Chapter 7 Quality Health Care Management
Jan 14, 2016
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