Title: Your Quality Improvement Plan Your Health Care Plan
1Your Quality Improvement Plan Your Health
Care Plan ..and
stuff like that
- Marti Wolf, RN, MPH
- Clinical Programs Director
- North Carolina Community Health Center Association
2Session Description
- Clinical Quality measures are popping up in many
areas and under many identities- Meaningful Use,
Patient Centered Medical Home, UDS, FTCA and
others. A good organizational plan for quality
improvement integrates all areas of operations
and all of the forms quality takes while
minimizing effort.
3Objectives
- Whats a Health Care Plan?
- Whats a Quality Plan?
- Clinical UDS???
- Meaningful Use
- Medical Home
4Words From HRSA
- Quality is a focus area nationally and at HRSA
- Assessment of QI plans showed areas for
improvement - Invest in your QI infrastructure
- Clinical quality and beyond
- Focus on implementation
- This work never ends
5Benefits of an Effective QI Plan
- Roadmap for HC organization
- Leadership, focus, prioritization
- Efficient coordination of staff resources
- Better outcomes
- Satisfy external requirements
- HRSA, State
- Third-party quality accreditation and recognition
6Benefits of QI Plan
- Federal Tort Claims Act deeming
- Health centers and free clinics
- ECRI resources
- Data collection and analysis
- UDS, patient survey, EHB
- Health Information Technology
- Adoption, meaningful use, health info exchange
- Quality
- Third party quality recognition
- Aligning technical assistance for PCMH
transformation - CMS
7QI Plan- Define Quality
- Phillip Crosby- Doing the right thing right the
first time and every time. - Ensuring Quality is a Risk Management Plan
- Institute of Medicine Definition of QualityThe
degree to which health services for individuals
and populations increase the likelihood of
desired health outcomes and are consistent with
current professional knowledge. STEEEP
8Quality
- Safe
- Effective
- Patient-Centered
- Timely
- Efficient
- Equitable
9QI Plan
- 2-3 pages
- General Concepts
- Written Commitment
- What do you mean by Quality?
- Provides Structure for your QI Program
- Quality Improvement Committee
- Who is on the Committee
- Terms of Service?
- Ad hoc members?
- How often do they meet?
- Documentation (agenda, minutes)
10QI Plan
- Methodology
- Lean, 6 Sigma, PDSA,
- Root Cause Analysis, etc, etc, etc
- Data Collection Plan
- How data is collected
- Internal and external sources of data
- Core components (stay general)
- Patient satisfaction
- Staff satisfaction
- HRSA measures
- Other regulatory measures
- Business Plan measures
11QI Plan
- Content/Authority
- QI activities in all areas of operation
- Audits
- Frequency
- Use of Date
- QI purpose (not punitive)
- Communication Plan
- Staff
- Board
- Management
- Patients
12Quality FTCA Deeming
- Federal Program Requirement in the Health Center
Program - Quality Improvement/Assurance Plan Health center
has an ongoing Quality Improvement/ Quality
Assurance (QI/QA) program that includes clinical
services and management, and that maintains the
confidentiality of patient records. The QI/QA
program must include - Continued- next slide
13- a clinical director whose focus of responsibility
is to support the quality improvement program and
the provision of high quality patient care - periodic assessment of the appropriateness of the
utilization of services and the quality of
services provided or proposed to be provided to
individuals served by the health center and such
assessments shall - be conducted by physicians or by other licensed
health professionals under the supervision of
physicians - be based on the systematic collection and
evaluation of patient records - and identify and document the necessity for
change in the provision of services by the health
center and result in the institution of such
change, where indicated. - (Section 330(k)(3)(C))
14Elements of your Quality PlanFTCA recommended
- 1. QI teambuilding and responsibility across a
range of staff types - 2. Self-assessment of areas to target
- 3. Setting concrete goals
- 4. Identifying strategies for improvement
- 5. Data collection and analysis
- 6. Evaluation and dissemination of lessons
learned - 7. Integration with operations and other quality
related activities
15IHI Triple Aim
Quality of Care
Cost of Care
Patient Experience
16Perspectives on Quality
Medical
Administrative Patie
nt
17Quality
- Results of Quality
- Improved Outcomes
- Improved efficiency and productivity
- Staff and patient satisfaction
18QI includes
- Risk Management
- Credentialing and Privileging
- Current clinical standards of care
- Provider credentials and privileges
- Risk management procedures
- Patient grievance procedures
- Incident management
- Confidentiality of patient records
19Demonstrating Quality
- Patient Centered Medical Home
- Patient Centered Health Home Initiative
- Meaningful Use
20Quality - Food for Thought
- Consistency requires you to be as ignorant today
as you were a year ago . - -Bernard Berenson
21Health Care Plan/Clinical UDS
- PAL 2010-12 for the 2011 measures that will be
reported when you submit in 2012 - Trimester of entry into care
- LBW
- 2 year old immunization
- Diabetes- A1c
- HTN- BP lt140/90
22ENOUGH TO TRACK!
