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Board Quality Review Committee Meeting

OPEN SESSION ATTENDANCE ROSTER & MEETING MINUTES CALENDAR YEAR 2016

Voting Members

Palomar Health By-Laws’

Membership

Meeting Dates:

1/18/16 2/22/16 3/21/16 4/18/16 5/16/16 6/20/16 7/18/16 8/15/16 9/19/16 Annl Rpt

10/17/16 11/21/16 12/19/16 CANCELLED

DIRECTOR AERON WICKES , MD – CHAIR Board Member P P P P P E P P

DIRECTOR LINDA GREER, RN Board Member P P P P P P P P

DIRECTOR DARA CZERWONKA Board Member P P P E P P P E

DIRECTOR HANS SISON (ALT) Board Member P -- -- -- -- -- -- --

FRANK MARTIN, MD QMC Chair, Palomar Medical Ctr

P P -- P -- -- -- --

RICHARD ENGEL, MD Interim QMC Chair, Palomar Medical Ctr

-- -- P P P P -- --

CHARLES CALLERY, MD QMC Chair, Pomerado Hospital

P P P P P P P P

Non-Voting Members BEIRNE, FRANK EVP, Operations P P P P P P E P

BROWN, SHEILA, RN, FACHE VP, Continuum Care -- -- P P P P P P

CONRAD, ALAN, MD EVP,Physician Alignment P P P -- -- P P P

GOWER, JUNE, PH.D. Interim CNO, PHDC & Pomerado Hospitals

-- -- -- -- -- --

HEMKER, BOB President & CEO P P P E P E E P

KOLINS, JERRY, MD, FACHE VP, Patient Experience and Co-Chair, Patient

Safety Committee P P P P P P P P

LABOSSIERE, LARRY CNO, Pomerado Hospital -- -- -- -- P P P P

MARTINEZ, VALERIE, RN, BSN, MHA, CIC Co-Chair, Patient Safety Committee

P P P P P P P P

OLSON, CHERYL Interim VP, PHDC & Pomerado Hospitals

P P P P -- -- -- --

SHAW, DELLA EVP, Strategy P P P P -- --

SKINNER, JEANNETTE VP, Pomerado Hospital -- -- -- -- -- -- -- P

SUDAK, MARIA, MSN, CCRN, NEA-BC, RN CNO & VP, Palomar Medical Center

P P P P P P P P

Guests ADELMAN, MARCY, RN P

ANDREWS, SHELLY, RN P

BANDICK, BRET P

BARNES, DEBBIE, RN, CDS

FARROW, DAN P

GOELITZ, BRIAN, MD P

GRIFFITH, JEFF (BOARD MEMBER) P

HANSEN, DIANE P P

KAUFMAN, JERRY (BOARD MEMBER)

KIM, JESSICA P P P P

LEE, DAVID, MD P P P P P P E P

LEE, JEREMY P P

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Meeting Dates:

1/18/16 2/22/16 3/21/16 4/18/16 5/16/16 6/20/16 7/18/16 8/15/16 9/19/16 10/17/16 11/21/16 12/19/16

Guests (continued) MCCUNE, RAY (BOARD MEMBER) P

NAMENYI, JASMINA P

NEUSTEIN, PAUL, MD P

NICPON, GREGORY, MD P

PHILLIPS, DONITA, MBA, ARM P P P P P P P P

POPE, TINA P P P P P P P P

RIEHL, RUSSELL P

ROLIN, DONNA P

ROSENBURG, JEFFREY P E E E E

SCHULTZ, DIANA P

SOLOMON, LESLIE P

TERRELL, CEDRIC P P

TURNER, BRENDA P P P

WATSON, RAE ANNE P P

WIESE, LISHA P

To add to this list, please contact Christine Breese at 760-740-6353 or christine.breese@palomarhealth.org Page 1 of 5

Patient Experience Division ACRONYM GLOSSARY

Updated: 09/20/2016

AAPL: Academy of Applied Physician Leadership AAR: After Action Report ABX: Antibiotics ACE: Acute Care for Elderly ACEI: Angiotension Converting Enzyme Inhibitor ACNS-BC: Adult Health Clinical Nurse Specialist-Board Certified ACR: American College of Radiology AHP: Arch Health Partners AHRQ: Agency for Healthcare, Research and Quality ALICE: Alert Lockdown Inform Counter Evacuate AMI: Acute Myocardial Infarction APRN: Advanced Practice Registered Nurse ARB: Angiotension Receptor Blocker ARU: Acute Rehab Unit ATS: Automatic Transfer Switch BCACP: Board Certified Ambulatory Care Pharmacist BETA: BETA Healthcare Group (PH Insurer) BQRC: Board Quality Review Committee BSC: Balanced Score Card BSN: Bachelor of Science in Nursing BSIS: Bureau of Security and Investigative Services CALNOC: Collaborative Alliance for Nursing Outcomes CAP: Child Abuse Program CAP: College of American Pathologists CAP: Community-Acquired Pneumonia CAPG: The Voice of Accountable Physician Groups CARF: Commission on Accreditation of Rehabilitation Facilities CAUTI: Catheter Associated Urinary Tract Infection CC: Complications and Comorbidities CCTP: Community-Based Care Transitions Program CDAD: Clostridium Difficile Associated Diarrhea CDC: Center for Disease Control CDE: Certified Diabetes Educator CDI: Clinical Documentation Improvement CDI: C. Difficile Infections C-diff: Clostridium difficile CDPH: California Department of Public Health CEP: California Emergency Physicians CHA: California Hospital Association CHF: Congestive Heart Failure CIHQ: Center for the Improvement in Healthcare Quality CLABSI: Central Line Blood Stream Infection CLIP: Central Line Insertion Practices CMMI: Center for Medicare and Medicaid Innovation

To add to this list, please contact Christine Breese at 760-740-6353 or christine.breese@palomarhealth.org Page 2 of 5

Patient Experience Division ACRONYM GLOSSARY

Updated: 09/20/2016

CMS: Centers for Medicare & Medicaid Services COP: Conditions of Participation COPD: Chronic Obstructive Pulmonary Disease CPE: Certified Physician Executive (American College of Physician Executives) CPHQ: Certified Professional in Healthcare Quality CPOE: Computerized Physician (Provider) Order Entry CRE: Carbapenem-resistant Enterobacteriaceae CRM: Clinical Resource Management CSHE: California Society Healthcare Engineers CVICU: Cardio Vascular Intensive Care Unit CY: Calendar Year DI: Diagnostic Imaging DM: Diabetes Mellitus DPT: Doctor of Physician Therapy DRT: Diabetes Resource Team DVT: Deep Vein Thrombosis EBP: Evidence Based Practice ED: Emergency Department EHR: Electronic Health Record ELNEC: End of Life Nursing Education Consortium EMS: Emergency Medical Services EMT: Emergency Medical Technician EMT: Executive Management Team EOC: Environment of Care EOP: Emergency Operations Plan EVS: Environment of Care Services / Environmental Services FACHE: Fellow American College of Healthcare Executives FACPM: Fellow of the American College of Preventive Medicine FANS: Food and Nutrition Services FHS: Forensic Health Services FMEA: Failure Mode Effects Analysis FY: Fiscal Year HAC: Hospital Acquired Conditions HAI: Healthcare Associated Infections HAPU: Hospital Acquired Pressure Ulcers HASFZ: Heart Attack and Stroke Free Zone HbA1c: Hemoglobin A1C HCAHPS: Hospital Consumer Assessment of Healthcare Providers & Systems HCC: Hospital Command Center HCP: Health Care Provider HDL: High Density Lipoprotein Cholesterol HDS: Healthy Development Services HHSA: Health and Human Services Agency HICS: Hospital Incident Command System

