Presentation Objectives

Transcription

1 ISQua s 31 st International Conference Quality and Safety Along the Health and Social Care Continuum Integrating Performance Measurement into Every Level of Care: What Does it Mean in Your Organization? Is Your Organization Ready? Yosef D. Dlugacz, PhD, CMQ Senior Vice President and Chief of Clinical Quality, Education and Research Catherine M. Besthoff, RN, MHA, CPHQ on behalf of Krasnoff Quality Management Institute a division of North Shore-LIJ Health System slide # 1 slide # 2 One of the most fundamental questions to be addressed to improve the situation is deceptively simple: How do we know when health care services are good? The answer, also simple, it to measure those services. Another basic question is this: Is health care fair in terms of access and cost? The answer, again, is measures. When measures are used to analyze how health care institutions perform in quality and in finance, the organization has a basis for understanding its delivery of care and for improving that care. SOURCE: Dlugacz, Yosef D. MEASURING HEALTH CARE: USING QUALITY FOR OPERATIONAL, FINANCIAL, AND CLINICAL IMPROVEMENT Presentation Objectives Highlight the role of performance measurement and analytics in: Prioritizing performance improvement Internalizing patient safety systems Applying analytic principles for evaluation Educating physicians and leadership slide # 3 slide # 4 Performance Measurement in Healthcare Provide objective information Prioritize performance improvement Construct and internalize patient safety systems Educate clinical and administrative leadership slide # 5 slide # 6 1

2 What s Driving Evolution of the New Quality? Value-based purchasing Economics of healthcare Transparency Advanced measurement systems Innovative improvement methods Characteristics of the New Quality Continuous improvement to sustain achievement Organizational capacity to maintain excellent performance Statistical methods to assess and evaluate performance Inter-professional methods for improvement slide # 7 slide # 8 Safety Rounds Tool slide # 9 slide # 10 slide # 11 Copyright 2014, Krasnoff Quality Management Institute slide # 12 2

3 Evaluating Ambulatory Health Services Collecting Data to Provide Oversight Medical Record Review Hospital-based Clinics Faculty Practices Family & Community Health Centers Medical Homes Behavioral Health Homes Ambulatory Care Models Registration Systems Electronic Health Record Ancillary Systems Care Management Systems Patient Registries Information Technology Process Measures Outcome Measures Cost /Utilization Measures Efficiency Measures Biomedical Measures s and Measurement Models Healthfirst2011 Spring Symposium Making Care Accountable: Innovative Best Practices in Ambulatory Care May 12, 2011 Healthfirst2011 Spring Symposium Making Care Accountable: Innovative Best Practices in Ambulatory Care May 12, 2011 slide # 13 slide # 14 Measuring Care in the Community Accountability Structure Patient Centered Medical Home Health Information Technology Care Coordination Information Technology Business Intelligence Practice Transformation Interoperable Health Information High-risk Obstetrics OB/GYN & Community Measures and Analysis slide # 15 slide # 16 Data Transformation Process Impact: Leadership Gets Results EHR Documentation Systems Measure requested OB/GYN IT Data Reporting IT OB/GYN Data Validation Data Analysis IT IT Measure Approved slide # 17 slide # 18 3

4 H1N1 Project Purpose/Mission Operate regularly scheduled public vaccination clinics for H1N1 influenza on a weekly basis on behalf of Nassau County Department of Health (NCDOH) at accessible community settings for a period of weeks beginning November 1, H1N1 Project Goals Create sustainable vaccination sites (point of dispensing sites -PODs) over a week period Vaccinate residents in the priority groups recommended by the Center for Disease Control (CDC) to receive the H1N1 influenza vaccine slide # 19 slide # 20 BEFORE NCDOH H1N1 Project Vaccination Rate by Zip Code (H1N1 Vaccines / Census population) * 100 N = 6,066 PRE-GEOGRAPHIC TARGETING AFTER NCDOH H1N1 Project Vaccination Rate by Zip Code (H1N1 Vaccines / Census population) * 100 N = 15,005 POST-GEOGRAPHIC TARGETING An Evolution in Measurement The best measure of quality is not how well or how frequently a medical service is given, but how closely the result approaches the fundamental objectives of prolonging life, relieving distress, restoring function and preventing disability. Paul A. Lembcke, MD, MPH-1952 Data based Copyright 2014, on Krasnoff Census Quality Management 2000 Population Institute slide # 22 slide # 21 Dashboard Characteristics CEO s improvement prioritization based on an executive dashboard Provides accessibility through Internet/Intranet Fosters accountability to the governing body User friendly for administrators, clinicians and staff Educational (tutorial and explanatory key) Enables feedback through in-depth analysis Illustrates changes i.e., are improvements successful? slide # 23 slide # 24 4

