NURS 8300 Week 5: System Management of Populations

NURS 8300 Week 4 Discussion: Quality Metrics for Chronic Disease Management

Discussion: Quality Metrics for Chronic Disease Management

According to the CDC, chronic diseases are the leading cause of death in the United States, with almost 50% of the population suffering from at least one chronic illness. As a result, almost 80% of health care spending is devoted to its management (CDC, 2010). To this end, the National Committee for Quality Assurance (NCQA) developed performance measures. These performance measures allow organizations to compare yearly quality improvement outcomes in the management of chronic diseases. As a nurse engaged in advanced practice, you may find yourself at the forefront of prevention and care management efforts.

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To prepare:

• Review the National Committee for Quality Assurance report, presented in the Learning Resources, and examine current trends and measures associated with at least two chronic diseases. This information will form the basis for this Discussion.
• Review examples of measures that address the management of chronic diseases for an inpatient setting that might not be relevant in an outpatient setting. Be sure to explore the companion metrics that influence a patient’s ability to manage chronic disease.
• Consider how these metrics facilitate change and improve the management of chronic disease.
• Examine the efficiency of current automated trigger systems for managing patient safety. Ask yourself: How do these automated trigger systems help improve quality of health care, patient education, and management of chronic illnesses?

By Day 3 OF Discussion: Quality Metrics for Chronic Disease Management

Post a cohesive scholarly response that addresses the following:

• Compare one quality metric for managing chronic disease that applies to your practice setting to ametric that applies in a different practice setting (i.e. hospital nurse compared to home health nurse).
• Evaluate how these quality metrics facilitate change and improve the management of chronic disease.
• Take a stance on the efficiency of current automated trigger systems to help manage patient safety. Do you believe these to be proactive or reactive responses when educating patients on disease management?

Read a selection of your colleagues’ responses.

By Day 7 OF Discussion: Quality Metrics for Chronic Disease Management

Respond to two of your colleagues in one or more of the following ways:

• Ask a probing question, substantiated with additional background information, evidence, or research.
• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Offer and support an alternative perspective, using readings from the classroom or from your own research in the Walden Library.
• Validate an idea with your own experience and additional research.
• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 5 Discussion Rubric

Post by Day 3 and Respond by Day 7

To participate in this Discussion:

Week 5 Discussion

Discussion: Quality Metrics for Chronic Disease Management SAMPLE APPROACH

Asthma Management across Practice Settings

As the chronic disease burden continues to rise across the lifespan, quality patient care includes improving management of chronic conditions.  Asthma is the most common chronic condition and one of the most common reasons for inpatient admission in children (Ferrante & La Grutta, 2018).  Approaches to asthma management vary across health care settings. Outpatient care providers are tasked with routine assessment of asthma symptoms and lung function, patient education on potential triggers and other factors such as illness that can exacerbate asthma symptoms, and creating an appropriate medication regimen based on the patient’s symptoms, lung function, and the number of asthma exacerbations annually (Fanta, 2017).  While outpatient providers create and manage the patient’s overall asthma care plan, emergency department and inpatient providers provide care to patients in acute distress who may require treatment ranging from inhaled short-acting beta-agonists (SABAs) and supplemental oxygen to intravenous medications and, in rare cases, emergency endotracheal intubation (Scarfone, 2018).

How Quality Metrics Improve Asthma Management

The National Committee for Quality Assurance (NCQA) reports medication compliance rates and asthma medication ratios as their quality measures in the management of asthma (National Committee for Quality Assurance, 2018). Reducing asthma exacerbations is directly related to patients’ compliance with prescribed asthma medication regimens, and patients who have a higher ratio of controller medications to total number of asthma medications combined are more likely to follow their treatment plan, have better disease control, and report a higher quality of life (Broder et al., 2010). Therefore, by working to improve the ratio of controller medications included in patients’ asthma action plan may facilitate increased control of asthma symptoms and reduce the asthma burden on patients and the health care system.

Trigger Systems for Patient Safety

Electronic health records have many features designed to improve patient care quality and safety. One such feature that prompts completion of an asthma-specific assessment tool if the patient had a diagnosis of asthma and the patient’s asthma control had not been assessed in the last 3 months led to an increased number of pediatric patients with up-to-date asthma action plans and prescriptions for controller medicines (Bell et al., 2010). While there have been many discussions on how large numbers of alerts are eventually ignored due to alert fatigue, careful selection of clinical prompts can lead to improved patient care by reminding care providers to complete routine asthma assessments.

