performance measures and quality improvement (qi) · 2018. 4. 6. · clinical quality measures •...
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Performance Measures and Quality Improvement (QI)Nicole Foster
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Concept Overview• The practice establishes a culture of data-driven performance improvement on clinical
quality, efficiency and patient experience, and engages staff and patients/families/caregivers in quality improvement activities.
• Competency: 3
• Criteria: 19
• Core: 9
• Elective: 10 (16 credits)
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Clinical Quality Measures• A. Immunization
• B. Other preventative measures• Cancer screening, developmental screening,
ADHD screening, behaviors affecting health, dental appointment
• C. Chronic or acute clinical measures• Heart disease, asthma, diabetes, depression,
cancer, hypertension, Alzheimer’s, autism, COPD
• D. Behavioral health measures• PHQ-9, CAGE, substance abuse
• *Choose 5 measures at least one from each type
QI-01• Monitors
QI-08• Set goals
QI-12• Improve
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Clinical Quality Measures Example
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Clinical Quality Measures Example
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PDSA Example
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PDSA Example
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Resource Stewardship Measures• Measures related to care coordination
• Transitions care, ER follow-up, new diagnosis, high or abnormal labs
• Measures affecting health care cost
• Readmissions to hospital, ER visits, redundant labs and imagining, genetic vs. name brand prescriptions
• *Choose 2 measures, 1 from each type
• MonitorsQI-02
• Set goalsQI-09
• ImproveQI-12
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Resource Stewardship Measures
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PDSA Example
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Appointment Availability • The practice consistently reviews the
availability of major appointment types:• Urgent
• New patient
• Routine
• Follow-up
• Acute
• Assessing the third next available appointment (AC-01 & 02)
• What is your clinic’s policy
QI-03• Assess
QI-10• Set
goals
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PDSA Example
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Patient Experience Feedback• Quantitative Data
• Patient survey, written questionnaire or telephone
• Access (AC-01)
• Communication
• Coordination
• Whole-person care• * At least 3
• Qualitative Data• Focus groups, individual interview, patient
walkthrough, suggestion box (state SHIP evaluators)
QI-04• Survey
QI-11• Set goals
QI-12• Improve
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Patient Experience Feedback Example
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PDSA Example
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Reporting Performance
QI-15
QI-16
QI-18
• QI-15: reports individual clinician or practice numbers with the providers and practice staff
• QI-16: reports individual clinician or practice numbers with the public
• QI-18: reports individual clinician or practice numbers with Medicare or Medicaid agency
• Immunization
• Chronic or acute
• Behavioral health
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Reporting Performance Example
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Reporting Performance Example
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PDSA Example
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Elective Criteria• QI-05: Assesses health disparities using
performance data for a vulnerable population
• QI-06: Uses a standardized validated patient experience tool (CAHPS)
• QI-07: Obtains feedback from experience of vulnerable patient group
• QI-17: Involving patient, family or caregivers in QI activities
• QI-19: Value-based contract agreements
• A: Upside risk agreement (Medicare or Medicaid)
• B: Two-sided risk agreement (MIPS)
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Questions
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Resources• https://www.healthmanagement.com/what-we-do/government-programs-
uninsured/chip/chipra-library/pcmh-toolkit/
• https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool2b.html