Component 2: The Culture of Health Care Unit 7: Quality Measurement, Performance Improvement, and Incentive Payment Schemes Lecture 2 This material was.

Slides:



Advertisements
Similar presentations
© 2010, American Heart Association. All rights reserved. Hospital Performance Recognition with the Get with the Guidelines Program and Mortality for Acute.
Advertisements

Disease State Management The Pharmacist’s Role
Department of Vermont Health Access Vermont Blueprint for Health: Using APCD to Evaluate Health Care Reform Pat Jones, MS Blueprint Assistant Director.
Introduction to Core Measures Lynn Benson Preferred Nurse Staffing.
Data Collection Support Webinar MetaStar, Inc. April 18, 2007 Carol Ferguson Pam Clemens.
Quality Improvement In Neurosurgery
CMS Core Measures Evidence-Based Performance Measurement.
QUALITY AND YOU GUIDE for New Physicians, Dentists, Podiatrists, and Extenders.
0 Hospital Quality Incentive Demonstration (HQID) Key Facts Three year demo ( ); extended for three additional years through Oct hospitals.
US Health Care: Half Right. Thomas L. Garthwaite, MD Director and Chief Medical Officer Department of Health Services County of Los Angeles USC Health.
2.11 Conduct Medication Management University Medical Center Health System Lubbock, TX Jason Mills, PharmD, RPh Assistant Director of Pharmacy.
Medicare Quality Improvement and Provider Technical Assistance: An Overview of the Next Five Years December 8, 2014 Mary Fermazin, MD, MPA, Chief Medical.
The Cost-Quality Connection in Southeast Michigan A Call for Consistency in Performance-Based Differential Reimbursement John E. Billi, MD University of.
Value & Coverage Issue Brief Slides A Closer Look at Evidence-Based Performance Measurement.
Saeed A. Khan MD, MBA, FACP © CureMD Healthcare ACOs and Requirements for Reporting Quality Measures © CureMD Healthcare Saeed A. Khan MD, MBA, FACP.
The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b This material (Comp2_Unit10b) was developed by Oregon Health and.
HealthPartners Clinical Indicators Communication Toolkit HealthPartners Communication Toolkit HealthPartners is pleased to provide you with.
Implementing Quality Improvement and P4P in Ambulatory Academic Group Practice Neil Goldfarb Associate Dean for Research, JSPH Co-Director, College for.
Quality in Laboratory Medicine Conference Business Case for Quality Recognizing Excellence in Practice Presented to the Institute for Quality in Laboratory.
EHR for Meaningful Use Clinical Quality Measures Dr. Aneel Advani Associate Director for Informatics IHS Office of Information Technology Indian Health.
Measuring the Quality of Pennsylvania’s Commercial HMOs Joe Martin Director of Communications and Education Pennsylvania Health Care Cost Containment Council.
The Culture of Healthcare
Health Care Effectiveness Summer Quarterly Meeting July 19, 2011.
Introduction to Healthcare and Public Health in the US Delivering Healthcare (Part 2) Lecture a This material (Comp1_Unit3a) was developed by Oregon Health.
Alternative Quality Contract: Improving Health Care Quality While Reducing Spending Growth Alliance for Health Reform Deborah Devaux Monday, August 10,
BDK10-1 Secondary Use (Re-Use) of Clinical Information
Primary Care Workforce Summit November 29, 2012 Country Springs Hotel, Waukesha Primary Care Workforce Summit Pharmacy Perspective Kate Hartkopf, PharmD.
Basma Y. Kentab MSc.. 1. Define ambulatory care 2. Describe the value of ambulatory care practices 3. Explore pharmacy services in some ambulatory care.
Unit 1a: Health Care Quality and HIT Introduction to QI and HIT This material was developed by Johns Hopkins University, funded by the Department of Health.
The Culture of Healthcare Nursing Care Processes Lecture a This material (Comp2_Unit6a) was developed by Oregon Health and Science University, funded by.
Performance Measurement Orientation To schedule a presentation of “Performance Measurement Orientation” for your organization staff and/or collaborators,
Pay for Performance: Choosing Measures Linda K. Shelton AVP, Product Development PFP Boot Camp for Physicians and Physician Organizations February 2006.
Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d This material (Comp1_Unit9d) was developed.
Vermont Department of Banking, Insurance, Securities and Health Care Administration Act 53 of 2003 Hospital Community Reports Community Needs Assessments.
Performance Measurement Sets Dolores Yanagihara Program Development Manager IHA.
Michigan Quality Improvement Consortium Measurement Committee Year-End Report December 14, 2006.
Ambulatory Care Quality Measures: Disease Management Research Opportunities Neil Goldfarb Director of Research and Research Assistant Professor of Health.
Quality Measurement and Gender Differences in Managed Care Populations with Chronic Diseases Ann F. Chou Carol Weisman Arlene Bierman Sarah Hudson Scholle.
Pay-for-Performance in Safety Net Settings: New Evidence from the Agency for Healthcare Research and Quality (AHRQ) Gary Young, J.D., Ph.D., Bert White.
Introduction to Core Measures
Buying Quality HPA 420 Spring Plan for Today  Accreditation of MCOs National Committee for Quality Assurance (NCQA)  Performance Measures Health.
HITECH/MEANINGFUL USE Danielle Smith Trends and Issues in Healthcare December 2, 2014 Power Point Project.
Managed Care. In the broadest terms, Kongstvedt (1997) describes managed care as a system of healthcare delivery that tries to manage the cost of healthcare,
Component 2: The Culture of Health Care Unit 7: Quality Measurement, Performance Improvement, and Incentive Payment Schemes Lecture 4 This material was.
Quality Measurement and Improvement Component 2 / Unit 7d.
Pay-for-Performance in Safety Net Settings: New Evidence from the Agency for Healthcare Research and Quality (AHRQ) Gary Young, J.D., Ph.D., Bert White.
Slide 1 Regional Care Collaborative March 26, 2015.
Hospital Measures Reporting in Ohio Michele Shipp, MD, DrPH AHRQ QUALITY INDICATORS USERS MEETING Wednesday September 9, 2008 AHRQ ANNUAL CONFERENCE 2008.
Component 2: The Culture of Health Care
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator.
1 Data Reporting In The CMS Physician Quality Reporting Initiative National P4P Summit February 15, 2007 Ron Bangasser, M.D.
Quality Measurement and Improvement Component 2, Unit 7a.
The Role of Health Information Technology in Implementing Disease Management Programs Donald F. Wilson, MD Medical Director Quality Insights of Pennsylvania.
The Hospital CAHPS Program Presented by Maureen Parrish.
The Wisconsin Experience Building A “High Value” Health Care Measure Christopher Queram / President and CEO Wisconsin Collaborative for Healthcare Quality.
What does the National Healthcare Agenda Mean to Us? Developed in cooperation with Patricia C. Kienle, MPA, FASHP and Wayne S. Bohenek, Pharm.D., M.S.,
Promoting Health Information Technology Linda Magno Director, Medicare Demonstrations Group.
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator.
The Department of Quality and Risk Management
If I Ran the Zoo: Quality Measures in Accountable Care and the Fit with Integrative Health and Medicine. Jim Whedon, DC, MS Research Working Group,
Attachment #1: Examples of Encounter Data
Quality Measurement and Improvement
The Focus on Quality A Closer Look at a National Trend
Measuring Efficiency HSCRC Performance Measurement Workgroup
Highmark QualityBLUE Pay for Performance Program
Information provided by: Yvette Mansion-Whittaker
Component 2: The Culture of Health Care
Measuring Efficiency HSCRC Performance Measurement Workgroup
Information provided by: Yvette Mansion-Whittaker
Presentation transcript:

