NUR 545 PNUR 545 Population Health: Analysis and Evaluation week 8 Assignment
Evaluation of Practice at the Population Level
At the end of the week, the student will be able to:
- Identify a minimum of two healthcare monitoring measures and the sources for the information.
Healthcare goes through constant change to improve patient care and keep costs controlled. Process improvement is a big part of day-to-day operations for many organizations.
Providers, and organizations, are graded on their ability to meet assigned measures from organizations such as CMS, AHRQ, and NCQA.
- Select two of the organizations listed in the chapter and compare-contrast the measures that they monitor.
- Do you have any experience with these measures?
Cupp Curley, A. L. (2020). Population-Based Nursing Concepts and Competencies for Advanced Practice (3rd Ed.). New York, NY: Springer Publishing Co. ISBN: 978-0-8261-3673-2
- Read: Chapter 8, Evaluation of Practice at the Population Level
Improvement of patient care and cost effective measures are results of constant, necessary, changes in healthcare. Evidence-based methods help in attaining techniques used to measure outcomes and important indicators of quality. Deficiencies in key care components could be attributed to the lack of structures, processes, outcomes, or views on health. The Institute for Healthcare Improvement (IHI) implemented the Triple Aim initiative with goals of better health, better experience of care, and lower cost (Nelson & Staggers, 2020). The Triple Aim initiative is important in process improvement, which occurs daily. Organizations, such as Centers for Medicare & Medicaid (CMS), Agency for Healthcare Research and Quality's (AHRQ), and the National Committee for Quality Assurance (NCQA), evaluate providers, and their establishments, on their capability of achieving specific measure.
CMS applies plans to guarantee quality health care for Medicare recipients by means of holding healthcare providers, and their organizations, accountable and through public disclosure. CMS utilizes quality measures comprising of quality improvement, reimbursement for quality reports, and community reporting (CMS, 2020). A prime example of a prevention indicator, utilized by CMS, is body mass indexes in the battle of obesity and other co-morbidities associated, i.e. diabetes. Prevention, screening, and assisting patients with self-care management will help in decreasing the incidence of obesity and problems associated with it. Resulting in a decrease in healthcare costs and improved overall health of patients. In the CMS five-point star system, “clinical quality measures include process indicators collected through administrative means that contribute to a given health plan’s STAR rating” (Nelson & Staggers, 2020, p. 196)
Many organizations have incorporated each other’s forms of measuring quality improvement. For example, the Patient Safety Indicator (PSI) 11 was developed by AHRQ and implemented by CMS and other comparative databases to enhance quality care (Stein & Newell, 2016). Both CMS and NCQA incorporate Healthcare Effectiveness Data and Information Set (HEDIS) as significant measures of quality health plans. Standardized data definitions and codes have allowed for easier comparison of quality measures amongst these organizations.
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NCQA HEDIS framework allows for collection of data from healthcare organizations and healthcare plans. Results and validity are protected by audits performed. There are many measures over 6 domains of care, effectiveness, access/availability, experience, utilization and risk adjusted utilization, health plan descriptive information, and measures collected using electronic clinical data systems (NCQA, 2020).
Being in the medical field for over a decade contributes to my experience with these measures. Contributing improved health to the population of the Western Mass area has been a pleasure. Delivering enhanced patient care as an organization, in order to receive reimbursements for services, has always been a priority. Without patients or consumers, and payments, no matter the type including reimbursement, hospitals and other organizations would not function. Often times, behind the scenes, nurses, administration, etc, have been trying to improve patient care, lower costs of care and enhance the quality of care. Quality improvement is an important part a successful business and evaluation from organizations, such as CMS or NCQA, are necessary to maintain improved quality and patient care.
CMS. (2020). Research, statistics, data & systems. Retrieved April 21, 2020, from https://www.cms.gov/Research-
Cupp Curley, A. L. (2020). Population-Based nursing concepts and competencies for advanced practice (3rd ed.). New York, NY: Springer Publishing Co.
NCQA. (2020). HEDIS measures and technical resources. Retrieved April 21, 2020, from https://www.ncqa.org/hedis/
Stein, R., & Newell, S. (2016). Postoperative respiratory failure’s introduction into the CMS value-based reimbursement model. HIM Briefings, 31(9), 4–7.
