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Your Quality Improvement Plan Your Health Care Plan

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Title: Your Quality Improvement Plan Your Health Care Plan


1
Your Quality Improvement Plan Your Health
Care Plan ..and
stuff like that
  • Marti Wolf, RN, MPH
  • Clinical Programs Director
  • North Carolina Community Health Center Association

2
Session 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.

3
Objectives
  • Whats a Health Care Plan?
  • Whats a Quality Plan?
  • Clinical UDS???
  • Meaningful Use
  • Medical Home

4
Words 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

5
Benefits 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

6
Benefits 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

7
QI 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

8
Quality
  • Safe
  • Effective
  • Patient-Centered
  • Timely
  • Efficient
  • Equitable

9
QI 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)

10
QI 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

11
QI 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

12
Quality 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))

14
Elements 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

15
IHI Triple Aim
Quality of Care
Cost of Care
Patient Experience
16
Perspectives on Quality

Medical
Administrative Patie
nt
17
Quality
  • Results of Quality
  • Improved Outcomes
  • Improved efficiency and productivity
  • Staff and patient satisfaction

18
QI 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

19
Demonstrating Quality
  • Patient Centered Medical Home
  • Patient Centered Health Home Initiative
  • Meaningful Use

20
Quality - Food for Thought
  • Consistency requires you to be as ignorant today
    as you were a year ago .
  • -Bernard Berenson

21
Health 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

22
ENOUGH 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

23
Risk Management
24
Disclaimer
  • Risk Management is like liver.
  • The more you chew it,
  • the bigger it gets.

25
Risk Management
  • PROTECT
  • AGAINST
  • LOSS

Identify and plan for potential and actual
risks in terms of facilities, staff, clients,
financial, clinical and organizational
well-being. (NACHC, 2003)
26
RM 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)

27
RM 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

28
RM in Amb Care Hot Topics
  • Credentialing and Privileging
  • Medical Records
  • Confidentiality
  • Backup (paper or electronic)
  • Documentation
  • Legibility

29
Meaningful 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.

30
Meaningful 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.

31
Meaningful 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.

32
EP 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.

33
Clinical 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

34
Additional Set (minus oncology)
  1. Diabetes eye examination
  2. Diabetes urine screening
  3. Diabetes foot examination
  4. Diabetes poor hemoglobin A1c control (gt9.0)
  5. Diabetes hemoglobin A1c control (lt8.0)
  6. Diabetes low-density-lipoprotein (LDL)
    cholesterol management and control
  7. Diabetes blood pressure management
  8. Diabetic retinopathy documentation of presence
    or absence of macular edema and level of severity
    of retinopathy
  9. Diabetic retinopathy communication with the
    physician managing ongoing diabetes care
  10. Primary open-angle glaucoma optic nerve
    evaluation

35
Additional 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

36
Additional 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

37
Additional 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)
39
Healthy 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
  • Resources

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
40
Resources
  • Meaningful Use Stage 1 Clinical Quality Measures
    http//www.hrsa.gov/healthit/meaningfuluse/MU20St
    age120CQM/index.html
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