To add to this list, please contact Christine Breese at 760-740-6353 or christine.breese@palomarhealth.org Page 3 of 5

Patient Experience Division ACRONYM GLOSSARY

Updated: 09/20/2016

HLD: High Level Disinfectant HF: Heart Failure HIPAA: Health Insurance Portability and Accountability Act HPP: Hospital Preparedness Program HPRO: Hip Replacement Surgery HRRP: Hospital Readmission Reduction Program HVA: Hazard Vulnerability Analysis IC: Infection Control ICU: Intensive Care Unit IHA: Integrated Healthcare Association IHI: Institute for Healthcare Improvement ILSM: Interim Life Safety Measures IMI: Inpatient Mortality Indicator IMM-2: Influenza Immunization IOM: Institute of Medicine IP: Infection Prevention (RN Staff) IPCC: Infection Prevention and Control Committee ISBARR: Introduction, Situation, Background, Assessment, Recommendations, Read back KP: Kaiser Permanente KPRO: Knee Replacement Surgery LSC: Life Safety Conditions MAB: Management of Assaultive (or Aggressive) Behavior MAC: Medicare Administrative Contractor MCC: Major Complications and Comorbidities MCI: Mass Casualty Incident MDRO: Multi Drug Resistant Organism MERP: Medication Error Reduction Plan MHA: Masters of Healthcare Administration MOM: Master of Arts in Organizational Management MPH: Master of Public Health MRI: Magnetic Resonance Imaging MRSA: Methicillin-resistant Staphylococcus aureus MSN: Master of Science in Nursing MSPRC: Medical Staff Peer Review Committee MY: Measurement Year NACo: National Association of Counties NDNQI: National Database of Nursing Quality Indicators NEA-BC: Nurse Executive Advanced-Board Certified NHQM or NIHQM: National Improvement for Healthcare Quality Measure NHSN: National Healthcare Safety Network NICHE: Nurses Improving the Care for Hospital System Elders NIMS: National Incident Management System NPSF: National Patient Safety Foundation NPSG: National Patient Safety Goals

To add to this list, please contact Christine Breese at 760-740-6353 or christine.breese@palomarhealth.org Page 4 of 5

Patient Experience Division ACRONYM GLOSSARY

Updated: 09/20/2016

NQF: National Quality Forum OB: Obstetrics OES: Office of Emergency Services OPPE: Ongoing Professional Practice Evaluation OSHA: Occupational Safety and Health Administration OSHPD: Office of Statewide Health Planning and Development PASS: Pull Aim Squeeze Sweep PCCN: Progressive Care Credentialed Nursing PCEA: Patient Controlled Epidural Analgesia PCM: Perinatal Care Measure PDCA: Plan Do Check Act PH: Palomar Health PharmD: Doctor of Pharmacology PI: Performance Improvement PM: Preventative Maintenance PMC: Palomar Medical Center PN: Pneumonia POCT: Point of Care Testing PPE: Personal Protective Equipment PPFR: Physician Performance Feedback Report PRIME: Public Hospital Redesign and Incentives in Medi-Cal PSI: Patient Safety Indicator PSR: Patient Service Representative QAPI: Quality Assurance Performance Improvement QIO: Quality Improvement Organization QRR: Quality Review Report RAC: Revenue Cycle Audits RACE: Rescue Alert Confine Extinguish RCA: Root Cause Analysis RN-BC: Registered Nurse-Board Certified RT: Respiratory Therapist RHIT: Registered Health Information Technician RVT: Registered Vascular Tech SART: Sexual Assault Response Team SCIP: Surgical Care Improvement Project SDHDC: San Diego Healthcare Disaster Coalition SDS: Safety Data Sheet SHP: Strategic Healthcare Program SIR: Standardized Infection Ratio SIRS: Systemic Inflammatory Response Syndrome SIT: Security Integration Team SMILE: Share yourself, Make it clear, Inform on timing, Listen with care, End with Kindness

SNF: Skilled Nursing Facility SNS: Strategic National Stockpile

To add to this list, please contact Christine Breese at 760-740-6353 or christine.breese@palomarhealth.org Page 5 of 5

Patient Experience Division ACRONYM GLOSSARY

Updated: 09/20/2016

SOC: Statement of Conditions SSI: Surgical Site Infection STK: Stroke TAT: Turn Around Time THA: Total Hip Arthroplasty TICU: Trauma Intensive Care Unit TJC or JC: The Joint Commission TKA: Total Knee Arthroplasty TRAIN: Triage Resource Allocation for In-patients UDI: Unique Device Identification UST: Underground Storage Testing US: Ultra Sound VAE: Ventilator Associated Event VAP: Ventilator Associated Pneumonia VBAC: Vaginal Birth After Caesarian Section VBP: Value Based Purchasing VRE: Vancomycin-resistant enterococcus VTE: Venous Thrombo-embolism WHO: World Health Organization

BOARD QUALITY REVIEW COMMITTEE

MONDAY, AUGUST 15, 2016 POMERADO HOSPITAL 5:30 p.m. Dinner at Café for Committee members & invited guests CONFERENCE ROOM E 6:30 p.m. Meeting 15615 POMERADO ROAD, POWAY, CA 92064

Page 1

OPEN SESSION AGENDA

PLEASE TURN OFF CELL PHONES OR SET THEM TO SILENT MODE UPON ENTERING THE MEETING Time Form A

Page # Target

CALL TO ORDER 6:30

Establishment of Quorum 1 N/A 6:31

Public Comments1 15 N/A 6:46

Information Item(s)

1. *Review/Approve: Minutes – Monday, June 20, 2016 (Addendum A, Page 8 -17) 4 3 6:50

Standing Item(s)

1. Journal Club Article (Addendum B, Page 18 - 20) “Workplace Violence in Health Care - A Critical Issue With a Promising Solution” in Journal of the American Medical Association, written by Ron Wyatt, MD, MHA, DMS (HON), Kim Anderson-Drevs, PhD, RN and Lynn M. Male, PhD

10 4 7:00

2. The Patient Experience (Addendum C, Page 21 - 39) Tina Pope, Manager, Service Excellence

a) Letters from Patients/Families b) Service Excellence Quarterly Reports

15 5 7:15

3. Quality and Safety Dashboards (Addendum D, Page 40 - 48) a) CMS Star Ratings Report, Jerry Kolins, MD, Vice President, Patient Experience b) CMS Healthcare Associated Infections Report, David Lee, MD, Medical Quality Officer c) CMS HAC (Hospital Acquired Conditions) Report, Valerie Martinez, RN, BSN, MHA,

CPHQ, CIC, NEA-BC, Director, Quality, Patient Safety & Infection Control

15 6 7:30

New Business

1. Arch Health Annual Report Update (Addendum E, Pages 49 - 65) GB “Robin” Rowland, MD, MPH, FACPM Deanna Kyrimis, Executive Director, Arch Health Partners Jessica Gharbawy, PharmD

20 7 7:50

Public Comments1 15 N/A 8:05

FINAL ADJOURNMENT 8:05

NOTE: The open session agenda, without public comments, is scheduled for 1 hour, 5 minutes. Based on above agenda, without public comments the meeting starts at 6:30 p.m. and adjourns at 7:35 p.m.

