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Weekly Overview: Week Five 1 HCS/588 Version 5 Weekly Overview

Week Five

Overview

Health care is becoming more consumer-focused and friendly. Consumers demand additional information to assess the qualifications, competencies, and training as well as the experience, expertise of health care providers. This demand has created another level of accountability in the quality improvement process for health care organizations. It has allowed the general public to have a higher level of understanding that is needed to make better decisions for their individual health and well-being.

What you will cover

.1 Consumerism .a Analyze publically available quality measures affecting health care organizations. )1 Monitor CMS Hospital Compare website for quarterly updates on mortality, infection, readmission rates, emergency room wait times, etc. )2 Ensure publically released or available organizational data is accurate and complete )3 Ensure interpretation and relevant narrative accurately defines and explains the data being presented. Ask if it is consumer friendly and easy to understand. )4 Monitor other external sources publishing your organization's quality measures such as: a) The Commonwealth Fund b) Leapfrog c) Truven Health Analytics d) NDNQI e) The Joint Commission f) Healthgrades )5 Monitor local news release and publication of data provided by: a) U.S. News and World Report b) Consumer Reports c) Reader's Digest d) Local news organizations .b Analyze the use of consumer utilization of external quality indicators on health care organizations. )1 The Institute of Medicine's National Roundtable on Health Care Quality report )a Assessment of state of quality ()1 Underuse: medical practices are not used as often as they should be ()2 Overuse: medical practices test or diagnose when not medically indicated to do so ()3 Misuse: care is not used or executed appropriately )b Contributes to a knowledge base of quality )2 Six aims for quality improvement )a Safe: care must be as safe in a health care organization as it is in the patient's home )b Effective: science and evidence behind health care must be applied as the standard in the delivery of care )c Efficient: care and service must be cost-effective and eliminate waste )d Timely: the patient must experience no delays in care and services

)e Patient-centered: care must revolve around the patient, respect patient preferences, and put the patient in control )f Equitable: unequal treatment must be in the past, and disparities in care must be eradicated )3 Measuring and improving patient experiences of care )a Regulatory and federal patient survey initiatives, such as Hospital Consumer Assessment of Health care Providers and Systems (HCAHPS) ()1 Patients’ perspective on care received ()2 Patients’ perspective on caregiver’s customer service )b Consumers select health care based on how providers improve services based on patient feedback. )4 Utilization of external quality indicators available to patients )a External resources ()1 Health finder: http://www.healthfinder.gov ()a Consumer source for reliable health information from federal government ()b Offers quick guides to healthy living, personalized health advice, and tips and tools to help consumer ()2 Health grades: http://www.healthgrades.com/ ()a An independent health care ratings company available to consumers ()b Researches hospitals, doctors, nursing homes, and more ()3 Institute for Healthcare Improvement: http://www.ihi.org/ (a) A site devoted to the improvement of health care quality (b) A resource for consumers and medical professionals ()4 The Joint Commission: http://www.jointcommission.org/ ()a The Joint Commission accredits and certifies more than 16,000 health care organizations and programs in the United States ()b A resource for consumers indicating how an organization is rated and complies with established regulatory requirements ()5 National Committee for Quality Assurance: http://ncqa.org/ ()a A central figure in driving improvement throughout the health care system ()b Helps to elevate the issue of quality ()6 National Quality Measures Clearinghouse: http://qualitymeasures.ahrq.gov/ ()a A national database of measure sets for practitioners, health delivery systems, and health care providers, with standardized abstracts and ordering details ()7 Medicare: http://www.medicare.gov/Default.asp ()a Compares the quality of nursing homes, prescription drug plans, hospitals, and home health care providers for Medicare beneficiaries ()8 Hospital Compare: www.hospitalcompare.hhs.gov: ()a A Medicare site that provides quality information about hospitals across the country ()9 Agency for Healthcare Research and Quality (AHRQ)- National Healthcare Quality and Disparities Reports: http://statesnapshots.ahrq.gov/snaps08/index.jsp ()a Provides state-specific health care quality information, including strengths, weaknesses, and opportunities for improvement ()b Its goal is to help state officials and their public- and private-sector partners better understand health care quality and disparities in their states )b Evaluation of care through the use of measures

()1 Asthma symptom-free days ()2 Average hemoglobin A1c levels ()3 Risk- or severity-adjusted mortality rate ()4 Catheter-related infection rates in the intensive care unit patient population ()5 Speed of treatment for AMI patients ()6 Average minutes spent with clinician in an office ()7 Inpatient falls in critical care nursing units )c The value of measures from the patient's perspective ()1 Direct and understandable communication with caregivers ()2 Ability to measure expected outcomes ()3 Patient-friendly discharge instructions ()4 Patient-friendly outcome measures on medical or surgical progress )d Eight dimensions of measurable patient-centered care as delineated by Picker/Commonwealth Program for Patient-Centered Care ()1 Access to care ()2 Respect for patients’ values, preferences, and expressed needs ()3 Coordination of care and integration of services ()4 Information, communication, and education ()5 Physical comfort ()6 Emotional support and alleviation of fear and anxiety ()7 Involvement of family and friends ()8 Transition and continuity )e Measures and organizational processes to support patient safety ()1 Risk management ()a Ensures a patient-safe environment ()b Monitors quality outcomes ()c Physician practice patterns ()2 Organizational quality or performance improvement plans ()a Organizations' improvement plans must be patient-centered ()b Plans must be available to the consumer for review ()3 Organizational leadership focuses on patient safety questions such as: ()a Does leadership actively participate and hold staff accountable for continuous focus on quality improvement plans focused on a patient-safe environment? ()b Do they establish quality outcome targets and monitor performance to these targets? ()4 Ask questions about internal occurrence reporting system ()a Is there an internal system that captures all patient-related adverse events or occurrences? ()b How is it used to improve care and services? ()5 Following AHRQ’s patient safety index analysis ()a Does the organization provide detailed data using a clinical decision support system based on AHRQ's standards and definitions? ()b Do they monitor performance using the standards that focus on patient safety issues? ()6 Medication error question: does the organization capture data on medication errors to ensure a patient-safe outcome?

()7 Patient fall question: does the organization capture data on patient falls to ensure a patient-safe outcome? ()8 Infection control question: does the organization capture data on hospital-acquired infections to ensure a patient-safe outcome? .c Evaluate feedback from consumers on the quality improvement process. )1 Patient feedback to improve quality )a Focus on the patient ()1 Minimizing the frustration and despair with care given ()2 Minimizing anxiety over ever-increasing costs and complexities of care ()3 Limiting the tension between the need for and limited access to care ()4 Minimizing alienation from care providers and the system )b The patient's contribution to the knowledge base of improving quality care ()1 Use of surveys ()2 Use of focus groups ()3 Walkthroughs ()4 Complaint and compliment letters ()5 Patient and family advisory councils )c The patient's assessment of the state of quality care ()1 Completing patient surveys such as HCAHPS ()2 Completing organization's internal surveys for specific care services )2 Other stakeholder feedback and how to achieve better customer service )a Hire service-savvy people )b Establish high standards of customer service )c Help staff hear the customer’s voice )d Remove barriers so staff may serve customers )e Design processes of care to reduce patient and family anxiety and to increase satisfaction )f Help staff cope in a stressful atmosphere )g Maintain a focus on service