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Measurement and Quality Care

Measurement and Quality Care. Can we improve patient outcomes?. US Healthcare Spending. 2.1 Trillion Dollars (2006) – 16% of GDP $6600 per capita (Switzerland $4100) (Canada $3800) (UK $2200) (Mexico $550). Does Quality Improvement Work?. Werner.

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Measurement and Quality Care

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  1. Measurement and Quality Care Can we improve patient outcomes?

  2. US Healthcare Spending • 2.1 Trillion Dollars (2006) – 16% of GDP • $6600 per capita (Switzerland $4100) (Canada $3800) (UK $2200) (Mexico $550)

  3. Does Quality Improvement Work?

  4. Werner • Bottom Line for across all AMI measures: **Absolute mortality risk reduction for patients cared for in high performing vs. low performing institutions Inpatient 5/1000 30-day 6/1000 1-year 12/1000

  5. Measures and Meaning • Process of Care • Intermediate Outcomes • Patient Outcomes

  6. CQI - HEDIS • Trivedi et al. Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med 2005;353:692-700.

  7. Davis et al. JAMA (1995) 274:1836. Bloom. Int Journal Tech Assess (2005) 21:380. Davis et al. JAMA (1999) Cochrane Database 2000. Cochrane Database 2001. Cochrane Database 2006. Which CME Methods Improve Patient Outcomes?

  8. What Works? • Printed Materials • Didactics NOO!

  9. What Works? • Workshops / Practicums - good for procedural skills if interactive, hands-on

  10. What Works? • Audit / Feedback + (low performing practices +++) • Opinion Leaders ++ • Academic Detailing ++ • Patient Activation ++1/2 • Outreach Activities (e.g. QIC’s) +++

  11. PDSA’s and Data Driven Change

  12. Choosing Measures for IPIP • Everyone has opinions about quality measures • Quality measures are designed for a variety of purposes • All have limitations

  13. Rely Upon Nationally Endorsed Measures • Determining “ideal” measures was beyond IPIP • Other organizations do this (NCQA, Physicians Consortium, National Quality Forum, Ambulatory Care Quality Alliance) • IPIP decided to require measures endorsed by a one or more of the above organizations

  14. Benefits • Lessens the impact of individual opinions • Dramatically improves our ability to align (NCQA certification, MOC, and insurers audits)

  15. Liabilities • Reduces flexibility • Often leaves us with “clunky” measures • Measures sometimes become obsolete

  16. Role of Required Measures • Compare apples to apples within IPIP states and practices • Address the specific measures that national organizations are targeting • Help practices improve important outcomes and processes that should not be very controversial

  17. Required IPIP Measures Are Not The Only Measures That Practices Can Or Should Use!!! • Use other measures to help ensure reliable processes and do small PDSAs

  18. Chronic Disease Measures • 2008 – DM, Asthma • 2009 – CHF, HTN, post-MI care • 2010 – ? peds, ? preventive care

  19. Diabetes - Required

  20. Diabetes - Optional

  21. Asthma - Required

  22. Asthma - Optional

  23. Data Use • Practice level • Aggregate

  24. Conclusions • QI is here to stay • CANNOT have improvement without measurement • Docs should lead the way • Primary Care Prediction • Your neighbors’ health

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