Your Quality Improvement Plan Your Health Care Plan

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Your Quality Improvement Plan Your Health
Care Plan ..and
stuff like that

• Marti Wolf, RN, MPH
• Clinical Programs Director
• North Carolina Community Health Center Association

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Session Description

• Clinical Quality measures are popping up in many
  areas and under many identities- Meaningful Use,
  Patient Centered Medical Home, UDS, FTCA and
  others. A good organizational plan for quality
  improvement integrates all areas of operations
  and all of the forms quality takes while
  minimizing effort.

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Objectives

• Whats a Health Care Plan?
• Whats a Quality Plan?
• Clinical UDS???
• Meaningful Use
• Medical Home

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Words From HRSA

• Quality is a focus area nationally and at HRSA
• Assessment of QI plans showed areas for
  improvement
• Invest in your QI infrastructure
• Clinical quality and beyond
• Focus on implementation
• This work never ends

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Benefits of an Effective QI Plan

• Roadmap for HC organization
• Leadership, focus, prioritization
• Efficient coordination of staff resources
• Better outcomes
• Satisfy external requirements
• HRSA, State
• Third-party quality accreditation and recognition

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Benefits of QI Plan

• Federal Tort Claims Act deeming
• Health centers and free clinics
• ECRI resources
• Data collection and analysis
• UDS, patient survey, EHB
• Health Information Technology
• Adoption, meaningful use, health info exchange
• Quality
• Third party quality recognition
• Aligning technical assistance for PCMH
  transformation
• CMS

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QI Plan- Define Quality

•  Phillip Crosby- Doing the right thing right the
  first time and every time.
• Ensuring Quality is a Risk Management Plan
• Institute of Medicine Definition of QualityThe
  degree to which health services for individuals
  and populations increase the likelihood of
  desired health outcomes and are consistent with
  current professional knowledge. STEEEP

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Quality

• Safe
• Effective
• Patient-Centered
• Timely
• Efficient
• Equitable

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QI Plan

• 2-3 pages
• General Concepts
• Written Commitment
• What do you mean by Quality?
• Provides Structure for your QI Program
• Quality Improvement Committee
• Who is on the Committee
• Terms of Service?
• Ad hoc members?
• How often do they meet?
• Documentation (agenda, minutes)

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QI Plan

• Methodology
• Lean, 6 Sigma, PDSA,
• Root Cause Analysis, etc, etc, etc
• Data Collection Plan
• How data is collected
• Internal and external sources of data
• Core components (stay general)
• Patient satisfaction
• Staff satisfaction
• HRSA measures
• Other regulatory measures
• Business Plan measures

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QI Plan

• Content/Authority
• QI activities in all areas of operation
• Audits
• Frequency
• Use of Date
• QI purpose (not punitive)
• Communication Plan
• Staff
• Board
• Management
• Patients

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Quality FTCA Deeming

• Federal Program Requirement in the Health Center
  Program
• Quality Improvement/Assurance Plan Health center
  has an ongoing Quality Improvement/ Quality
  Assurance (QI/QA) program that includes clinical
  services and management, and that maintains the
  confidentiality of patient records. The QI/QA
  program must include
• Continued- next slide

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• a clinical director whose focus of responsibility
  is to support the quality improvement program and
  the provision of high quality patient care
• periodic assessment of the appropriateness of the
  utilization of services and the quality of
  services provided or proposed to be provided to
  individuals served by the health center and such
  assessments shall
• be conducted by physicians or by other licensed
  health professionals under the supervision of
  physicians
• be based on the systematic collection and
  evaluation of patient records
• and identify and document the necessity for
  change in the provision of services by the health
  center and result in the institution of such
  change, where indicated.
• (Section 330(k)(3)(C))

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Elements of your Quality PlanFTCA recommended

• 1. QI teambuilding and responsibility across a
  range of staff types
• 2. Self-assessment of areas to target
• 3. Setting concrete goals
• 4. Identifying strategies for improvement
• 5. Data collection and analysis
• 6. Evaluation and dissemination of lessons
  learned
• 7. Integration with operations and other quality
  related activities

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IHI Triple Aim
Quality of Care
Cost of Care
Patient Experience
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Perspectives on Quality

Medical
Administrative Patie
nt
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Quality

• Results of Quality
• Improved Outcomes
• Improved efficiency and productivity
• Staff and patient satisfaction

