This report is written for the Board of Directors of the Nazarene Community Health Clinic (NCHC). It outlines the importance and necessity of quality management as it pertains to the health care reform’s mandate that all Americans have access to quality, affordable health care.
The eight step change model in practice, a case study on medication error pri...Dr. Wazhma Hakimi
Medication Error Prioritization System (MEPS) is used to improve the quality care and the culture of patient safety within organizations. MEPS can be effective in identifying and controlling high hazard medication (e.g., narcotics and anti-coagulants) and expired medicine and it can help with reducing preventable medical errors including errors in prescriptions, inappropriate use of medication and their adverse effects. Preventable medical errors are the leading cause of death in many countries while two-thirds of such errors could have been prevented and the most successful error-reduction strategy is MEPS. Using the online MEPS database, pharmacists answer a series of questions to report a medication error, including medication name, type of error, and location of event. Then, it provides recommendations on prevention of error and has the ability to teach employees how to prevent the error in the future. In addition, it provides insight that how the organization can improve patient safety by reviewing medication errors. For introducing MEPS and its successful implementation, in this document I recommend the Kotter’s 8 Steps of Change Management Model which can be implemented step by step.
Background: A unique statewide multipayer initiative in Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) with diabetes as an initial target disease. it is and one of the largest PCMH multipayer
initiatives.
Results: During the first intervention year (May
2008–May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician
Practice Connections Patient-Centered Medical Home
(PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based
complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.
Conclusions: Transforming primary care delivery through
implementation of the PCMH and CCM supported
by multipayer infrastructure
The eight step change model in practice, a case study on medication error pri...Dr. Wazhma Hakimi
Medication Error Prioritization System (MEPS) is used to improve the quality care and the culture of patient safety within organizations. MEPS can be effective in identifying and controlling high hazard medication (e.g., narcotics and anti-coagulants) and expired medicine and it can help with reducing preventable medical errors including errors in prescriptions, inappropriate use of medication and their adverse effects. Preventable medical errors are the leading cause of death in many countries while two-thirds of such errors could have been prevented and the most successful error-reduction strategy is MEPS. Using the online MEPS database, pharmacists answer a series of questions to report a medication error, including medication name, type of error, and location of event. Then, it provides recommendations on prevention of error and has the ability to teach employees how to prevent the error in the future. In addition, it provides insight that how the organization can improve patient safety by reviewing medication errors. For introducing MEPS and its successful implementation, in this document I recommend the Kotter’s 8 Steps of Change Management Model which can be implemented step by step.
Background: A unique statewide multipayer initiative in Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) with diabetes as an initial target disease. it is and one of the largest PCMH multipayer
initiatives.
Results: During the first intervention year (May
2008–May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician
Practice Connections Patient-Centered Medical Home
(PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based
complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.
Conclusions: Transforming primary care delivery through
implementation of the PCMH and CCM supported
by multipayer infrastructure
The Evolution of Physician Group from Patient Centric Medical HomesVitreosHealth
A Quest to Achieve Higher Quality and Bend the Employers Health Care Cost Curves. Medical Clinic of North Texas (MCNT) enjoys a stellar FY 2010 performance with Total Medical Cost trend for their managed population 2.4% better than market. We tried to understand the journey and the drivers behind the success of Medical Clinic of North Texas from its early years and its future direction.
Marketing proposal to Hartford HealthcareArchit Patel
The presentation is a brief description to the proposed marketing strategy for the Hartford healthcare specifically targeting on the New Health Enhancement Program proposed for Connecticut state employees.
How to Improve Hospital Accreditation - Linta Meyla PutriLinta Meyla Putri
Hospital as a health care institution must provide quality services to the community. Quality of service is a standard that will be made to increase the hospital accreditation. In addition to the accredited national standards, some hospitals in Indonesia, especially government hospitals, will also be accredited to use international standards. Actually in Indonesia has a lot of hospitals which are internationally accredited, but most private hospitals. This condition is to give the impression that government hospitals are less credible and less able to provide the best service both communities. To achieve this, the government in collaboration with international accreditation agency that is Joint Commission International (JCI), USA.
The Evolution of Physician Group from Patient Centric Medical HomesVitreosHealth
A Quest to Achieve Higher Quality and Bend the Employers Health Care Cost Curves. Medical Clinic of North Texas (MCNT) enjoys a stellar FY 2010 performance with Total Medical Cost trend for their managed population 2.4% better than market. We tried to understand the journey and the drivers behind the success of Medical Clinic of North Texas from its early years and its future direction.
