1. Chapter 7 Quality Health Care Management

2. 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”

3. 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

4. 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

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

6. 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

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

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

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

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

11. Tools Brainstorming Benchmarking Affinity diagram Nominal group technique Gantt charts

12. Tools PERT Cause-and-effect diagram Pareto chart

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

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

15. Benchmarking Outcomes Core measurements Quality improvement model

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

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

18. 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

19. Utilization Management Definition History Case management Case managers or utilization coordinators

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