- 2011 Clinical UDS New and Revised Measures
- 2010 UDS manual- clinical measures start on p 49
- http//bphc.hrsa.gov/healthcenterdatastatistics/re
porting/ call archive - http//bphc.hrsa.gov/healthcenterdatastatistics/re
porting/2010manual.pdf - Program Requirements 8
- HCP Template
23Risk Management
24Disclaimer
- Risk Management is like liver.
- The more you chew it,
- the bigger it gets.
25Risk Management
Identify and plan for potential and actual
risks in terms of facilities, staff, clients,
financial, clinical and organizational
well-being. (NACHC, 2003)
26RM in Ambulatory Care
- Identify and plan for potential and actual
risks in terms of facilities, staff, clients,
financial, clinical and organizational
well-being. (NACHC, 2003)
27RM in Ambulatory Care
- How to pay for losses
- Policy and Procedures
- Review and evaluation of effectiveness
- Annual employee training
- System of anonymous reporting
- Methods for investigating
- Corrective actions
28RM in Amb Care Hot Topics
- Credentialing and Privileging
- Medical Records
- Confidentiality
- Backup (paper or electronic)
- Documentation
- Legibility
29Meaningful Use CORE - EP
- Eligible Professional (EP) Core Objectives (All
15 Must Be Implemented) - 1. Use computerized prescriber order entry (CPOE)
for medication orders directly entered by any
licensed health care professional who can enter
orders into the medical record per state, local,
and professional guidelines. - 2. Implement drugdrug and drugallergy
interaction checks. - 3. Maintain an up-to-date problem list of current
and active diagnoses. - 4. Generate and transmit permissible
prescriptions electronically. - 5. Maintain active medication list.
30Meaningful Use CORE - EP
- 6. Maintain active medication allergy list.
- 7. Record all of the following demographics
preferred language, sex, race, ethnicity, and
date of birth. - 8. Record and chart changes in the following
vital signs height, weight, blood pressure,
calculate and display body mass index (BMI), and
plot and display growth charts for children 220
years, including BMI. - 9. Record smoking status for patients 13 years
old or older. - 10. Report ambulatory clinical quality measures
to the CMS or, in the case of Medicaid EPs, the
states.
31Meaningful Use CORE - EP
- 11. Implement one clinical-decision-support rule
relevant to specialty or high clinical priority
along with the ability to track compliance with
that rule. - 12. Provide patients with an electronic copy of
their health information (including diagnostic
test results, problem list, medication lists,
medication allergies) upon request. - 13. Provide clinical summaries for patients for
each office visit. - 14. Capability to exchange key clinical
information (for example, problem list,
medication list, allergies, and diagnostic test
results) electronically among providers of care
and patient authorized entities. - 15. Protect electronic health information created
or maintained by the certified EHR technology
through the implementation of appropriate
technical capabilities.
32EP Menu Objectives (Must Implement 5 of 10)
- Implement drug formulary checks.
