Chapter 7 Quality Health Care Management

Introduction Quality health care – doing the right thing at the right time, in the right way, for the right person, and getting the best possible results There may be different interpretations of what is “right”

Data Quality High grade, superiority, or excellence of data Intertwined with quality patient care Data can demonstrate and represent in an objective sense the delivery of quality patient care

Historical Developments The study of the quality of patient care has existed for almost 100 years ACS created Hospital Standardization Program in 1918 The ACS program lead to JCAHO in 1951

Terms Total quality management Continuous quality improvement Quality management Quality assurance Process improvement Performance improvement

Data To measure patient care for quality purposes, must have data Data must be reliable, consistent, and accurate –Documentation process –Abstracting process –Coding process –Indexing and registry processes –Interpreting process

Assessment Models Quality circles PDSA FOCUS PDCA Malcolm Baldridge National Quality Award Six Sigma Improvement Methodology

Malcolm Baldridge National Quality Award Leadership Strategic planning Customer and market focus Information and analysis Human resource focus Process management Business results

Federal Efforts AHRQ –MEPS –HCUP –CAHP –TRIP –Quality/Safety of Patient Care Program –CERT President George W. Bush statement

Private Efforts Aims for improvement Ten steps for redesign NCQA –MCO –HEDIS NAQAP –CPHQ

Tools Brainstorming Benchmarking Affinity diagram Nominal group technique Gantt charts

Tools PERT Cause-and-effect diagram Pareto chart

Data Display Bar graph Histogram Pie chart Line graph Control chart Scatter diagram

Applications Prospective approach Concurrent approach Retrospective approach Focus on how to use data to improve patient care and safety –PDSA –Benchmarking

Benchmarking Outcomes Core measurements Quality improvement model

QI Reports MDS – Minimum Data Set OSCAR – Online Survey, Certification, and Reporting database Selecting core measurements for tracking

Performance Improvement Clinical function focused on how to improve patient care HIM involvement Use of benchmarking technology ORYX Initiative CATCH

Risk Management Nonclinical function focused on how to reduce medical, financial, and legal risk to an organization Role expanding to include more focus on database management Issues related to risk management

Utilization Management Definition History Case management Case managers or utilization coordinators

Utilization Review Preadmission review Admission review Concurrent review Discharge planning Special 10 Transfer DRGs