Test 2 Flashcards
Name some ways EHR’s improve performance
Easily searchable records Track patients easier Prescribing error decrease Test results Communication
Some difficulties with EHRs
Costly
Large time investment
Inaccuracy of records
Poor design
Meaningful use of EHR
Up to date problem list
Computerized medication orders
Clinical support rules
Drug checks
EHR adoption
84% hospitals, 54% physicians
What is patient-centered medical home
Health care setting that facilitates partnerships between individual patients, physicians, and patient’s family
Core idea of medical home
Patient has ongoing relationship with provider
Continuity of care
Patient self-management
Just culture
No blame approach: human error (console), at risk behavior (coach), reckless behavior (discipline)
Difference between management and medical culture
bureaucratic vs. collegial
Low group loyalty vs high loyalty
Patients as groups vs. patients as individuals
Success is efficiency vs. Success is effectiveness
What is patient-centeredness
Respect for patient values, preferences and needs Coordination of care Education, information, communication Comfort Access to Care
Decision Making modalities for patients (all models are legitimate)
Paternalism by permission
Partnership
Patient in charge
What is patient self management?
Management by patients of aspects of diagnosis and treatment formerly managed only by clinicians
5 levels of engaging patients
- Gather info on experience of care
- Include patients on improvement project teams
- Patient advisory councils
- Include patients in management
- Include patients in governance
General model of PI
Set organizational goals measure performance against goals select areas for improvement set objectives for improvement plan & take action stabilize improvements
System level goals should fulfill what or what?
The triple aim or the IOM six aims
Potential system level measures
Sentinel events per year
Nosocomial infections
Readmission rates
HCAHPS
Change adopter categories
Innovators, early adopters, early majority, late majority, laggards
Steps of creating PI teams
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.
Details on team charter
Should be written
Content focuses on (topic, scope, aim for team, team composition, timeline),
Principles for managing change
Senior leadership support Right structure Engaged team (esp. physicians) Use motivators Use champions
Principles of TPS
Look to the long term Create continuous flow Grow leaders Respect each other Observe work directly
Baldridge categories
Leadership Strategy Customers Measurement Workforce Operations Results
What gets reported to the public?
Clinical outcomes Safety Patient experience Waiting times Cost NOT efficiency and equity
Examples of public reporting
Consumer Reports Adverse Health Events in Minnesota Minnesota health scores Massachusetts Health Quality Partners CMS
Possible problems with public reporting
Small sample sizes
Lack of risk adjustment
Reporting errors
