Operational Analysis and Quality Improvement assignment

Operational Analysis and Quality Improvement assignment ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Operational Analysis and Quality Improvement assignment Answer must be APA Format with in text citations at least 4 sources 6 pages prefered. Operational Analysis and Quality Improvement assignment Instructions : Write a short (5-6 page) APA style term paper answering the following: Define accreditation Explain the difference between accreditation and licensure Describe the history of accreditation in the United States Outline the current and future challenges with accreditation Operational Analysis and Quality Improvement assignment continuous_quality_improvement_in_health_care_chapter5.pdf continuous_quality_improvement_in_health_care_chapter_18.pdf ha425_ch18.pptx ha425_ch5_1.pptx unit4_assignment.docx Continuous Quality Improvement in Health Care 1 of 17 https://jigsaw.vitalsource.com/api/v0/books/9781449679606/print?from… PRINTED BY: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted. Susan I. DesHarnais “Quality is never an accident. It is always the result of intelligent effort.” —John Ruskin A critical question facing most health care quality improvement efforts is how to evaluate clinical performance. The objectives of this chapter are to: • Present a conceptual framework for measuring the quality of health care • Provide a definition of quality that focuses on the outcomes of care • Present a brief historical overview of outcome measurement in the United States • Examine the data requirements and risk-adjustment techniques for comparing health outcomes across providers and/or over time Quality may be defined in many ways and from many perspectives. Dr. Avedis Donabedian (1980, 1982, 1986) observed that definitions of quality ordinarily reflect the values and goals of the current medical care system, as well as those of the larger society of which it is part. In 1980, Donabedian presented his model for categorizing the different ways that one might measure the quality of health care in a given setting. Operational Analysis and Quality Improvement assignment His model has provided an excellent framework for conceptualizing quality in a broad manner and then classifying the measures that one can use to assess different aspects of the quality of care. Donabedian began by differentiating three aspects of care: • Structure. The resources available to provide adequate health care. Resources include facilities, equipment, and trained personnel. • Process. The activities of giving and receiving care (the patient’s activities in seeking care as well as the practitioner’s activities). • Outcomes. Primarily, changes in the patient’s condition following treatment; outcomes also include patient knowledge and satisfaction. In addition, Donabedian broadened the definition of quality to include not just the technical management of the patient but also the management of interpersonal relationships, as well as access to care and continuity of care. The conceptual framework shown in Table 5–1 allows us to appreciate the complexity of defining and measuring the quality of health care and provides guidance in what aspects of care we might wish to measure. One could then fill in this matrix to apply to a particular setting. For example, in Table 5–2, the matrix is applied to the care provided at a cancer center. This approach is important in that it gives a broad definition to quality of care that goes well beyond simply looking at technical management. 10/15/2016 10:52 AM Continuous Quality Improvement in Health Care 2 of 17 https://jigsaw.vitalsource.com/api/v0/books/9781449679606/print?from… PRINTED BY: [email protected] Printing is for personal, private use only. Operational Analysis and Quality Improvement assignment No part of this book may be reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted. Structure Process Outcome Accessibility Technical management Management of interpersonal relationships Continuity Source: Donabedian, A. 1980. The definition of quality and approaches to its assessment. In Explorations in Quality Assessment and Monitoring (Vol. 1, pp. 95–99). Ann Arbor, MI: Health Administration Press. In 1988, the U.S. Office of Technology Assessment (OTA) defined quality of care as “the degree to which the process of care increases the probability of outcomes desired by the patient, and reduces the probability of undesired outcomes, given the state of medical knowledge.” This is a useful definition because it emphasizes the patient’s role and perspective in choosing among possible treatments. This definition also makes an explicit connection between the processes of treatment that are used and the resulting outcomes, thus demanding that evidence-based medicine be the standard of care. One is therefore forced to focus on evidence of the effectiveness of various treatments from the patient’s point of view. This definition also implies that there are no meaningful or useful measures of quality if there is no effective treatment known for a given condition. Operational Analysis and Quality Improvement assignment Thus, one can use quality measures only for those conditions where the technology is reasonably effective and also acceptable to the patient. Structure Process Outcome Accessibility Waiting time for Hours of operation of mammogram mammogram facility appointment Technical management Certification of nurses in oncology nursing; availability of various pieces of up-to-date radiation equipment 5-year survival rates for stage 1 Systematic use of breast cancer patients ages evidence-based practices 50–70 at the time of diagnosis Management of interpersonal Physicians and nurses trained in cultural competency techniques Involving the patient in treatment decisions Satisfaction with various aspects of accessibility Patient satisfaction with whether they were able to 10/15/2016 10:52 AM Continuous Quality Improvement in Health Care 3 of 17 https://jigsaw.vitalsource.com/api/v0/books/9781449679606/print?from… PRINTED BY: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted. Structure Process participate in treatment decisions relationships Continuity Outcome Presence of a trained nurse navigator Number of contacts per patient with the nurse navigator Patient satisfaction with continuity of care More recently, the Institute of Medicine (IOM) discussed quality of care in a series of reports. To Err Is Human: Building a Safer Health System was released in 2000, and Crossing the Quality Chasm: A New Health System for the 21st Century was released in 2001. Operational Analysis and Quality Improvement assignment These two reports