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Quality Improvement

Quality Improvement. Introduction to Quality Improvement and Health Information Technology. Lecture b.

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Quality Improvement

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  1. Quality Improvement Introduction to Quality Improvement and Health Information Technology Lecture b This material (Comp 12 Unit 1) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000013. This material was updated in 2016 by Johns Hopkins University under Award Number 90WT0005. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/

  2. Introduction to Quality Improvement and Health Information TechnologyObjectives — Lecture b • Explain health care quality and quality improvement (QI). • Describe quality improvement as a goal of key national health care priorities, including the National Quality Strategy.

  3. Quality Health Care “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge.” (IOM, 2001)

  4. Quality Health Care — Who Defines it?

  5. Organizations That Are Part of the Tapestry of QI and Health Care • National Quality Forum (NQF) • National Committee for Quality Assurance (NCQA) • Provider organizations: • AMA’s Physician Consortium for Performance Improvement (PCPI) • Joint Commission (JC) • Institute for Healthcare Improvement (IHI)

  6. U.S. Health Care System: How Are We Doing? • Needs to be improved, especially for the uninsured. • Patient safety and health care–associated infections have shown improvement. • Quality is improving, but pace is slow, especially in preventive care & chronic disease management. • Disparities are common, and lack of insurance is a contributor. • Many disparities are not decreasing; those that warrant increased attention include care for cancer, heart failure, and pneumonia. Source: AHRQ Research Findings page.

  7. National Quality Strategy (NQS)Aims • Better care: improve overall quality by making health care more patient centered, reliable, accessible, and safe. • Healthy people/healthy communities: improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher quality care. • Affordable care: reduce the cost of quality health care for individuals, families, employers, and government.

  8. National Quality Strategy (NQS) Priorities • Patient safety: making care safer by reducing harm caused in the delivery of care. • Person-centered care: ensuring that each person and family is engaged as partners in their care. • Care coordination: promoting effective communication and coordination of care. • Effective treatment: promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. • Healthy living: working with communities to promote wide use of best practices to enable healthy living. • Care affordability: making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

  9. Basics of Quality Improvement

  10. Set an Aim • Make it specific. • Assign it a number if possible. • Assign it a timeline. • Make it measurable. • Make sure it is challenging but doable.

  11. Measure • Process Measure:Are we doing what we must to get the improvement we seek? • Outcome Measure:Are we getting what we expect? • Balancing Measure:Are we causing new problems in other parts of the system?

  12. Examples Hospital • Aim: we will reduce the number of ventilator-associated pneumonias (VAP) in the ICU from the current 23% to under 10% in 4 months. • Measures: • Process measure: • Ventilator days • Over-sedation hours • Oral care performed • Outcome measure: Number of VAP • Balancing measure: • Cost of care • Re-intubation rates Ambulatory • Aim: we will reduce the amount of time it takes our patients to get an appointment (request to appointment) from 23 days to 0 days in 6 months. • Measures: • Process measure: • Supply • Demand • No-show rate • Outcome measure: Third next available appointment • Balancing measure: Patient satisfaction

  13. Change • Concepts and strategies: decide on the overall changes that will lead to the desired improvement. • Specific changes: • Make them small. • Make them fast. • Make them frequent. • You may need to include additional measures specifically to decide if a change you have tested is worth keeping or did not lead to improvement. • Consider using pre-existing change packages.

  14. Example of a Change Package

  15. Learn • One of the most important aspects of QI is to understand how your systems actually perform, under a range of conditions. • Deming’s theory of profound knowledge is based on the principle that each organization is composed of a system of interrelated processes and people. • The improvement of the system depends on the capability to organize the balance of each component to enhance the entire system. • Understanding and learning about your system is essential to improve it.

  16. Introduction to Quality Improvement and Health Information TechnologySummary — Lecture b • The quality of care received in the U.S. needs improvement. • Quality improvement is an ongoing process that includes the setting of an aim and a progressive measurement, change test, and understanding of the system.

  17. Introduction to Quality Improvement and Health Information Technology References — Lecture b — 1 References Agency for Healthcare Research and Quality (AHRQ). Available from: http://www.ahrq.gov/ Agency for Healthcare Research and Quality. (2013). National Healthcare Quality Report. 2013. Retrieved March 28, 2016, from http://www.ahrq.gov/research/findings/nhqrdr/nhqr13/index.html Centers for Medicare and Medicaid Services. Available from: http://www.cms.gov/ IOM — Institute of Medicine. Available from: http://www.nationalacademies.org/hmd/ Institute for Healthcare Improvement (IHI) Available from: http://www.ihi.org/Pages/default.aspx Joint Commission. Available from: http://www.jointcommission.org/ National Committee for Quality Assurance. Available from: http://www.ncqa.org/ National Quality Forum (NQF). Available from: http://www.qualityforum.org/Home.aspx Physician Consortium for Performance Improvement (PCPI) – American Medial Association. Available from: https://www.thepcpi.org/

  18. Introduction to Quality Improvement and Health Information Technology References — Lecture b — 2 Charts, Tables, Figures 1.2 Table: Example of a Change Care Package. California Academy of Family Physicians Diabetes Initiative Care Model Change Package. Available from: http://eo2.commpartners.com/users/acme/downloads/CAFP._Diabetes_Change_Package.pdf Images Slide 4: Quality Health Care: Who Defines It? Courtesy of Dr. Anna Maria Izquierdo-Porrera. Slide 6: Cover of the 2013 National Healthcare Quality Reportand the 2014 National Healthcare Quality and Disparities Report. Agency for Healthcare Research and Quality. Retrieved March 28, 2016, from: http://www.ahrq.gov/research/findings/nhqrdr/index.html Slide 9: Basics of Quality Improvement. Courtesy of Dr. Anna Maria Izquierdo-Porrera. Slide 11: Process Measure, Outcome Measure, Balancing Measure. Courtesy of Dr. Anna Maria Izquierdo-Porrera.

  19. Quality ImprovementIntroduction to Quality Improvement and Health Information TechnologyLecture b This material (Comp 12 Unit 1) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000013. This material was updated in 2016 by Johns Hopkins University under Award Number 90WT0005.

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