Marketing proposal to Hartford HealthcareArchit Patel
The presentation is a brief description to the proposed marketing strategy for the Hartford healthcare specifically targeting on the New Health Enhancement Program proposed for Connecticut state employees.
How to Improve Hospital Accreditation - Linta Meyla PutriLinta Meyla Putri
Hospital as a health care institution must provide quality services to the community. Quality of service is a standard that will be made to increase the hospital accreditation. In addition to the accredited national standards, some hospitals in Indonesia, especially government hospitals, will also be accredited to use international standards. Actually in Indonesia has a lot of hospitals which are internationally accredited, but most private hospitals. This condition is to give the impression that government hospitals are less credible and less able to provide the best service both communities. To achieve this, the government in collaboration with international accreditation agency that is Joint Commission International (JCI), USA.
ASSOCIATION BETWEEN SERVICE HEALTH QUALITY AND PATIENT SATISFACTION – A CASE ...IAEME Publication
Satisfaction is a comparison between the perceptions of services received with expectations, while the quality of health services is act or services provided by one party to another in form of care or provision of health facilities. Health resources are one contributing factor in provision of qualified health care, which is expected to improve public health. Aspects of provided services quality will affect patient satisfaction. If their expectations are met, it means that service has provided good quality and will also lead to high satisfaction. This study aims to determine the relationship of health services quality and satisfaction level in people of North Mamuju. Analytic observational research with cross-sectional study design, population of the entire community of North Mamuju regency and research subjects were aged >18 years. The results showed significant value in registration 0.010 and physicians 0.007, implying registration and physicians have significant effect on customer satisfaction. The conclusions of this study indicate that the registration, doctors, nurses, pharmaceutical, environmental and hospital / clinic variables collectively have positive effect on customer satisfaction
تطبيق مبادئ إدارة الجودة الشاملة في المكتبات ومراكز المعلومات/ بحث منشور في أعمال الملتقى العربي الأول للمكتبات والمعلومات حول الاساليب الحديثة لادارة المكتبات ومراكز المعلومات بالجودة الشاملة، مكتبة الاسكندرية (ديسمبر 2005 )، ومتاح على الرابط التالي:-
http://www.ta9weer.com/vb/showthread.php?t=1016
يطلق على هذا العصر الذى نعيش فيه عصر "ثورة المعلومات" ولتحقيق هذا المفهوم وتطبيقه فإنه يحتاج الى ادارة جيدة لتطويع هذه التكنولوجيا وذلك داخل كافة المؤسسات البحثية فيما يطلق عليها الادارة الرشيدة او الجودة الشاملة والتى تعد احدى الركائز الاساسية لنموذج الادارة الجديدة التى تولد لمسايرة المتغيرات الدولية والمحلية.
وادارة الجودة الشاملة احد الاساليب الحديثة المستخدمة فى تقويم أداء المكتبات ومراكز المعلومات ووضع رؤية جديدة لأهداف وغرض المكتبات .
وتعتمد الجودة الشاملة على مجموعة من المحاور من اهمها التخطيط الاستراتيجى والادارة الرشيدة والحكم الديمقراطى ورضاء العملاء والوصف الوظيفى للعاملين .... لتحسين الاداء فى العمل والالتزام الكامل من جميع الافراد وكذلك الاشخاص العاملين داخل المؤسسة الأم التابعة لها هذه المكتبات ، ويتضح بذلك أن الجودة الشاملة مسئولية الجميع وليست مسئولية مجموعة من الفنيين والمختصين كما هو متبع فى مبادىء الجودة النوعية .