5 10/15/2014 slide # 25 slide # 26 slide # 27 slide # 28 slide # 30 Sepsis Initiative Prioritization throughout the US and at North Shore-LIJ Major improvement initiative with IHI partnership Implementation of EBM and measurements via creation of web-based tool Rapid cycle PDSA utilized to effect improvement Process control charts provided to assess changes slide # 29 5

6 Source: Clinician s Black Bag of Quality Improvement Tools. Dartmouth Medical School slide # 31 slide # 31 slide # 32 By sharing information and by working in teams to analyze performance using the PDCA cycle you can allow information from your unit to contribute to formulating improvements throughout the organization, avoiding redundancies, and developing greater efficiencies by reducing the unnecessary use of resources. SOURCE: Dlugacz, Yosef D. THE QUALITY HANDBOOK FOR HEALTH CARE ORGANIZATIONS: A MANAGER S GUIDE TO TOOLS AND PROGRAMS slide # 33 slide # 34 Sepsis Task Force guidelines issued (February 2009) Focus on early identification & timely antibiotics in the ED (March 2011) Six Sigma & Lean projects (April 2013) slide # 35 slide # 36 6

7 What is SF-36 v2? Standard, universal tool Measurement of functional health status and well-being 36 questions 8 Health Domains 2 Summary Measures Physical Component Summary (PCS) Mental Component Summary (MCS) Individual item for scoring Health Utility Index Physical Functioning (PF) Role-Physical (RP) Bodily Pain (BP) General Health (GH) Vitality (VT) Social Functioning (SF) Role-Emotional (RE) Mental Health (MH) Program Results Patient Perception SF-36 v2 is used to assess patient s perception of physical and mental well-being Measurements at: Pre-op visit Six week post-op One year post-op slide # 37 slide # (March 2008 May 2014) (March 2008 May 2014) Median Physical Health Component Score SF-36 Pre/Post/Annual Test: Physical Health Component Analysis N = 494 Complete Data Sets (all survey time points) = Better General Health Physical Functioning Bodily Pain Role Physical Physical Component Summary Median Mental Health Component Score SF-36 Pre/Post/Annual Test: Mental Health Component Analysis N = 494 Complete Data Sets (all survey time points) 40 = Better Social Functioning Vitality Role Emotional Mental Health Mental Component Summary Before Surgery Three Months After Surgery One Year After Surgery Before Surgery Three Months After Surgery One Year After Surgery slide # 39 slide # 40 Educating Residents on Quality Patient Care Medical Knowledge Practice Based Learning and Improvement Systems Based Practice Professionalism Interpersonal Skills and Communication E-Learning Quality Management Education Introduction to Quality Management in Healthcare Provides health care professionals with information on data analytics, performance measurement, team building, collaboration, and inculcating a culture of safety into the delivery of care Assists staff with an understanding of the financial implications of P4P, bundled reimbursement, and performance measures Prepares newly appointed members of the governance and leadership positions to more fully engage and function in their roles and responsibilities. Enables leaders to develop strategies to prevent adverse events and mitigate risk to patient safety slide # 41 slide # 42 7

8 E-Learning Quality Management Education Advanced Research Methodology Fundamentals in research methodology Developing a research/performance improvement project Impact of various research designs on validity and reliability Indicator development Healthcare is Changing Accountable Care Organizations Patient Centered Medical Homes Health Homes Medical Neighborhoods Sampling techniques Data collection issues NQF: Patient Reported Outcomes in Performance Measurement - January 2013 slide # 43 slide # 44 slide # 45 slide # 46 What Does Activation Look Like? Patient Activation Measure Patient Activation Measure slide # 47 slide # 48 8

9 Shared Learning and Discovery Institute for Healthcare Improvement Sepsis Collaborative Dartmouth-Hitchcock High Value Healthcare Collaborative (HVHC) Hip & Knee Shared Decision Making Diabetes and Depression Severe Sepsis & Septic Shock Care Bundles Thank You slide # 49 slide # 50 The government has stepped in to encourage hospitals to adopt safer practices through offering financial incentives to hospitals that can document that they have met specific and defined quality measures, such as giving aspirin to heart attack victims or reducing the rate of decubitus ulcers. In the near future, if this trend continues, all reimbursements will be based on performance measures. SOURCE: Dlugacz, Yosef D. VALUE-BASED HEALTH CARE: LINKING FINANCE AND QUALITY slide # 51 9