. In this way, when the material is used in the paper or project, the student can avoid plagiarism resulting from verbatim use of notes. Both quoted and paraphrased materials must be given proper citations.
DEFINITION OF CHEATING:
Cheating is defined as the act of obtaining or attempting to obtain or aiding another to obtain academic credit for work by the use of any dishonest, deceptive or fraudulent means.
Examples of cheating during an examination would include, but not be limited to the following: copying, either in part or in wholes, from another test or examination; discussion of answers or ideas relating to the answers on an examination or test unless such discussion is specifically authorized by the instructor; giving or receiving copies of an exam without the permission of the instructor; using or displaying notes; "cheat sheets," or other information or devices inappropriate to the prescribed test conditions, as when the test of competence includes a test of unassisted recall of information, skill, or procedure; allowing someone other than the officially enrolled student to represent the same. Also included is plagiarism, which is defined as altering or interfering with the grading procedures.
It is often appropriate for students to study together or to work in teams on projects. However, such students should be careful to avoid use of unauthorized assistance, and to avoid any implication of cheating, by such means as sitting apart from one another in examinations, presenting the work in a manner which clearly indicates the effort of each individual, or such other method as is appropriate to the particular course.

ACADEMIC ACTION:
One or more of the following academic actions are available to the faculty member who finds a student has been cheating or plagiarizing.

  1. Review -- no action.

  2. An oral reprimand with emphasis on counseling toward prevention of further occurrences;

  3. A requirement that the work be repeated;

  4. Assignment of a score of zero (0) for the specific demonstration of competence, resulting in the proportional reduction of final course grade;

  5. Assignment of a failing final grade;

  6. Referral to the Office of Judicial Affairs for possible probation, suspension, or expulsion


COURSE BIBLIOGRAPHY



  1. Adams, Karen, Greiner, Ann C., Corrigan, Janet M., Committee on the Crossing the Quality Chasm: Next Steps Toward a New Health Care System, 2004, 176 pages.




  1. Aspden, Philip, Corrigan, Janet M., Wolcott, Julie, Erickson, Shari M., Editors, Committee on Data Standards for Patient Safety; Patient Safety: Achieving a New Standard for Care, 2004, 550 pages




  1. Berwick Donald, Payment by Capitation and the Quality of Care- Part 5 (1996) The New England Journal of Medicine, 335,16,1227-1231




  1. Blumenthal David, Quality of Care – What is it? – Part I, (1996) The New England Journal of Medicine, 335, 12, 891-894




  1. Blumenthal David, The Origins of Quality of Care Debate- Part 4 ( 1996) The New England Journal of Medicine, 335, 15, 1146-1149




  1. Brook Robert, McGlynn Elizabeth, Measuring Quality of Care – Part 2, (1996) The New England Journal of Medicine, 335, 13, 966-970




  1. Brown, RN, CPHQ, Janet A., The Healthcare Quality Handbook: A Professional Resource and Study Guide, 2004/2005 Edition (20th edition available after 7/31/05)




  1. Budetti, PP; 10 Years Beyond the Health Security Act Failure: Subsequent Developments and Persistent Problems. 2004, JAMA; 292: 2000-2006




  1. Bush, GW, Ensuring Access to Health Care: The Bush Plan. JAMA, 2004; 292: 2010-2011




  1. Chassin Mark, Improving the Quality of Care- Part 3, (1996) The New England Journal of Medicine, 335, 14, 1060-1063




  1. Chassin Mark, Hannan Edward and DeBuono Barbara , Benefits and Hazards of Reporting Medical Outcomes Publicly ( 1996) The New England Journal of Medicine, 334,6, 394-398




  1. Couch James (Editor), Health Care Quality Management/Improvement Program for the 21st Century, 1991, American College of Physician Executives and American College of Medical Quality.




  1. Davies, H. O., Washington, A. Eugene, Health Care Report Cards: Implications for vulnerable patient groups and the organizations providing them care (2002), Journal of Health Politics, Policy and Law, Vol. 27, 379- 399




  1. Dlugacz, Yosef D., Alice Greenwood, Andrea Restifo The Quality Handbook for Health Care Organizations: A Manager's Guide to Tools and Programs ISBN: 0787969214 Pub. Date: March 2004 Series: J-B AHA Press, #131




  1. Ellen Nolte and C Martin McKee, Measuring the health of nations: Updating an earlier analysis, Health Affairs, Volume 27, 58-71, 2008.




  1. Golub, Robert M, Beyond Mental Mediocrity, JAMA, 2006, 296, 1139-1140




  1. Gruen, RL, Pearson, SD, Brennan, TA, Physicians-Citizens-Public Roles and Professional Obligations. JAMA, 2004; 291: 94-98




  1. Hagland, Mark, Transformative Quality, 2009, CRC Press, ISBN: 13: 978-1-4200-8492-4




  1. Health Employer Data Information Set –HEDIS 2005/2006, Published by NCQA




  1. Hersh, W, Health Care Information Technology: Progress and Barriers. JAMA 2004; 292: 2273-2274




  1. Iezzoni Lisa, Assessing Quality Using Administrative Data, (1997) Annals of Internal Medicine , 127, 8 (Part 2), 666-674




  1. Kerry, J., Ensuring Access to Health Care: The Kerry Plan. JAMA, 2004; 292: 2010-2011




  1. Landrum, Mary Beth et al, Is spending more always wasteful? The appropriateness of care and outcomes among colorectal cancer patients. Health Affairs, Volume 27, 159-168, 2008




  1. Leach, David C, Philibert, Ingrid, High Quality Learning for High Quality Health Care-Getting it Right, JAMA, 2006, 296: 1132-1134






  1. Lighter Donald, E., Advanced Performance Improvement in Health Care-Principles and Methods, 2011, Jones and Bartlett Publishers, ISBN: 13: 978-0-7637-6449-4




  1. Mclaughlin Curtis and Kaluzny Arnold, Continuous Quality Improvement in Health Care, 3rd Edition, 2006, Aspen Publication




  1. Prevalence of Overweight and Obesity Among US Children, Adolescents and Adults, 1999-2002. JAMA, 2004; 291 2847-2850




  1. Quality First: Better Healthcare for All Americans, Advisory Commission on Consumer Protection and Quality in the Healthcare Industry (Call 800/732-8200 for your free copy)




  1. Ransom, Elizabeth, Joshi, Maulik, S., Nash, David, B., Ransom, Scott, B., The Healthcare Quality Handbook, Second Edition, 2008, ISBN: 978-1-56793-301-7




  1. Reschovsky, J, D., Hargraves, J. Lee., and Smith, A. F., Consumer beliefs and health plan performance: It’s not whether you are in an HMO but whether you think you are. ( 2002), Journal of Health Politics, Policy and Law, Vol 27, 353-377




  1. Robinson, JC, Reinvention of Health Insurance in the Consumer Era. JAMA, 2004; 291: 1880-1886




  1. Robinson, J.C., Slouching towards value based health care. Health Affairs, Volume 27, 11-12, 2008




  1. Spath , Patrice: Introduction to HealthCare Quality Management, 2009, AUPHA, Health Administration Press, Chicago, Illinois, ISBN: 978-1-56793-323-9








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