Your Quality Improvement Plan

Your Health Care Plan ………………………………………………………………..and stuff like that

Marti Wolf, RN, MPHClinical Programs DirectorNorth Carolina Community Health Center Association

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.

Objectives

What’s a Health Care Plan?

What’s a Quality Plan?

Clinical UDS???

Meaningful Use

Medical Home

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

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

recognition5

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

 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 Quality:The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. STEEEP

QI Plan- Define Quality

Quality

Safe

Effective

Patient-Centered

Timely

Efficient

Equitable

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)

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

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

QI Plan

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…

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))

Elements of your Quality Plan:FTCA 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

IHI Triple Aim

Quality of Care

Patient Experience

Cost of Care

Perspectives on Quality

Medical

Administrative

Patient

Quality

Results of Quality

Improved Outcomes

Improved efficiency and

productivity

Staff and patient satisfaction

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

Demonstrating Quality

Patient Centered Medical Home Patient Centered Health Home

Initiative

Meaningful Use

Quality - Food for Thought

Consistency requires you to be

as ignorant today as you were a

year ago .

-Bernard Berenson

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 <140/90

2011 Clinical UDS New and Revised Measures

2010 UDS manual- clinical measures start on p 49

http://bphc.hrsa.gov/healthcenterdatastatistics/reporting/ call archive

http://bphc.hrsa.gov/healthcenterdatastatistics/reporting/2010manual.pdf

Program Requirements #8

HCP Template

ENOUGH TO TRACK!

RISK MANAGEMENT

Disclaimer

Risk Management is like liver.

The more you chew it,

the bigger it gets.

PROTECT

AGAINST

LOSS

Risk Management

“Identify and plan for potential and actual risks… in terms of facilities, staff, clients, financial, clinical and organizational well-

being”. (NACHC, 2003)

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)

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

RM in Amb Care: Hot Topics

Credentialing and Privileging Medical Records

Confidentiality

Backup (paper or electronic)

Documentation

Legibility

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 drug–drug and drug–allergy 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.

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 2–20 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.

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.

Meaningful Use CORE - EP

EP Menu Objectives (Must Implement 5 of 10)

1. Implement drug formulary checks.

2. Incorporate clinical laboratory test results into EHR as structured data.

3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

4. Send patient reminders per patient preference for preventive/follow-up care.

5. 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.

6. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient, if appropriate.

7. 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.

8. 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.

9. Capability to submit electronic data to immunization registries or immunization information systems and actual submission in accordance with applicable law and practice.

10. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice.

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

Additional Set (minus oncology)1. Diabetes: eye examination

2. Diabetes: urine screening

3. Diabetes: foot examination

4. Diabetes: poor hemoglobin A1c control (>9.0%)

5. Diabetes: hemoglobin A1c control (<8.0%)

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

Additional Set

11. Heart failure (HF): angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker therapy for left ventricular systolic dysfunction (LVSD)

12. HF: β-blocker therapy for LVSD

13. HF: warfarin therapy for patients with atrial fibrillation

14. Coronary artery disease (CAD): β-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

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

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

HEALTHY NORTH CAROLINA 2020: A BETTER STATE OF HEALTHHTTP://WWW.PUBLICHEALTH.NC.GOV/HNC2020/

INSTITUTE FOR HEALTHCARE IMPROVEMENTHTTP://WWW.IHI.ORG/IHI/TOPICS/IMPROVEMENT/IMPROVEMENTMETHODS/MEASURES/

IMPROVING CHRONIC ILLNESS CAREHTTP://WWW.IMPROVINGCHRONICCARE.ORG

2011 NEW AND REVISED CLINICAL MEASURESHTTP://WWW.CMS.GOV/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

Resources

Meaningful Use Stage 1 Clinical Quality Measures http://www.hrsa.gov/healthit/meaningfuluse/MU%20Stage1%20CQM/index.html