documented the scope of quality and safety problems in the United States and offered an analysis of these problems. These committees stressed that quality health care must be all of the following (IOM, 2001, pp. 5–6): • Safe—avoiding injuries to patients from the care that is intended to help them • Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit • Patient centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions • Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care • Efficient—avoiding waste, including waste of equipment, supplies, ideas, and energy • Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status This definition of quality broadens the earlier definitions of quality to recognize that high-quality care must not only focus on the processes of care (timeliness), patient outcomes (safety and effectiveness), and the patient’s perspective (patient centered), but must also focus on some of the broader requirements of the social and economic system within which health care is provided (efficiency and equity). While recognizing this broader perspective, this chapter will concentrate on the measurement of health outcomes, a difficult enough task in itself.Operational Analysis and Quality Improvement assignment Why might one choose to use outcome measures, when it is much easier to measure or monitor structure or processes of care? Structure measures are relatively simple to use. In many cases, one can simply do an “inventory” of structural measures by using a checklist of those resources that are thought to be necessary to ensure the capacity for providing a given type of care. The Joint Commission (TJC) took this approach in its early days because there was some agreement that certain structural elements were needed as minimal standards to ensure an environment in which good care was possible. However, it should be evident that adequate inputs alone do not ensure good outcomes. All the structural measures can do is indicate whether a facility has the capacity to provide good care. Then why not focus on process measures, which take into account professional performance? It is often easier to measure provider performance than it is to measure patient outcomes. Processes of care are generally documented in patient records, and also in billing or claims data sets, since the procedures that are done usually determine the payment that the professional receives. However, there are several problems with using process measures to look at the quality of care. For a process measure to be valid, there must be good evidence regarding what a professional should do under defined circumstances. This means that a particular process must be strongly linked to better patient outcomes, compared with alternative processes. 10/15/2016 10:52 AM Continuous Quality Improvement in Health Care 4 of 17 https://jigsaw.vitalsource.com/api/v0/books/9781449679606/print?from… PRINTED BY:Operational Analysis and Quality Improvement assignment [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted. While it is sometimes possible to use evidence from clinical trials and published studies, and to translate these studies into treatment guidelines, often this is not possible. Clinical trials are often done on carefully selected people/subjects, and compliance is carefully monitored. Once the treatment goes into general use, it does not work in the same way. The people who actually get the treatment may be older, may have comorbid conditions, and may be noncompliant with various aspects of the treatment protocol. Therefore the evidence from clinical trials may not be generalizable to the population for which the treatment is intended. Because of this problem, it is often necessary for a group (or groups) of experts to translate evidence from clinical trials into treatment guidelines. It is very difficult to develop consensus among relevant professional groups on treatment guidelines and then to develop explicit process criteria that state under what circumstances one should or should not follow the guidelines, due to certain combinations of comorbid conditions, the advanced age of the patient, patient preferences, or other valid reasons. Another difficulty of using process measures is that the provider may do the “right thing in the right way,” but the patient may be dissatisfied, may be noncompliant, or may respond poorly to the treatment. The process, though done correctly, may not always produce the desired outcome. Using a process measure, rather than an outcome measure, to evaluate the quality of care is valid if and only if there is solid evidence that supports doing so. This means that there is strong evidence that there is a very high correlation between “doing the right thing in the right way” and getting good outcomes. This criterion will be met for some conditions, but not for all. For example, if a certain type of treatment is very effective and has few side effects, then the process of doing that treatment can be used as a valid and useful quality measure, rather than trying to monitor the effects of the treatment on patients’ health status. Unfortunately, not many treatments fall into this category. Operational Analysis and Quality Improvement assignment Outcome measures are what we really would like to use, since the whole point of treating the patient is to increase the probability of outcomes desired by the patient and reduce the probability of undesired outcomes, given the state of medical knowledge, according to the OTA definition of quality previously cited. Outcome measures are, in effect, the “gold standard” for measuring the quality of care. However, it is much more difficult to gather and analyze outcome data than it is to measure structure or process. Ideally one would like to have data on each patient’s health status before and after treatment for a large national sample of patients treated for each common condition. Instead, the only information available in most of our databases is information on what procedures were done and, to some extent, what adverse events occurred. Data on patient outcomes are usually missing. There are many reasons why useful health status information is often lacking. In most cases, there is a time delay until one can really assess the effect of a treatment on a patient. One must wait until the patient has recovered from the treatment. It is expensive to try to follow up on patients once they have completed treatment and recovery, and it is difficult to systematically measure the health status of each patient after treatment. Moreover, health status following treatment is often not a direct result of the care provided, since outcomes are not determined solely by professional