Assignment 6 - Measuring and Improving Quality of Care Flashcards
What dual concerns regarding health care are shared by both private and governmental purchasers of health care? (2)
- health care costs
- how to improve the quality of both care and patient experience
What are the two? goals promulgated by the Institute of Medicine (IOM) following the two landmark reports identifying widespread quality problems nationally within the U.S. health care system?
- To Err Is Human - quantified the frequency and severity of errors in hospital care
-
Crossing the Quality Chasm - put those errors in a broad perspective and set six national goals for improvement
3.
While primary care medicine has been the focus of redesign and improvement efforts, why has that area of care continued to deteriorate? (3)
- Fewer young doctors are going into primary care
- most primary care practices are financially insecure
- primary care doctors are being forced to focus primarily on productivity.
What three elements characterize the “triple aim” in health care, and
what is meant by a quest for value?
- (a) improving health
- (b) enhancing patient experience of care
- (c) reducing costs.
quest for value entails pursuing higher quality and experience at lower cost.
The historical lack of integration within most medical groups, even large multispecialty groups, created a situation where these larger evolving organizations had to address_____
quality improvement (QI).
The emergence of increasingly complex medical organizations has required __________
leadership
Standardized practice systems that ensure comprehensive, continuous and coordinated care are at the heart of the primary care practice redesign currently called______
medical homes
Identify the frequently referenced strategies that can be combined to effect QI using a multiple strategy approach (10)
- Using system supports like reminders, registries and task delegation
- Focusing on changes that would make physician work easier
- Reducing or removing barriers
- Measuring for improvement periodically
- Providing information or training
- Delegating authority to the implementation planners
- Providing comparative feedback of relevant measurements
- Pretesting change through pilots and rapid cycling
- Tailoring implementation to each practice setting
- Focusing on changes that make the system better for patients
In achieving health care quality improvements, it appears that these improvements depend mainly on three factors and that if any of these three are absent or only minimally present, there will not be much improvement.
- (1) A high priority placed upon the specific improvement by leaders that is higher than their need to undertake most other changes in the organization
- (2) A high capability to manage the change process, including knowledge and experience with a particular approach to change as well as adequate resources and leadership to accomplish the proposed change.
- (3) A choice of care process changes that are highly likely to be effective for accomplishing the improvements desired.
After much study and research, there are certain conclusions that can be drawn concerning various approaches to achieve quality improvement. Performance measures, incentives and penalties that are only focused on or used by _____ are not likely to be very successful in bringing about effective and extensive quality improvement.
health plans
It is recognized that ____________ must take a leading role in any serious improvement in care and costs, and that only happens when payment systems require and reward such changes.
physicians and care delivery organizations
What impedes the ability of primary care practices to marshal consultative assistance to achieve quality improvement?
they lack the resources
As an alternative or in addition to external facilitators, one of the most promising ways to help clinics and medical groups to improve may be through their participation in local, regional or national
quality improvement collaboratives (QICs).
A wide variety of other QICs have developed on a regional basis or within a large organization like the Department of Veterans Affairs. One of the oldest and most successful has been the ___________
Institute for Clinical Systems Improvement (ICSI) in Minnesota,
Evaluations of the ICSI program have suggested that participating medical groups and clinics tend to evolve in their understanding and work on quality through four stages as they participate in the ICSI collaborative:
- (1) Implementation of specific guidelines, one at a time
- (2) Implementation of combinations of guidelines that use similar systems (e.g., all preventive services) or relate in a specific condition
- (3) Development or remodeling of the group’s general systems and infrastructure for improvement of care
- (4) Redesign of the entire approach the group takes to providing health care as well as the culture of the group