BOARD QUALITY REVIEW COMMITTEE

MONDAY, AUGUST 15, 2016 POMERADO HOSPITAL 5:30 p.m. Dinner at Café for Committee members & invited guests CONFERENCE ROOM E 6:30 p.m. Meeting 15615 POMERADO ROAD, POWAY, CA 92064

Page 2

OPEN SESSION AGENDA

NOTE: If you have a disability, please notify us by calling 760-740-6353, 72 hours prior to the event so that we may provide reasonable accommodations

Asterisks indicate anticipated action. Action is not limited to those designated items. 1

5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in meeting room.

Board Quality Review Committee Members

VOTING MEMBERSHIP NON-VOTING MEMBERSHIP

Aeron Wickes, MD – Chairperson, Board Member Bob Hemker, FACHE, President & CEO

Linda Greer, RN, Board Member Frank Beirne, FACHE, EVP, Operations

Dara Czerwonka, Board Member Alan Conrad, MD, EVP, Physician Alignment

Richard Engel, MD – Interim Chair of Medical Staff Quality

Management Committee for Palomar Medical Center

Charles Callery, MD - Chair of Medical Staff Quality

Management Committee for Pomerado Hospital

Della Shaw – EVP, Strategy

Maria Sudak, RN, MSN, CCRN, NEA-BC – Vice President and Chief Nursing Officer, Palomar Medical Center

Jeannette Skinner, RN, MBA, FACHE, Vice President, Pomerado Hospital

Larry LaBossiere, RN, MSN, CEN, CNS, MBA, Interim Chief Nursing Officer, Pomerado Hospital and Director, Clinical Operations Improvement

Sheila Brown, FACHE, VP, Continuum Care

Jerry Kolins, MD, FACHE – VP, Patient Experience and Co-Chair of Patient Safety Committee

Valerie Martinez, RN, BSN, MHA, CPHQ, CIC, NEA-BC, Co-Chair of Patient Safety Committee and Director, Quality, Patient Safety & Infection Control

Copyright 2016 American Medical Association. All rights reserved.

Workplace Violence in Health CareA Critical Issue With a Promising Solution

Workplace safety is a critical issue in health care. TheNational Institute for Occupational Safety and Health de-fines workplace violence as “violent acts (including physi-cal assaults and threats of assaults) directed towards per-sons at work or on duty.”1 This Viewpoint discusses thescope and characteristics of workplace violence in healthcare settings, relevant government regulations, the re-sponsibility of health care leaders in addressing work-place violence, a model program for violence preven-tion in health care settings, and a comprehensiveenvironmental risk analysis.

Extent and Characteristics of Workplace Violencein Health CareApproximately 24 000 workplace assaults occurred inhealth care settings between 2010 and 2013, resultingin major and minor physical injury, psychological harm,temporary or permanent physical disability, anddeath.2 The Joint Commission analyzed 33 homicides,

38 assaults, and 74 rapes in health care workplaces from2013 to 2015. Health care workers identified in theseevents included 10 nurses, 2 physicians, 3 security em-ployees, and 7 other health care workers.3 These senti-nel events resulted in death, permanent harm, or se-vere temporary harm. The most common root causes ofthese events were failures in communication, inad-equate patient observation, lack of or noncompliancewith policies addressing workplace violence preven-tion, and lack of or inadequate behavioral health assess-ment to identify aggressive tendencies in patients.3 Com-prehensive behavioral health assessments may be ableto identify biopsychosocial factors known to increase therisk of violent behavior.

In US hospitals, there has been an increase in vio-lent crime, from 2.0 events per 100 beds in 2012 to 2.8events per 100 beds in 2015.3 A disproportionate num-ber of aggravated assaults (44%) and other assaults(46%) occurred in emergency departments comparedwith the entire hospital.4 Bureau of Labor statistics datadocument that while less than 20% of workplace inju-ries involve health care workers, 50% of workplace-related assaults involve health care workers. In 2013, 27of 100 health care worker or patient fatalities in healthcare settings were attributable to assaults and violence.2

Workplace violence in health care includes verbal,sexual, and physical assaults; threats; stalking; inti-

mate partner violence; and homicide. In addition toemergency departments, workplace violence mostfrequently occurs in behavioral health settings,extended-care facilities, and inpatient units.6 Femalenursing staff and psychiatric assistants most fre-quently experience assaults.5 Approximately 60% ofreported threats and assaults occur between noonand midnight.5

Government Regulations Addressing Health CareWorkplace ViolenceThe Occupational Safety and Health Act of 1970, 26states, and 2 US territories now require elements of com-prehensive health care violence prevention programs.A 2016 Government Accountability Office reportmade recommendations for how violence prevention inhealth care settings is addressed in the United States.7

The office recommended that the Occupational Safetyand Health Administration develop, implement, and en-

force standards addressing the uniqueattributes of violence prevention inhealth care workplaces, including penal-izing employers for exposing employ-ees to potential workplace violence.A specific example is exposing employ-ees to the hazard of violent behavior

and being physically assaulted by patients withknown histories of violence or the identified potentialfor violence.

Leadership ResponsibilityLeadership commitment is manifested by establishinga violence prevention program, encouraging reportingof violent and behavioral safety events, reassuring em-ployees that appropriate actions will be taken, engag-ing personnel and patients in safety plans, and measur-ing performance of violence prevention programs.

Although zero-tolerance policies for workplace vio-lence have been suggested, such language may createbarriers to program success by inhibiting reporting ofsafety issues and concerns. Rather, leaders have a dutyto their employees to institute programs and ensure ad-herence to policies requiring all reported events be takenseriously, assessed appropriately, and managed indi-vidually and ethically.

Health Care Violence Prevention Program:Model and ProcessWorkplace violence prevention should be part of new-employee training and ongoing training of existingemployees. Programs aimed at prevention of work-place violence should include employee training andawareness, reporting, threat assessment, management

Workplace violence preventionshould be addressed aggressivelyand comprehensively in health care.

VIEWPOINT

Ron Wyatt, MD, MHA,DMS (HON)Office of Qualityand Patient Safety,The Joint Commission,Oakbrook Terrace,Illinois.

Kim Anderson-Drevs,PhD, RNOffice of Qualityand Patient Safety,The Joint Commission,Oakbrook Terrace,Illinois.

