PPPM460LectureNotesWeek7.pdf PPPM 460
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This 6 page Class Notes was uploaded by Kaitlyn Endo on Friday September 25, 2015. The Class Notes belongs to PPPM 460 at University of Oregon taught by Nicole Ngo in Spring 2015. Since its upload, it has received 32 views.
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Date Created: 09/25/15
PPPM 460 Lectures Notes Week 7 Review What is quality of care 0 Important to increase the likelihood of desired health outcomes 0 Make it more patientfamily centered 0 Like ending of life care9 make it as comfortable as possible not necessarily prolong life 0 Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Types of problems with quality 0 Overuse misuse and underuse Geographic variation in cost and quality 0 Higher cost is not equal to sicker population 0 Higher cost is not equal to higher quality Examples of problems in quality of care On washing hands by Gawande o washing hands after meeting with patients stops spread of most infections 0 13 to 12 as much as they re supposed to 0 gt1 year to get staff to accept 60 alcohol gel I smell irritate skin fertility which is unfounded 0 hand hygiene at 70 by stopping rumors and using better smelling hand sanitizer to raise it to 70 IOM s To err is human report 44000 98000 die in hospitals per year from preventable medical errors 2 older studies 17 billion to 29 billion in hospitals per year medical error considered threat to public health as lethal as breast cancer motor vehicle accidents or AIDS 9 aka it s a huge issue why 0 Errors caused by faulty systems and processes 0 Not typically individuals or bad apples Solution Berwick 9 the quality chasm Quality Chasm Recal Don Berwick from the bell curve 0 Xperiement with more transparent hospital data Background of the quality chasm 0 Problems of patient safety is common9 healthcare quality 0 Overuse underuse misuse o the people work well by and large but the system often does not analogy to escape fire 9 incident where firefighters fighting fire fire got out of control only option was to run over this hill but hill was very steep running up the hill with fire chasing you is really hard Firefighter lit match and set area on fire and stood in ashes and survived almost everyone else died Berwick Escape Fire Berwick s preconditions 0 We need to face reality 0 Drop the current tools drop old assumption I A lot of doctors use traditional methods or assumptions that they shouldn t be Should be using more evidence based knowledge 0 Stay in formation include stakeholders 0 Talk to each other and listen 0 Leadership Berwick s designs 0 Access 0 Science 0 Relationshipsinteractions Berwick the quality chasm 6 aims for improvement in healthcare 0 safety 0 effectiveness avoiding overuse and misuse o patient centeredness o timeliness o efficiency reduce waste and cost 0 equity close racial and ethnic gaps Group Discussion does the healthcare industry really fall short compared to other industries like the automobile industry regarding quality of goods or services offered Why or why not How are they similar or different 0 Services depends on where you go o Transparency 9 cars you have car fax health care it s more hidden and thus can t make informed decisions 0 Human error 9 regulations for other industries that are enforced health care does not 0 Certain industries require use every day so easy to know if something is wrong but healthcare isn t 0 Industry is too similar moneyprofit focused rather than health of patient 0 Both are too standardized 0 Service guarantee in car industry but isn t in health care 0 Car industry has competition health care doesn t really 0 Leverage of doctor versus car salesman Current Policy Approaches for Quality of Care Public Reporting of Quality and Pay for Performance Current policy approaches to improving quality 0 Public reporting of quality 0 pay for performance 0 information technology Public Reporting of Quality 0 How does public reporting of care affect quality of care I Patients choose higher quality hosptials I Hospitals care about their reputation o Leads to more questions I Do consumers i e you and providers use public reports I Does it distort provider s incentives to see patients Disincentive to see unhealthy patients Overutilization eg McAllen TX in The Cost Conundrum Public Reports 0 Rate of unplanned readmission for hear attack patients US national rate of unplanned readmission for heart attack patients 183 0 Medicare hospital spending per beneficiary I A ratio less than the national avg medicare spends LESS per patient for an episode of care initiated at this hospital than it does per hospital patient at the average hospital nationally o How many Americans saw ANY quality information in 2008 30 o How many Americans saw ANY quality info AND used it to make healthcare decisions in 2008 14 0 Only 6 have heard of the new govt website Hospital Compare that lets consumer compare hospitals 0 Exposure to and use 0 comparison quality info by education status I Percent who say they saw quality info on health insurance plans hospitals or doctors in the past year College grad 34 Some college 38 High school or less 24 I Percent who say they saw quality info on health insurance plans hospitals or doctors in the past year and used it to make health care decisions College grad 18 Some college 17 High school or less 11 Do public reports