NURS 8300 Week 3: Drivers of Quality Management in Healthcare

NURS 8300 Week 3 Discussion: Measures of Quality

Measures of Quality Discussion

Health care quality is a nationally recognized topic that is addressed through public policies, licensure, and accreditation standards for health care professionals and organizations. Throughout history, numerous organizations have been involved in developing health care quality and safety initiatives.

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The Joint Commission and Centers for Medicare and Medicaid Services (CMS) developed quality and safety indicators for various health care systems. These indicators seek to establish accountability for health care organizations through a reporting system, which is available to the public. For this Discussion, explore various accrediting organizations and specific measures that pertain to quality. In your research on accrediting organizations, consider how these quality measures affect quality outcomes, support ethical principles, and influence the delivery of clinical services.

To prepare for Measures of Quality Discussion:

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• Select one specific quality indicator from the Week 2 Discussion and compare it with those outlined in this week’s Learning Resources.
• Review the accrediting body standards that pertain to your organization focusing on those standards that require your organization to define its quality management program.
• Consider regulatory requirements at the state or national level that affect quality outcomes in your organization.
• Ask yourself: How do the Centers for Medicare and Medicaid Services (CMS) restricted reimbursements affect quality management or improvement efforts at my organization? How do these standards and regulations influence or support ethical principles and influence patient care and nursing practice?

By Day 3, post a cohesive scholarly response that addresses the following:

• Choose any measurement and explain the extent to which your chosen measure is affected by CMS driven incentives and disincentives. From a systems perspective, discuss how this measure affects quality outcomes, supports ethical principles, and influences patient care and nursing practice.

Read a selection of your colleagues’ responses.

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By Day 7, respond to two of your colleagues in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence, or research.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
• Validate an idea with your own experience and additional research.
• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

Click on the Reply button below to post your response.

NURS 8300 Week 3 Discussion: Measures of Quality

CMS Incentive Program

The Centers for Medicare and Medicaid Services (CMS) developed a program called Value based purchasing.  This was an incentive program developed to reward hospitals with high quality and compliance rates of approximately 13 indicators.  Readmission rate of patient with congestive heart failure within 30 days of admission was one of the quality indicators and was incentivized if acute care hospitals had found ways to lower and maintain their rates. So for example, hospital looking for incentive reimbursement for 2013 world submit data for the performance period of July 1, 2011, through March 31, 2012. The closer to the top decile (top performing hospitals) the higher the incentive payment (Thompson, 2011).

To accomplish the goal of CMS and thus attaining incentive payments.  Many programs were launched in relation to the quality indicators.  One is the Hospital Admission Reduction Program (to be referred to as “the program”).  The program identified the patients at highest risk for readmission of both COPD and CHF.  Focusing on CHF, patient with suboptimal medication regimes, poor or undeveloped outpatient follow up plans and socioeconomic status all increased chances or readmission within 30 days (Castillo, Edriss, Selvan & Nugent, 2017)…..

NURS 8300 Week 1 Assignment 1: Measuring Quality Guidelines and Grading Rubric

By Day 7 in Week 5

In an 8 to 10 page paper, describe three rate based measurements of quality.

Select three rate based measurements of quality that you will use as the primary basis for this paper.

These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care.  For the purposes of this assignment, an analysis of staffing levels is not permitted.  You can find useful information on quality indicators that are of interest to you on these websites and resources.  You may choose only one of the three measures to be some form of patient satisfaction measure.

Deconstruct each measure to include descriptions of the following:

• The definition of the measure
• The numerical description of how the measurement is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.)
• Explain how the data for this measure are collected
• Describe how the measurement is compared externally to other like settings; differentiate between the actual rate and a percentile ranking.
• Explain whether the measure is risk adjusted or not.  If so, explain briefly how this is accomplished.
• Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace.

Describe the importance of each measure to a chosen clinical organization and setting.

Using these websites and resources you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic or private office; a total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might hone in a particular healthplan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings. Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the instructor for guidance. You do not need actual data from a given organization to complete this assignment.

Relate each measure to patient safety, to the cost of poor quality, and to the overall cost of healthcare.

