Domain 3 Flashcards
Quality Indicators
Objective and quantitative measures of the structures, processes, or outcomes of care, indicating a starting point for those who want to improve care/processes
-Clinical
-Financial
-Productivity
-Utilization
-Quality
-Client experience
Benchmarking
Comparing care between two places
Delphi Technique
Method of obtaining quality indictors through questionnaires
Plan-Do-Study-Act Approach (PDSA) – Quality Improvement Strategy
Plan- identify process that isn’t providing ideal outcomes
Do- measure key performance attributes
Study- devise new approach
Act- integrate new approach
Small scale
Six Sigma Approach – Quality Improvement Strategy
Focuses on eliminating defects (in products, processes, or practice) to improve patient safety
DMAIC
Define- goal
Measure- collect data
Analyze- reveal root cause of inefficiencies
Improve- develop and implement methods to address deficiencies
Control- assess success in implemented changes
Lean Approach – Quality Improvement Strategy
Reduce waste and increase value
Waste is identified as DOWNTIME:
Defects
Overproduction
Waiting
Non-utilized talent
Transportation
Inventory
Motion
Extra-processing
Kaizen – Quality Improvement Strategy
Lean and Six Sigma combined: continuous improvement
7 phases:
-Identify
-Analyze
-Develop solution
-Implement solution
-Study results
-Standardize solution
-Plan for future
Accreditation
Voluntary process in which trained peer reviewers evaluate a healthcare organization’s compliance with national and accreditation standards
Commission on Accreditation of Rehabilition Facilities (CARF) – Accreditation Agency
Non-profit accreditor of health and human services focused on improving service outcomes, client satisfaction, and quality service delivery
Utilization Review Accreditation Commission (URAC) – Accreditation Agency
Primary focus is case management to enable health programs to build a program capable of managing transitions
National Committee for Quality Assurance (NCQA) – Accreditation Agency
Accreditor of healthcare organizations and managed care organizations, maintains HEDIS measures, core is care coordination, patient-centeredness, and quality of care
Healthcare Effectiveness Data and Information Set (HEDIS)
Measures standardized performance measures (90) in 6 healthcare domains of care
The Joint Commission (TJC) – Accreditation Agency
Accredits variety of healthcare settings, evaluates healthcare organizations to inspire them to excel in providing safe and effective care at highest quality and value, certification programs offered for condition/disease management and Primary Care Medical Home/Integrated Care
National Quality Forum (NQF) – Healthcare Quality Organization
Non-profit, non-partisan, membership based, endorse performance measures to quantify healthcare processes, outcome, patient perceptions, and organizational structures/system, public and private sector
Centers for Medicare and Medicaid Services (CMS)
Federal agency within US Department of Health and Human Services. Contracts with agencies to manage 2-fold initative of QIOs and QIN
Beneficiary and Family Centered Care Quality Improvement Oganization (BFCC-QIO) – Healthcare Quality Organization
Works under direction of CMS, analyze data and patient records to identify areas for improvements in care for beneficiaries, address individual complaints
Clinical Quality Measures (CQMs)
Track quality of healthcare services provided and examine providers’ ability to deliver high-quality care or relate to long-term goals for quality healthcare
Quality Innovation Network-Quality Improvement Organization (QIN-QIO) – Healthcare Quality Organization
12 regional contractors designed to improve quality of healthcare for people with specific conditions or address specific gaps in healthcare for Medicare beneficiaries, shares resources, help healthcare entities understand different quality initiatives
Agency for Healthcare Research and Quality (AHRQ) – Healthcare Quality Organization
Publishes and disseminates national clinical practice guidelines, evidence-based, maintains Healthcare Cost and Utilization Project (HCUP), 4 QI models: prevention, inpatient, patient safety, pediatric
National Quality Strategy (NQS) – Healthcare Quality Organization
Led by AHRQ, 3-6-9 approach: triple aim-6 priorities of common health concerns-9 levers to align function
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
Nationally standardized survey of patients’ perspectives of their hospital experience allowing objective comparison of hospitals, used to calculate VBP incentive
Cost-Benefit Analysis Report
Provide a summary of case management interventions and document overall costs of care and savings related to CM activities
Hard Savings
Savings directly related to case manager’s actions (i.e. decrease in length of stay, transfer)
Soft Savings
Potential savings, costs avoided due to case management intervention (i.e. avoid ER visits, readmission)
Cost-Benefit Analysis Equation
Cost savings = potential costs - (actual cost + cost of CM)
Health Risk Assessment (HRA) – Risk Stratification Tool
Tool to assess a patient’s health status, risk of negative health outcomes, and readiness to change certain behaviors; used to design prevention plan
Predictive Modeling – Risk Stratification Tool
Uses technology and statistical methods to analyze large amounts of data to predict outcomes for patients
Adjusted Clinical Group (ACG) – Risk Stratification Tool
Uses diagnostic and phamaceutical code information from insurance claims and medical records to measure morbidity in large populations based on disease patterns, age, and gender
Acuity
Level of need and frequency of CM intervention
Community Assessment Risk Screen (CARS) – Risk Stratification Tool
Determines risk for rehospitalization and ER visits for seniors
Hierarchical Condition Category (HCC) – Risk Stratification Tool
Used to calculate risk scores that quantify and project financial risk of each Medicare beneficiary to adjust payments to Medical Assistance plans
LACE Tool – Risk Stratification Tool
L- length of stay
A- acuity of admission
C- comorbidities
E- ER visits
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
Nursing home surveys
Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS)
Home health care surveys
