Monitoring Quality Data

Healthcare has evolved over past decades and continues to remain an issue of concern for individuals everywhere. Effectively managing data is important to improving the performance in the health care system. Accumulating, evaluating, deciphering and acting on data for particular performance measures allow health professionals to identify shortcomings and make the necessary adjustment, and track the outcome.

Healthcare is in a constant state of change with movements that impact rates, access and quality of care. Hospitals have become more competitive due to the rising cost of care delivery and the reduction in reimbursement from payers. This causes difficulty in delivering quality care to all patients, which is being measured by mandated patient perception surveys, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS scores are part of value

HIM Personnel play an important role in the Medicare system. Medicare has transitioned from “fee for service” to providing incentive payments for providers that issue high quality care at affordable prices. In order to achieve the “pay-for-quality” incentives hospitals and health care officials must improve their documentation processes. “If it isn’t documented, it wasn’t done” is more important than ever. It is the responsibility of the HIM professional to ensure the integrity of the patient chart. HIM professionals monitor the quality of documentation and ensure all clinical documentation is complete and accurate. HIM professionals are the key to identifying process problems while keeping in mind patient safety, quality of care, and revenue integrity. Medicare requires that hospitals report quality improvement measures in order to receive payments; HIM professionals can directly impact Medicare incentive payments. HIM professionals are directly involved with the Medicare Audit Improvement Act. The HIM professional collects health data that is subject to the audits; HIM professionals are the point of contact for responding to Medicare audit requests.

The surveys are meant to be specific and consistent and are not just used to evaluate the organizations for improvement but are also to educate in the best practice standards adopted throughout health care and to help staff in ways to continually improve an organizations performance. For this purpose, in 1996 the Quality Check website was launched to help the Joint Commission provide information regarding the performance of accredited organizations to consumers and organizations. Users are able to search for accredited or certified organizations; they can locate organizations by either type of service or geographical area and lists of certified organizations as well as a hospital’s performance measures can be obtained.

Quality of service should be one of the most important and well monitored goals for any medical facility, from your small town family doctor’s office, to nursing and rehabilitation facilities, all the way to large hospital systems. The quality of service provided in a facility doesn’t just affect the patients. Quality of service also affects the bottom line, or whether or not the hospital system is profitable. In order to better access the system’s current quality of service and to devise improvement plans I would need to explore issues that have significant effect on quality of care such as, patient satisfaction and retention, medical errors

NAHQ is dedicated to the advancement of healthcare quality and patient safety and the professionals working in the field. “These professionals drive the delivery of vital data for effective decision making in healthcare systems by combining technology with their unique expertise in quality management” (NAHQ, n.d.). Also, at NAHQ, these healthcare quality professionals are provided with resources and tools that expand knowledge and skills in the competency areas that require advance quality. This helps the strategic leaders in achieving regulatory, accreditation and organizational compliance in quality and safety improvement

A quality improvement (QI) project involves data-guided activities with short timelines to improve health care delivery systems (Arndt & Netsch, 2012). The setting of QI projects take place in a single setting and are monitored in the institution where the QI project is conducted. The purpose of a QI project is to change practice outcomes and apply known solutions to a known problem in that institution (Arndt & Netsch, 2012). Data obtained from the activities is disseminated through newsletters, flyers, through staff meetings, or submitted for publication and presented in

In any continuous quality improvement effort, measurement is the key element (Sollecito, & Johnson, 2013). “Measurement and statistical analysis are used to assess the impact of an improvement effort” (Sollecito & Johnson, 2013). To Measure the impact of the program, the hospital utilized a departmental quality improvement assessment with a scoring matrix for self-assessment (McLaughlin, et. al., 2012). The scoring matrix consisted of five category ratings which each department head had to complete. Univer4sal Charting and Resource Utilization were also used for measurement (McLaughlin, et. al., 2012).