Component 2: The Culture of Health Care Unit 7: Quality Measurement, Performance Improvement, and Incentive Payment Schemes Lecture 2 This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

Overview State of the quality of care Definitions and operationalization of quality measurement and improvement Quality measures Role of information technology (IT) and informatics Results of current approaches Challenges, limitations, and ethical issues Quality measurement and improvement under meaningful use Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

Definitions and operationalization What is healthcare quality? Different views… From Blumenthal (1996) –Donabedian, 1988: “That kind of care which is expected to maximize an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts.” –Lohr, IOM, 1990: The “degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge.” In era of rising costs and concerns about quality, physicians and the healthcare system must have public accountability (Lanier, 2003) Research and practice still evolving (Berwick, 2008; Miller, 2009) Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

Donabedian (2002) model of quality Three categories –Structural – factors that make it easier or harder to deliver high-quality care, e.g., hospital location, volume, association with teaching hospital –Process – factors describing healthcare content and activities, e.g., adherence to screening, guidelines, etc. –Outcomes – changes attributable to care, e.g., mortality, morbidity, functional status Implemented and measured at different levels at an institution, e.g., individual, department, organization Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

Examples in Donabedian’s model IndividualDepartmentOrganization Structural -Professional certification -Credential review -Staffing analysis -Equipment safety checks -Licensure -Fire safety inspections Process -Peer review -Performance evaluations -Productivity monitors -Review of performance indicators -Flow process analysis -Infection surveillance -Review of utilization data Outcome -Practice profiles -Rework required -Error/complication rate analysis -Mortality rates -Quality sanctions Health IT Workforce Curriculum Version 2.0/Spring Component 2/Unit 7-2