performance. Other patient-related factors, such as comorbid conditions, patient age, patient compliance, and financial resources, also enter into the equation. Unless one can adequately account for these factors, one cannot validly compare the performance of different providers by looking at patient outcomes. Operational Analysis and Quality Improvement assignment Outcomes attained by a provider treating higher risk patients cannot really be compared with outcomes attained by a provider treating lower risk patients unless one can adequately adjust for the impacts of the risks when comparing the providers. Because of these difficulties in measuring outcomes, we are often forced to measure negative outcomes rather than positive outcomes. Since the purpose of care is to produce the positive outcomes while minimizing the negative outcomes, this is a real problem. Some examples of the type of positive outcomes we would like to measure include 10/15/2016 10:52 AM Continuous Quality Improvement in Health Care 5 of 17 https://jigsaw.vitalsource.com/api/v0/books/9781449679606/print?from… PRINTED BY: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted. the proportion of patients who have the following outcomes: •Operational Analysis and Quality Improvement assignment A better score on a depression scale 3 months after a specific drug treatment • A given level of improvement in range of movement of a joint 1 year following joint replacement • Greater time between hospitalizations for acute episodes for patients with a chronic disease, such as diabetes or alcohol/drug problems • Return to work within 60 days after a given type of heart surgery • A given level of improvement in quality of life after back surgery Instead, we often end up using available data, and thus measuring negative outcomes, such as the proportion of patients who have the following outcomes: • Death during their hospital stay • Unscheduled readmission to the hospital within 30 days of discharge • Complications of surgery during their hospital stay • Preventable adverse events, including medication errors, wrong site surgery, and so on, during their hospital stay While the information on negative outcomes is useful, it is only part of the picture when we are measuring patient outcomes. Instead, we would like to measure quality using data on both positive and negative outcomes of care. What do we do when we find unacceptably high rates of negative outcomes? The general approach is to go back and see what went wrong with the processes of care the patient received. Sometimes a good process has been described, but the health care professionals are not using it. In that case, we need to understand why they are not willing to use the process. More often, we will discover that we may have to redesign the processes to attain better outcomes. As described in Crossing the Quality Chasm: Health care has safety and quality problems because it relies on outmoded systems of work. Poor designs set the workforce up to fail, regardless of how hard they try. If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes. (IOM, 2001, p. 4). Operational Analysis and Quality Improvement assignment Risk adjustment is crucial in accurately evaluating providers. In terms of quality, we want to take into account what health outcomes we could reasonably expect from a provider, given the technology available, the severity of the disease treated, and other risk factors of the provider’s patients. It is therefore essential to risk-adjust outcome variables to allow for valid comparisons of these outcomes across hospitals. In the second half of the 20th century, computers and large databases made it much easier to benchmark and monitor the outcomes of hospital care (see Chapter 12). Also, researchers began to develop more sophisticated techniques for modeling risk factors affecting the outcomes of care. The increased availability of data on the use, cost, and outcomes of medical services also enabled consumers, insurance companies, and regulatory agencies to independently analyze trends in the use and costs of health care services and to draw their own conclusions. In the mid-1980s, the Health Care Financing Administration (HCFA), which is presently known as the Centers for Medicare and Medicaid Services (CMS), began releasing information on hospital mortality rates to the public. Because the methods HCFA used to derive these rates had major flaws, in many cases the findings were invalid. Hospitals needed to defend themselves against such data releases. In some communities, hospitals received negative publicity for 10/15/2016 10:52 AM Continuous Quality Improvement in Health Care 6 of 17 https://jigsaw.vitalsource.com/api/v0/books/9781449679606/print?from… PRINTED BY: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher’s prior permission. Violators will be prosecuted. having high mortality rates when, in fact, their mortality rates were better than what would have been expected, given the severity and complexity of the cases they treated. By the late 1980s, several states began to gather mortality data for various types of cardiac surgery. Operational Analysis and Quality Improvement assignment In 1980, the New York State Department of Health and its Cardiac Advisory Committee began an effort to reduce mortality from coronary artery bypass grafts by collecting clinical data on all patients undergoing that procedure. In 1990, the department made public the data on mortality rates, both crude and risk-adjusted. Surgeon-specific data on mortality were released after a lawsuit by a newspaper. Subsequently, other data releases were made, some of which were likely misleading and superficial (Chassin et al., 1996). Understandably, many surgeons and hospitals had unfavorable reactions to these releases. There were concerns with the accuracy of the data, as well as the methods of risk adjustment. Many of these problems have been resolved, and public releases of high-quality mortality data have become more common. Pennsylvania has had a similar program of reporting hospital performance. In 1986, the Pennsylvania Health Care Cost Containment Council was established by the General Assembly and the state governor to help improve the quality, and restrain the costs, of health care. This council developed a series of “Hospital Performance Reports,” covering 28 different conditions that are reasons for hospitalization. Reports are divided into regions and are hospital-specific. These reports have been made available on the Internet for several years. In addition, various sites on … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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