improve quality 0 Studies show that public reports improve overall quality 0 BUT hard to separate improvements from other factors and gaming too soon to tell I Gaming look at unhealthy patients only EX 0 Vonnegut is quality improvement improving quality Costly insurance companies can take away if don t meet sometimes irrational quality metrics high overhead and time commitment Pay for Performance 0 Pay for Performance P4P 0000 Current healthcare payment system reimbursement based on quality of healthcare services FSS Improvement Quality over quanitity using incentives Ex Medicare 0 65 of Medicare beneficiaries use traditional Medicare FFS 0 Medicare fees don t vary based on quality but as you learned various factors eg geography Financial info reputational incentives Medicare fees set by Centers of Medicare and Medicaid services don t vary based on quality No reimbursement under FFS for certain preventive services pre ACA like health counseling etc Change provider s behaviors motivation Already implemented in public sector and private sector Expanding under ACA Flipside of P4P also punish providers Ex medicare won t pay to treat patients who acquire preventable conditions during hospital stay Vonnegut is quality improvement improving quality Quality measures Description Ex Process Performance of activities Apsrin given to heart attack that have been patients demonstrated to contribute to positive health outcomes for patients Outcome Effects that care had on patients If patient s diabetes is under control using lab tests Patient Experience Assess patient s perception of the quality of care they receive and their satisfaction with the care experience How patients perceived the quality of communication with their doctors and nurses Structure Measures relate to the facilities personnel and equipment used in treatment If proviers adopt health info tech What are some drawbacks to P4P What was Vonnegut s argument against P4P o Vonnegut is quality improvement improving quality Costly Insurance companies can take away if don t meet sometimes irrational quality metrics High overhead and time commitment less time spent on patient 0 Footnote Capitation co e g manage care Ex of irrational quality metrics plan for asthma for patients who no longer have asthma Background FFS incentive to use of many services managed care and capitationlump sum payments pre existing conditions ACA expands use of P4P in Medicare Accountable Care orgs Experiments in design gt40 private sector P4P programs Pay for Performance continued 0 Increasingly used worldwide to improve quality of health care 0 Practice Incentives Program Australia PIP Payments and requirements the PIP Asthma Incentive has two compenents the sign on payment and the service incetive payment At minimum the asthma cycle of care must include At least two asthma related consultations within 12 months for a patient with moderate to severe asthma At least one of these consultations to have been planned at a previous consultation Documented diagnosis and assessment of the patient s level of asthma control and severity of asthma Review of the patient s use of and access to asthma related medication and devices Provision to the patient of a written asthma action plan if the patient is unable to use a written asthma action plan then discussion with the patient of other methods of providing an asthma action plan and note the discussion in the patient s medical record General practitioner s experience with PIP Findings Athma GPs report being much less likely to use the asthma PIP o I don t do that one at all It looks too difficult 0 I m not quite as familiar with it GPs feel uncomfortable asking patients to come in for asthma well visits 0 To tell a patient to come back just for management when they are find to me is intrusive 0 They think we are tyring to drum up business and you are busy enough already you don t need to drum up business It s not easy to do It feels wrong 0 What do studies suggest P4P programs are typically associated with moderate positive 5 improvement in health care quality Substantial variation in impact across and within programs Despite international concern that p4p might widen socio economic disparities in health evidence from the UK shows a narrowing disparities Hospital compare compares quality of care at 4000 Medicare hospitals Does Pay for Performance improve quality 0 Again too soon to tell 0 Current studies show mixed results I No difference I Effects short lived 0 Challenges in design I Payments to acute care hospital will change by only 1 0 Cost containment I Measure quality AND cost I Info technology is expensive 0 Safety net providers similar to public reports of quality I Providers for low income patients had lower P4P scores Information Technology IT and quality of care 0 How does IT affect quality of care I Reduce errors I Improve communication I Provide access to information I Requiring info and assisting with calucluations I Decision support I Monitoring I Rapid response and tracking adverse events I Medication safety I Summary of preventive care 0 Barriers and directions for improvements I Financial barriers High fixed costs Need more public investment I Lack of standars No single standard of rep of medical data I Cultural barriers Too new I Few IT widely implemented Seen as commodity instead of as a resource
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