Sir_Excellence

Unit 5: Week 5 - Chapter 12 Outline

CHAPTER TWELVE: LONG-TERM CARE QUALITY

LEARNING OBJECTIVES

After completing this chapter, the reader will be able to

1.  Understand the concept of quality improvement and how it applies to long-term care,

2.  Identify the similarities and differences between quality assurance and continuous quality improvement,

3.  Discuss and compare outcomes-based measures and process-based measures and the advantages of each,

4.  Discuss the value of a system-wide approach to management of quality,

5.  Identify government and private resources available to assist providers in developing and maintaining quality improvement programs.

 

CHAPTER HIGHLIGHTS

Defining Quality

·         Means different things to different people and different things in different situations.

·         Includes both technical care and the management of the interpersonal exchanges between residents and providers.

·         Includes three generally accepted measurement types: structure, process, and outcomes:

·         Structure – organizational makeup.

·         Process – how care is delivered.

·         Outcomes – results of care.

·         Quality of life refers to the total living experience, which results in overall satisfaction with one’s life.

Total Quality Management/Continuous Quality Improvement

·         Has been used extensively in business and industry for years.

·         An organized quality program based on concept that those delivering the care want to do a good job and know how.

Quality Initiatives – growing emphasis on measuring and improving quality in long-term care.

·         System-Wide Quality Programs – include both government and private programs.

·         Government Programs – have historically consisted mostly of regulating quality, but have recently included quality information initiatives.

History of Government Quality Regulations

·         Quality Assurance – an early method of quality management that identified quality issues and set minimum standards to be met for the issues.

·         Quality Assurance and Performance Improvement (QAPI) program as proscribed by Section 6102(c) of the Affordable Care Act

·         Minimum Data Set (MDS) for Long-Term Care - a means of structuring the assessment of nursing facility residents.

·         OASIS - an assessment tool for home health care, called the Outcomes and Assessment Information Set (OASIS).

·         Quality Improvement Organizations – CMS-contracted organizations that review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care.

·         Pay-for-Performance - involves identifying procedures for which providers will not be reimbursed as CMS identifies them as not necessary or resulting from poor quality.

Public Information Quality Initiatives

·         Nursing Home Compare – designed to identify certain quality measures and to show how individual facilities compared to the preset standard and to each other. The information is available on the CMS website.

·         “Five-Star” Ratings – a rating system based on the quality and safety information on Nursing Home Compare to help beneficiaries, their families, and caregivers compare nursing homes more easily.

Quality-Related Research – government agencies that fund and publish quality research.

·         AHRQ - Agency for Healthcare Research and Quality funds quality-related research.

·         National Library of Medicine - collects materials and provides information and research services in all areas of biomedicine and health care

Private Quality Programs – nongovernment programs focusing on quality in health care.

·         Quality First - a voluntary initiative created by several leading long-term care professional organizations and designed to improve the quality of nursing home care and other long term care services.

· AHCA/NCAL Quality Award: a criteria-based program that recognizes a commitment to performance excellence by member facilities.

·         Advancing Excellence in America’s Nursing Homes - a coalition of 14 national provider organizations that care for 650,000 elderly and disabled patients annually.

·         Alliance for Quality Nursing Home Care - a coalition of 14 national provider organizations that care for 650,000 elderly and disabled patients annually.

·         American Health Quality Association - a charitable, educational, not-for-profit national membership association dedicated to health care quality through community-based independent quality evaluation and improvement programs.

·         National Quality Forum - a private, not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting.

·         Accreditation Organizations – organizations that require a strong emphasis on quality improvement in the provider organizations they accredit.

·         Private Foundations - foundations (e.g., the Robert Wood Johnson Foundation and the Henry. J Kaiser Family foundation) that provide funding for quality-related research and project implementation.

·         College and University Research Institutes - many colleges and universities maintain research institutes or other organizational divisions addressing quality of care.

·         Other Organizations - There are many other organizations, associations, and coalitions working to improve long-term care

Provider-Administered Quality Improvement Programs - programs used by long-term and other health care providers to ensure quality of care within their organizations.

Developing a Quality Improvement Program – includes several important elements, including:

·         Top-Level Support - must have support from the very top levels of administration.

·         Mission Based – should be an integral part of the mission of the organization.

·         Defining the Customers - the organization will need to define who its customers are, those residents or other individuals served by the organization.

·         Measurement – defining and monitoring certain key indicators (e.g., the number of residents with physical restraints, number of medication errors, or infection rates).

