California State University at Long Beach - College of Health and Human Services s1

California State University at Long Beach - College of Health and Human Services Department of Health Science - Health Care Administration Program

Course: HCA 450 - Quality Management/Improvement in Health Care Delivery Instructor’s Name: Rus Billimoria, M.D., MPH, CPHQ Office Number (562) 985-5694 (Department Office for Information only) Office Telephone Number or an E-Mail Address (213) 694-1250 or [email protected] Office Hours: By appointment only on day of the class.

Term: Spring Semester 2009 Class Meeting Times: Hours: 7:00 p.m. to 9:45 p. Class Location: VEC-113

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:

Prior to attending this course students are required to complete the following courses:  HCA 402 and  HCA 465

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. Quality Management In Health Care Delivery HCA 450 - Course Syllabus

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.

2. Understand the reasoning and the importance of the requirements for Health Care Quality Management/Improvement Programs.

3. 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.

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

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

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

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

8. Understand basic elements of provider credentialing, risk management and liability issues as they relate to Quality Management/Improvement Programs.

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

10. 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.

11. Demonstrate understanding of the principles in the development of a Quality Management/Improvement Program 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:

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

2. 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 (This book is optional at this time)

3. Lecture notes and handout materials

D:\Docs\2018-04-18\04b63372dc8ddecec5dc3c9b5e9537e8.doc 2 Quality Management In Health Care Delivery HCA 450 - Course Syllabus

TYPES OF ASSIGNMENTS

Essays (20% of overall class Grade for 3 essays over the course of the semester)

To understand the theories around developing 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:

a) Journal of the American Medical Association (JAMA) - http://jama.ama-assn.org/ b) New England Journal of Medicine - http://content.nejm.org/ c) Annals of Internal Medicine - http://www.annals.org/ d) Journal of Health Politics, Policy and Law - http://www.jhppl.org/ e) Journal of HealthCare Quality - http://www.allenpress.com/jhq/ f) 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 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.

Class Participation (20% of Overall Class Grade)

Active classroom participation is encouraged. Each student will have adequate opportunities to participate in classroom discussions. Level of participation will contribute towards the overall course grade.

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 development.

D:\Docs\2018-04-18\04b63372dc8ddecec5dc3c9b5e9537e8.doc 3 Quality Management In Health Care Delivery HCA 450 - Course Syllabus The programs developed will be presented to the class by a representative from each team. 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:

a) Introduction to the portion being contributed by the student. (10% of Mid term Grade) b) Presentation of the ideas and components the student is responsible for(10% of Mid term Grade) c) 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) d) Class Presentation by Team (40% of the Mid Term Grade)

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:

a) Introduction (20% of the question grade) b) Factual presentation of the areas asked for in the question. (40% of the question grade) c) Brief Discussion of the topic (30% of the question grade) d) 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.

SEQUENCE OF ASSIGNMENTS

Week Objective

Week 1 – January 27 a) Introduction to the course. b) Literature Review Guidelines. c) Introduction to Terminologies. d) Introduction to Health Care Systems.

Week 2 – February 3 a) The evolution of Health Care Quality Management with a historic perspective. b) Basic Elements of Quality Improvement Readings: Review Chapters 1 & 2(Prescribed Text Book)

Week 3 – February 10 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: Lecture Notes and Literature (Prescribed )

Essay # 1 – Topic to be announced in class Week 4 – February 17 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. d) Selection of Team Leaders for the project. Review: Chapters 1 & 3 (Prescribed Text Book) Essay # 1 to be submitted in class or electronic Week 5 – February 24 a) Development of a Quality Improvement Program ( Part 2). b) Project on Quality Improvement Program development. c) Suggested Readings and literature search discussions. Review: Lecture Notes & Literature (Prescribed )

Week 6 – March 3 a) Use of Data for Quality Improvement. b) Tools for Quality Review: Chapters 4 & 5 (Prescribed Text Book)

Essay # 2 --- Topic will be announced in class Week 7 – March 10 a) Progress Report and Updates on the Quality Improvement Program development by each team. b) Data Analysis in Quality Management Review: Chapter 5 & 6 (Prescribed Text Book) & Lecture Notes

Essay # 2 to be submitted in class or electronic Week 8 – March 17 a) Health Plan Report Cards. b) Health Employer Data Information Set -2007 (HEDIS). c) Group Presentations of Quality Improvement Program. Review: Lecture Notes & Literature (Prescribed)

Week 9 – March 24 MID-TERM EXAM / PRESENTATIONS

March 31 SPRING BREAK

Week 10 – April 7 a) Guest Lecturer: Topic to be announced b) Suggested Readings- Chapter 10

Essay # 3 ---- Topic to be announced in class Week 11 – April 14 a) Introduction To Government Legislation in Health Care & Understanding Regulatory Requirements (Guest Lecturer) Review: Chapter 8 (Prescribed Text Book)

Essay # 3 to be submitted in class Week 12 – April 21 a) Understanding Accreditation b) Disease Management Programs. Review: Chapter 7

Week 13 – April 28 a ) Practical applications, examples and case studies in Quality Improvement

Week 14 – May 5 a) Incentive Programs and improving Health Care Quality b) Safety Review: Chapter 9 (Prescribed Text Book) & Lecture Notes

Week 15 - May 12 a) Course Summary. b) The Future of Health Care Quality c) Wrap Up

Week 16 – May 19 Finals

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 Discussion Papers 20% Development of a Quality Management Program 30% Project (Mid Term Exam) Final Exam 30% Class Participation 20% TOTAL 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

ADDITIONAL INTERNET RESOURCES(Con’t.):

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. a) Review -- no action. b) An oral reprimand with emphasis on counseling toward prevention of further occurrences; c) A requirement that the work be repeated; d) Assignment of a score of zero (0) for the specific demonstration of competence, resulting in the proportional reduction of final course grade; e) Assignment of a failing final grade; f) 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.

2. 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

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

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

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

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

7. 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)

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

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

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

11. 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

12. 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.

13. 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

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

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

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

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

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

19. Mclaughlin Curtis and Kaluzny Arnold, Continuous Quality Improvement in Health Care, 2nd Edition, 1999, Aspen Publication

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

21. 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)

22. 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

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

24. 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

D:\Docs\2018-04-18\04b63372dc8ddecec5dc3c9b5e9537e8.doc 12