Lynn M. Van Male, PhDWorkplace ViolencePrevention Program,Veterans HealthAdministration, OregonHealth and ScienceUniversity, Portland.

CorrespondingAuthor: Ron Wyatt,MD, MHA, DMS (HON),Office of Qualityand Patient Safety,The Joint Commission,One Renaissance Blvd,Oakbrook Terrace, IL60181 (rwyatt@jointcommission.org).

Opinion

jama.com (Reprinted) JAMA Published online July 18, 2016 E1

Copyright 2016 American Medical Association. All rights reserved.

Downloaded From: http://jama.jamanetwork.com/ by a Palomar Health User on 07/18/2016

Attachment #1

Copyright 2016 American Medical Association. All rights reserved.

plans, and a communication strategy. All employees should havetraining relevant to the risk for violence that may exist in theirrespective workplaces.

Reporting is an essential element of a successful workplace vio-lence prevention program. Without efficient and fully utilized eventreporting systems, employees have a limited ability to communi-cate their safety and risk issues to leadership. Reporting helps lead-ership develop relevant violence prevention programs. However, per-sonnel underreport violent events because they believe theseexperiences are part of the job, reporting is either cumbersome orunlikely to result in action from leadership, or they fear retaliationfor reporting.6 For these reasons, reporting systems should besimple, trusted, secure, and with optional anonymity; result in trans-parent outcomes and delivery of a report confirmation; and be fullysupported by leadership, labor unions, and management.

Every report of alleged workplace violence should be assessedand managed individually, using evidence-based, data-driven as-sessment of violence risk and management best practices, and in-volve a multidisciplinary team trained in the fundamentals of vio-lence risk and threat management. Multidisciplinary threatassessment teams usually operate under the authority of a facili-ty’s chief medical officer and are chaired by senior clinicians trainedin threat assessment practice (most commonly, behavioral scienceprofessionals). Team members should include representatives fromthe behavioral sciences, security/law enforcement, labor union(s),known high-risk workplaces, employee education (eg, trainers), pa-tient advocates, and legal counsel.

If the reported behavior is determined by the multidisciplinarythreat assessment team to pose an ongoing safety or security risk,then a treatment and safety management plan should be devel-oped and implemented to reduce the likelihood of safety risk expo-sure. Such plans augment relevant protective factors and reduceidentified risk factors. Management plans may include noninvasiveinterventions (eg, conversation with the individual or individuals;written letters expressing behavioral expectations) to more restric-tive approaches (eg, limiting the time, place, or manner in which safeand effective health care may be delivered). The safety manage-ment plan should not permanently bar an individual from care.

Informing employees of the management plan should enablethe ongoing cycle of effective violence prevention programming: em-ployees are educated and trained regarding the management planand have the skills necessary to implement it; they report the out-come of implementing the plan; information regarding the manage-ment plan’s effectiveness is assessed (or reassessed) and modifiedaccording to risk; and such modifications are then communicatedback to employees.

Environmental Analysis and InterventionsOrganizations should assess risk factors for violence in the internalenvironment and the surrounding community. Internal environ-mental assessment focuses on dynamic factors (eg, staffing levels,census, weather, and traffic) and static factors (eg, floor plans, alarms,surveillance equipment, entry points, and reception areas). The sur-rounding community should be assessed by examining the type andseverity of crime and violence, including the frequency with whichthe health care organization provides care for victims of violence.Physical security measures should align with known risks of com-munity-based violence migrating into the health care setting. Re-current comprehensive environmental risk analysis identifies emerg-ing vulnerabilities, allowing for relevant employee training, proactivemodification of existing processes, and the development of new riskmanagement measures.

ConclusionsWorkplace violence prevention should be addressed aggressivelyand comprehensively in health care. Safety in health care work-places relies on leadership enacting appropriate policies; trainedemployees intervening and reporting; multidisciplinary teams usingevidence-based threat assessment and management practices,communicating safety plans, and analyzing the environmental con-text; and ongoing evaluation of program effectiveness. A work-place violence prevention program should be a required compo-nent of the patient safety system of all health care organizations.Comprehensive patient safety systems can effectively manage abroad range of worker safety risks in health care, including work-place violence.

ARTICLE INFORMATION

Published Online: July 18, 2016.doi:10.1001/jama.2016.10384.

Conflict of Interest Disclosures: All authors havecompleted and submitted the ICMJE Form forDisclosure of Potential Conflicts of Interest andnone were reported.

REFERENCES

1. Centers for Disease Control and Prevention(CDC)/National Institute for Occupational Safetyand Health. Violence: Occupational Hazards inHospitals. CDC website. http://www.cdc.gov/niosh/docs/2002-101/. 2002. Accessed July 6, 2016.

2. Occupational Safety and Health Administration(OSHA). Guidelines for Preventing Workplace

Violence for Healthcare and Social ServicesWorkers. OSHA 3148-04R 2015. OSHA website.https://www.osha.gov/Publications/osha3148.pdf.2015. Accessed June 20, 2016.

3. The Joint Commission. Sentinel Event Data.Oakbrook Terrace, IL: The Joint Commission; 2016.

4. International Association of Healthcare Safetyand Security Foundation. 2016 Healthcare CrimeSurvey. http://c.ymcdn.com/sites/www.iahss.org/resource/collection/48907176-3B11-4B24-A7C0-FF756143C7DE/2016CrimeSurvey.pdf.Accessed June 15, 2016.

5. Pompeii L, Dement J, Schoenfisch A, et al.Perpetrator, worker and workplace characteristicsassociated with patient and visitor perpetrated

violence (type II) on hospital workers: a review ofthe literature and existing occupational injury data.J Safety Res. 2013;44:57-64.

6. Speroni KG, Fitch T, Dawson E, Dugan L,Atherton M. Incidence and cost of nurse workplaceviolence perpetrated by hospital patients or patientvisitors. J Emerg Nurs. 2014;40(3):218-228.

7. US General Accountability Office (GAO).Workplace Safety and Health: Additional EffortsNeeded to Help Protect Healthcare Workers FromWorkplace Violence (GAO-16-11). http://www.gao.gov/assets/680/675858.pdf. 2016. AccessedMarch 18, 2016.

Opinion Viewpoint

E2 JAMA Published online July 18, 2016 (Reprinted) jama.com

Copyright 2016 American Medical Association. All rights reserved.

