The Importance of Quality Improvement

Transcription

1 The Importance of Quality Improvement Mary Beth Farrell, MS, CNMT, NCT Disclosure: Director of Accreditation and Research Objectives Here s where our story begins. Review why quality is such a buzz word March 2001 Review why you should care Institute of Medicine s (IOM) Report: Define quality improvement Describe several types and examples 3 Crossing the Quality Chasm: A New Healthcare System for the 21 st Century 4 Established Provide unbiased in 1970 and authoritative Independent, nonprofit organization advice Help government Work outside of make informed the government health decisions by providing Health arm evidence of the upon National which Academy they can of Sciences rely The US health care delivery system does not provide consistent, highquality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge yet there is strong evidence that this frequently is not the case. 1

2 Continuing Continuing again Health care harms patients too frequently and routinely fails to deliver its potential benefits. Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm. A number of factors have combined to create this chasm. Medical science and technology have advanced at an unprecedented rate during the past half century. Ongoing Assessment to Assure Complete, Accurate, High Quality Results Improvements and Innovation And the landslide of change began. Differences in Patient Care Management QA/QI Rationale Improved Accuracy and Detail Enhanced Ability to Identify and Diagnose 9 Equitable Efficient Safe 6 Aims for Improvement Timely Effective Patientcentered A couple of recommendations are now reality Apply evidence to health care delivery It now takes an average of 17 years for new knowledge generated by controlled trials to be incorporated into practice Use information technology e.g. eprescribing, EMR Align payment policies with quality improvement Remove barriers that impede quality improvement and build stronger incentives for quality enhancement PQRS Physician Quality Reporting System, MOC and.. 2

3 Our story continues March Agency for Healthcare Research and Quality (AHRQ) Leads NQS 3 Aims On behalf of the US Department of Health and Human Services NQS established as part of the Affordable Care Act Affordable Care Reduce cost for quality healthcare Healthy People/Healthy Communities Behavioral Social Environmental Better Care Patient centered Reliable Accessible Safe Serves as a catalyst and compass for nationwide focus on quality improvement efforts and approach to measuring quality works with National Quality Forum (NQF) Focus on six priorities: Making care safer by reducing harm caused in the delivery of care. Ensuring that each person and family are engaged as partners in their care. Promoting effective communication and coordination of care. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. Working with communities to promote wide use of best practices to enable healthy living. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models. 17 3

4 Appropriate Use Criteria Patient Satisfaction Radiation Dose Patient Centered Safe Report Accuracy Report Timeliness Equitable Efficient 6 Aims for Improvement Effective Patientcentered Timely I don t have time! Quality Improvement Definition is a formal approach to the analysis of performance and systematic efforts to improve it Key Focus Points 1. Ensuring Patient Safety 2. Improve accuracy and efficiency Focus on the Human Factors! 3. Enhancing the Patient Experience 23 4

5 So How Do You Do QI? Problem Solving Models and Information Analysis Tools 26 PDCA Problem Solving Model Plan-Do-Check-Act cycle: a four-step process for quality improvement Plan Do Plan: A plan for improvement is developed. Do: Experiments and measurements Act Check 27 Check: Evaluate the results 28 Plan-Do-Check-Act (Continued) Act: If the result of the experiment was an increase in quality, it is made standard operating procedure. If quality decreased, the cycle continues until the desired improvement is realized. K.I.S.S

6 How many patients do I have to do? Statistically Significant = (1/ Sample size) *100 = Margin of Error 3 Types of Quality Improvement Administrative Technical Interpretive Administrative Appropriate Use Criteria Patient Satisfaction Timeliness of Reporting Completeness of Documentation Spreadsheet Tools 6

7 Report Turnaround Technical Image Quality Adequacy of Patient Prep Adequacy of Stress Radiation Dose Reduction Therapy Performance Image Quality Image Quality Measures Patient Motion Breast Atten. Diaphragmatic Atten. Superimposed Bowel Hot Liver Low count Gating error Overall Quality 39 Mod Mod Mod Mod Heart is hotter than Liver Or Liver and Heart = intensity Or Liver is hotter than Heart Does the study appear low count? Mottled or pixelated? Y or N Is there flashing? Y or N Poor Fair Good Exc 40 Predictors and Thresholds Patient Motion Breast Atten Diaphragmatic Attenuation Superimposed Bowel Hot Liver Low count Gating error Overall Quality Measure Threshold Moderate pts with mod or severe Moderate pts with mod or severe Moderate pts with mod or severe Moderate pts with mod or severe Heart is hotter than liver, liver and heart are equal in intensity, or Liver is hotter than heart patients with liver hotter than heart Does the study appear low count? (Mottled or pixelated?) Y or N patients with low count study Is there flashing? Y or N studies with flashing Poor Fair Good Excellent studies poor or fair Predicted Threshold 10% 10% 10% 10% 10% 10% 10% 10%

8 Results Examples of Lessons That Can Be Learned From Drilling Down Into Data Pt Motion Breast Atten Diaphrag Atten Bowel Hot Liver Low count Gate error Overall Quality 17% 23% 10% 13% 13% 7% 3% 12% Low count studies Hot livers on rest imaging Extremely hot livers on pharmacologic stress imaging Bone Scan -Bone Uptake -Soft Tissue -Resolution -Hydration -Labeling -Views -Infiltration -Artifact PET Scan Variations on the Theme -NPO -Parenteral nutrition -IV Dextrose -Metformin -Serum Glucose Level - Metal Therapy -Order -MD History -Preg/Breast Feeding -Informed Consent -Patient ID -Written Directive -Dose -Post Tx Instructions -Follow-up Adequacy of Stress -Age -MPHR -Ex Protocol -METs -Exercise Time -Peak HR -Peak BP -Rate- Pressure Product % MPHR Symptoms -NPO 12 Hours -No Caffeine or xanthines -Beta Blockers -Calcium Channel Blockers -Adequately Dressed Patient Prep Interpretive Report Accuracy Interobserver variability Intraobserver variability Correlation QI Meetings Include everyone in the department Discuss the reason for discordant findings Define methods to improve Re-evaluate 48 8

9 Help? 50 But wait one minute! 52 Protecting Access to Medicare Act 2014 Section 218 Quality Incentives for Computed Tomography and Promoting Evidence-Based Care (p64) Consistency with CT Equipment Standards (NEMA) % and 2017 and 53 after 15% 54 9

10 (b) Promoting Evidence-Based Care Appropriate Use Criteria Advance Diagnostic Imaging (MR, CT, NM and PET) Private Office AND Hospital Outpatient Services and Emergency Departments, Ambulatory Surgical and any other determined by secretary (FFS and HOPPS) Details Professional Society AUC AUC selected Nov 2015 Clinical support tools Apr 2016 Ordering MD AUC using tools Jan 2017 Performing MD reports Support tool used Indication adheres to AUC or Not Ordering MD NPI Details (continued) Ordering physicians who are outliers (5%) will have to undergo Prior AuthoriZation! Do You Really Gotta Do QI? References Summary: Crossing the Quality Chasm: A New Health System for the 21 st Century Available at: There a lots of good reason to do QI Important in providing quality care Patients deserve the best care Fat Lady has finished singing 59 10