وقد يظهر للبعض من علماء المكتبات ان هناك صعوبات كبيرة قد تواجه المكتبات ومراكز المعلومات فى تطبيق مفهوم الجودة الشاملة بسبب حداثة هذا المفهوم على المؤسسات الخدمية أو البحثية غير الهادفة إلى الربح ، بالاضافة إلى أن مفاتيح الجودة الشاملة هى مجموعة من المواصفات والمعايير المحددة والتى تحتاج إلى نظرة شاملة لابد من استيعابها لكافة الافراد ذوى الحيثيات داخل مؤسسات المعلومات ، ويرى الباحث أن هذا قول مردود عليه حيث أنه بالرغم من أن المكتبات قد نشأت باعتبارها مؤسسات خدمية إلا أن التطور التقنى قد لعب دوراً بارزاً فى تخلى المكتبات عن هذا التقليد بدخولها فى نطاق المؤسسات البحثية ذات الطابع التجارى من خلال منظومة تسويق خدمات المعلومات ، وبالتالى بدأت المكتبات ومراكز المعلومات رغم كونها مؤسسات خدمية من الدرجة الاولى فى التخلص تدريجياً عن المفهوم القديم الحديث وادراك ان هذه المؤسسات تحتاج إل�
Quality Improvement In Healthcare: Where Is The Best Place To Start?Health Catalyst
One of the biggest challenges providers face in their quality improvement efforts is knowing where to get started. In my experience, one of the best ways to overcome that “where do we begin?” factor is by using data from an enterprise data warehouse to look for high-cost areas where there are large variations in how health care is delivered. Variation found through the KPA is an indicator of opportunity. The more avoidable variation that is reflected in a particular care process, the more opportunity there is to reduce that variation and standardize the process. Suppose after performing a KPA you discover three areas of opportunity. How do you determine which one to pursue, especially if it’s your first journey into process improvement? The most obvious answer would seem to be the one with the largest potential ROI. That may not always be the best course to pursue, however. You will also want to take into consideration the readiness/openness to change in each of those areas.
Quality Management Health Plan is a roadmap to apply standards of health care quality improvement for health care providers. An individualized one is to be taken into consideration, cause quality isn't a fit-for-all dress, despite of having similar objectives
The how of a design, for health care quality improvement, made simple, would help constructing bridges for and effectively acceptable template for a better performance.
How to Make Awesome SlideShares: Tips & TricksSlideShare
Turbocharge your online presence with SlideShare. We provide the best tips and tricks for succeeding on SlideShare. Get ideas for what to upload, tips for designing your deck and more.
4508 Final Quality Project Part 2 Clinical Quality Measur.docxblondellchancy
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the 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.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
4508 Final Quality Project Part 2 Clinical Quality Measurromeliadoan
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the 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.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
Read the scenario that you will use for the Individual Projects in ea.pdfashokarians
Read the scenario that you will use for the Individual Projects in each week of the course. The
Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health
care delivery. Many changes have transpired to improve patient safety along with the
implementation of additional quality metrics, and these changes impact reimbursement rates
Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee
structure of Medicare and Medicaid reimbursement for health care services. Other legislation
including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015
(MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use
of data to improve quality and delivery of patient care Mr. Magone, CEO of Healing Hands
Hospital, has asked you to join the \"Future of Healing Hands Task Force, and your first
assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a
summary of the current regulations regarding Medicare reimbursement including how MACR
impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with
physician practices For this assignment, write a 2-3 page report that you will deliver to Mr.
Magone on how the new CMS initiatives and regulations impact the organization\'s revenue
structure. In your presentation, address the following questions: Why did CMS become more
involved in the reimbursement component of health care? How does CMS\'s involvement impact
the reimbursement model for Healing Hands Hospital and other health care organizations If
CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other
insurance providers change heir policies on reimbursement? What tools can be implemented to
ensure organizations such as Healing Hands Hospital and physician practices are meeting the
policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are
helpful in meeting the requirements for Medicare reimbursement set forth by CMS
Solution
Part-a & part-b:
The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for
Medicare and Medicaid services) is required to control overall expenditures in health care
organization. Therefore, CMS become highly involved in the reimbursement component of
health care to patients as per their \"insurance packages\". The CMS\' involvement in “budget
Neutrality” & the reimbursement model at Healing Hand hospital & other health care
organizations is mainly for physician RVU based payments from Medicare & Medicare that can
control its physician costs by adjusting physician payment rates based on “previous periods in a
calendar year” as per federal acts and regulations. The Medicare is going to control physicians
costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec
31. Conversion Factor is main basis to control the physician costs ac.
Running Head ACCREDITION PROGRAMS1ACCREDITION PROGRAMS2.docxSUBHI7
Running Head: ACCREDITION PROGRAMS 1
ACCREDITION PROGRAMS 2
Quality Improvement in Health Care Organization
Name
Course
Instructor
Institution
Date
Introduction
In the wake of an increased concern of the quality of consumer product and services, the necessity to meet the quality standards has grown tremendously. It’s because the quest of quality within hospitals and healthcare providers is paramount. The major concern of accreditation programs are often on issues pertaining quality to meet patient demands. Therefore, accreditation is the conformity assessment practice in which organizations outline standards of performance/ operation and determine their compliance to them (Hamm, M. S., 2007). Following utilization of various programs around the U.S. health programs, many hospitals use Joint Commission Programs. But due to the program’s pressure on workers due to high-level of inspections and nonprofit nature to comply to Joint commission necessities, many facilities are exiting. The organization has also opted to quit and employ the following programs instead.
