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

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

Course: Quality Management/Improvement In Health Care Delivery HCA 450/550 - Spring Semester 2008

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 ext 4274 or [email protected] Office Hours: By appointment only on day of the class. Term: Thursdays, January 31 – May 16 , 2008 Class Meeting Times: Hours: 7:00 p.m. to 9:45 p. Class Location ET 105

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 or 502 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.

D:\Docs\2018-04-07\032bf9c1796c5394b4d6623fbd84a1b8.doc Quality Management In Health Care Delivery HCA 450/550 - Course Syllabus

EXPECTED STUDENT LEARNING OUTCOMES

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

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

2. Understand the reasoning and the importance behind the requirements for Quality Management/Improvement Programs in the health care environment.

3. Describe the current state-of-the-art 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 behind 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. Lecture notes and handout materials

D:\Docs\2018-04-07\032bf9c1796c5394b4d6623fbd84a1b8.doc 2 Quality Management In Health Care Delivery HCA 450/550 - Course Syllabus

TYPES OF ASSIGNMENTS

Papers (20% of overall class Grade)

To understand the latest trends in Quality Management/Improvement, it is necessary to review articles related to health care quality from professional medical or health care journals. All class sessions incorporate discussions on the latest trends presented in these journal articles. Students will be expected to read and summarize assigned articles or readings in the form of short papers (a minimum of two amd maximum of three, doubled spaced and typed pages).

Examples of Journal materials that may be the subject of your reviews 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 papers should be well thought out. Following is a suggested format for your papers.

1) Introduction – Reason for selecting the article. 2) Ideas or thoughts presented by the article. 3) Your analysis of the article and a critique. 4) Conclusions that may be derived from the article.

The summary papers will be graded on a scale of zero – 10 points (Total of 30 Points for 3 papers which is 20% of the overall class Grade). Grading will be based on the following criteria:

1) Selection and current relevance of the topic for review. 2) Clear presentation of the ideas and thoughts from the article. 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 summary papers will be due on the weeks assigned. Please see agenda on the following pages. The papers must be well presented. Submit one copy to the instructor. The copy will be returned.

Class Participation (20% of Overall Class Grade, which is 30 Points)

Active classroom participation is encouraged. Each student will have adequate opportunities to participate in classroom discussions and a small class room project in addition to the project mentioned above. Level of participation will contribute towards the overall course grade. A small proportion of the grade is assigned to class room attendance.

PROJECT: Quality Management/Improvement Program Development (Project in Fall Semester only for HCA 450 and HCA 550)

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 Quality Improvement principles and guidance provided in the course. Each student within a team will make specific contributions to program development. Programs developed will be presented to the class by representative(s) 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 or a total of 45 Points)

Each student’s contribution towards the team project will be presented in form of a paper not less than two or maximum of three double-spaced type written pages. The paper shall comprise of the following elements:

a) Introduction to the portion being contributed by the student. (20% of Mid term Grade) b) Presentation of the ideas and components the student is responsible for(40% 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)

Position Paper (HCA 550): Position Paper (For Graduate HCA 550 Students only. This constitutes 30% of the overall class grade or 45 Points)

Students are free to select their own topic in relevance to the subject of Health Care Quality Improvement for the position paper. Students may use as an alternative, the Quality Management/Improvement Program development exercise as its base.. Development of a Quality Management/Improvement Program may present organizational and process problems or issues that need to be reviewed and resolved if possible. However student is free to select a different Quality Improvement topic. The topic for position paper needs approval by the lecturer. Develop your view of an idea or a problem related to the topic selected, using professional literature and other resources from within or without the course materials. This position paper must have four major components.

a) Description of the problem or idea. (Approx. 20% of the Final Exam Grade) b) Description of the significance of the problem or issue arising out of the Quality Management/Improvement Program development. (Approx.30% of the Final Exam Grade) c) Your position, analysis and proposed solution if applicable. (Approx.40% of the Final Exam Grade) d) Literature support for your position and analysis. (Approx.10% of the Final Exam Grade)

The position paper will need to be written on a minimum of 10 or maximum of about 18 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. Oral presentations will only help enhance the overall final class grade for 550. Please note: student’s grades will not be affected adversely if oral presentations are not made. No presentations will be allowed after week 14. D:\Docs\2018-04-07\032bf9c1796c5394b4d6623fbd84a1b8.doc 4 Quality Management In Health Care Delivery HCA 450/550 - Course Syllabus

Final Exam for HCA 450 (Constitutes 30% of the Overall Class Grade or 45 Points)

HCA 450 students will be administered a final exam equivalent to 30% of the overall class grade.

Then exam may be a multiple choice exam or an essay exam ( series essay questions). Exam format will be selected by the lecturer.

1) Multiple Choice Exam: A set number of questions (Approximately 40 to 50) will be provided to students through Beach Board. Students would have a fixed amount of time (2 Hours to answer all questions). The exam will be scored by the computer.

2) The essay exam: Exam comprises four questions. Three questions are discussions from the topics reviewed in class during the semester. These may be in form of problems built around specific health Care Quality Improvement scenariosThe fourth question is a series of short notes on specific topics discussed during the course.

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, students will be expected to write a short paragraph on each of the topics.

