Quality Assessment Flashcards
Two aspects of quality assurance are:
Outcome Assessment
Retrospective Audit
Change in the health of an individual that is attributable an intervention or a series of an intervention
Outcome
Assessment treatment effectiveness
Outcome Assessment
It is a process used by health care professionals to assess, evaluate and systematically improve care.
Audit
It takes place before the claim of submission of services and focuses on revealing specific and targeted cases
Prospective Audit
Assessing the result of care
Retrospective Audit
Why is measuring health care important?
- Improve the patient experience of care
- Improve the health of populations
- Reduce the per capita cost of healthcare
- Reduce clinician and staff burnout
Quality PT started during the?
1970
The regulatory effort by the government
Professional Standards Review Organizations
Considered non-hospital institutional care
Physical Therapy
Assessment of organization staffing and staff qualifications, rules and policies governing professional work, records equipment, and physical facilities
Structure
It is based on the degree or extent to which the physical therapist conforms to accepted professional practices in providing services
Process
An assessment is based on the condition of the patient after care about the goals of treatment assessment of outcomes
Outcome
Proposed a system of collecting hospitals statistics in 1863
Florence Nightingale
Father of outcome patient care audit systems
Ernest Codman
Qualified health professionals
will=__________
Good care
What organization happened in 1952?
Joint Commission on Accreditation (JACAH)
What happened in 1965?
utilization review for Medicare funding
What happened in 1972?
Bennett Amendment of social security act (PSROs)
- Review of PT service
2 MAJOR FORCES INFLUENCING
QUALITY ASSURANCE
DEVELOPMENT IN US (United States)
- JCAH
- PSROs
performance evaluation procedure (PEP)
JCAH
The standard for PT services and standards for PT practitionerprofession statement of conditions and performances which are essential for quality
physical therapy services and
patient care
APTA
QUALITY ASSURANCE STANDARDS WHERE IS ESTABLISHED BECAUSE OF:
- Reluctance of health
professionals to objectively
evaluate the quality services they
provide - An informed public
- Spiraling cost of health care
SOCIAL SECURITY ACT OF 1972 (THREE OBLIGATIONS)
- Order or Furnish
- Furnish
- Provide
Only care is medically necessary
Order or Furnish
Meet professionally recognized
standards of quality
Furnish
_______ documentation of the medical necessity and quality of care provided ass the PSRO may reasonably require
Provide
Quality assurance system focuses on:
- monitoring the results of care
- assessing the results of care
- Improving the results of care
A process in which criteria or standards are used to
review actual practice to identify those areas requiring in-depth study or to determine the results
of corrective action.
Monitoring
This is done through retrospective patient care audits. The area of concern becomes the audit topic.
Assessing the results of care
The corrective action that must be implemented
Improving the results of care
The audit has four distinct steps:
- development of screening
criteria - Data Retrieved
- Data Display
- Data Analysis
The criteria should be designed to screen out records most likely representing acceptable patient
care from a direct physical therapist
Development of screening criteria
This information indicates whether the record/data gathered satisfied the element
Data Retrieved
Summarizes the medical data analyst review of all records
Data Display
It records that did not satisfy screening criteria to determine the quality of care
Data Analysis
Patient care responsibilities of
managers:
- Managing Professionals
- Utilization Management
- Case Management
- Quality Care
- Patient Satisfaction
- Patient rights and responsibilities
- do not have direct responsibility for individual patients
- direct patient care responsibility
belongs to each physical therapist - assist with nonclinical problems;
provide performance feedback; and reaffirm the Vision, mission, and goals of their organizations - heavy workloads, interprofessional role conflicts or
ambiguity, scarce resources, understaffing, physical strain, emotional labor - interpreting the big picture of healthcare policy,
reimbursement, and organizational goals
Managing professionals
-Responding to the efforts of third-party payers to manage their costs and the quality of the care
-conditions that are the costliest, most utilized, or result in questionable outcomes receive the greatest scrutiny
- determine whether patient care is
efficient, effective, medically necessary and appropriate
- quantity of services, the timetable for
delivery, and appropriate sources
of evaluation and treatment
- received a level of care that was
efficient, effective, and
consistent
Utilization Management
- meet a person’s needs through available resources
- duties of case managers may include:
- Screening to identify appropriate patients
- Planning and coordinating the
delivery of care - Evaluating the outcomes of care for each patient
- Checking benefits available and coordinating with other benefits
Case Management
defined as the degree to which a healthcare organization increases the likelihood of desired health outcomes, consistent with current evidence about the scientific, interpersonal and organizational
components of healthcare
Quality Care
Healthcare quality with six
dimensions of patient care:
- Safe
- Effective:
- Efficient:
- Timely:
- Patient-centered:
- Equitable:
Quality defects can be classified as:
- Underuse
- Overuse
- Misuse
Failure to employ many scientifically sound practices as often as they should be
Underuse
Failure to eliminate diagnostic tests and interventions when they are not indicated
Overuse
Failure to appropriately execute the proper clinical care process
Misuse
Two critical aspects of patient satisfaction
- Content of quality
- Service-delivery quality
It depends on performance evaluations, staff development, compliance with evolving guidelines and standards
Content of quality
It depends on managers having processes that meet patient expectations for convenience and
timeliness
Service-delivery quality
A list of guarantees while receiving
medical care, which may be a voluntary declaration developed by an organization for its own
members or goals
A bill of rights
