HCI 660 GCU Quality of Health Care Services Discussion

Hi, 

Please reply to the following DQ's with 100-150 words each. Thank you 

Margaret: 

“Electronic clinical quality measures (eCQMs) are tools that help measure and track the quality of health care services that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) provide, as generated by a provider's electronic health record (EHR). Measuring and reporting eCQMs helps to ensure that our health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care. eCQMs measure many aspects of patient care, including: Patient and Family Engagement, Patient Safety, Care Coordination, Population/Public Health, Efficient Use of Healthcare Resources, Clinical Process/Effectiveness” (CMS, 2021). Patient engagement can improve adherence to post-discharge instructions which leads to better treatment outcomes. Reporting on patient safety can expose possible issues with current protocols or medications. Analyzing large scale data can help identify trends in population health, and these at risk populations can be targeted for interventions. Measuring the efficient use of healthcare resources encourages the movement towards value-based healthcare. Reporting on clinical processes helps with workflow improvements and leads to greater efficiency for providers. 

CMS. (2021, April). Electronic Clinical Quality Measures Basics. Centers for Medicare & Medicaid Services. Retrieved October 13, 2021, from https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures. 

Miriam: 

Quality measures are instruments that enable us to assess or quantify healthcare processes, outcomes, patient perceptions, organizational structure, and/or systems that are linked to the ability to offer high-quality health care and/or connect to one or more healthcare quality goals. Effective, safe, efficient, patient-centered, equitable, and timely care are among these objectives (Quality Measures | CMS, 2017).

The five clinical quality measures include controlling blood pressure, hemoglobin AIC, Medication adherence, Statin in use in patients with cardiovascular disease, Mammogram, and colorectal screening. Each quality measure focuses on a different aspect of healthcare, such as processes, patient health outcomes, patient perceptions, and organizational structure and/or systems (Clark,2021).

Outcome- Measures the health status of a patient (or change in health status) resulting from healthcare—desirable or adverse. Example- 30-Day Unplanned Readmissions for Cancer Patients measure is a cancer-specific measure. Medicare beneficiaries have an unplanned readmission within 30 days of discharge from an acute care hospital. For many cancer patients, readmission following hospitalization may be preventable and should be addressed to potentially lower costs and improve patient outcomes

Process-Measures steps that should be followed to provide good care. Note: there should be a scientific basis for believing that the process, when executed well, will increase the probability of achieving the desired health outcome. Example- All patient visits during which a new diagnosis of major depressive disorder MDD or a new diagnosis of recurrent MDD identified for patients aged 18 years and older with a suicide risk assessment should be completed during the visit. suicide risk must be monitored especially for the 90 days following the initial visit and throughout MDD treatment.

Structure- Measures features of a healthcare organization or clinician relevant to its capacity to provide healthcare. For instance- Radiology: Reminder System for Screening Mammograms- The use of patient reminders is associated with an increase in screening mammography. Encouraging the implementation of a reminder system could lead to an increase in mammography screening at appropriate intervals.

Efficiency- Measures the cost of care (inputs to the health system in the form of expenditures and other resources) associated with a specified level of health outcome. Example- Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac Low-Risk Surgery- while it is important to perform a cardiac risk assessment before surgery to identify high-risk patients, an extensive cardiac workup is unnecessary for both low-risk patients and low-risk surgeries. According to research, preoperative cardiac tests should be performed only if their results are likely to influence patient treatment.

While clinical quality reporting has a variety of applications, it is most closely related to EHR Incentive Programs or meaningful use. CMS reimburses qualifying providers, hospitals, and critical access hospitals when they submit reports on the required quality metrics.

Adeyiga:

According to the Centers for Medicare & Medicaid Services (CMS.gov) website, “Clinical quality measures (CQMs) are tools that help measure and track the quality of health care services that eligible professionals, eligible hospitals, and critical access hospitals provide…measuring and reporting CQMs helps to ensure that our health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care,” (2020, para. 1). CQMs can be gathered electronically using EHRs.

There are many different CQMs that are used by CMS. In general, the CQMs cover patient safety, care coordination, patient and family engagement, clinical process/effectiveness, and efficient use of healthcare resources (CMS.gov, 2020). However, different types of healthcare organizations have different CQMs. For an eligible hospital/critical access hospital, five CQMs are: anticoagulation therapy for atrial fibrillation/flutter, antithrombotic therapy by end of hospital day two, discharged on statin medication, ICU Venous Thromboembolism Prophylaxis, and median admit decision time to ED departure time for admitted patients (eCQI Resource Center, 2020).

Anticoagulation therapy for atrial fibrillation/flutter: This measure is for ischemic stroke patients that have atrial fibrillation/flutter (eCQI Resource Center, 2020). It is important for them to be prescribed anticoagulation or continue to take their previously prescribed anticoagulation to prevent a future stroke (eCQI Resource Center, 2020). This includes patients 18 and older, discharged from inpatient care (non-elective admissions) who have a diagnosis of ischemic or hemorrhagic stroke with a stay of 120 days or less (eCQI Resource Center, 2020). These patients also must have a history or new diagnosis of atrial fibrillation/flutter (eCQI Resource Center, 2020). This is classified as a “preventive care” measure because it is attempting to prevent future ischemic strokes and hospital admissions (eCQI Resource Center, 2020

Antithrombotic Therapy by end of hospital day 2: This measure is also for ischemic stroke patients, and it ensures they are administered antithrombotic therapy by the end of hospital day 2 (eCQI Resource Center, 2020). This measures patients 18 and older who are discharged from inpatient care (non-elective) who have a diagnosis of ischemic or hemorrhagic stroke that stay less than 120 days (eCQI Resource Center, 2020). An example of a common antithrombotic medicine used in these cases is Ticagrelor which I give often to my patients in the Neurological ICU (eCQI Resource Center, 2020). This is also considered a “preventive care” measure to try to prevent future stroke (eCQI Resource Center, 2020)

Discharged on statin medication: This measure is for ischemic stroke patients who are previously prescribed or need to continue to take their statin (i.e. atorvastatin) medication at hospital discharge (eCQI Resource Center, 2020). This is for patients 18 and older, discharged from inpatient care non-electively of 120 days or less (eCQI Resource Center, 2020). This is also considered a “preventive” care measure because high cholesterol can lead to another ischemic stroke.

ICU VTE Prophylaxis: This measure assesses the number of patients who have received VTE prophylaxis by the day after admission or transfer to the ICU (eCQI Resource Center, 2020). This includes patients 18 ad older, discharged from inpatient hospital without a diagnosis of VTE or obstetrics with a length of stay of 120 days or less (eCQI Resource Center, 2020). This is considered a preventive care measure because VTE prophylaxis such as sequential compression devices (SCDs) or subcutaneous heparin injections are given to prevent VTE or blood clots that can travel to the lungs and cause a pulmonary embolism (PE) that will lead to a much longer hospital stay

Median admit decision time: This measure is the median time, in minutes, from when the decision to admit a patient is made in the emergency department to the time of departure form the emergency department for admission (eCQI Resource Center, 2020). For this measure, it is very important to document that time the “Decision to admit” was decided (eCQI Resource Center, 2020). This documentation could include: an admission order, a documented bed request, or documented acceptance from admitted physician (eCQI Resource Center, 2020). This measure is considered an “admission and readmissions to hospitals” measure. It is important for hospitals to look at median admit decision times in order for patients to get the care they need as an inpatient in the hospital.