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Week 3 – Discussion No unread replies.No replies. Your initial discussion thread is due on Day 3 (Thursday) and you have until Day 7 (Monday) to respond to your classmates. Your grade will reflect both the quality of your initial post and the depth of your responses. Refer to the Discussion Forum Grading Rubric under the Settings icon above for guidance on how your discussion will be evaluated. Topic CQI Models After reading Chapter 1 through 4, you should be familiar with quality improvement initiatives including the National Committee for Quality Assurance (NCQA) HEDIS & Quality Measurement: HEDIS Measures (Links to an external site.)Links to an external site.. Health plans and physicians must ensure they are meeting standards set by the accreditation agencies, such as NCQA. As a physician practice manager for Dr. Jones, you have just conducted a mock survey of the patient chart data. The data shows that your physician practice is not meeting standards for two HEDIS measures. Choose two HEDIS measures from the list below that must be implemented in a physician practice to improve patient outcomes.Describe the sources of data needed to conduct the two measures. What source would you use obtain the data? For example, if we were to look at patients receiving a beta blocker after discharge from the hospital, we would obtain data from pharmacy claims.Using one of the quality improvement models (i.e., Lean, PDSA, or Six Sigma), explain how you would use the model to implement the two chosen HEDIS measures. Include information on how the quality initiatives chosen are linked to the rising costs of health care. Consider government mandates that have improved quality initiatives related to implementing the HEDIS measures or added to the burden of increased costs. Your initial post should be 250 to 300 words and utilize at least one scholarly source from the Ashford University Library to justify your choice of improvement models. Cite all sources in APA format as outlined in the Ashford Writing Center’s Introduction to APA (Links to an external site.)Links to an external site.. HEDIS Measures Hypertension/Cardiovascular: Patients who were hospitalized and discharged alive after an acute Myocardial Infarction (heart attack) who received treatment with beta-blockers for six months after discharge. Patients 18 to 85 with a diagnosis of hypertension whose most recent blood pressure reading was controlled. Age 18 to 59 whose BP was <140/90 Age 60 to 85 with a diagnosis of diabetes whose BP was <140/90 Age 60 to 85 without a diagnosis of diabetes whose BP was <150/90 Smoking Cessation: Current smokers seen by a physician during the year who were advised to quit, and cessation medications were recommended and discussed. Different cessation methods were discussed. Weight Assessment: Patients between the ages of 3 to 17 who had been examined for body mass index (BMI, received counseling on nutrition). Counseling or referral for physical activity or indication physical activity was addressed during an outpatient visit either by a claim or as a medical record entry during the measurement year. Mammograms: Women age 50 to 74 years who have had a mammogram during the preceding 24 months. Exclusion of those women who have undergone bilateral mastectomy. Prostate Screening: Male 50 years and greater who have received an annual PSA and/or digital rectal exam. Guided Response: Choose two classmates’ posts, and respond to the questions listed below. Your guided response posts should be a minimum of five well-developed sentences.*CITE for ContentServer-2 attachment needed below source from the Ashford LibraryJihan Quraishi, & Jordan, L. (2014). Quality and Performance Measurement: National Efforts to Improve Quality of Care Through Measurement Development. AANA Journal, 82(3), 184–187. Retrieved from 06ch_moin_healthcare.pdf 05ch_moin_healthcare.pdf contentserver__2_.pdf contentserver__2_.pdf Unformatted Attachment Preview What is Special Education? Measuring Performance 1 6 Stefano Lunardi/iStock/Thinkstock iStockphoto/Thinkstock Learning Objectives Pre-Test After reading this you should behandicap able to dointerchangeably. the following: T/F 1. You can use thechapter, terms disability and 2. • The history special education began in Europe. T/F Discover theofroles of measurement in quality improvement. 3. • The first American legislation protected students withDonabedian disabilities was passed in the 1950s. T/F Compare three different typesthat of quality measures in the framework. 4. All students with disabilities should be educated in special education classrooms. T/F • Explain the validity and reliability of a quality measure. 5. Special education law is constantly reinterpreted. T/F • Summarize key considerations in selecting measures for quality improvement projects. Answers can be found at the end of the chapter. • Describe sampling strategies and explain when they should be employed. 149 fin81226_06_c06_149-176.indd 149 10/30/14 7:32 PM Introduction Introduction You may have heard the adage, “If you can measure it, you can improve upon it.” Measurement certainly plays a central role in the process of quality improvement. Let’s take an example. Summit Medical Group is a physician-owned primary care group with over 53 clinics operating in 11 counties around Knoxville, Tennessee. Since 2008, the physician group began benchmarking its diabetic care processes with the National Committee for Quality Assurance (NCQA) Diabetic Recognition Program (McBride & Hensley, 2013). The program focuses on the care provided to diabetic patients. Diabetes is a serious disease that can lead to many health complications. It’s important that diabetics control their blood sugar levels, as too high or low levels can lead to health complications that include problems with eyesight and even amputations when an infection occurs in the hands