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Performance Improvement > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Name some ways EHR’s improve performance

A 
Easily searchable records
Track patients easier
Prescribing error decrease
Test results
Communication
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2
Q

Some difficulties with EHRs

A

Costly
Large time investment
Inaccuracy of records
Poor design

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3
Q

Meaningful use of EHR

A

Up to date problem list
Computerized medication orders
Clinical support rules
Drug checks

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4
Q

EHR adoption

A

84% hospitals, 54% physicians

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5
Q

What is patient-centered medical home

A

Health care setting that facilitates partnerships between individual patients, physicians, and patient’s family

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6
Q

Core idea of medical home

A

Patient has ongoing relationship with provider
Continuity of care
Patient self-management

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7
Q

Just culture

A

No blame approach: human error (console), at risk behavior (coach), reckless behavior (discipline)

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8
Q

Difference between management and medical culture

A

bureaucratic vs. collegial
Low group loyalty vs high loyalty
Patients as groups vs. patients as individuals
Success is efficiency vs. Success is effectiveness

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9
Q

What is patient-centeredness

A 
Respect for patient values, preferences and needs
Coordination of care
Education, information, communication
Comfort
Access to Care
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10
Q

Decision Making modalities for patients (all models are legitimate)

A

Paternalism by permission
Partnership
Patient in charge

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11
Q

What is patient self management?

A

Management by patients of aspects of diagnosis and treatment formerly managed only by clinicians

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12
Q

5 levels of engaging patients

A
  1. Gather info on experience of care
  2. Include patients on improvement project teams
  3. Patient advisory councils
  4. Include patients in management
  5. Include patients in governance
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13
Q

General model of PI

A 
Set organizational goals
measure performance against goals
select areas for improvement
set objectives for improvement
plan & take action
stabilize improvements
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14
Q

System level goals should fulfill what or what?

A

The triple aim or the IOM six aims

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15
Q

Potential system level measures

A

Sentinel events per year
Nosocomial infections
Readmission rates
HCAHPS

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16
Q

Change adopter categories

A

Innovators, early adopters, early majority, late majority, laggards

17
Q

Steps of creating PI teams

A

Charter by senior leadership to focus on a need
Sponsorship
Mix clinicians and managers to create a team
Staffers provide experise in improvement methods, measurement, etc.

18
Q

Details on team charter

A

Should be written

Content focuses on (topic, scope, aim for team, team composition, timeline),

19
Q

Principles for managing change

A 
Senior leadership support
Right structure
Engaged team (esp. physicians)
Use motivators
Use champions
20
Q

Principles of TPS

A 
Look to the long term
Create continuous flow
Grow leaders
Respect each other
Observe work directly
21
Q

Baldridge categories

A 
Leadership
Strategy
Customers
Measurement
Workforce
Operations
Results
22
Q

What gets reported to the public?

A 
Clinical outcomes
Safety
Patient experience
Waiting times
Cost
NOT efficiency and equity
23
Q

Examples of public reporting

A 
Consumer Reports
Adverse Health Events in Minnesota
Minnesota health scores
Massachusetts Health Quality Partners
CMS
24
Q

Possible problems with public reporting

A

Small sample sizes
Lack of risk adjustment
Reporting errors

25
Q

P4P

A

Paying for any action or result deemed desirable by the payer

26
Q

VBP

A

Purchasing on the basis of the value of the product or service that is delivered

27
Q

What performance is targeted by p4p?

A

Process, outcomes, cost

28
Q

Examples of p4p

A

CMS Premier hospital quality incentive
Integrated Health Association of California Medical group
Medicare value-based programs

29
Q

Problems of P4P

A

Providers aren’t incetivized to perform their best
Focus is on rewards rather than holistic improvement
Only some evidence that it improves care

30
Q

Why is improvement so slow in healthcare?

A 
Narrow focus on preventable complications
Quality improvement is an "add-on"
Lack of quality leadership
Weak process improvement
FFS 
Fragmentation of care

Performance Improvement (2 decks)

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