Alternative Choices
The National Committee for Quality Assurance (NCQA) – It is a national organization which entails certification programs specified for recognition and service programs suited to various illnesses and medical practices. Additionally, its process of accreditation depends on Health Plan Employer Data, a quantitative outcome tool and IPS (Information and Point of Service accreditation (NCQA, n.d.).
Accreditation Association for Ambulatory HealthCare (AAAHC) – A non for profit organization which develops standards which are utilized in the advancement and promotion of the safety of patients, improve quality of healthcare and ambulatory healthcare’s value. This it accomplishes via education, research and peer-based accreditation processes for these healthcare organizations in addition to ambulatory surgery centers, college student health centers among other centers.
Underwriter Laboratories Inc. - UL Inc. operates as a not for profit organization providing safety related testing for products, training and inspections, certifications among other services.
Centers for Medicare and Medicaid Service (CMS) Condition
The National Committee for Quality Assurance, NCQA
Among some of NCQA background performance measures are;
· Access and service – guaranteeing the facility’s services are available to all through promotion of affordable fees charged to acquire quality healthcare services.
· Quality Provision – only competent and qualified persons to deliver quality service to maintain the kind of service offered to the public in general
· Health maintenance – it is a measure utilized to describe amount of time required for an individual to gain full health after medical treatment. It allows the organization through feedback mechanisms to gunner for best practices in healthcare provision.
This program necessitates the involved healthcare plans to gather data i ...
To support your work, use scholarly sources and also use outside s.docxedwardmarivel
To support your work, use scholarly sources and also use outside sources. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Regulations in Long-Term Care
There are many federal and state regulations when it comes to long-term care. Using scholarly sources and the Internet research any four specific regulations related to long-term care and summarize them.
Based on the regulations you identified, respond to the following questions:
· What are the benefits and shortcomings of your identified regulations? Which of these shortcomings have an effect on the quality and the cost of health care services? How?
· Do you believe there is a link between regulations and better care? Why or why not?
· Why do you think long-term care services are subjected to so much external control by government agencies? Provide a rationale for your responses.
· How is quality measured in long-term care? Is there only one, or are there several approaches to measure quality? What are they? Who should be given the responsibility to measure quality?
Notes from class
The increasing need for long-term care has caused several public and private agencies to participate in its managing process. These public and private agencies are increasingly attempting to control costs, providing protection to consumers considered unable to protect themselves. Public controls are nonvoluntary and are imposed by government agencies through the implementation of laws and regulations. Private controls are provided by nongovernment agencies and organizations, and compliance is voluntary.
Public Control
Public control on long-term care is imposed by federal, state, or local (including county and municipal) government units. These units set laws, regulations, and standards to be followed by long-term facilities in order to:
· Give better care facilities to the poor, who are unable to take care of themselves, by making them formal or informal wards of the state.
· Provide quality health care facilities to consumers.
· Create awareness in consumers regarding the types of services provided in the facilities and let the consumers themselves judge the quality of the services.
· Set the minimum level of staffing, cleanliness, and safety, ensuring consumers needing long-term care are treated properly and receive the necessary services.
· Follow all long-term care regulations to provide quality care.
Private Control
Besides government agencies, several private organizations are involved in managing long-term care. Both public and private control focus on long-term care organizations as well as the individuals in those organizations. The only difference is public control can maintain both the cost and the quality of care, while private care can focus only on measuring, evaluating, and ensuring the quality of care.
Private control agencies focusing on the quality of care of long-term organizations are known as accreditation bodies, while those ...
White Paper - Building Your ACO and Healthcare IT’s RoleNextGen Healthcare
The tools needed to capture, organize, and share healthcare data are truly evolving at the speed of light. Patient Centered Medical Homes play a vital role in the path toward accountable care and technology, staff, and workflow transformation are necessary to achieve PCMH recognition. This transformation allows healthcare providers to deliver higher quality coordinated care by streamlining and rationalizing the patient experience.
