Health Quality Program


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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.

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Health Quality Program

  1. 1. Running head: QUALITY MANAGEMENT REPORT 1 Health Quality Program Cynthia Brown March 20, 2012
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. CCHIS PRESENTATION TERMS AND CONDITIONS OF USE All content provided in this “CCHIS Document” is for informational purposes only. The owner of this document makes no representations as to the accuracy or completeness of any information in this document or found by following any link in this document. The owner of will not be liable for any errors or omissions in information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information. The terms and conditions are subject to change at any time with or without notice.
  11. 11. QUALITY MANAGEMENT REPORT 11 References Anabari, F.T. & Kwak, Y.H. (2006). Benefits, obstacles, and future of six sigma approach. Technovation, 26, 708-715. Retrieved March 13, 2012 from Benedetto, A.R. (2003). Six sigma: Not for the faint of heart. Radiology Management, 25(2), 40-53. Retrieved March 13, 2012 from Bradley, E.H., Burns, L.R., & Weiner, B.J. (2012). Healthcare Management: Organization, Design & Behavior (6th ed.). Clifton Park, NY: Delmar, Cengage Learning. Democrats.Senate.Gov. (2011). Responsible reform for the middle class: The patient protection and affordable care Act, detailed summary. Retrieved March 2, 2012 from Institute of Medicine. (2003). Key capabilities of an electronic health record system. Washington, DC: National Academy Press. Retrieved March 15, 2012 from Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. Retrieved March 15, 2012 from Varkey, P., M.D. (2010). Medical quality management: Theory and practice/American College of medical quality (2nd ed.) Sudbury, MA: Jones and Bartlett Publishers.