·         Evaluation - evaluating how well the organization is doing.

·         Improvement – making changes in procedures based on the information gleaned.

·         Ongoing Measurement and Evaluation – a continuous process.

Quality Teams - quality improvement usually involves teams consisting of staff closely involved with the area being evaluated.

Technology – an increasingly valuable resource in measuring and maintaining quality.

 

LECTURE OUTLINE

A.  Identify learning objectives for the session

B.  Introduce the lecture topic

C.  Defining Quality: Discuss how quality is defined and the implications of that definition to long-term care providers and consumers.

D.  Measuring Quality: Discuss the three primary quality measurement methods:

      1.   Process

      2.   Structure

      3.   Outcome

E.   TQM & CQI. Discuss Total Quality Management and Continuous Quality Improvement and their role in long-term care.

F.   Quality Initiatives: Discuss the difference between internal (provider-administered) and external (system-wide) quality improvement programs differ.

G.  External (System-wide) Quality Improvement Programs. Discuss the nature of government and private quality improvement initiatives.

K.  Government Quality Initiatives. Discuss government efforts, including:

      1.   Regulation of quality

      2.   History of government quality regulations

·         Quality assurance

·         Minimum Data Set (MDS) for long-term care

·         OASIS

·         Quality Improvement Organizations (QIO)

·         Pay-for-performance

      3.   Public information quality initiatives

1.  Nursing Home Compare

2.  “Five Star” ratings

4.   Quality-Related Research

1.  AHRQ

 

2.  National Library of Medicine

 

L.   Private Quality Initiatives. Discuss private efforts, including:

      1.   Quality First

      2.   AHCA/NCAL Quality Award

      3.   Advancing Excellence in America’s Nursing Homes

      4.   Alliance for Quality Nursing Home Care

      5.   AHQA

      6.   NQF

      7.   Accreditation organizations

      8.   Private foundations

      9.   College and university research institutes

      10. Other Organizations

  M. Provider-Administered Quality Improvement Programs. Discuss development and administration of a quality improvement program.

      1.   Top-Level Support

      2.   Mission Based

      3.   Defining the Customers

      4.   Defining the Customers

      5.   Measurement

      6.   Evaluation

      7.   Improvement

      8.   Ongoing Measurement and Evaluation

L.   Quality Teams. Discuss the role of quality teams.

M.  Technology. Discuss the role of technology in a quality improvement program.

N.  Summarize the topic, recapping the key points of the lecture.

 

VOCABULARY TERMS

Advancing Excellence in America’s Nursing Homes – an ongoing, coalition-based campaign concerned with how we care for the elderly, chronically ill, and disabled, as well as those recuperating in a nursing home environment.

American Health Quality Association (AHQA) – a charitable, educational, not-for-profit national membership association dedicated to healthcare quality through community-based, independent quality evaluation and improvement programs.

CARF International - an organization that accredits rehabilitation and human services providers.

Continuous Quality Improvement (CQI) - a form of quality improvement adapted from Total Quality Management (TQM).

Five-Star Quality Rating System - federal system of rating nursing care facilities.

Joint Commission - an organization providing voluntary accreditation for health care providers.

Outcomes measures - quality measures based on the status of the care recipient following care or treatment.

Process measures - quality measures based on how care is delivered.

Quality - the degree to which services achieve desired outcomes.

Quality assurance (QA) - a quality control mechanism mandated by Medicare, based on an institutional committee whose duties include monitoring quality, quantity, and necessity of services provided and recommending changes in policies or procedures.

Quality assurance committee - the Medicare-mandated committee overseeing the QA plan in a long-term care organization.

Quality First - a voluntary 5-year initiative by several leading long-term care professional and trade organizations created to improve the quality of nursing home care and other long term care services.

Quality improvement - system of quality management designed to improve the quality of care provided.

Quality indicators - a pointer or an index showing the level of quality in certain situations.

Quality of life - overall measure of the quality of an individual’s status, including factors such as dignity, comfort, and security.

Quality steering committee oversees the work of other committees and individuals.

Quality teams - groups of individuals given the task of improving specific areas of quality improvement.

Standards - established or agreed-upon acceptable levels of performance.

Structure measures - quality measures focused on the organizational and operational arrangements in place for delivering care.

Total quality management (TQM) was created by Dr. W. Edwards Deming is generally called continuous quality improvement in long-term care.

Utilization Review - process of reviewing all admissions to assure that they are at the appropriate level of care.