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Jean Moody Williams
Running Head QUALITY IMPROVEMENT PLAN 1QUALITY IMPROVEMENT .docxtoltonkendal
Running Head: QUALITY IMPROVEMENT PLAN 1
QUALITY IMPROVEMENT PLAN 12
Quality Improvement Plan; Mayo Clinic
Introduction
Quality in the healthcare organisation is of paramount importance. This is not only for the purpose of ensuring that more customers are attracted to the business but also to make sure that the services being offered comply with the standard that are required for medical practitioners. Quality in mayo clinic is realised through various ways in accordance with the services that are offered. Each personal work strives to ensure that quality medical services are offered. Mayo clinic is a healthcare facility that offers medical services at a fee. People who attend the facility come with the hope of getting quality services they are paying for; this is the driving force of the facility- to ensure that quality services are offered.
With the above being said, the purpose of this paper is to evaluate quality improvement for conflict in mayo clinic caused by diversity of cultures.
Description of the environment and the departments of mayo clinic
Mayo clinic is located in different parts of the United States of America, with over 3300 physicians, researchers and other professionals sharing expertise to empower its clients. Being among one of the renowned healthcare organizations, mayo clinic is not without its own weaknesses. Many of these weaknesses as presented in the SWOT analysis were obtained from the interview conducted in this environment (Bauer, Kermott, Millman, & Mayo Clinic, 2017). The objective of this healthcare organization is to provide quality services in order to attract more customers seeking for services. Therefore, seeking quality plans to counter the possible weaknesses arising in the departments is inevitable.
In order to embrace the tradition of providing quality in all areas, such as the effectiveness of Medicare program, mayo clinic utilizes the department ad centres for research (Bauer, Kermott, Millman, & Mayo Clinic, 2017). Irrespective of the various challenges this healthcare organization go through, its belief that quality improvement is an endless task makes it moving. The research department and centres always endeavour to identify every possible gap in health care provisions going on in the different departments as a foundation of solution seeking.
The services offered in mayo clinic ranges from consumer services to business services. For the former, this healthcare organization offers health living programs, book and related programs, health letter for future reference, gift shop and mayo clinic voice apps which helps the customers to get health services in a convenient way using technological means (Bauer, Kermott, Millman, & Mayo Clinic, 2017). On the other hand, business services offered by this healthcare organization include medical laboratory services and Global business solutions.
In regard to the equipment being used at mayo clinic, the belief is that provision of care to patie ...
NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
The Top Five Essentials for Quality Improvement in HealthcareHealth Catalyst
Quality improvement in healthcare is complicated, but we’re beginning to understand what successful quality improvement programs have in common:
Adaptive leadership, culture, and governance
Analytics
Evidence- and consensus-based best practices
Adoption
Financial alignment
Although understanding the top five essentials for quality improvement in healthcare is key, it’s equally important to understand the most useful definitions and key considerations. For example, how different service delivery models (telemedicine, ACO, etc.) impact quality improvement programs and how quality improvement starts with an organization’s underlying systems of care.
This executive report takes an in-depth look at quality improvement with the goal of providing health systems with not only the top five essentials but also a more comprehensive understanding of the topic so they’re in a better position to improve quality and, ultimately, transform healthcare.
This issue discusses the code structure for the ICD-10 PCS Medical and Surgical Section. It also differentiates between a valid and an invalid PCS code.
Codes 518.81 (ICD-9 CM) and J96.00-.02 (ICD-10 CM) may be assigned as the principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital and if the selection is supported by the Alphabetic Index and Tabular List for both nomenclatures.
The January 2015 issue of the CCHIS Newsletter "Coding Yesterday's Nomenclature Today" discusses Human Immunodeficiency Virus (HIV) Infection coding guidelines in both ICD-9 CM and ICD-10 CM.
Sometimes the difficulty in medical coding can be traced back to the lack of understanding of what is taking place during the encounter. For instance, knowing the difference between the types ostomies can assist the coder in assigning both the correct diagnosis codes and the procedural codes. This slideshare is an effort to illustrate the coding for some of the more common ostomies. There are certainly others to consider.
