Healthcare Effectiveness Data and Information

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Healthcare Effectiveness Data and Information

Several organizations play a role in patient safety. AHRQ, whose mission is to produce evidence that helps improve healthcare safety and quality—and make healthcare more acces- sible, equitable, and affordable—is a division of the US Department of Health & Human

Healthcare Effectiveness Data and Information

HIGHLIGHT 12.2 Healthcare Effectiveness Data and Information

Healthcare Effectiveness Data and Information

In 1991, the National Committee for Quality Assurance (NCQA) created the HMO

Healthcare Effectiveness Data and Information

Employer Data and Information Set to help measure the quality of care at healthcare

Healthcare Effectiveness Data and Information

institutions. This data set has undergone four name changes while maintaining the

Healthcare Effectiveness Data and Information

same acronym, HEDIS; the name was changed to Healthcare Effectiveness Data and

Healthcare Effectiveness Data and Information

Information Set in 2007.

Healthcare Effectiveness Data and Information

According to NCQA (2020), 90 percent of health plans use HEDIS to monitor quality

Healthcare Effectiveness Data and Information

of care. HEDIS consists of more than 90 measures across six domains:

 

1. Effectiveness of care

 

2. Access to, or availability of, care

 

3. Experience of care

 

4. Utilization and risk-adjusted utilization

 

5. Descriptive information of health plan

 

6. Measures collected with electronic clinical data systems

 

Healthcare institutions are evaluated on how well they perform on the 90-plus

 

measures. Examples include adult body mass index assessment, childhood weight as-

 

sessment, cancer screening, prenatal and postpartum care, mental health utilization,

 

antibiotic utilization, emergency department (ED) utilization, depression screening, and

 

pneumococcal vaccination for adults (NCQA 2020). NCQA collects the data from health

 

plans, healthcare organizations, and government agencies. It uses these numbers to

 

calculate national benchmarks and to set standards for NCQA accreditation.

 

HEDIS is used by employers and consumers to compare health plans and identify

 

those most appropriate for their needs. Because the measures reported to HEDIS are

 

specific (all organizations report the same measurements), healthcare organizations

 

across the nation can be easily compared.

 

*

 

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Harrison, Jeffrey P.. Essentials of Strategic Planning in Healthcare, Third Edition, Health Administration Press, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=6349384. Created from apus on 2022-03-25 01:06:10.

 

C h a p t e r 1 2 : Q u a l i t y , S a f e t y , P a t i e n t E x p e r i e n c e , a n d V a l u e 2 6 3

 

Services (HHS). The agency also works with HHS and other industry partners to make sure that the evidence is understood and used (AHRQ 2018). AHRQ programs and software are free and publicly available for download on its

website (www.ahrq.gov). It produced the Consumer Assessment of Healthcare Providers and Systems (CAHPS) database that now expands beyond hospitals to nursing homes, dialysis centers, EDs, outpatient clinics, and

hospice programs.

 

AHRQ has also taken a lead in promoting patient safety standards and metrics. Its Patient Safety Network website, or PSNet, has such resources as a patient safety culture assessment, education materials, and toolkits for

practice improvement (PSNet 2020). PSNet also created TeamSTEPPS, an evidence-based set of teamwork tools aimed at optimizing patient outcomes by improving communication and collaborative skills among healthcare

professionals (Baker, Battles, and King 2017).

 

The Joint Commission publishes National Patient Safety Goals that it expects hos- pitals to address when pursuing accreditation (see highlight 12.3). There is even a simpli- fied version without medical jargon for the public. The commission believes in engaging patients in this safety journey also.

 

The American College of Healthcare Executives (ACHE) and the IHI/NPSF Lucian Leape Institute, a think tank dedicated to patient safety, collaborated with prominent healthcare organizations and safety and leadership experts to highlight six priorities that

 

HIGHLIGHT 12.3 The Joint Commission’s 2020 National Patient Safety Goals for Hospitals

 

1. Improve the accuracy of patient identification.

 

2. Improve the effectiveness of communication among caregivers.

 

3. Improve the safety of using medications.

 

4. Reduce the harm associated with clinical alarm systems.

 

5. Reduce the risk of healthcare-associated infections.

 

6. Identify safety risks inherent in the hospital’s patient population.

 

7. Practice the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and

 

Wrong Person Surgery.

 

Source: Adapted from the Joint Commission (2020).

 

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Harrison, Jeffrey P.. Essentials of Strategic Planning in Healthcare, Third Edition, Health Administration Press, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=6349384. Created

from apus on 2022-03-25 01:06:10.

a gr O w i n g de m a n d f O r Qu a L i t y-re L at e d data Demand for quantitative data on healthcare quality continues to grow. Electronic health records (EHRs) have whetted the appetite for even more data. Each organization or

agency that monitors quality has its own set of metrics required of healthcare organizations. In 2020, for example, the “measure madness” of public reporting included countless sets of metrics: 33 for accountable care

organizations, more than 100 for Medicaid’s Delivery System Reform Incentive Payment program, 546 for private health plans, 635 for the National Quality Forum, and 850 for CMS (HANYS 2020). To add to the challenges, current

EHR technology does not meet the needs for timely and efficient data that matters. A healthcare institution needs to use consistent sources with transparent measurement methods if it is to develop a quality- improvement plan.

Hospitals must plan for the resources required to meet these demands.

 

Clinicians often complain that this surging need for data and electronic documenta- tion has taken time away from patients. The American Medical Association estimates that physicians spend up to 50 percent of their time

doing nonclinical work like documentation and coding, and the American Nursing Association has reported even higher percentages (70–75 percent) for nurses (Burroughs 2018). A study of physicians’ compliance with multiple

quality reporting measures estimates that 785 hours of staff time and a total cost of $15.4 billion nationally is spent annually by physician offices to keep track of metrics (Casalino et al. 2016). To minimize the burden on

clinicians, healthcare organizations need to apply a combination of clinical knowledge and technological expertise to maximize the efficiency of the EHR system.

 

Data is the cornerstone of evaluating how current systems are working, whether changes have been effective, and which outcomes are improving. The following questions can be considered in a strategic plan related to data management:

 

➤◆ How can leadership separate what it thought was happening from what is really happening?

 

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Harrison, Jeffrey P.. Essentials of Strategic Planning in Healthcare, Third Edition, Health Administration Press, 2020. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/apus/detail.action?docID=6349384. Created from apus on 2022-03-25 01:06:10.

Healthcare Effectiveness Data and Information

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