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QI includes

• Risk Management
• Credentialing and Privileging
• Current clinical standards of care  
• Provider credentials and privileges 
• Risk management procedures  
• Patient grievance procedures 
• Incident management
• Confidentiality of patient records

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Demonstrating Quality

• Patient Centered Medical Home
• Patient Centered Health Home Initiative
• Meaningful Use

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Quality - Food for Thought

• Consistency requires you to be as ignorant today
  as you were a year ago .
• -Bernard Berenson

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Health Care Plan/Clinical UDS

• PAL 2010-12 for the 2011 measures that will be
  reported when you submit in 2012
• Trimester of entry into care
• LBW
• 2 year old immunization
• Diabetes- A1c
• HTN- BP lt140/90

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ENOUGH TO TRACK!

• 2011 Clinical UDS New and Revised Measures
• 2010 UDS manual- clinical measures start on p 49
• http//bphc.hrsa.gov/healthcenterdatastatistics/re
  porting/ call archive
• http//bphc.hrsa.gov/healthcenterdatastatistics/re
  porting/2010manual.pdf
• Program Requirements 8
• HCP Template

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Risk Management
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Disclaimer

• Risk Management is like liver.
• The more you chew it,
• the bigger it gets.

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Risk Management

• PROTECT
• AGAINST
• LOSS

Identify and plan for potential and actual
risks in terms of facilities, staff, clients,
financial, clinical and organizational
well-being. (NACHC, 2003)
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RM in Ambulatory Care

• Identify and plan for potential and actual
  risks in terms of facilities, staff, clients,
  financial, clinical and organizational
  well-being. (NACHC, 2003)

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RM in Ambulatory Care

• How to pay for losses
• Policy and Procedures
• Review and evaluation of effectiveness
• Annual employee training
• System of anonymous reporting
• Methods for investigating
• Corrective actions

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RM in Amb Care Hot Topics

• Credentialing and Privileging
• Medical Records
• Confidentiality
• Backup (paper or electronic)
• Documentation
• Legibility

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Meaningful Use CORE - EP

• Eligible Professional (EP) Core Objectives (All
  15 Must Be Implemented)
• 1. Use computerized prescriber order entry (CPOE)
  for medication orders directly entered by any
  licensed health care professional who can enter
  orders into the medical record per state, local,
  and professional guidelines.
• 2. Implement drugdrug and drugallergy
  interaction checks.
• 3. Maintain an up-to-date problem list of current
  and active diagnoses.
• 4. Generate and transmit permissible
  prescriptions electronically.
• 5. Maintain active medication list.

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Meaningful Use CORE - EP

• 6. Maintain active medication allergy list.
• 7. Record all of the following demographics
  preferred language, sex, race, ethnicity, and
  date of birth.
• 8. Record and chart changes in the following
  vital signs height, weight, blood pressure,
  calculate and display body mass index (BMI), and
  plot and display growth charts for children 220
  years, including BMI.
• 9. Record smoking status for patients 13 years
  old or older.
• 10. Report ambulatory clinical quality measures
  to the CMS or, in the case of Medicaid EPs, the
  states.

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Meaningful Use CORE - EP

• 11. Implement one clinical-decision-support rule
  relevant to specialty or high clinical priority
  along with the ability to track compliance with
  that rule.
• 12. Provide patients with an electronic copy of
  their health information (including diagnostic
  test results, problem list, medication lists,
  medication allergies) upon request.
• 13. Provide clinical summaries for patients for
  each office visit.
• 14. Capability to exchange key clinical
  information (for example, problem list,
  medication list, allergies, and diagnostic test
  results) electronically among providers of care
  and patient authorized entities.
• 15. Protect electronic health information created
  or maintained by the certified EHR technology
  through the implementation of appropriate
  technical capabilities.

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EP Menu Objectives (Must Implement 5 of 10)

• Implement drug formulary checks.
• Incorporate clinical laboratory test results into
  EHR as structured data.
• Generate lists of patients by specific conditions
  to use for quality improvement, reduction of
  disparities, research, or outreach.
• Send patient reminders per patient preference for
  preventive/follow-up care.
• Provide patients with timely electronic access to
  their health information (including lab results,
  problem list, medication lists, and allergies)
  within 4 business days of the information being
  available to the EP.
• Use certified EHR technology to identify
  patient-specific education resources and provide
  those resources to the patient, if appropriate.
• The EP who receives a patient from another
  setting of care or provider of care or believes
  an encounter is relevant should perform
  medication reconciliation.
• The EP who transitions a patient to another
  setting of care or provider of care or refers
  that patient to another provider of care should
  provide summary care record for each transition
  of care or referral.
• Capability to submit electronic data to
  immunization registries or immunization
  information systems and actual submission in
  accordance with applicable law and practice.
• Capability to submit electronic syndromic
  surveillance data to public health agencies and
  actual submission in accordance with applicable
  law and practice.