The Johns Hopkins Hospital, located in Baltimore, MD, is one of the greatest institutions in modern medicine. Established in 1889 from the donation of philanthropist Johns Hopkins, the hospital and university serve millions of patients annually for emergency, inpatient, and outpatient visits. Patient care is the focus of Johns Hopkins vision. The hospital uses quality care and innovation to enhance patient care. It is the hospital’s goal to have great precision, safety, comfort, coordination, and improved workflow to achieve an outstanding customer experience. An added feature to the customer experience are the design elements that can be found flowing throughout their newest facilities which helps foster healing and stress free environments. From the dramatic art collections that fill the walls and windows of patients rooms, to its 20-year reign as U.S. News and World Report’s “Best Hospital”, Johns Hopkins has made its mark on society. At some point, however, every great dynasty loses its ranks. Unfortunately, Johns Hopkins is no different. With the creation of a federally-mandated patient satisfaction survey for Medicare and Medicaid reimbursement, the stakes for high ratings is of fiscal importance. In an effort to increase its patient satisfaction ratings, the hospital created performance measurements to highlight strengths and areas of improvement with patient outcomes. The implementation of this new initiative, the Patient Toolbox, considers the fundamental reasons

The Computerized Provider Order Entry is effective program to help organization improve quality measures and financial margins. The CPOE is effective program; which monitors a hospitals current performance and calculates methods of improvement. For example, Trinity Hospital a leader in clinical intelligence to track and report across it members hospitals on systems wide quality measures (Balgrosky, 2015). The Clinical Provider Order Entry will help patients compare programs graded by the Center for Medicare & Medicaid and Hospital Quality Assurance. This program will further enhance the patient-centric model because patients will have comprehensive comparison of hospitals to make informed medical decision as to where they would like to receive treatment. The quality measures monitor readmission, complications, patient’s experience surveys and other categories. Patients are interested in receiving health care in top-notched care facilities that address their needs. Consumer needs are very important because translating into referrals by word-of-mouth or rankings. Technology plays a major role in an organization's success with supports Judy Murphy idea of enhancing patient’s health information technology

Quality measures are strategies that gauge, evaluate or compute health care processes, results, discernments, patient insight, and administrative structure. In addition, quality measures are frameworks that are connected with the capacity to deliver first-class health care and/or that are able to identify with one or more quality objectives for medicinal services. These objectives include: compelling, protected, effective, quiet focused, impartial, and opportune consideration. Quality measures can be used to measure quality improvement, public reporting, and pay-for-reporting programs specific for health care providers (CMS.gov, 2016). There are an assortment of quality measures in which health care organizations can use to determine the status of the care they are delivering. Many are appropriate, but few are chosen for this research paper. Among them are: National Health Care Surveys, Hospital IQR Programs, Scorecards, and Political, Power, and Perception/Data for Decision-making tools.

Time and again, hospitals are often called upon to improve the quality of its various health care activities in order to better serve patients and immediate communities. A quality improvement plan thus helps in the selection of high priority areas and the utilization of evidence-based practices in conducting the improvement (Berenguer et al., 2010). In view of the healthcare improvement needs of Sunlight Hospital, this paper seeks to classify and justify five measurements of quality of care in a hospital, specify the four main features in a health care organization that can be used in the design of a quality improvement plan, and suggest the salient reasons quality of care would add value and create a competitive advantage

Examining planning for and effectively measuring the health care quality indicators make healthcare quality more transparent and provide information for quality improvement programs and initiatives in the healthcare system.

Quality is one of the most essential elements of healthcare. As stated by the Agency of Health Research and Quality, “Everyday, millions of Americans receive high-quality health care that helps to maintain or restore their health and ability to function” (Agency of Health Research and Quality, 2014). Improvements have become vital to the success of health care organizations and in the Healthcare Quality Book, it is explained that quality in the U.S. healthcare system is not at the standard that it should be (Ransom, Joshi, Nash & Ransom, 2008). Although this has been a reoccurring issue, attempts to fix the insufficiency have been less successful than expected.

The Utilization Management Program of the Naval Hospital Guam facility is one which is designed to ensure that high quality, cost efficient health care is delivered to all members of the community. The Utilization Management Division is responsible for implementing a Utilization Management Plan which will monitor the appropriate usage of the health care facilities, services and its resources. These services may include utilization reviews, case management, discharge planning and outcome-based evaluations. The Utilization Management Program is completely planned and put into action by this division. It is also responsible for coordinating and monitoring access to care, developing programs, and evaluating