. In ICD-9 CM codes can be found in Chapter 11 Complications of Pregnancy, Childbirth and the Puerperium (630-679). Any conditions which occur during or affect the pregnancy and puerperium periods MUST be preceded by a code from this chapter with the use of additional codes from other chapters to further described the condition when needed. ICD-10 CM codes can be found in Chapter 15 Pregnancy, Childbirth and the Puerperium (O00-O9A).
The Centers for Medicare & Medicaid Services (CMS) defines a debridement as “the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound (CMS.gov, 2014). Debridement may include the following: skin, subcutaneous tissue, fascia, muscle, bone and the removal of foreign material (CMS.gov, 2014).
Atherosclerosis of the extremities (Monckeberg’s Sclerosis) is a peripheral vascular disease (PVD) that occurs in the arteries of extremities; which is why it is sometimes referred to as peripheral artery disease (PAD). The coder however, must have the physician’s documentation indicating the PAD is due to atherosclerosis to ensure correct code assignment.
The presumption behind spaced repetition is simple. When we first learn a fact, the memory of it is fresh, but subject to change or it simply disappears. Each time we encounter that fact again, however, the memory becomes a more established part of our knowledge, especially if the encounters are spread out over time. In other words, exposing your mind to that same fact multiple times over weeks or months fixes it firmly in your brain.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Health Quality Program
1. Running head: QUALITY MANAGEMENT REPORT 1
Health Quality Program
Cynthia Brown
March 20, 2012
2. QUALITY MANAGEMENT REPORT 2
Abstract
This report is written for the Board of Directors of the Nazarene Community Health Clinic
(NCHC). It outlines the importance and necessity of quality management as it pertains to the
health care reform’s mandate that all Americans have access to quality, affordable health care.
To meet the requirement of quality health care, the Nazarene must implement and sustain a
Quality Improvement Program which effectively measures and improve the health care outcomes
in the clinic. The Institute of Medicine’s (IOM) definition of quality is given in this report. The
report will discuss in detail the role of a Quality Improvement Program as a tool for quality
management within the clinic by covering the following topics:
• The Patient Protection and Affordable Care Act (PPACA)
• Two Top-level Principles and Related Concepts for Measuring and Managing Quality in
the Clinic
• Comparison and Contrast of Two Statistical Tools and Methods that can be used to
Measure and Improve Health Care Outcomes in the Clinic.
• Description of How These Tools and Methods will Assure Safety of the Clinic’s Patients
Keywords: community living assistance services and support (CLASS), Continuous Quality
Improvement (CQI), Department of Health and Human Services (DHHS), electronic health
record (EHR)
3. QUALITY MANAGEMENT REPORT 3
Health Quality Program
It has always been the mission of the Nazarene Community Health Clinic (NCHC) to
provide quality health care to its patients. The Board of Directors and all other stakeholders are
in agreement that high quality is essential to the organizational goals and/or objectives in serving
our community. In the health care arena, quality is a very difficult concept to measure, manage,
and even define. The Institute of Medicine (2001) has tried to defined quality as the extent that
health services increase the probability that expected health outcomes are met while being
consistent with present day professional expertise. The IOM (2001) further implies that efforts
to improve health care should focus on six major components: safety, effectiveness, patient-
centeredness, timeliness, efficiency, and equitability. These components are in alignment with
the goals and/or objectives set forth in the NCHC mission statement which we believe ensure
that the health care provided by our clinic is of high quality. We however lack a program which
will assist the clinic in measuring, managing, and improving quality throughout the organization.
This report will discuss particular topics that will justify the need to develop, finance, and
implement a health quality program for the Nazarene Community Health Clinic.
Topics
The Patient Protection and Affordable Care Act
The government has become the leader in developing quality indicators and patient safety
goals which will measure a health care organization’s quality and quality improvement efforts;
thereby linking reimbursement payments to quality outcomes. The mandate to link
reimbursement payments to quality outcomes can be found in the Patient Protection and
Affordable Care Act (PPACA). The PPACA is comprised of nine titles which deal with health
care reform (Democrats, 2011):
4. QUALITY MANAGEMENT REPORT 4
Quality, affordable health care for all Americans. Under this title, the focus is making
health insurance affordable through shared responsibility. The idea is to create a total
reformation of the insurance market through the elimination of discriminatory practices; ensuring
that all Americans are covered under some type of health insurance; and by offering tax credits
for individuals and families.
The role of public programs. Under this title, PPACA expands the eligibility for
Medicaid for lower income individuals for which the federal government will pay the majority of
the cost.