Downloaded From: http://jama.jamanetwork.com/ by a Palomar Health User on 07/18/2016

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lity

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Attachment #3

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80%

79%

78%

77%

76%

76%

76%

75%

4

4

4

3

3

3

3

3

3

3

75

%

75

%

80

%

80

%

0%

10

%

20

%

30

%

40

%

50

%

60

%

70

%

80

%

90

%

10

0%

Scri

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Top Box Percentage/Number of Stars

Faci

lity

HC

AH

PS

Co

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ica

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5

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ly 2

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01

6

Top

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x P

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tage

Star

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ing

CA

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rage

NA

TL A

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ge

Attachment #3

Dis

pla

yed

by

Rec

eive

d D

ate

82

%

81

%

82

%

80

%

82

%

84

%

81

%

78

%

89

8

7

91

8

4

88

9

2

85

76

0

10

20

30

40

50

60

70

80

90

10

0

7/1

/14

-9

/30

/14

n=7

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10

/1/1

4-1

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1/1

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=79

9

1/1

/15

-3

/31

/15

n=8

36

4/1

/15

-6

/30

/15

n=8

02

7/1

/15

-9

/30

/15

n=8

42

10

/1/1

5-

12

/31

/15

n=7

44

1/1

/16

-3

/31

/16

n=9

16

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-6

/30

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77

Top Box Percentage/Percentile Ranking

Qu

arte

r

Ove

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arte

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Inp

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Attachment #3

Dis

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ate

62

%

64

%

68

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73

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66

%

70

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%

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17

1

9

35

56

25

39

3

8

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0

10

20

30

40

50

60

70

80

90

10

0

7/1

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n=2

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-3

/31

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/30

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7/1

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10

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/31

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77

Top Box Percentage/Percentile Ranking

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Attachment #3

18

54

4

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51

4148

2626

23

7083

9090

0102030405060708090100

110

7/1/15

‐7/31/15

n=69

8/1/15

‐8/31/15

n=49

9/1/15

‐9/30/15

n=48

10/1/15‐

10/31/15

n=72

11/1/15‐

11/30/15

n=60

12/1/15‐

12/31/15

n=68

1/1/16

‐1/31/16

n=55

2/1/16

‐2/29/16

n=55

3/1/16

‐3/31/16

n=63

4/1/16

‐4/30/16

n=39

5/1/16

‐5/31/16

n=49

6/1/16

‐6/30/16

n=24

Percentile Ranking

Mon

th

POM M

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ommun

ication with

 Doctors

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HPS

 Actua

l Percentile

 Ran

king

 & FY2

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 Ran

king

*Official M

onthly Results by Discharge Date

Actual Percentile

 Ran

king

Target Percentile

 Ran

king

Attachment #3

31

169

1924

55

41

19

33

5765

61

9090

0102030405060708090100

110

7/1/15

‐7/31/15

n=68

8/1/15

‐8/31/15

n=49

9/1/15

‐9/30/15

n=45

10/1/15‐

10/31/15

n=71

11/1/15‐

11/30/15

n=60

12/1/15‐

12/31/15

n=68

1/1/16

‐1/31/16

n=55

2/1/16

‐2/29/16

n=54

3/1/16

‐3/31/16

n=63

4/1/16

‐4/30/16

n=38

5/1/16

‐5/31/16

n=49

6/1/16

‐6/30/16

n=24

Percentile Ranking

Mon

th

POM M

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/TELE ‐R

ate Hospital 0

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 Actua

l Percentile

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 & FY2

016 Target Percentile

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*Official M

onthly Results by Discharge Date

Actual Percentile

 Ran

king

Target Percentile

 Ran

king

Attachment #3

5

26

1

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30

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51

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0102030405060708090100

110

7/1/15

‐7/31/15

n=69

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n=49

9/1/15

‐9/30/15

n=48

10/1/15‐

10/31/15

n=72

11/1/15‐

11/30/15

n=60

12/1/15‐

12/31/15

n=68

1/1/16

‐1/31/16

n=55

2/1/16

‐2/29/16

n=55

3/1/16

‐3/31/16

n=63

4/1/16

‐4/30/16

n=39

5/1/16

‐5/31/16

n=49

6/1/16

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n=24

Percentile Ranking

Mon

th

POM M

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ication with

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l Percentile

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*Official M

onthly Results by Discharge Date

Actual Percentile

 Ran

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Target Percentile

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Attachment #3

58

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ance

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9)

Attachment #3

35

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lity

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7%

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% (

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Attachment #3

30

.9%

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MC

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MC

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ast

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%

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D -

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n=3

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% (

n=2

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(n

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n=2

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C 6

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1.8

% (

n=1

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C 8

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t -

1.8

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PO

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(n

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Attachment #3

35

.9%

P

MC

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23

.1%

P

OM

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7.7

%

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C 8

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t

5.1

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2.6

%

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2.6

%

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t

2.6

%

PM

C 5

W I

CU

2.6

%

PM

C 6

We

st

2.6

%

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C 7

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t

2.6

%

PO

M M

/S/T

(3

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loo

r)

2.6

%

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(4

th

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%

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mb

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of

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mp

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nit

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16

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C E

D -

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(n

=14

)

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M E

D -

23

.1%

(n

=9)

PM

C 8

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t -

7.7

% (

n=3

)

PM

C Im

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g -

5.1

% (

n=2

)

PM

C S

urg

ery

- 5

.1%

(n

=2)

PH

DC

BH

U -

2.6

% (

n=1

)

PM

C 4

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t -

2.6

% (

n=1

)

PM

C 5

W IC

U -

2.6

% (

n=1

)

PM

C 6

We

st -

2.6

% (

n=1

)

PM

C 7

Eas

t -

2.6

% (

n=1

)

PO

M M

ed/S

urg

/Tel

e (3

rd F

loo

r) -

2.6

% (

n=1

)

PO

M M

ed/S

urg

/Tel

e (4

th F

loo

r) -

2.6

% (

n=1

)

PO

M S

urg

ery

- 2

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(n

=1)

PO

P W

ou

nd

Car

e -

2.6

% (

n=1

)

Attachment #3

26

.0%

47

.0%

37

.4%

58

.5%

74

.0%

53

.0%

66

.7%

41

.5%

0.0

%

10

.0%

20

.0%

30

.0%

40

.0%

50

.0%

60

.0%

70

.0%

80

.0%

90

.0%

10

0.0

%

Jun

e 2

01

5Ja

nu

ary

20

16

Mar

ch 2

01

6Ju

ne

20

16

Percentage

Mo

nth

Pe

rce

nta

ge o

f C

om

plim

en

ts v

s. C

om

pla

ints

/Gri

evan

ces

*Off

icia

l Mo

nth

ly R

esu

lts

Co

mp

lime

nts

Co

mp

lain

ts/G

rie

van

ces

Attachment #3

CMS Star Ratings Report 7/28/2016

HospitalLeapfrog Grade

(Spring 2016)

CMS Star

Rating

(July 2016)

Kaiser Foundation Hospital – San Diego A 3

Scripps Memorial Hospital – La Jolla A 5

Tri-City Medical Center A 2

UC San Diego Medical Center* A 3

Scripps Memorial Hospital - Encinitas B 4

Scripps Mercy Hospital B 3

Scripps Green Hospital B 5

Sharp Grossmont Hospital B 3

Alvarado Hospital C 4

Palomar Medical Center C 3

Paradise Valley Hospital C 4

Pomerado Hospital C 3

Sharp Chula Vista Medical Center C 4

Sharp Memorial Hospital C 4

* includes campuses in Hillcrest and La Jolla

Attachment #4

Cliff Notes Summary of the Medicare Star Rating Program

Page 1 of 2

After a three-month delay and negative chatter from many stakeholder groups, CMS released its

Overall Hospital Quality Star Rating program in full Wednesday on its Hospital Compare

website.