- Incorporate clinical laboratory test results into
EHR as structured data. - Generate lists of patients by specific conditions
to use for quality improvement, reduction of
disparities, research, or outreach. - Send patient reminders per patient preference for
preventive/follow-up care. - Provide patients with timely electronic access to
their health information (including lab results,
problem list, medication lists, and allergies)
within 4 business days of the information being
available to the EP. - Use certified EHR technology to identify
patient-specific education resources and provide
those resources to the patient, if appropriate. - The EP who receives a patient from another
setting of care or provider of care or believes
an encounter is relevant should perform
medication reconciliation. - The EP who transitions a patient to another
setting of care or provider of care or refers
that patient to another provider of care should
provide summary care record for each transition
of care or referral. - Capability to submit electronic data to
immunization registries or immunization
information systems and actual submission in
accordance with applicable law and practice. - Capability to submit electronic syndromic
surveillance data to public health agencies and
actual submission in accordance with applicable
law and practice.
33Clinical Quality Measures for EPs (Must Report 6
Total 3 of 6 From Core or Alternate Set and 3 of
38 From Additional Set)
- Core Set
- Hypertension blood pressure measurement
- Preventive care and screening measure pair
tobacco-use assessment and tobacco cessation
intervention - Adult weight screening and follow-up
- Alternate Core Set
- Weight assessment and counseling for children and
adolescents - Preventive care and screening influenza
immunization for patients 50 years or older - Childhood immunization status
34Additional Set (minus oncology)
- Diabetes eye examination
- Diabetes urine screening
- Diabetes foot examination
- Diabetes poor hemoglobin A1c control (gt9.0)
- Diabetes hemoglobin A1c control (lt8.0)
- Diabetes low-density-lipoprotein (LDL)
cholesterol management and control - Diabetes blood pressure management
- Diabetic retinopathy documentation of presence
or absence of macular edema and level of severity
of retinopathy - Diabetic retinopathy communication with the
physician managing ongoing diabetes care - Primary open-angle glaucoma optic nerve
evaluation
35Additional Set
- 11. Heart failure (HF) angiotensin-converting-enz
yme inhibitor or angiotensin receptor blocker
therapy for left ventricular systolic dysfunction
(LVSD) - 12. HF ß-blocker therapy for LVSD
- 13. HF warfarin therapy for patients with atrial
fibrillation - 14. Coronary artery disease (CAD) ß-blocker
therapy for patients with prior myocardial
infarction - 15. CAD oral antiplatelet therapy
- 16. CAD drug therapy for lowering LDL
cholesterol - 17. Ischemic vascular disease (IVD) blood
pressure management - 18. IVD use of aspirin or another antithrombotic
- 19. IVD complete lipid panel and LDL cholesterol
control
36Additional Set
- 20. Asthma assessment
- 21. Asthma pharmacologic therapy
- 22. Use of appropriate medications for asthma
- 23. Controlling high blood pressure
- 24. Antidepressant medication management
effective acute phase treatment and effective
continuation phase treatment - 25. Appropriate testing for children with
pharyngitis - 26. Chlamydia screening for women
- 27. Cervical cancer screening
- 28. Breast cancer screening
- 29. Colorectal cancer screening
37Additional Set
- 30. Smoking and tobacco-use cessation, medical
assistance advising smokers and tobacco users to
quit, discussing smoking and tobacco use
cessation medications, and discussing smoking and
tobacco use cessation strategies - 31. Initiation and engagement of alcohol and
other drug dependence treatment - 32. Prenatal care screening for human
immunodeficiency virus - 33. Prenatal care anti-D immune globulin
- 34. Low back pain use of imaging studies
- 35. Pneumonia vaccination status for older
adults
38(No Transcript)
39Healthy North Carolina 2020 A Better State of
Healthhttp//www.publichealth.nc.gov/hnc2020/In
stitute for Healthcare Improvementhttp//www.ihi.
org/IHI/Topics/Improvement/ImprovementMethods/Meas
ures/Improving Chronic Illness
Carehttp//www.improvingchroniccare.org2011
New and Revised Clinical Measureshttp//www.cms.g
ov/QualityMeasures/03_ElectronicSpecifications.asp
An Introduction to Quality Assurance in Health
Care. Avedis Donabedian. 2003. Oxford
University Press The Improvement Guide. Jerry
Langley, et al.1996. Jossey-Bass
Publishers. Continuous Quality Improvement in
Health Care. McLaughlin and Kaluzny
40Resources
- Meaningful Use Stage 1 Clinical Quality Measures
http//www.hrsa.gov/healthit/meaningfuluse/MU20St
age120CQM/index.html