1. Brooklyn College Spring 2003 February 18, 2003 Gene Shagas Student, CIS 763 Quality Management in Health Care

2. Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 2 Dimensions of Quality Quality Management processes address: ä structure (viewed as the capacity to provide high quality care) - roles, communication, expectations ä process (now often termed performance ) - the way we function in the facility ä outcomes : å traditional measures of survival å unintended effects of treatment å relief of symptoms

3. Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 3 Why Are We Measuring Care? We measure care to: ä Assure the public that you know what you are doing and that you are doing it for the right reason ä Meet patient/consumer expectations ä Achieve an internal benchmarking process, for comparison ä Strive to define high quality care ä Implement the same methodology across the complex system

4. ä deals only with case in question ä reaction based ä closed door review ä analysis of specific incident ä review specific facts of specific case ä aggregate incidents/all similar cases ä commonalities/variations ä multidisciplinary analysis ä proactive - not reactive ä focus on process not outcome ä critical thinking for individuals involved No Q A (No Quality Assurance) No Q A (No Quality Assurance) Q M (Quality Management) Q M (Quality Management) ä the problem is too big to handle ä reaction to the media and family complaints ä no analysis ä search for a “scape- goat” ä review of evidence that is based on opinion(s) Q A (Quality Assurance) Q A (Quality Assurance) 4

5. Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 5 Guidelines for Future Quality Management Process Adds Value Health Care Retrospective Review Data Collection Root Cause Analysis Identified Problem Stratification of Patients Preventable Incidents

6. Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 6 Measurements ä Data collection is based on 10% of a random sample. å SPARCS Database å Patient – level Data ä Identification of a disease is often done manually due to lack of medical record coding. ä Data are sent to the Quality Management Department with analysis. ä A report is presented by Practice to the Performance Improvement Coordinating Group and then to the Joint Conference/Professional Affairs Committee.

7. Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 7 Core Measurement sets & Performance Measures ä Acute Myocardial Infarction ä Heart Failure ä Community Acquired Pneumonia ä Pregnancy and Related Conditions

8. Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 8 Current quality indicators for the hospital ER Unscheduled Returns ER X-Ray Reading Discrepancy Falls Insulin Prep and Administration Laparoscopic Cholecystectomy Medication Errors Medication Teaching Multiple Meds Patient Restraints Primary Cesarean Deliveries Repeat Cesarean Deliveries Unplanned Overnight Stays Following Ambulatory Surgery Vaginal Birth After Cesarean Deliveries Vaginal Deliveries

9. åMorse Scale (Risk Assessment) åCompetency åEnvironment Rounds åPatient Education Patient Falls ä Patient Fall Index Outcome 9

10. Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 10 Best Practices - Patient Falls

11. Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 11 The Literature on Measuring Falls Fall Index = X 1000 No. of Patient Falls No. Patient Care Days Injury Rate = X 100 No. of Patient Injuries No. Patient Falls Fall Rate = X 100 No. of Patient Falls No. Patient Bed Days Falls Per Bed = X 100 No. of Patient Falls Per Time Period No. Beds Risk of Falling = Fall Rate 1000

12. Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 12 Sentinel Events: Where Are the Surgeons in All of This? Reference: JCAHO, 2002

13. Observed for Trends System PICG and Medical Advisory Committee System PICG and Medical Advisory Committee Hospital PICG Hospital Medical Board Hospital PICG Hospital Medical Board Algorithm for Determining Reportability of Adverse Patient Event (Sentinel Event) Caused Harm? Standard of Care Met? An Adverse Patient Event Therapeutic Intervention Peer Review Conducted By 2 Hosp. MDs To Determine Deviation from Standard of Care Peer Review Conducted By 2 Hosp. MDs To Determine Deviation from Standard of Care To Be Filed with NYSDOH/ JCAHO (within 45 days) To Be Filed with NYSDOH/ JCAHO (within 45 days) JC/PA Committee Board of Trustees JC/PA Committee Board of Trustees No Yes No If clarification needed in relation to peer review, call System QM.

14. Systemwide Initiatives Intensive Performance Assessments Data elements are linked to outcomes. Data drives recredentialing, competency, re- evaluation and improvement. Directed by goals and priorities set by the administration and medical staffs. STRUCTURESTRUCTURE PROCESSPROCESS OUTCOMESOUTCOMES ASSESSMENTASSESSMENT REPRIORITIZATIONREPRIORITIZATION Framework for Quality Management Based on Donabedian, A. (1980) Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 14

15. Student: Gene Shagas, Project #1, CIS 763, Spring 2003, Brooklyn College 15 Advances in Quality Measurement å Automated ways of reminding physicians and other practitioners about the appropriate use of antibiotics. å The measurement of risk-adjusted mortality. å Measuring errors that occur in organizations. å The development of patient-reported measures of quality. å Quality measurement in integrated delivery systems that include multiple settings of care. å The translation of well-developed clinical practice guidelines into performance measures for use by purchasers and patients.