Here are 12 things to know about the program, its methodology, the pushback against it and how

stakeholders are responding.

1. In a post on CMS' blog, Kate Goodrich, MD, director of the Center for Clinical Standards and

Quality, wrote that the agency released the overall ratings "to help millions of patients and their

families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask

important questions about care quality when visiting a hospital or other healthcare provider."

2. The Overall Hospital Quality Star Rating combines 64 measures that are already public on

Hospital Compare into one star rating. The measures fall into seven groups: mortality, safety of

care, readmission, patient experience, effectiveness of care, timeliness of care and efficient use

of medical imaging.

3. Because the quality measures used for the overall rating reflect routine care and hospital-

acquired infections, specialized care provided by certain hospitals is not reflected in the ratings.

4. A hospital's rating is only calculated using as many measures for which data is available. That

means hospitals' star ratings could be based on as few as nine measures or as many as 64; the

average is roughly 40.

5. CMS assigns weights to the group scores (mortality, safety, readmission and patient

experience are each weighted 22 percent, and effectiveness of care, timeliness of care and

efficient use of medical imaging each get 4 percent) and then assigns a summary score. If a

hospital is missing data in a group, the agency redistributes the weights among the other

categories. Then, CMS calculates an overall rating using the summary score.

6. If a hospital doesn't have data for three measures within at least three of the seven measure

groups, including one outcome group (meaning mortality, safety or readmission), the hospital

doesn't get a score. Currently, 937 hospitals do not have an overall star rating.

7. CMS developed the program's methodology with input from a technical expert panel and then

refined it after public input, according to the agency, and CMS plans to "consider public

feedback to make enhancements to the scoring methodology as needed."

8. Star ratings will be updated each quarter. Currently, 102 hospitals have five stars, 934 have

four stars, 1,770 have three stars, 723 have two stars and 133 have one star.

9. The July 27 release date is roughly three months after the planned release date on April

21. CMS delayed launchingthe program because of pushback it received from stakeholders and

members of Congress, who argued that because the methodology is not risk-adjusted and doesn't

account for socioeconomic factors, it puts certain hospitals, like academic medical centers and

safety-net hospitals, at a disadvantage.

Attachment #4

Cliff Notes Summary of the Medicare Star Rating Program

Page 2 of 2

10. Per Dr. Goodrich's blog post, CMS "paused to give hospitals additional time to better

understand our methodology and data" and has "conducted significant outreach and education to

hospitals to understand their concerns and directly answered their questions" in the three months

between the delay and the release of the program. This included hosting two national calls with

more than 4,000 hospital representatives and holding meetings with hospital associations to

explain data and answer questions.

11. Even with the three-month delay and tweaks to the methodology, stakeholders are still not

pleased with the program. Rick Pollack, president and CEO of the American Hospital

Association, called the ratings "confusing" in a statement Wednesday and said the AHA is

"especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and

those serving higher numbers of the poor."

Similarly, Chip Kahn, president and CEO of the Federation of American Hospitals, released a

statement Wednesday saying "the new hospital star ratings fall short and are not ready for prime

time," and said there were "many important defects" in the methodology because it doesn't

"recognize the often significant differences between large and small hospitals, teaching and

nonteaching, and those hospitals providing care in underprivileged areas."

Bruce Siegel, MD, president and CEO of America's Essential Hospitals, also said AEH is

"disappointed" in CMS for releasing the ratings "when so many questions remain about the data

behind the ratings and their value to consumers."

12. Despite being disappointed with CMS for releasing the overall ratings right now, most

stakeholder groups still back the overall goal of the program — to be more transparent and allow

stakeholders to make informed decisions.

"FAH will continue to work with policy makers and our health care partners to ensure this

process is transparent and to fix the technical flaws in the star rating process so that it ultimately

yields value-added information for patients as well as hospitals," Mr. Kahn said.

Mr. Pollack from AHA said, "We want to work with CMS and the Congress to fix the hospital

star ratings so that it is helpful and useful to both patients and the hospitals that treat them."

And finally, Dr. Siegel from AEH said, "Consumers deserve accurate, comprehensive and

relevant information to make healthcare decisions. Hospitals Deserve to be on a level playing

field. The star ratings accomplish neither. We urge CMS to work with hospitals and independent

experts to revise the star ratings to correct shortcomings in its methodology and to immediately

share all its data, so hospitals can confirm the agency's calculations."

Attachment #4

Page 1 of 2

House Introduces Bill to Delay CMS Hospital Star Ratings By Vera Gruessner on July 28, 2016

The Hospital Quality Rating Transparency Act of 2016 was introduced in

the House to postpone release of the CMS hospital star ratings system.

The Centers for Medicare & Medicaid Services (CMS) hospital star ratings may be postponed due to a

new bill introduced on Monday, July 25 by House Representatives Jim Renacci (R-OH) and Kathleen

Rice (D-NY). The reasoning for the delay is due to ensuring the hospital star ratings system is flawless

and dependable, according to the American Hospital Association (AHA).

The bill is called the Hospital Quality Rating Transparency Act of 2016 and asks to push back the date

for unveiling the CMS hospital star ratings system to no earlier than July 31, 2017. Additionally, the bill

is calling for CMS to establish a comment period of 60 days in which the public can inform the federal

agency of any issues or discrepancies with the methodology and data included in the hospital star

ratings program.

Another important point that the bill includes is its requirement of having a third party confirm the

methodology and data provided by CMS. Any star ratings available on the Hospital Compare website

operating through CMS are asked to be taken down prior to the enactment of the Hospital Quality

Rating Transparency Act of 2016.

The American Hospital Association and members of Congress have previously expressed some

concerns about potential flaws in the CMS hospital star ratings system, which is why there is more

pressure to postpone the deadline for releasing this particular program.

“Patients need clear, meaningful information to make important healthcare decisions,” Tom Nickels,

Executive Vice President of Government Relations and Public Policy at the American Hospital

Association, said in a public statement. “Yet, thus far, it is unclear whether the Centers for Medicare &

Medicaid Services’ (CMS) star ratings actually provide accurate and reliable data to the public. As a

result, we applaud and thank Reps. James Renacci (R-OH) and Kathleen Rice (D-NY) for introducing a

bill to delay, for at least one year, the introduction of the CMS hospital star ratings.”

“Hospitals and members of Congress are in agreement: CMS can do better,” Nickels continued. “The

majority of Congress – 60 members of the Senate and more than 225 members of the House – asked

CMS to delay and improve upon the star ratings. Our own analysis of preliminary data continues to

raise questions and concerns about the methodology, which may unfairly penalize teaching hospitals

and those serving the poor.”

Originally, this past April, CMS had promised to incorporate a hospital star ratings system on the

Hospital Compare website, which would have improved healthcare transparency greatly for

Attachment #4

Page 2 of 2

consumers. The way this star ratings would work is by using patient surveys, readmissions and

complications data, medical imaging rates, and the amount of Medicare beneficiaries served.

