Day 7: Quality Improvment Flashcards
What is an indicator?
Valid and quantitative measure of performance within a timeframe
EX: number of ER visits in 6 months b/c of penicillin allergy
What is a sentinel event?
Negative result requiring immediate investigation typically involving death
What is a benchmark / standard?
Point of reference for measurement and comparison / provides a baseline
What is a normative standard?
What we think “it” should be
EX: 100% of patients should be adherent to their medications
What is an Empirical Standard?
What “it” really is
EX: if only 75% of those patients are adherent, “we did a great job”
What is quality assurance?
Activities that ensure that services are appropriate, effective and efficient
What is Continuous Quality improvement?
Structured, systematic, perpetual process
Pro-active: identify problems in advance
What is a root cause analysis (RCA)?
When a problem happens you trace it back to its source and perform a systematic investigation that is evidence-based
What is a failure mode and effects analysis (FMEA)?
Studies consequences of identified failures
Used when new systems are designed
What is Risk evaluation and mitigation strategy (REMS)?
FDA program that requires manufacturers to create REMS
Tailor programs to risk-benefit profiles of a specific drug
What are the four components of a REMS?
- Med guide
- Communication plan
- Elements to ensure safe use
- Implementation system
What is the joint commission?
Founded in 1951 and an independent NOT-FOR-PROFIT leader in promoting quality
They accredit and certify health care organization around the US
***** MAY NEED ACCREDITATION in order to be reimbursed for care
What is the agency for healthcare research and quality (AHRQ)
Health services research arm of the US health and human services
What are the center for Medicare and Medicaid services (CMS)?
Contract with private groups in each state to monitor care
What is the Institute of Medicine (IOM)?
Component of national academy of scene cue
Advisor to the nation to improve health
What 3 things should be evaluated when it comes to health care quality?
- Structure
- Process
- Outcomes
What does structure mean in terms of a part of health care quality?
It refers to material and Human Resources as well as policies and procedure
EX: Material resources (money, technology, facilities)
Human Resources (RPh, techs)
Policies and procedure (committees, error management policies)
What are the pros and cons of assessing structure in terms of health care quality?
Pros:
Easy to evaluate and measure
Objective
Cons:
It is tired to outcomes - where is the data
What is evaluating process mean in terms of evaluating health care quality?
Asks: How well is the structure ring used?
Activities that go on within and between practitioners and patients
EX: # of meds dispensed by an RPh per hour
of patients counseled by RPh per hour
% of pregnant mothers counseled to quit smoking
What are the pros and cons of assessing process as a form of health care quality?
Pros: Good to assess process when:
Outcomes are rare (death, med errors)
Patients have multiple disease states
Cons
It’s tied to outcomes - where is the date
EX: Do pharmacists who dispense 10 RX’s or less an hour make less errors?
Can be difficult to asses process (what is actually go or what is bad could turn out to be good in the future)
What does evaluating outcomes mean in terms of health care quality?
Changed in the patients health status
The 5 D’s:
- Death
- Disease
- Disability
- Discomfort
- Dissatisfaction
What is the issue with the 5 d’s when it comes to measuring outcomes in health care quality?
- Death :
May be uncommon - deaths from ear infection - Disease
How diagnosed - HTN vs Depression vs ADD - Disability
How is it measured - how much is “acceptable” - Discomfort
How to assess quality of life - Dissatisfaction
Correlation with quality, pt can still be stratified with ”quacks”
What is efficacy when in the context of outcomes in health care quality?
Outcomes in an ideal setting
EX: randomized clinical trial, everything is done under strict control and accounted for
What is effectiveness when in context of outcomes and health care quality?
Outcomes when care is provided by a typical provider to a typical pt
How many patients will ACTUALLY take the drug (real life compliance, not always great compared to a clinical trial)
Will a doc really order the lab tests to measure if its being effective
What is efficiency when it comes outcomes in the context of health quality care?
Role of cost in assessing quality
Higher spending might not mean higher quality
What is selection bias as a concern for about outcomes for quality health care?
Do sicker pts seek the better providers
If so, “good” provider could be at risk for poor outcomes (which could lead them to bad reviews or reports)
What is meant by potential for “skimming the cream from the top” when it comes to concerns about outcomes in quality health care?
Do providers avoid treating high risk pts b/c of the risk of obtaining poor outcomes
What are the pros and cons of assessing outcomes in health care quality?
Pros:
Promotes innovation
Ends justify the means
Cons:
May not know outcomes for many years (people not usually die at a young age when they get diabetes)
Multiple factors influence outcomes (genetics, lifestyle, nutrition)
Still need to connect structure and process to outcomes (why did this intervention work or fail?)
What are the pros and cons of Medical record being a source of health care quality?
Pro:
objective source of info
Cons:
Can be incomplete (limited documentation)
Poor source of data on interpersonal care
May not document ppt education, disability measures
Hard when multiple provider involved
What are the pros and cons of administrative (claims) data as a source of health care quality?
Pros
Can document access - did pt get drug
Measurable
Cons:
Biased - used to optimize reimbursement
Poor source of data on interpersonal care
Does not document pt education
DOES NOT CAPTURE DATA from pts who pay CASH b/c no claim is submitted ($4 generic drug in cash or good RX is not submitted)
What are the pros and cons of patient reports in terms of health care quality?
Pros:
Best resource to assess interpersonal care
Cons:
Subjective: pt can forget and emotions can influence reports
Poor resource to assess technical competence
What are the pros and cons of provider reports for as a source of health care quality?
Pros:
Good resource to assess technical skills
Cons:
Subjective, providers can have selective recall and emotions can influence the report
Can be different than how the patient perceives the interaction
What are the pros and cons of provider report card in evaluations of quality?
Pros:
Can show value of individual provider
Can help providers understand what to improve
Cons:
Results daily misinterpreted
“What” is being evaluated:
do consumers really know to use
Will they used to get price discounts?
What are the concerns about publicizing quality evaluations?
Invalid results mislead the public and payers (pt and payers can make poor choices)
Will hospitals and health care providers risk publishing reports of poor performance?
Study in 2007 could not find ANY hospital that published poor performance on its website
Public reporting or quality measure should meet same reporting standards as financial organization and pharmaceutical ads
What are the concerns about standers when it comes to health quality care?
Some standards only supported by expert opinion or suboptimal evidence
Guidelines and standards supported by observational evident and/or “experts” are commonly rejected when subjected to test of controlled trials
Organizations can reach different conclusions when looking at the same evidence
EX: AMerican cancer society and US preventative services task force had differences in the value of early cancer screenings
