chapter 7 quality health care management. introduction quality health care – doing the right thing...

Chapter 7

Quality Health Care Management

Introduction

• Quality health care – doing the right thing at the

right time, in the right way, for the right person,

and getting the best possible results

• There may be different interpretations of what is

“right”

Data Quality

• High grade, superiority, or excellence of data

• Intertwined with quality patient care

• Data can demonstrate and represent in an objective

sense the delivery of quality patient care

Historical Developments

• The study of the quality of patient care has

existed for almost 100 years

• ACS created Hospital Standardization Program

in 1918

• The ACS program lead to JCAHO in 1951

Terms

• Total quality management

• Continuous quality improvement

• Quality management

• Quality assurance

• Process improvement

• Performance improvement

Data

• To measure patient care for quality purposes, must have data

• Data must be reliable, consistent, and accurate– Documentation process– Abstracting process– Coding process– Indexing and registry processes– Interpreting process

Assessment Models

• Quality circles

• PDSA

• FOCUS PDCA

• Malcolm Baldridge National Quality Award

• Six Sigma Improvement Methodology

Malcolm Baldridge National Quality Award

• Leadership

• Strategic planning

• Customer and market focus

• Information and analysis

• Human resource focus

• Process management

• Business results

Federal Efforts

• AHRQ– MEPS

– HCUP

– CAHP

– TRIP

– Quality/Safety of Patient Care Program

– CERT

• President George W. Bush statement

Private Efforts

• Aims for improvement

• Ten steps for redesign

• NCQA– MCO

– HEDIS

• NAQAP– CPHQ

Tools

• Brainstorming

• Benchmarking

• Affinity diagram

• Nominal group technique

• Gantt charts

Tools

• PERT

• Cause-and-effect diagram

• Pareto chart

Data Display

• Bar graph

• Histogram

• Pie chart

• Line graph

• Control chart

• Scatter diagram

Applications

• Prospective approach

• Concurrent approach

• Retrospective approach

• Focus on how to use data to improve patient

care and safety– PDSA

– Benchmarking

Benchmarking

• Outcomes

• Core measurements

• Quality improvement model

QI Reports

• MDS – Minimum Data Set

• OSCAR – Online Survey, Certification, and

Reporting database

• Selecting core measurements for tracking

Performance Improvement

• Clinical function focused on how to improve

patient care

• HIM involvement

• Use of benchmarking technology

• ORYX Initiative

• CATCH

Risk Management

• Nonclinical function focused on how to reduce

medical, financial, and legal risk to an

organization

• Role expanding to include more focus on

database management

• Issues related to risk management

Utilization Management

• Definition

• History

• Case management

• Case managers or utilization coordinators

Utilization Review

• Preadmission review

• Admission review

• Concurrent review

• Discharge planning

• Special 10 Transfer DRGs