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HCMN 435 Class notes Chapters 1-4 and 6

by: Tony Phillips

HCMN 435 Class notes Chapters 1-4 and 6 HCMN 435

Marketplace > HCMN 435 > HCMN 435 Class notes Chapters 1 4 and 6
Tony Phillips

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These are my class notes on information that is key from chapters 1-4 and some of the charts and different styles of data organization from chapter 6
Community Health Administration
Dr. Cyrus Engineer
Healthcare quality management
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This 9 page Bundle was uploaded by Tony Phillips on Monday February 29, 2016. The Bundle belongs to HCMN 435 at a university taught by Dr. Cyrus Engineer in Spring 2016. Since its upload, it has received 23 views.

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Date Created: 02/29/16
Healthcare Quality Management Notes Chapter 1 Purchasers in Healthcare- Government, Employers of Large Companies Payers- Health Insurance Companies pay the providers with funds from the patient health plans Providers- Give the patients health services Patients- Receive treatment I.O.M- Institute of Medicine- A think tank of experts in medicine and other health fields to help consult with congress on regulations and rules, bills that should be passed Quality of Care is the degree to which health services increase the likely hoof of desired services STEEEP – The Six Domains of Quality  Safe  Timely  Effective  Efficient  Equitable  Patient Centered Chapter 2 Three Steps to Quality Management  Measurement  Assessment  Improvement Quality Gurus  Walter Shewart  Edward Deming  Joseph Juran Father in Quality of Healthcare  Avedis Donabedian Shewart- Developed the use of statistical process control charts, gave ability to control variability Healthcare Quality Management Notes Juran- Believed quality was based on ineffective management Created the 3 parts to effective quality Management Deming- Responsibility is put on upper management to have the power to change the organization if improvements are needed Systems- The goal is to get the best outputs from the inputs Inputs Conversions Outputs Patient’s Diagnostic Clinical status Personnel Treatment Satisfaction Supplies Operation Culture Equipment Business Cost effective Capital Management Function Internal Quality Control-  Quality Improvement Programs o TCM, CQI, LEAN, SIXSIGMA External Quality Control  Accreditation, Licensure, Registration Licensing- Minimal skill required, minimum standard of competence required Accreditation- Optimal standard of care, this is for industries and business to be accredited, sets high standards for healthcare industries An organization that is trying to exceed and improve fast focuses on Internal control because it focuses on the business solely and tries to understand customer values and what is needed to be improved within the business and management A business that is more satisfied with the current status of their management follow more of an external control system to follow and wait for standards that are set by outside forces Accreditations set standards  Standards- The explicit predetermined expectation set by a competent authority that measures an organization performance  Sources o Professional Societies o Panel of experts o Research Studies Healthcare Quality Management Notes Structural Standards- Input as everything in the hospital that can be touched, smelt, seen, used for patients, etc. Process Standards- Focuses on the different procedures that are preformed for patients Outcome Standards- (Ex. Check-ups and post surgery visits) looking at a patient’s status after their initial visits ensuring that certain health problems have been fixed and the purpose of the activity was achieved Triage Function- When a nurse takes your vitals determining a patient’s level of health and how severs their condition is, needing urgent or non urgent care Vitals- when checking someone’s vitals you are checking their Blood Pressure, Respiration and body temperature External Forces affecting healthcare quality management  State and Federal Regulations  Voluntary accreditation standards  Large purchasers Medicare associated businesses  In order to qualify for reimbursement in healthcare you must be accredited by a licensed organization  If not accredited Medicare will not allow patients to be admitted in hospitals, companies won’t be funded and neither patients or health services will be reimbursed for any expenses Chapter 3 What gets managed gets measured, when you measure you improve. Apgar Score- Infant analysis for health  Heart Rate  Respiratory capacity  Flexibility  Color  Reaction to nerves What is the purpose to measuring performance?  To understand the base line of where the patient or faculty stand on an ability scale and where abilities can be improved and then measured again Healthcare Quality Management Notes Expectations  Explicit set of expectations that are predetermined by a group of competent board members Base-Line  The measurement or starting point of the beginning of the study where it starts at ‘0’  End Line is the outcome at which the study was geared towards Sensitivity- Being able to explain problems to people in a sensitive manor Specificity- Being specific and to the point Accurate- Measure and be precise to the measurement of data Triangulation- Getting more than one piece of data to create a well- informed plan and decision Quantitative Indicators-  Objective and distanced  Very formal survey Rarely sufficient to acquire a complete picture of the interventions Qualitative Data  Tells the real story  Seen closer to the ground  Less formal and focused on groups bottom lines Direct- Measures that are directly related to the problem Indirect- Referred to as the “Proxy Measure” creative ways to obtain information when we cannot measure directly Physical Anthropometry  A process of measuring the thickness of skin to determine malnutrition Structure  A structural standard in healthcare is a measure that reflects input  I.e. Inventory of medical supplies, having an area of the hospital always ready for patients (Doctors to bed ratio) Healthcare Quality Management Notes Process Measure- Measuring the effectiveness of a