The Class agenda is presented below:

SEQUENCE OF ASSIGNMENTS

Week Objective

Week 1 – January 31, 2008 a) Introduction to the course. b) Literature Review Guidelines. c) Introduction to Terminologies. d) Introduction to Health Care Systems.

Week 2 – February 7, 2008 a) The evolution of Health Care Quality Management with a historic perspective. b) Basic Elements of Quality Improvement Readings: Review Chapter 1(Prescribed Text Book)

Week 3 – February 14, 2008 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 & 3; (Prescribed Text Book) D:\Docs\2018-04-07\032bf9c1796c5394b4d6623fbd84a1b8.doc 5 Quality Management In Health Care Delivery HCA 450/550 - Course Syllabus

Week 4 – February 21, 2008 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: Chapter 11 (Prescribed Text Book)

Week 5 – February 28, 2008 Paper # 1 Due in Class– Why Quality Improvement Program in Health Care? a) Development of a Quality Improvement Program ( Part 2). b) Strategic Planning and Quality Improvement. c) Project on Quality Improvement Program development. d) Suggested Readings and literature search discussions. Review: Chapter 6 (Prescribed Text Book)

Week 6 – March 6, 2008 a) Use of Data for Quality Improvement.  Data for Structure, Process and Outcomes Measures.  Data for service measures. b) Tools for CQI/TQM Review: Chapter 9 (Prescribed Text Book)

Week 7 – March 13, 2008 Paper # 2 Due in class- Report Cards in Health Care and their implications to quality of care a) Progress Report and Updates on the Quality Improvement Program development by each team. b) Statistical Analysis in Quality Management Review: Chapter 4 (Prescribed Text Book) & Lecture Notes

Week 8 – March 20, 2007 a) Health Plan Report Cards. b) Health Employer Data Information Set -2007 (HEDIS). c) Member Satisfaction as data used for Quality Improvement. d) Group Presentations of Quality Improvement Program. Review: Chapter 5 (Prescribed Text Book

Week 9 – March 28, 2007 MID-TERM EXAM / PRESENTATIONS

SPRING BREAK- March 31- April 4

Week 10 – April 10, 2008 a) Guest Lecturer: Regulation & Quality of Care issues b) Class Room Project c) Suggested Readings.

Week 11 – April 17, 2008 a) Long Term Care Quality of Care deficiencies (Guest Lecturer) b) Class Room Project -Determining Quality of Care issues c) Possible scenarios for improving the system Review: Chapter 13 (Prescribed Text Book)

Week 12 – April 24, 2008 Paper # 3 Due in class- Impact of legislation on Quality of care a) Class Room Project- present corrective actions b) Developing Quality Improvement Strategies - lessons learnt c) Provider Credentialing and Quality Implications. Review: Appendix A (Prescribed Text Book)

Week 13 – May 1, 2008 a) Incentive Programs and improving Health Care Quality b) Perceptions of Quality Leap Frog and IHA. d) Use of Clinical Practice Guidelines. e) Disease Management Programs. f) Safety

Week 14 – May 8, 2007 a) Accreditation and Accreditation Organizations. b) Selecting Quality Organizations c) Course Summary. d) The future of Healthcare Quality e) Opportunities in Health Care.

Week 15 – May 16, 2008 HCA 550 Graduate Students – Submission of Position Papers FINAL EXAMINATION FOR HCA 450

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, classwork 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 HCA 550

Discussion Papers 20% 20%

Development of a Quality 30% 30% Management Program Project (Mid Term Exam for both 450 and 550)

Final Exam (Position Paper for 550 only) 30% 30%

Class Participation-Small Project & 20% 20% (Includes Attendance)

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, D:\Docs\2018-04-07\032bf9c1796c5394b4d6623fbd84a1b8.doc 7 Quality Management In Health Care Delivery HCA 450/550 - Course Syllabus 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. By the same token, 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.

D:\Docs\2018-04-07\032bf9c1796c5394b4d6623fbd84a1b8.doc 8 Quality Management In Health Care Delivery HCA 450/550 - Course Syllabus 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. David C, Leach, Philibert, Ingrid, High Quality Learning for High Quality Health Care-Getting it Right, JAMA, 2006, 296: 1132-1134

14. 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

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

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

17. Health Employer Data Information Set –HEDIS 2007/2008, Published by NCQA

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

D:\Docs\2018-04-07\032bf9c1796c5394b4d6623fbd84a1b8.doc 10 Quality Management In Health Care Delivery HCA 450/550 - Course Syllabus 19. Mary Beth Landrum et al, Is spending more always wasteful? The appropriateness of care and outcomes among colorectal cancer patients. Health Affairs, Volume 27, 159-168, 2008

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

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

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

3. Mclaughlin Curtis and Kaluzny Arnold, Continuous Quality Improvement in Health Care, 3rd Edition, 2006, Jones and Bartlett Publishers, Inc. Sudbury, Massachusetts

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

24. 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)

25. 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

26. Robinson, J.C., Reinvention of Health Insurance in the Consumer Era. JAMA, 2004; 291: 1880-1886

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

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

D:\Docs\2018-04-07\032bf9c1796c5394b4d6623fbd84a1b8.doc 11