or feet that cannot heal. These complications also result in serious costs to the healthcare system. Therefore, groups such as the National Committee for Quality Assurance (NCQA) focus on care given to diabetic patients, as does the government, with its quality measure that looks at how well the country’s community health centers help diabetics control their blood sugar levels and its measures that focus on diabetes care on the Physician Compare website ( But how does a medical practice judge whether its doctors are providing good care to their diabetic patients? What are the measures to determine that? Some of the measures that Summit Medical Group focused on include whether patients have annual eye examinations, regular foot exams, and screening for kidney disease to prevent possible health complications. Given that diabetes is the seventh leading cause of death in the United States, one of the diseases that the NCQA has focused on is diabetes care. The NCQA has established Comprehensive Diabetes Care measures as part of its Healthcare Effectiveness Data and Information Set (HEDIS) measures used for health plan performance reporting. HEDIS is a tool to measure performance on care and service and its diabetes care measures assess whether patients with diabetes receive care as recommended by guidelines and achieve control levels for their blood sugar, cholesterol, and blood pressure. Using various tools that include checklists and templates, Summit created a systematic approach focused on continuous quality improvement to ensure that all of the physicians in its clinics provide quality of care to diabetic patients. The processes it set up enable Summit to incorporate effective coordination of care and collaboration among medical professionals across the continuum of care and provide evidence-based, patient-centric guidelines focused on patient health. Summit’s continuous quality improvement (CQI) team works with management at each clinic, individual physicians, and their staff members to identify gaps in clinical quality care from the standards Summit has set and establish processes to close those gaps. Summit uses an approach called FOCUS (which stands for Find a problem, Organize a team, Clarify the problem, Understand the problem, Select an intervention) Rapid Cycle PDSA (or Plan-Do-Study-Act model, which was described in Chapter 5). Data collection is essential to CQI projects, with data providing the CQI team with feedback and support. Once Summit had established standards of care for its diabetic patients, it could look for inconsistencies fin81226_06_c06_149-176.indd 150 10/30/14 7:32 PM Introduction in diabetes care related processes and procedures and address those problem outcomes through its CQI process. In 2008, most of Summit’s practice locations were still using paper medical charts and had not yet converted to an electronic health record. Therefore, Summit created a paper diabetic checklist. A care team member prepared for a diabetic patient’s visit by reviewing his or her chart and then prepared the patient for the doctor in the exam room. The completed diabetic checklist was scanned into the patient’s medical record, filed in the chart, or incorporated into the physician’s progress notes. The checklist included measures that were identified across the organization and ensured the scheduling of annual eye exams, foot exams, and screening for kidney disease. As Summit’s physician practices moved to adopt electronic health records (EHR), a physicianled workgroup designed a template within the EHR to ensure diabetic foot exams. The organization trained nurses to prepare patients for a foot exam prior to the physician entering the exam room; in some cases, the nurses did a preliminary exam, with follow-up by the doctor if any problems were seen. As a result, many physicians who had previously failed to perform and document a foot exam on diabetic patients were able to meet the CQI measure (McBride & Hensley, 2013). The EHR also alerts doctors to the need for regular screenings, such as eye exams and kidney screening. Summit also created care guides that allow physicians to quickly place reminders and orders simultaneously. As laboratory tests on a patient flow back into the EHR, the system automatically updates reminders with a date for when the test needs to be performed again. Members of Summit’s quality reporting and improvement division tracked whether physicians met the criteria and ordered the proper exams for diabetic patients. They worked with doctors whose scores were low, indicating they were not following the protocol. They implemented process improvements, including a standardized procedure that called for staff preparing a patient for the physician exam to review the patient’s chart, check for documentation that shows whether studies were previously ordered, and prepare for that day’s exam by the doctor. Doctors were given a score based on how well they followed the protocol. For example, one doctor improved from a score of 30 to a passing score of 90 in one year. The changes had minimal impact on physician workflow and actually allowed doctors to spend more time talking to the patient rather than reviewing the medical record and searching to see whether required test results and exams had been completed. One important factor in looking at quality improvement is sustaining that improvement over time and learning from failures. Summit did just that. Its quality and improvement team saw one case where a physician regressed back to previous behavior after the quality improvement project was put in place. The provider and a staff nurse had performed very well as a team following implementation of the quality improvement project in 2011, with a score of 80 out of 100, indicating most diabetic patients received care as desired. However, the nurse left the organization and her knowledge was not passed along to her successor. Failure