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Flashcards in Test 2 Deck (30):
1

Name some ways EHR's improve performance

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

2

Some difficulties with EHRs

Costly
Large time investment
Inaccuracy of records
Poor design

3

Meaningful use of EHR

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

4

EHR adoption

84% hospitals, 54% physicians

5

What is patient-centered medical home

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

6

Core idea of medical home

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

7

Just culture

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

8

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

9

What is patient-centeredness

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

10

Decision Making modalities for patients (all models are legitimate)

Paternalism by permission
Partnership
Patient in charge

11

What is patient self management?

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

12

5 levels of engaging patients

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

13

General model of PI

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

14

System level goals should fulfill what or what?

The triple aim or the IOM six aims

15

Potential system level measures

Sentinel events per year
Nosocomial infections
Readmission rates
HCAHPS

16

Change adopter categories

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

17

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.

18

Details on team charter

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

19

Principles for managing change

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

20

Principles of TPS

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

21

Baldridge categories

Leadership
Strategy
Customers
Measurement
Workforce
Operations
Results

22

What gets reported to the public?

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

23

Examples of public reporting

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

24

Possible problems with public reporting

Small sample sizes
Lack of risk adjustment
Reporting errors

25

P4P

Paying for any action or result deemed desirable by the payer

26

VBP

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

27

What performance is targeted by p4p?

Process, outcomes, cost

28

Examples of p4p

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

29

Problems of P4P

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

30

Why is improvement so slow in healthcare?

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