Improving the quality and efficiency of health care. Of particular interest to NCHC is
this title, because payment for services will be linked to better quality outcomes. Although the
goal of this title is to improve the medical services for everyone, particular attention will be paid
to patients under the Medicare and Medicaid programs. The patient base at NCHC is comprised
mostly of members in these two programs. Under the PPACA, a new program will be created
which will result in community health teams whose goal is to increase access to community-
based, coordinated care. A health delivery system center will be used to research health delivery
system improvement and best practices that contribute to the improvement, quality management,
and safety of health care delivery. Also under this title, the Department of Human Health
Services Secretary will launch a national strategy to improve health care service delivery, patient
outcomes, and population health. NCHC must have a quality program in place to meet the
quality standards set forth by the federal government in order to ensure optimal reimbursement
for services rendered.
Prevention of chronic disease and improving public health. Under this title, a new
Prevention and Public Health Investment Fund will be created. All barriers to accessing
5. QUALITY MANAGEMENT REPORT 5
preventive services will be eradicated. The ultimate goal of this title is that of creating healthy
communities through the development of a modern 21st
century public health infrastructure.
Health care workforce. Under this title, PPACA’s goal is to strengthen the American
workforce in health care professions by supporting institutions in training and education. Grants
for workforce planning and development in health care; grants for states and medical schools in
the area of emergency services; student loan program modification; scholarships for
disadvantaged students; strengthening of primary care training; and additional support for the
existing health care workforce are some of the benefits of this title.
Transparency and program integrity. Under this title, new requirements have been
implemented that call for public health system information to be made available. There are also
new requirements designed to eliminate fraud and abuse in public and private programs.
Improving access to innovative medical therapies. Under this title, biological product
licensing will be approved through a process established by the Federal Drug Administration.
Also drug discounts will be given to make drugs more affordable to certain children’s hospitals,
cancer hospitals, critical access and sole community hospitals, and rural referral centers.
Community living assistance services and supports. Under this title, a national
voluntary insurance program for purchasing community living assistance services and support
(CLASS) will be created. The program is designed to assist those persons with functional
limitations and has a five-year vesting period for eligibility of benefits. It is important to note
that no taxpayer funds will be used to pay the benefits.
Revenue provisions. The important item to note under this title is an excise tax of 40
percent will be placed on insurance companies and plan administrators on any annual premiums
over $8,500 for single coverage and $23,000 for family coverage.
6. QUALITY MANAGEMENT REPORT 6
Two Top-level Principles and Related Concepts for Measuring and Managing Quality in
the Clinic
Title III of the PPACA, proposes to link payment to quality outcomes. Therefore, I
believe one of the top-level principles and related concepts for measuring and managing quality
in the clinic should be to have a Quality Improvement Program whose responsibility would be to
examine and improve processes in the clinic. The Quality Improvement Program objective
should be that of evaluating actions taken for an intended health care outcome and the evaluation
of how well these actions were performed in the achievement of the health care outcome
(Varkey, 2010). The Quality Improvement Program would be comprised of members trained in
basic statistical techniques, clinical practices, and the use of problem-solving tools (Bradley,
Burns & Weiner, 2012). Team members of the Quality Improvement Program should also have
the authority to make decisions based on data analysis (Bradley et al., 2012).
The second top-level principle and related concept for measuring and managing quality in
the clinic is to continuously evaluate and improve on the three basic classes of quality measures;
structure, process, and outcome. Structural measures of quality in the clinic can include
measures taken to meet JCAHO accreditation for clinics; the use of electronic health records; and
in-service training for medical staff.
Process measures for quality can include activities such as reviewing the medical records
to ensure physician and nurse signatures on orders, monitoring physician and nurse compliance
with clinical standards for medication distribution, and evaluating the wait time upon arrival for
clinical appointments. The use of a Run Chart as a measurement tool can depict the wait time of
patients (see chart below). The clinical standard for wait time for a scheduled appointment is 15
7. QUALITY MANAGEMENT REPORT 7
minutes with a 98% compliance rate. The Run Chart will show that the clinic deviated from the
standard in 1st
quarter of the year.
Run Chart
0
20
40
60
80
100
Jan
FebM
arch
April
Months
Patients
15-20 min
25-30
over 30 min
Lastly, the clinic should be evaluating outcomes following health care treatment and the
costs of providing the treatment (Varkey, 2010). Outcomes can be measured using patient
satisfaction forms and by capturing the status of the patient after treatment in the health record.