to train the new nurse in the protocol resulted in the physician again failing to follow the proper protocol, and in 2012 his score dropped to 55. The problem was the ineffective training of new nurses to follow the protocol. fin81226_06_c06_149-176.indd 151 10/30/14 7:32 PM The Role of Measurement in Quality Improvement Section 6.1 As this case demonstrates, it is important to have measures in place that allow an organization to actually see whether a quality improvement project is working. While it is important that organizations track data to monitor the effects of their quality improvement efforts and make adjustments as they go along, it typically takes three years of data (36 monthly data points or data sets) to show whether or not a program is working. This is standard in CQI programming and involves pre- and post-testing validity based on a statistical principle known as Central Limit Theorem and assumptions of parametric distribution of data. Measurement is the process of describing a phenomenon such as healthcare quality. Frequently, measures are quantitative in nature. Many features of healthcare quality, such as length of hospital stay, can be expressed numerically. However, some measures of quality are not so straightforward and have to be looked at in the context of the complicated healthcare world. For example, it may seem straightforward to look at the number of deaths that occur in a hospital in a year as a measure of quality care. But is a higher number of patient deaths necessarily an indication of poor care? If a hospital treats complicated cases with many older or sicker patients who are at higher risk of death, its mortality rate may be much greater than a hospital that treats young, healthy patients or does not take on complex cases. Consider what happened in 2013, when Consumer Reports added to the drive for greater transparency in healthcare quality by releasing surgery ratings for nearly 2,500 hospitals in the United States (“What’s Behind,” 2013). The ratings drew national attention and responses from many hospitals, some of which simultaneously applauded the effort to inform patients about quality of care and questioned the validity of the ratings. Some hospital officials questioned various methodological aspects of the measures, including whether the assumption that extended hospital stays (i.e., longer than average) were a marker of patient complications. Due to legitimate concerns about the accuracy and validity of various quality measures, it is important to understand types of quality measures, the role measurement plays in quality improvement efforts, and important operational considerations, such as how specific measures and measurement strategies are selected. 6.1 The Role of Measurement in Quality Improvement Measurement plays a central role in the process of quality improvement. Broadly defined, measurement includes all efforts that relate to collecting data and manipulating it to understand its meaning. For example, a quality improvement project to reduce hospital readmissions for patients with pneumonia (a lung infection) might need to collect data on length of stay, patient age, other conditions a patient may have (such as diabetes), and other pieces of information. When initiating a quality improvement project, an early step is to construct the measurement strategy. A measurement strategy describes a project’s information needs and how these will be met during the project’s execution (Hackbarth et al., 2012). For example, in 2011 the Department of Health and Human Services (HHS) initiated the Partnership for Patients, which included more than 3,700 participating hospitals. This effort fin81226_06_c06_149-176.indd 152 10/30/14 7:32 PM The Role of Measurement in Quality Improvement Section 6.1 focused on improving patient safety and transitions between care settings, such as a move between a hospital and nursing home or rehabilitation center (Centers for Medicare & Medicaid Services, 2013h). One component of the project was to track national progress by determining whether participating hospitals across the country were improving patient safety. How could this be measured? One way to measure how well hospitals were doing was to estimate the reduction in adverse patient events—occurrences such as a bad reaction to a drug, a complication following surgery, or an infection—since the project’s initiation. The project planners used three sources to come up with the specific measures they wanted to track: • • • LCLPhoto/iStock/Thinkstock Over 3,700 hospitals participate in the Partnership for Patients program, which focuses on improving patient safety and transitions between care settings. Adverse events reported by the hospitals in the Medicare Patient Safety Monitoring System, a national surveillance project aimed at identifying the rates of specific adverse events The National Healthcare Safety Network, the nation’s most widely used healthcareassociated infection tracking system, maintained by the CDC Several Patient Safety Indicators, which provide information on hospital complications and adverse events following surgeries, procedures, and childbirth For each component the planners wanted to measure, they identified a source that would provide that data, such as the Healthcare Cost and Utilization Project, the largest collection of nationwide and state-specific hospital care data in the United States. Keep in mind that the Partnership for Patients is a national endeavor, so the strategy for measuring results is detailed and comprehensive. Measurement strategies for quality improvement projects undertaken in a healthcare organization will likely be far less comprehensive. However, when planning for any quality improvement project, a number of key stakeholder groups (and their measurement needs) should be considered (Hackbarth et al., 2012) (see Table 6.1). Some of those stakeholder groups include: • • • fin81226_06_c06_149-176.indd 153 Employees who work within the health system who need data to support their daily activities Members of the quality improvement team who need measures designed to determine the success or failure of any changes made in the organization Project leaders who need to monitor the progress of the quality improvement effort 10/30/14 7:32 PM Section 6.1 The Role of Measurement in Quality Improvement • • • External programs, such as public reporting entities or insurance companies with quality-based reimbursement mechanisms, that may seek data regarding performance at the provider, unit, or hospital level Public stakeholders who want to understand whether specific quality indicators are showing improvement Organizational leadership who will want progress reports in order to communicate the impact of the quality improvement effort Table 6.1: Key constituencies to consider when planning measurement strategy for quality improvement Constituents Information need Example(s) Employees Provide care to patients or support that care Monitor vital signs for fever or other symptoms of systemic infection Quality improvement team members Quality improvement project leaders External programs Public stakeholders (i.e., media) Organization leadership Determine whether change in care procedures resulted in desired effect Progress of quality improvement effort Hospital adherence to performance measures What is the quality of care at a hospital? Is care for the community improving? Impact of quality improvement effort Number of patients with central lines developing a bloodstream infection Central line bundle adherence by providers Overall change in number of centralline-associated bloodstream infections (CLABSI) Number of risk-adjusted hospitalacquired infections Number of deaths from sepsis Estimated number of lives saved Number of infections prevented Lives saved Infections prevented Costs reduced Source: Adapted from Hackbarth, A. D. (2012). Improvement Concepts and Methods Lecture Series, UCLA. 3. Improvement Project Measurement Design. As an example, consider a project to decrease central-line-associated bloodstream infections (CLABSIs). A central line is a small tube inserted directly into one of the major blood vessels of the body. It is used to deliver fluids and other medications. One of the major risks of central lines is an infection of the bloodstream, which can be lethal. In 2009, more than 40,000 patients experienced this serious infection, and thousands will die from such infections each year (CDC, 2012b). (More information is available on CLABSIs and their prevention on the CDC website at Therefore, hospitals are trying to prevent these infections from occurring in their patients. One of The Joint Commission’s National Patient Safety Goals for hospitals is the prevention of CLABSIs. Hospitals are also motivated to prevent hospital-associated infections for financial reasons. The Medicare program stopped payment for some hospital-acquired conditions—including vascular catheter-associated infections—starting in 2008, following provisions in the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005. The policy penalizes fin81226_06_c06_149-176.indd 154 10/30/14 7:32 PM The Role of Measurement in Quality Improvement Section 6.1 hospitals if Medicare patients acquire any of more than a dozen listed conditions during their stay in the hospital if those conditions were not present when they were admitted (CMS, 2013g). In other words, the government does not want to pay for additional care needed because a hospital made a patient sicker. A final rule released by CMS in 2010 also requires that hospitals that accept Medicare patients report CLABSIs to CMS through the CDC’s National Healthcare Safety Network (HCPro, 2010). Suppose that as part of a quality improvement project to decrease healthcare–associated infections in your hospital, you are asked to lead an improvement project in the medicalsurgical intensive care unit (ICU). The physicians and nurses will need to know if a patient with a central line has evidence of an infection. Typically, a CLABSI results in a variety of symptoms, potentially including fever, low blood pressure, or an increase in the number of infection-fighting cells in the patient’s bloodstream. Thus, providers will need to specifically monitor and measure a patient’s symptoms in order to detect and promptly treat infection in patients with a central line. As a focus of the quality improvement effort, your team decides to create a central line “bundle.” It includes all of the recommended equipment for inserting a central line safely and a checklist for evidence-based steps to minimize infection risk, such as ensuring that the doctors and nurses properly wash their hands before starting the procedure and ensuring they have cleaned the patient’s skin with an antiseptic so they do not allow germs into the site that can cause an infection. In order to determine whether use of the bundle has meaningfully changed outcomes, your quality improvement team will need to know whether a patient has a CLABSI and track the number of patients with these infections. As the project leader, you want to know about the CLABSI rate, but you may also want to measure compliance with the central line bundle. In other words, you want to know whether the doctors and nurses who need to insert a central line are correctly performing each of the evidence-based steps to prevent infection. If doctors and nurses follow the recommended steps, the number of patients with infections should decrease. If the CLABSI rate does not change, knowing whether doctors, nurses, and other healthcare professionals are complying with the steps outlined in the bundle will help you determine why the infection rate has not dropped. Are they appropriately washing their h ... Purchase answer to see full attachment

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