process and the factors that determine a good or bad process. An effective triage process, the time you wait for assistance in an ER. Are you doing what is supposed to be done in a timely manor to when these deeds need to be done? Outcome Measure- Determines the percentage to visits and procedures that have either good or bad results. Example: Infection rate (The number of infections/ number of patients) Patient Experience- Measures through surveys, a patients personal experience during a visit The most common measure of healthcare is a process measure Outcome = Endpoint of structure and process of care H.C.A.P.S- Also known as the CAHPS Hospital Survey, is a survey instrument and data collection methodology for measuring patients' perceptions of their hospital experience. H.E.D.I.S- Healthcare Effective Data and Information Set is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 81 measures across 5 domains of care. ECG- Electro Cardio Gram  Used to help patients with chest pain to asses heart rate A.H.R.Q- Agency for Healthcare research and quality  The nations lead federal agency for research on healthcare quality, costs, outcomes and patients safety Activity Level Measurement- Measures that are at the local level, overseeing all activity that happens within the hospital concerning patients System Level Measures- Macro-level measures high up in management in the hospital, measures that have to do finances and other parts of the industry that management would be more focused on Determining the frequency of a disease  Incidence- A report of a new case of disease or problem faced in a patient Healthcare Quality Management Notes  Prevalence- The total number of cases in a population How to construct a measure  Identify topic of interest  Develop a measure  Design data collection system Chapter 4 Evaluating Performance Assessment: Judging or evaluating measurement data for the purpose of reaching a conclusion  Question: Are we meeting expected expectations?  Action: Compare performance with expectation How to Display Data  Factors to consider o Type of data obtained o Audience for data o Intended use of data Types of Displays  Snapshot Report o Displays data from a single point in time, what has happened in a single quarter or time period  Types of Snapshot Reports o Pie Chart, Tabular Report, Scatter Plot, Bar Graph  Scatter Plots create and display correlation between two data points o Even if the scatter diagram shows a relationship do not assume one variable causes the other, both variables may be influenced by a third  Histogram- Frequency distribution chart (Bar chart style) o Set up as categories for a distribution of data in a certain way o Used to illustrate how often each different value in a data set o Spread of the process in measured by standard deviation Pareto Chart- Named after Vilfredo Pareto, is a type of chart that contains both bars and a line graph, where individual values are represented in descending order by bars, and the line represents the cumulative total. Pareto Developed the 20:80 Rule  80% of sales come from 20% of the re-occurring customers Healthcare Quality Management Notes  20%- The vital few  80%- The useful many Typically 20% of the issues are responsible for 80% of the problems Radar Chart:  Circular chart that measures performance characteristics or any other measuring characteristics  Typically 6 categories of measurement  Nice to use when looking at someone at a glance or in a summary Trend Reports  Show data from multiple points in time  Captures re occurring trends using multiple snapshot reports No external expectations- Set the performance targets on the basis of  Opinion  Criteria  Performance Benchmark: Setting what is known as the best department or process at a hospital Statistical Process Control (SPC)  Applying statistics in understanding processing performance  Used to identify performance variation  Variation is the first step in understanding what to improve  Helps to understand what causes normal and abnormal radiation Types of tools used to identify types of variation  Control Chart  Line Graph Line Graph- Used to understand if there is a shifting trend in performance, a trend is indicated when 7 consecutive points above/ below the mean showing a certain shift in performance A Control Chart is essential for a bell curve that shows data in a set of +/- 3 standard deviations  Think of a bell curve turned sideways on a graph Healthcare Quality Management Notes Normal or common cause variation occurs within the upper or lower control limits +/- 3 standard deviations The rationale for control limits  Tinker with operations  No need to try and change every little trend or false alarm When do we try to fix a process?  Performance does not meet expectations  When there are signs of special expectations Chapter 6 Tools that you need to improve quality 7 Basic quality tools  Flow Chart  Cause and Effect Diagram  Check Sheet  Histogram  Pareto Chart  Scatter Diagram  Control Charts  Quality tools help to identify and prioritize problems quickly and more effectively  Assist with decision making  Provide a vehicle for communicating problems Stratification  Basis of breaking down a problem to understand the cause  Classification of data in to a couple of layers and each layer is a subset of the population Flow Chart  Purpose is to illustrate the steps in a process  Analyze a process relating one step to the next  Initiate process improvements- non-values added steps  Indicated where in a process to take measurements and collect data Used to identify and document the flow or sequence of events in a process Healthcare Quality Management Notes Fishbone Diagram/ Cause and effect diagram  Purpose is to identify as many possible causes to a problem and sort them into useful categories  When to use a fishbone diagram is to identify possible problems, when a thinking team falls into a rut and needs to illustrate and organize their thoughts Check Sheet  A structure and prepared form is used to collect and analyze data so decisions can be based on facts  When collecting data on the frequency or pattern of events  Data collection and analysis tool  A check sheet can become a bar graph


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