There is nothing to submit this week. This Assignment is due in Week 5.

NURS 8300 Week 3 Assignment 2: Major Assessment 6

For this Assignment, continue to access IHI.org and complete the relevant modules.

IHI Open School Modules

• PS 102: From Error to Harm
• PS 103 Human Factors and Safety

There is nothing to submit this week.

Please save the certificate you receive upon completion. You will be required to upload this to gradebook in evidence of your completion.

Week in Review

This week you analyzed regulatory requirements at the state or national level that affect quality outcomes and discussed how these and professional nursing standards support ethical principles of patient care and nursing practice. Next week you will closely examine organizational tools used for measuring quality within a micro context: balanced scorecards and dashboards.

NURS 8300 Week 3: Drivers of Quality Management in Healthcare

What would our world look like if there were no licensing requirements, accreditation standards, or regulations governing organizations in various fields? Imagine the effect on society if health care provider organizations did not have to be accredited? Would you go to a physician’s office that did not abide by quality measures? As with any field, health care organizations must adhere to accrediting body standards, regulatory, and licensure requirements to ensure consistency, ethical practice, and quality delivery of clinical services. As a nurse leader, it is essential to be aware of these standards, quality indicators, accreditation and reporting requirements so you may ensure that your organization’s systems and initiatives adhere to appropriate regulatory requirements.

This week, you examine the various accrediting agencies and legal and regulatory requirements that guide quality improvement efforts generally and within your own organization. You also consider how these requirements support ethical principles and influence the delivery of clinical services.

Learning Objectives

By the end of this week, you will be able to:

• Analyze regulatory requirements at the state or national level that affect quality outcomes
• Discuss how professional nursing standards and other quality standards and regulatory requirements support ethical principles of patient care and nursing practice

Photo Credit: [simon2579]/[DigitalVision Vectors]/Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Adminisration Press.

• Chapter 5: “Data Collection”
• Chapter 6: “Statistical Tools for QI”

Park, J., Konetzka, R. T., & Werner, R. M. (2011). Performing well on nursing home report cards: Does it pay off? Health Services Research, 46(2), 531–554. doi:10.1111/j.1475-6773.2010.01197.x

Note: You will access this article from the Walden Library databases.

The study in this article evaluates whether or not nursing homes benefit from improvements in quality measures. Four financial outcomes are measured before and after the improvements are enacted. The study shows that the nursing homes that improved quality measures benefitted financially.

Suchy, K. (2010). A lack of standardization: The basis for the ethical issues surrounding quality and performance reports. Journal of Healthcare Management, 55(4), 241–251.

Note: You will access this article from the Walden Library databases.

Because performance reports are easily found online, this article supports creating ethical guidelines for the performance reports of the health care industry. It compares nearly ten different organizations that provide performance reporting, and then it proposes an ethical framework and principles for public quality reporting.

Wachter, R. M., & Pronovost, P. J. (2009). Balancing “no blame” with accountability in patient safety. New England Journal of Medicine, 361(14), 1401–1406.

Note: You will access this article from the Walden Library databases.

This article addresses the issue of individual accountability in health care organizations. It suggests moving from a culture within health care that does not place blame on individuals to a culture where individuals become more accountable.

Centers for Medicare & Medicaid Services. (n.d.). Quality initiatives: Overview. Retrieved from http://www.cms.gov/QualityInitiativesGenInfo/

Created by the U.S. Department of Health & Human Services, this website overviews quality initiatives that affect the health care industry. It also provides information and downloadable PDFs on the Post Acute Care Reform Plan and Development of Quality Indicators for Impatient Rehabilitation Facilities (IRF).

Measures of Quality Discussion Required Media

Video: Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: External quality improvement. Baltimore: Author.

Note: The approximate length of this media piece is 10 minutes.

The presenters in this video discuss various external organizations involved in quality, and examine the enforcement of standards by governmental agencies versus voluntary organizations. This program also addresses the publication of quality information and why organizations should do their own reporting in addition to mandated reporting. Licensing, credentialing, and certification are discussed as they relate to the social compact that health care providers have for quality and safety.