References

Bell, L.M., Grundmeier, R., Localio, R., Zorc, J., Fiks, A.G., Zhang, X., Stephens, T.B., Swietlik, M., & Guevara, J.P. (2010). Electronic health record-based decision support to improve asthma care: A cluster-randomized trial. Pediatrics, 125(4), e770-e777.

Broder, M.S., Gutierrez, B., Chang, E., Meddis, D., & Schatz, M. (2010). Ratio of controller to total asthma medications: Determinants of the measure. The American Journal of Managed Care, 16(3), p. 170-178.

Fanta, C.H. (2017). An overview of asthma management. In H. Hollingsworth (Ed.), UpToDate. Retrieved December 24, 2018, from https://www.uptodate.com/contents/an-overview-of-asthma-management

Ferrante, G. & Grutta, S.L. (2018). The burden of pediatric asthma. Frontiers in Pediatrics, 6. https://doi.org/10.3389/fped.2018.00186

National Committee for Quality Assurance. (2018). Medication management for people with asthma and asthma medication ratio (MMA, AMR). Retrieved from: https://www.ncqa.org/hedis/measures/medication-management-for-people-with-asthma-and-asthma-medication-ratio/

Scarfone, R.J. (2018). Acute asthma exacerbations in children: Emergency department management. In E. TePas (Ed.). UpToDate. Retrieved December 24, 2018, from https://www.uptodate.com/contents/acute-asthma-exacerbations-in-children-emergency-department-management?topicRef=547&source=see_link

SAMPLE RESPONSE

S. posted:” The National Committee for Quality Assurance (NCQA) reports medication compliance rates and asthma medication ratios as their quality measures in the management of asthma (National Committee for Quality Assurance, 2018).

Thank you for a very interesting post. I agree with you. The National Committee on Quality Assurance (NCQA) is dedicated to improve health care quality. It was founded in 1990 with the goal to elevate the quality of care of the nation. They implement rigorous reviews through annual reports of health care organizations performance. The seal of the NCQA is a reliable indicator for consumers that they will have high quality service.

According to the National Committee on Quality Assurance, “HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service.” (NCQA, n.d.) HEDIS has a broad range of important health issue data collected like, asthma medication use, the use of beta-blocker treatment after a heart attack, control of high blood pressure, diabetes care, breast cancer screening, management of antidepressant medications, immunization status of children, and their BMI assessment.

One of HEDIS measures that pull my attention is if “the asthmatics are controlling symptoms based on exploring the ratio of controller to reliever medications”, since I live with one asthmatic family member. In 2010, 25.7 million Americans reported to be asthmatic, and 3000 of annual deaths are because of this disease. (NCQA, 2015) The NCQA proposed HEDIS to measure the effectiveness of asthma management in people from five to 65 years old. (NCQA, 2015) In 2007, approximately 56 billion dollars were spent to cover asthma medication, which could be reduced by appropriate medication management.

The quality of assurance for a patient’s health outcome is essential at this era where information is available anywhere, at any time. People like to be informed and ask for more information and opinion to many sources, and the data collected by HEDIS gives them the reliable answer to many of those questions, and the confidence on the quality of care. This not only informs the patient, but also allows the staff to have transparency in their performance.

References:

NCQA. (n.d.) About NCQA. Retrieved from http://www.ncqa.org/AboutNCQA.aspx

NCQA. (n.d.) HEDIS and Quality Compass. Retrieved from http://www.ncqa.org/hedis-quality- measurement/what-is-hedis

NCQA. (2009). National Committee for Quality Assurance 2009 programs and Initiatives Case Statement NCQA. (2015). Proposed Retirement for HEDIS 2016: Use of Appropiate Medications for People with Asthma (ASM) Retrieved from            https://www.ncqa.org/Portals/0/PublicComment/HEDIS2016/11.%20Use%20of%20Appropriate            %20Medications%20for%20People%20with%20Asthma.pdf

NCQA. (2015). Use of Appropriate Medications for People with Asthma and Medication Management for People with Asthma Retrieved from http://www.ncqa.org/report-cards/health-/state-of-health-care-quality/2015-table-of-contents/asthma

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