Process vs. outcomes In general, want to focus on outcomes –Represents what actually happens to patient –But difficult to measure and have confounding factors Do we know about relationship between them? –In acute coronary syndromes, there is strong correlation between process and outcome measures (Peterson, 2006) –In other areas, however, there is not a strong relationship between satisfaction with care (“global ratings”) and its technical quality (Chang, 2006) –The science behind care also changes, e.g., recognition that too tight of control (HgbA1C) in diabetes can be detrimental (Aron, 2009) –There is not always consensus, e.g., “drugs to avoid” in the elderly (Steinman, 2009) Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

Ideal quality measures Landon, 2003 – should be –Evidence-based –Agreed-on standards for satisfactory performance –Standardized specifications –Adequate sample size for reliable estimates –Adjustment for confounding patient factors –Care attributable to individual physician –Feasible to collect –Representative of activities of specialty “In God we trust, all others bring data” –Edward Deming, statistician ( ) Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

Other definitions and issues Pay for performance (P4P) (Rowe, 2006) –Often equated with quality assessment but is just one approach (Rosenthal, 2008) –Based on notion that healthcare should be held accountable financially and otherwise Value-based purchasing (Leapfrog, 2007) –Application of P4P –Uptake among employers (major purchasers of healthcare in US besides governments) modest so far (Rosenthal, 2007) Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

A sampling of current quality measures Warning: There are many sets and acronyms, and they change constantly –We are still “early” in the science of quality improvement (Berwick, 2008) –“Science” defined in an IOM report (2006) Many measures have been developed, reflecting various perspectives –AHRQ maintains clearinghouse – –Growing consensus that standard sets are needed for each perspective We will view them from following perspectives –Health plans –Outpatient –Inpatient Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

Measures for health plans Called out because of historic role Health Plan Employer Data and Information Set (HEDIS) by NCQA provides 60 measures that evaluate health plans, particularly health maintenance organizations NCQA annual reports calculate lives saved based on outcomes from adherence Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

HEDIS categories and example measures Effectiveness of care –Childhood and adult immunizations –Use of beta blockers after myocardial infarction –Screening for various types of cancer –Comprehensive diabetes care Access/availability of care –Access to preventive health services –Availability of primary care providers –Initiation of prenatal care Satisfaction with care –Member satisfaction surveys Use of service –Rate trends Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

Measures for outpatient setting Standardization around Ambulatory Care Quality Alliance (AQA, providing “starter set” of measures –Endorsed by major primary care associations (ACP, AAFP) as well as health plans (AHIP) Physician Quality Reporting Initiative (PQRI, of Medicare –Extra 2% reimbursement each for Reporting on large number of measures (153 in 2009) Use of e-prescribing Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

AQA measures Fall into eight main categories –Prevention –Coronary artery disease –Heart failure –Diabetes –Asthma –Depression –Prenatal care –Quality measures addressing overuse or misuse Not meant to denote “standard of care” but only to provide sample of quality Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

AQA prevention measures Breast Cancer Screening – % screened in last two years Colorectal Cancer Screening – % with appropriate screening –Several possible tests, e.g., sigmoidoscopy, colonoscopy, etc. Cervical Cancer Screening – % screened in last two years Tobacco Use – % queried about use in last two years Advising Smokers to Quit – % counseled to quit Influenza Vaccination – % aged who received Pneumonia Vaccination - % who ever received Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

AQA diabetes measures HbA1C Management – % with diabetes having in last year HbA1C Management Control – % with diabetes having value < 9 Blood Pressure Management – % with diabetes having blood pressure under 140/90 Lipid Measurement – % with diabetes screened LDL Cholesterol Level (<130mg/dL) – % with diabetes with level <130mg/dL Eye Exam – % with diabetes having in last year Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

Measures for inpatient settings Hospital Quality Alliance (HQA, –Collaboration among CMS, Joint Commission, and others to create a starter set of quality measures for various conditions (four initially) –In Hospital Compare Project, hospitals voluntarily provide quality information that can be accessed via a Web site – –Consists of two programs based on reporting to CMS Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) – for HQA data; not participating in 2010 results in 2% Medicare reimbursement reduction Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) – reporting of patient satisfaction at hospitals Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

HQA categories and examples Myocardial infarction –Aspirin at arrival and discharge –Inpatient mortality Heart failure –Discharge instructions –Evaluation of left ventricular systolic function Pneumonia –Time to blood cultures and antibiotics –Pneumococcal and influenza vaccinations Surgical infection prevention –Prophylactic antibiotics –Prophylaxis for deep venous thrombosis Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring

Other inpatient quality initiatives National Surgical Quality Improvement Program (NSQIP – –Effort of American College of Surgeons to measure, risk-adjust, and improve quality of surgical care University HealthSystem Consortium (UHC – –Quality measurements to benchmark academic medical centers –Measured by “green dots” and “red dots” (½ to 2) Component 2/Unit 7-2 Health IT Workforce Curriculum Version 2.0/Spring