Conduct a search of literature or online resources to find quality measures used in settings other than acute care facilities. Present your findings in a 2-4 page paper (written in APA format) that answers the following questions:

1. What type of quality measures can the organizations evaluate (process or outcomes)?
2. Is aggregate data publicly reported? If so, is there a website or other medium the report is published in?
3. Are these measures required to meet accreditation and/or licensure standards? Specify the requirements
4. Are the measures based on clinical, administrative and other sources, like patient satisfaction, or patient-reported outcomes?
5. Are benchmarking data available through an accrediting body, quality organization or professional association for facilities to compare their quality data?
6. Can the measures be used to evaluate patient safety, reduce risk or monitor healthcare utilization? Explain the aspects of quality the measures are focused on.

This week we will cover some of the more current developments in evaluating healthcare quality. Newer models of healthcare delivery and reimbursement include their own set of quality improvement requirements. Among these newer trends are accountable-care organizations, and population health, which are defined in the module lecture notes. Please read all articles carefully, so you will understand the concepts involved.

The theme of the Written Assignment covers quality improvement requirements in healthcare settings other than acute care, which has been the focus of the course. You can research the CMS website for quality improvement requirements for ambulatory or outpatient care, long-term care and other settings, like ambulatory surgery centers (ASC).

The requirements for the assignment are:

• Describe the types of measures organizations use (e.g. process or outcomes)
• Give the specific measures used
• Are aggregate (summarized) data reported and published?
• Are the measures required for licensure or accreditation?
• Are the measures based on clinical or administrative data?
• Are benchmarking (comparison) data available?
• Can the measures be used to evaluate patient safety, reduce risk or monitor utilization?

For the Discussion Question, you will consider the role of documentation in quality improvement. Clinical documentation improvement is another process that has grown in importance, especially with the implementation of ICD-10. How does this process benefit health care organizations?

Reading

• Article: The Next HIM Frontier: Population Health Information Management Presents a New Opportunity for HIM
  Cassidy, B. (2013). THE NEXT HIM FRONTIER… …population health information management presents a new opportunity for HIM. Journal of AHIMA, 84(8), 40-46.
• Article: Clinical Documentation Improvement: Focus on Quality
  Breuer, S., & Arquilla, V. (2011). Clinical Documentation Improvement: Focus on Quality. Hfm (Healthcare Financial Management), 65(8), 84.
• Article: Quality Measures Present ACOs with Unique Challenges and Opportunities
  Roop, E. S. (2012). Quality Measures Present Challenges & Opportunities. For The Record (Great Valley Publishing Company, Inc.), 24(19), 16.
• Article: How to Measure CDI Effectiveness
  Macios, A. (2011). How to Measure CDI Effectiveness. For The Record (Great Valley Publishing Company, Inc.), 23(9), 14-17.
• Article: CDS Tools and Patient Satisfaction
  Schaefer, J. (2013). CDS Tools and Patient Satisfaction. For The Record (Great Valley Publishing Company, Inc.), 25(6), 6-7.

Despite concerted efforts by health care organizations and individual providers, improving patient outcomes, providing services efficiently, and controlling health care expenditures continue to be major challenges.

Traditional Model

The traditional model of health care delivery in the United States is fee-for-service, where providers are paid for the services they provide, even if they are not the most optimal treatment options or the most cost-effective. Furthermore, the country’s health care system was built around treatment of acute illness and conditions (rather than managing long-term and chronic illnesses) which utilize a major portion of resources and cost the most to treat. In response to those issues, newer health care delivery models have been developed that incorporate efficient management of patient care and reduce costly health complications and hospital admissions.

Accountable Care Organizations (ACOs)

One of the models that are gaining ground is the Accountable Care Organization (ACO). In this model, a group of physicians, hospitals, and other facilities form a partnership to coordinate health care for a patient population. The goal is to provide patients better access to care as early as possible, when treatment is less costly and complications are less likely to develop.

There are number of processes involved in coordinating care and they are expected to result in better patient outcomes, financial incentives, and cost savings to all of the providers involved in the partnership.

Quality Measures for ACOs

Although standardized quality measures for ACOs are not available currently, quality measurement is performed using existing measures such as:

• Physician Quality Reporting System (PQRS)
• Ambulatory care measures from the National Committee for Quality Assurance (NCQA) such as Healthcare Effectiveness Data Information Set (ACO HEDIS)
• As well as measures required by health plans

The Centers for Medicare and Medicaid (CMS) have established a set of quality measures for ACOs that treat Medicare patients. These ACOs must report their performance regarding these quality measures in order to participate in the Shared Savings Program. These measures evaluate the processes involved in coordinating patient care, demonstrate evidence of improved utilization of health care resources, and generate outcomes data that is used to trend the effectiveness of patient care over time.

• Medicare.gov: Accountable Care Organization (ACO) Quality Reporting

Additional Resources

• ACOs: Coordinated Care – A video published by Centers for Medicare and Medicaid (CMS) on YouTube
• Improving the Quality of Care for Medicare Patients: Accountable Care Organizations – A fact sheet published by Centers for Medicare and Medicaid (CMS)

In the 2008 Consensus Statement on Quality in the Public Health System, the U.S. Department of Health and Human Services defined Quality in Public Health as follows:
“Quality in public health is the degree to which policies, programs, services, and research for the population increase desired health outcomes and conditions in which the population can be healthy.“

The public health system in the U.S. has established goals for improving the quality of health for the population. These goals involve using tools and methodologies that have been discussed throughout the course such as evidence-based practices and guidelines, the need for leadership in quality improvement and the use of quality measures (metrics) to evaluate public health.

Population Health Measures

Population health measures include structure, process and outcomes measures, and are based on clinical and non-clinical data. The measures represent information about the status of a population at a given time, the efficiency of processes related to health care delivery and other areas such as costs associated with public health educational efforts. Patient outcomes are analyzed using factors such as age, geographic location or other characteristics to study access to care and the effect of socioeconomic status on access to care. The research performed on population health data often becomes the basis for the creation of healthcare policy and guidelines which can be adapted for providers and organizations at each level of the health care continuum.

Additional Resources

• Public Health Quality – Provides a listing of areas of public health quality efforts.
• AHRQ – Population Health Measures – Provides actual measures used in assessing quality in population health.