CMS has already delayed its unveiling of the hospital star ratings program until the end of July due to

concern from the House of Representatives. This past April, a large number of representatives sent a

letter to CMS to postpone the implementation of this rating system since it did not have quality

benchmarks for measuring which hospitals serve patients with the most complex medical conditions.

Additionally, the representatives argued in the letter that the star ratings system was not transparent

enough with the methodology it uses to compare hospitals. Five dozen US Senators also wrote a letter

in which they urged the delay of the hospital star ratings system due to a lack of transparency and

inadequacies regarding clinical quality measures.

“We are writing to express our concerns with the Centers for Medicare and Medicaid Services’

upcoming release of the Hospital Compare Star Ratings,” the letter stated. “While we support the

public reporting of provider quality data, we are concerned that the current Star Ratings system may

not accurately take into account hospitals that treat patients with low socioeconomic status or

multiple complex chronic conditions.”

Despite this bill, CMS unveiled the first version of the Hospital Quality Star Rating system on the

Hospital Compare website yesterday, according to a press release from the federal agency. This will

allow patients and families to compare hospitals on a five-point scale side-by-side.

CMS has worked with stakeholders across the aisles to create this rating system for hospitals in order

to simplify the entire process of comparing hospitals and helping patients better understand the

quality of care they would receive at their respective medical facilities. A Technical Expert Panel along

with public input were used to create the hospital star ratings program.

CMS also stated in the release much support from patient advocacy groups in favor of having these

type of rating systems set in place for greater healthcare transparency for consumers. This is especially

important if looking at the type of hospitals that have had much lower rates of hospital readmissions

and mortality.

“Consumers will be able to make smarter, better informed choices about their health care thanks to

the hospital star ratings tool the Centers for Medicare & Medicaid Services (CMS) released

today," Debra L. Ness, President of the National Partnership for Women & Families, said in a public

statement. "Publication of the hospital quality performance scores to the CMS Hospital Compare

website will strengthen our country’s health care system. Millions of patients and family members can

now access a tool that provides important information on how their hospitals are performing on key

health quality measures. Consumers can use this trustworthy program to compare hospitals side-by-

side. This is a huge step forward."

Since some of the aspects used within the star ratings system relies mostly on patient feedback, it is

understandable why a number of opponents are looking to delay this hospital comparing program.

Time will tell whether this bill will pass and whether CMS will be left to renovate its hospital star

ratings system to alleviate the concerns from Congress.

Attachment #4

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Attachment #4

PALOMAR HEALTH

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PMC POMMetric Decile Decile

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Jan 2013 - Dec 2014 4th 3rd

Jan 2014 - Dec 2015 9th 8th

Jan 2013 - Dec 2014 9th 10th

Jan 2014 - Dec 2015 8th 9th

Jan 2013 - Dec 2014 9th 6th

Jan 2014 - Dec 2015 8th 6th

Jan 2014 - Dec 2015 8th 10th

Decile definition:

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re-f

orm

ing,

Gra

m-p

osi

tive

an

aero

bic

b

acill

us

•p

rod

uce

s tw

o e

xoto

xin

s: t

oxi

n A

an

d t

oxi

n B

•ac

cou

nts

fo

r 1

5-2

5%

of

all e

pis

od

es o

f an

tib

ioti

c-as

soci

ated

dia

rrh

ea

Attachment #5

Wh

at a

re s

om

e t

ypic

al c

linic

al s

ymp

tom

s o

f C

. dif

f in

fect

ion

?

•w

ater

y d

iarr

hea

•fe

ver

•lo

ss o

f ap

pet

ite

•n

ause

a

•ab

do

min

al p

ain

/ten

der

nes

s

Attachment #5

Do

all

pat

ien

ts w

ith

C. d

iff

sho

w

sym

pto

ms?

•N

o –

aro

un

d 2

0%

of

ho

spit

aliz

ed a

du

lts

are

asym

pto

mat

ic C

. dif

f ca

rrie

rs

•Th

ese

pat

ien

ts s

hed

C. d

iff

in t

hei

r st

oo

l bu

t d

o n

ot

exh

ibit

dia

rrh

ea o

r o

ther

clin

ical

sy

mp

tom

s

Attachment #5

Wh

at a

re s

om

e p

ote

nti

al c

om

plic

atio

ns

of

C. d

iff

infe

ctio

n?

•d

ehyd

rati

on

•ki

dn

ey f

ailu

re

•to

xic

meg

aco

lon

–gr

eatl

y d

iste

nd

ed c

olo

n (

meg

aco

lon

)

–le

ft u

ntr

eate

d, t

he

colo

n c

ou

ld r

up

ture

(p

erfo

rate

)

•d

eath

Attachment #5

Ho

w is

C. d

iff

tran

smit

ted

?

•fe

cal-

ora

l

•C

. dif

f is

sh

ed in

fec

es

•Fe

cally

-co

nta

min

ated

su

rfac

es, d

evic

es, o

r m

ater

ials

bec

om

e re

serv

oir

s fo

r C

. dif

f sp

ore

s

•C

. dif

f sp

ore

s ar

e tr

ansf

erre

d t

o p

atie

nts

m

ain

ly v

ia t

he

han

ds

of

hea

lth

care

pe

rso

nn

el

wh

o h

ave

tou

ched

co

nta

min

ated

su

rfac

es o

r it

ems

Attachment #5

Wh

at c

an w

e d

o t

o p

reve

nt

the

tr

ansm

issi

on

of

C. d

iff?

•C

on

tact

Pre

cau

tio

ns

for

pat

ien

ts w

ith

kn

ow

n o

r su

spec

ted

C. d

iff

infe

ctio

n

–p

riva

te r

oo

ms

–gl

ove

an

d g

ow

n w

hen

en

teri

ng

pat

ien

ts’ r

oo

ms

and

du

rin

g p

atie

nt

care

–re

mo

ve g

ow

n a

nd

glo

ves

bef

ore

leav

ing

the

pat

ien

ts’ r

oo

ms

–h

and

hyg

ien

e af

ter

rem

ovi

ng

glo

ves

Attachment #5

Wh

at c

an w

e d

o t

o p

reve

nt

the

tr

ansm

issi

on

of

C. d

iff?

–P

reve

nti

ng

con

tam

inat

ion

of

the

han

ds

via

glo

ve

use

rem

ain

s th

e co

rner

sto

ne

for

pre

ven

tin

g C

. dif

f tr

ansm

issi

on

Attachment #5

Wh

at e

lse

can

we

do

to

pre

ven

t th

e

tran

smis

sio

n o

f C

. dif

f?

•R

ob

ust

en

viro

nm

enta

l cle

anin

g an

d

dis

infe

ctio

n s

trat

egy

–En

sure

ad

equ

ate

clea

nin

g an

d d

isin

fect

ion

of

envi

ron

men

tal s

urf

aces

an

d r

eusa

ble

dev

ices

•Ju

dic

iou

s an

tib

ioti

c u

se

–an

tib

ioti

c u

se p

uts

pat

ien

ts a

t gr

eate

r ri

sk f

or

C.

dif

f co

litis

, wh

ich

is w

hy

it is

imp

ort

ant

to u

se

anti

bio

tics

on

ly w

hen

nee

ded

Attachment #5

So w

hat

are

we

to

do

wit

h o

ur

un

acce

pta

bly

hig

h C

. dif

f ra

tes?