The clinic can use a Patient Satisfaction Survey to find out if the patient was satisfied with the
care received, the providers, costs of treatment, and whether or not they would refer
friends/relatives for the care. The clinic can also follow the results of certain treatments for
chronic illnesses along with the cost of providing the treatment. For example, the number of
times dietary consultations and exercise classes were suggested for non-insulin dependent
diabetic patients.
Comparison and Contrast of Two Statistical Tools and Methods that can be used to
Measure and Improve Health care Outcomes in the Clinic
Two statistical tools and methods that can be used in the measurement and improvement
of outcomes in the NCHC are Continuous Quality Improvement (CQI) and Six Sigma. In
8. QUALITY MANAGEMENT REPORT 8
comparison, both methodologies measure the result of work performed using such health care
outcomes as patient satisfaction, mortality rates, and safety. Both CQI and Six Sigma focus on
the processes that are in place and their effectiveness. Both methodologies can be used by the
Quality Improvement Team as tools of empowerment, education, and leadership. Organization-
wide acceptance and participation is imperative for the success of both CQI and Six Sigma.
Both require the involvement of key personnel, such as physicians, at the onset. The clinic must
also be willing to support the efforts of CQI and Six Sigma financially. This financial
commitment would involve the resources needed to collect and interpret data; trained team
members on the effective use of methodologies, and the costs of implementing necessary
changes to processes.
In contrast, CQI is used when the problem is minor in nature while Six Sigma is used
when there is a need for major changes (Benedetto, 2003). Also, Six Sigma uses more advanced
data analysis tools, integrates clearer financial data into its process, and is performed under rigid
time constraints (Anabari & Kwak, (2006). The goal of Six Sigma is to minimize variations to
the process by improving on the process; whereas CQI’s approach is to plan and implement
continuous organizational improvement to the process (Bradley et al., 2012).
Description of how These Tools and Methods will Assure Safety of the Clinic’s Patients
Efforts to strengthen the infrastructure of NCHC can be achieved by using the tools of
CQI and Six Sigma to address the issue of patient safety. One of the areas of concern when it
comes to patient safety is the process of health record availability at the time of patient visits and
complete, accurate documentation in the health record. It is the policy of the clinic to ensure that
all health information pertinent to the continual care of its patients is made available and is a part
of the organization’s best practices. Government funding for the electronic health record (EHR)
9. QUALITY MANAGEMENT REPORT 9
and the clinic’s policy to ensure patient safety in all of its processes should be main motivators in
the creating of an EHR system. The Department of Health and Human Services (DHHS) sought
the help of the Institute of Medicine (IOM) to research the EHR system’s impact on patient
safety and quality care (IOM, 2003). One of the recommendations of the IOM was that all health
care organizations should establish a comprehensive patient safety system in the form of an EHR
which would allow access to complete patient information and decision support tools (IOM,
2003). It was also recommended at the end of IOM’s study that the Federal government provide
financial support for implementation of EHRs throughout the health care system (IOM).
Using CQI and the Six Sigma methodologies to analyze the use of the clinic’s current
health record information availability and completeness, accuracy documentation can help to
decide whether an investment in an EHR is both cost-effective and can improve patient safety.
The CQI methodology can be used to identify instances when health record availability did not
meet the clinic’s standards and when documentation errors could have posed potential harm in
the treatment of patients. The Six Sigma methodology can be used to measure the process of
installation, use, and costs of an EHR system.
In conclusion, a Quality Improvement Program should definitely be a part of the
Nazarene Community Health Clinic’s best practices in an effort to measure and manage quality
care. The importance of quality management as it pertains to safety, quality measures, and
quality management are evident in this report. The Board of Directors should pay particular
attention to the nine titles outlined in the Patient Protection and Affordable Care Act as a
guideline for developing a health quality program. The financial justification can be seen in the
new health care reform’s proposal to link repayment to quality outcomes. Therefore, it would
benefit the clinic both financially and competitively to create a Quality Improvement Program
10. QUALITY MANAGEMENT REPORT 10
that focuses on quality measurement, improvement, and management. Today’s health care
consumer expects safety and quality to be key components of their medical experience at
Nazarene Community Health Center. As health care providers it is our duty to provide safe,
quality health care to each of our patients.
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11. QUALITY MANAGEMENT REPORT 11
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