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Flashcards in Class 3 Deck (29):
1

Significance of quality (regarding payments)

By 2016, CMS is targeting 85% of Medicare FFS payments are linked to quality

By 2018, CMS is targeting 90% of Medicare FFS payments are linked to quality

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Quality

The degree to which health services for individuals and populations increase the likelihood of desired health outcomesand are consistent with current professional knowledge

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Performance management

The use of performance management information to effect positive change in organizational culture, systems and processes

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Performance management components

1. Setting goals (help set agreed-upon performance goals)
2.Allocating resources (allocate and prioritize resources)
3.Evaluating programs (Informing mangers to either confirm or change current policy or program direction to meet those goals)
4.Sharing results of performance in pursing those goals

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Key agencies for quality management

CMS
NCQA (HEDIS measures)
AHRQ (ARC measures)
National Quality Forum
3M Groupers used in DSRIP

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Quality measures based on 6 domains

1. Safe
2. Effective
3. Patient-centered
4. Timely
5. Efficient
6. Equitable

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Safe

Avoiding harm to patients from the care that is intended to help them

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Effective

Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively)

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Patient-centered

Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

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Timely

Reducing waits and sometimes harmful delays for both those who receive and those who give care

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Efficient

Avoiding waste, including waste of equipment, supplies, ideas, and energy

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Equitable

Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status

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Types of quality measures

1. Structural
2. Process
3. Outcomes
4. Patient experience

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Structural

Health care provider’s capacity, systems, and processes to provide high-quality care. Ex:
•Whether the health care organization uses electronic medical records or medication order entry systems
•The ratio of providers to patients

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Process

What a provider does to maintain or improve health. These processes can contribute to health outcomes. Ex:
•% of people receiving preventive services (such as mammograms or immunizations).
•% of people with diabetes who had their blood sugar tested and controlled

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Outcomes

Outcome measures reflect the impact of the health care service or intervention on the health status of patients. Ex:
•% of patients who died as a result of surgery (surgical mortality rates).
•The rate of surgical complications or hospital-acquired infections

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Patient experience

Can be part of the Process and Outcome measures. Ex:
•How well do doctors communicate with their patients?
•Consumer Assessment of Health Care Provider and Systems (CAHPS)

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Quality measured can be expressed as

•percentages or proportions (most common)
•ratios
•means & medians
•counts

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Risk adjustment

Technique used to take into account or to control the fact that different patients with the same diagnosis may have additional conditions or characteristics that can affect how well they respond to treatment

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Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey

Employed because experiences with care, particularly communication with providers, correlate with adherence to medical advice and treatment plans

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Types of CAHPS Surveys

•Hospital (H-CAHPS)
•Scores can be found in Hospital Compare
•Clinician Group (CG-CAHPS)
•Home Healthcare (HH-CAHPS)
•Ambulatory Surgery (AS-CAHPS)

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Comparative Data

Reference point of outcome data must always be kept in mind whenever the results of such data are analyzed

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Benchmarking

The comparison of an organization’s or an individual practitioner’s results against a reference point. Ideally, the reference point should be a demonstrated best practice.

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Gap to goal

% needed to reach goal; NYS DSRIP PPSs need to demonstrate 10% gap to goal improvement

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PDSA

Try different changes to fix a problem, then see if it worked

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Plan

1.What is the current problem?
2.What is your goal?
3.What is your plan to accomplish your goal?
4.What is your prediction?

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Do

What did you observe

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Study

1.What did you learn?
2.Did you meet your measurement goals?
3.Was there any barriers?

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Act

Was this cycle successful? If so, are you ready to share best practices? If not, what do you plan to do differently?