We’

ve b

een

her

e b

efo

re.

We’

ve d

on

e th

is b

efo

re.

Attachment #5

If w

e ar

e P

ERSI

STEN

T w

e w

ill g

et it

If w

e ar

e C

ON

SIST

ENT

we

will

kee

p it

Attachment #5

Ho

w d

o w

e s

tay

CO

NSI

STEN

T?

Pati

ent

Firs

t

Attachment #5

An

d a

ll th

e h

osp

ital

-acq

uir

ed

infe

ctio

ns

we

re b

anis

he

d f

rom

th

e h

eal

th s

yste

m,

and

all

the

pat

ien

ts li

ved

hap

pily

eve

r af

ter…

Attachment #5

Au

gust

15

, 20

16

Q

ual

ity

Rev

iew

Co

mm

itte

e R

epo

rt

Attachment #6

GB

“R

OB

IN”

RO

WLA

ND

, MD

, MP

H,

FAC

PM

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UA

LITY

MA

NA

GEM

ENT

Attachment #6

QU

ALI

TY D

EPA

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ENT

TRIP

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IM

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w C

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alit

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Ph

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In

de

pen

de

nt

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Ass

oci

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ep

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Attachment #6

SER

VIC

ES

FFS

PATI

ENT

PAN

EL

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IEN

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S

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0

Attachment #6

PATI

ENT

SATI

SFA

CTI

ON

84

.00

%

86

.00

%

88

.00

%

90

.00

%

92

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14

20

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Pre

ss G

aney

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n P

atie

nt

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sfac

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core

s

Attachment #6

CLI

NIC

AL

QU

ALI

TY M

AN

AG

EMEN

T

Qu

alit

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pro

vem

ent

Co

mm

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ter

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ten

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n

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etes

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tien

t C

ente

red

Med

ical

Ho

me

Attachment #6

QU

ALI

TY &

OP

ERAT

ION

S A

LIG

N

Min

d t

he

Gap

s •

Car

e O

pp

ort

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in t

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ds

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clin

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m

Bal

dri

ge F

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tten

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Bal

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ge

Jou

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ent

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Ho

me

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Cen

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Spec

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tien

t En

gage

men

t

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ehav

iora

l Hea

lth

Inte

grat

ion

Attachment #6

CLI

NIC

AL

QU

ALI

TY D

ASH

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AR

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ata

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spar

ency

Attachment #6

Wel

l Man

aged

Car

e M

etri

c A

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He

alth

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tne

rs

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mm

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adm

issi

on

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e

12

.00

%

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G R

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RT

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Attachment #6

CLI

NIC

TR

AN

SFO

RM

ATIO

N

KIO

SKS

•Im

ple

men

ted

“ex

pre

ss c

hec

k-in

” ki

osk

s at

ou

r cl

inic

s in

Mar

ch, 2

01

6.

•“S

elf-

serv

e” k

iosk

s im

pro

ve t

he

pat

ien

t ex

per

ien

ce b

y p

rovi

din

g a

“fas

ter

and

eas

ier”

ch

eck

-in

pro

cess

.

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s al

low

pat

ien

ts t

o s

can

dri

ver’

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ense

s an

d in

sura

nce

car

ds,

mak

e co

-pay

men

ts

and

pay

ou

tsta

nd

ing

bal

ance

s, u

pd

ate

pat

ien

t in

form

atio

n, s

ign

form

s el

ectr

on

ical

ly a

s w

ell a

s ve

rify

th

eir

insu

ran

ce.

•W

e an

tici

pat

ed t

hat

50

% o

f o

ur

pat

ien

ts w

ou

ld s

hif

t to

th

e ch

eck

-in

kio

sks

du

rin

g th

e tr

ansi

tio

n y

ear;

ho

wev

er, t

he

tran

siti

on

has

bee

n h

igh

er t

han

an

tici

pat

ed a

t 7

0%

.

•K

iosk

s h

ave

red

uce

d t

he

che

ck-i

n t

ime

ove

rall

for

pat

ien

ts.

The

ave

rage

ch

eck

-in

tim

e fo

r n

ew p

atie

nts

is 2

:48

an

d 1

:07

min

ute

s fo

r re

turn

pat

ien

ts

•Th

e P

SR’s

are

ab

le t

o s

pen

d m

ore

tim

e w

ith

pat

ien

ts w

ho

nee

d a

dd

itio

nal

su

pp

ort

.

Attachment #6

Medic

al Q

ualit

y A

ward

s

Aw

ard

ing

Org

an

iza

tio

n

Aw

ard

2

011

2012

2013

2014

2015

Inte

gra

ted

He

alth

ca

re A

sso

cia

tio

n

Exce

llen

ce

in

He

alth

ca

re

Mo

st Im

pro

ve

d

To

p P

erf

orm

er

Ca

lifo

rnia

Asso

cia

tio

n o

f P

hysic

ian

Gro

ups

Exe

mpla

ry A

wa

rd

Elit

e A

wa

rd

Attachment #6

JESS

ICA

GH

AR

BA

WY,

PH

AR

MD

, B

CA

CP,

CD

E

PH

AR

MA

CY:

TH

E FO

UN

DA

TIO

N O

F O

UR

QU

ALI

TY M

AN

AG

EMEN

T

Attachment #6

Ref

ill C

ente

r

•In

crea

se p

resc

rib

er’s

dir

ect

pat

ien

t ca

re t

ime

•

Qu

alit

y im

pro

vem

ent

–

Snap

sho

t: 4

-6 o

ver

du

e la

bs

and

ap

po

intm

ents

fo

un

d p

er d

ay

•C

on

nec

t p

atie

nts

to

car

e th

ey n

eed

Jun

e 2

01

6 R

efi

ll P

resc

rip

tio

ns

Ref

ill C

ente

r

Oth

er

Tota

l = 8

98

6

N=3

48

6

(39

%)

N=5

50

0

(

61

%)

Attachment #6

Hyp

erte

nsi

on

0

50

10

0

15

0

20

0

25

0

30

0

Number of Patients

Mo

nth

E

nro

llmen

t Ta

rge

t

July

1: 2

51

Pa

tien

ts

•C

MM

I Hea

rt A

ttac

k an

d

Stro

ke F

ree

Zon

e (H

ASF

Z)

•G

oal

: en

roll

30

0 p

atie

nts

b

y A

ugu

st 3

1, 2

01

6

•R

edu

ce h

eart

att

acks

an

d

stro

ke in

San

Die

go b

y 5

0%

Attachment #6

Dia

bet

es

•Te

am b

ased

ap

pro

ach

–O

utr

each

–R

efer

rals

•P

har

mac

y st

ud

ents

an

d

resi

den

ts

Attachment #6

Attachment #6