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Clinical Quality Measures for EPs (Must Report 6
Total 3 of 6 From Core or Alternate Set and 3 of
38 From Additional Set)

• Core Set
• Hypertension blood pressure measurement
• Preventive care and screening measure pair
  tobacco-use assessment and tobacco cessation
  intervention
• Adult weight screening and follow-up
• Alternate Core Set
• Weight assessment and counseling for children and
  adolescents
• Preventive care and screening influenza
  immunization for patients 50 years or older
• Childhood immunization status

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Additional Set (minus oncology)

1. Diabetes eye examination
2. Diabetes urine screening
3. Diabetes foot examination
4. Diabetes poor hemoglobin A1c control (gt9.0)
5. Diabetes hemoglobin A1c control (lt8.0)
6. Diabetes low-density-lipoprotein (LDL)
   cholesterol management and control
7. Diabetes blood pressure management
8. Diabetic retinopathy documentation of presence
   or absence of macular edema and level of severity
   of retinopathy
9. Diabetic retinopathy communication with the
   physician managing ongoing diabetes care
10. Primary open-angle glaucoma optic nerve
    evaluation

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Additional Set

• 11. Heart failure (HF) angiotensin-converting-enz
  yme inhibitor or angiotensin receptor blocker
  therapy for left ventricular systolic dysfunction
  (LVSD)
• 12. HF ß-blocker therapy for LVSD
• 13. HF warfarin therapy for patients with atrial
  fibrillation
• 14. Coronary artery disease (CAD) ß-blocker
  therapy for patients with prior myocardial
  infarction
• 15. CAD oral antiplatelet therapy
• 16. CAD drug therapy for lowering LDL
  cholesterol
• 17. Ischemic vascular disease (IVD) blood
  pressure management
• 18. IVD use of aspirin or another antithrombotic
• 19. IVD complete lipid panel and LDL cholesterol
  control

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Additional Set

• 20. Asthma assessment
• 21. Asthma pharmacologic therapy
• 22. Use of appropriate medications for asthma
• 23. Controlling high blood pressure
• 24. Antidepressant medication management
  effective acute phase treatment and effective
  continuation phase treatment
• 25. Appropriate testing for children with
  pharyngitis
• 26. Chlamydia screening for women
• 27. Cervical cancer screening
• 28. Breast cancer screening
• 29. Colorectal cancer screening

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Additional Set

• 30. Smoking and tobacco-use cessation, medical
  assistance advising smokers and tobacco users to
  quit, discussing smoking and tobacco use
  cessation medications, and discussing smoking and
  tobacco use cessation strategies
• 31. Initiation and engagement of alcohol and
  other drug dependence treatment
• 32. Prenatal care screening for human
  immunodeficiency virus
• 33. Prenatal care anti-D immune globulin
• 34. Low back pain use of imaging studies
• 35. Pneumonia vaccination status for older
  adults

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(No Transcript)
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Healthy North Carolina 2020 A Better State of
Healthhttp//www.publichealth.nc.gov/hnc2020/In
stitute for Healthcare Improvementhttp//www.ihi.
org/IHI/Topics/Improvement/ImprovementMethods/Meas
ures/Improving Chronic Illness
Carehttp//www.improvingchroniccare.org2011
New and Revised Clinical Measureshttp//www.cms.g
ov/QualityMeasures/03_ElectronicSpecifications.asp

• Resources

An Introduction to Quality Assurance in Health
Care. Avedis Donabedian. 2003. Oxford
University Press The Improvement Guide. Jerry
Langley, et al.1996. Jossey-Bass
Publishers. Continuous Quality Improvement in
Health Care. McLaughlin and Kaluzny
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Resources

• Meaningful Use Stage 1 Clinical Quality Measures
  http//www.hrsa.gov/healthit/meaningfuluse/MU20St
  age120CQM/index.html