Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality

Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality Question: This week you read about health care literacy and several articles about health care quality and costs. Please share one specific example from the readings or personal experience (or both) that demonstrates how a patient’s involvement or lack of involvement impacted the quality of care they received. Second, discuss how patient literacy and involvement can improve health care quality. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality NOTE : You must provide quotes, reference and cite at least two of the articles from this module’s articles in your initial response. In addition, you must provide at least one quote, reference and cite at least one of the articles from this module’s articles in each of your follow-up responses. read articles attach and the following links If the link does not work, here is the URL: http://www.commonwealthfund.org/publications/fund-reports/2010/sep/analysis-of-the-payment-and-system-reform-provisions http://www.kaiserhealthnews.org/stories/2012/octob… value_based_purchasing.pdf a_framework_for_institutionalizing_quality_assurance.pdf patient_literacy_and_health_outcomes_article.pdf Value-Based Purchasing and Bundled Payments What hospitals should know about new federal payment and purchasing strategies Research by Lee Ann Jarousse Payment based on quality and service is not a new concept, but it’s finally coming into play in health care. Delivery system reforms included in the Patient Protection and Affordable Care Act provide incentives for health care organizations to improve care coordination and quality and reduce costs—and penalties if they fail to do so. These provisions include pilot projects to test bundled Medicare payments and new value-based purchasing regulations. The goal is to create integrated delivery systems that are more accountable to their communities and to make providers assume greater financial risk. This isn’t the first attempt at Medicare payment reform, but there is a certain level of optimism that it will succeed in developing a more patient-centered and efficient delivery system. “The law is a significant move toward clinical integration,” says Paul Keckley, executive director of the Deloitte Center for Health Solutions. “This is not Capitation 2.0. This is very different.” The difference lies in the Click here for PDF version of Gatefold. link between cost and quality. Hospitals and health networks will have to deliver high-quality care at a lower cost in concert with physicians and the full continuum of care. “When you combine cost and quality, you get organizational commitment,” says Nancy Carragee, R.N., vice president of quality at Daughter’s of Charity Health System, Los Altos Hills, Calif. “It puts the focus on the patient.” Value-based purchasing seems like the logical next step, says Beth Feldpush, senior associate director for policy for the American Hospital Association, noting that many hospitals already report the proposed quality measures to the Centers for Medicare & Medicaid Services on a voluntary basis. “We’ve seen the field improve steadily over time on these measures,” Feldpush says. “It’s important for organizations to stay the course. They already have the groundwork in place.” Through the value-based purchasing program, Medicare will offer incentive payments to hospitals for delivering high-quality care. The incentives will be funded through a 1 percent deduction in the base operating diagnosis-related group payments for hospitals’ discharges. The reductions will increase over subsequent years. Hospitals must meet or exceed a baseline score on a set of predetermined clinical and patient experience measures. Organizations will need to figure out where they stand relative to the metrics to determine the organization’s risk of losing reimbursement. “The biggest risk that a hospital may have is the damage to its reputation,” says George Whetsell, managing director of Huron Consulting Group, Chicago. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality “The information will be out there and poor performance will lead to both financial and image consequences.” Another aspect of payment reform—bundled payments—presents more of a challenge. “Many organizations are well-positioned to manage under value-based purchasing types of arrangements, but they are not ready for shared-savings arrangements,” says Chad Mulvany, technical director for the Healthcare Financial Management Association. That’s due, in part, to limited data on how to design and administer bundled-payment arrangements. Through demonstration projects, CMS plans to test the use of bundled payments to enhance health care quality and efficiency. “If successful, bundled payments will provide benefits to all parties involved in the care delivery process: the payer, the patient, the hospital and the physician,” says Steve Landgarten, M.D., chief medical officer of Hillcrest Medical Center, Tulsa, Okla. Hillcrest is serving as a pilot site for the Medicare Acute Care Episode Demonstration project for orthopedic and cardiovascular surgery. “We believe we can achieve equal or better-quality care at a better cost,” Landgarten says. This gatefold examines value-based purchasing and bundled payments and the potential implications for hospitals. Why Value-Based Purchasing? CMS has big intensions for value-based purchasing with the ultimate goal being the delivery of patient-centered, high-quality, efficient care. Value-based purchasing would incentivize providers to deliver high-quality care at a lower cost. 1 | Financial viability: The financial viability of the traditional Medicare fee-for-services program is protected for beneficiaries and taxpayers. 2 | Payment incentives: Medicare payments are linked to the value (quality and efficiency) of care provided. 3 | Joint accountability: Physicians and providers have joint clinical and financial accountability for health care in their communities. 4 | Effectiveness: Care is evidence-based and outcomes-driven to manage diseases better and prevent complications from them. 5 | Ensuring access: A restructured Medicare fee-for-service payment system provides equal access to high-quality, affordable care. 6 | Safety and transparency: A value-based purchasing-payment system gives beneficiaries information on the quality, cost and safety of their health care. 7 | Smooth transitions: Payment systems support well-coordinated care across different providers and settings. 8 | Electronic health records: Value-driven health care supports the use of information technology to give providers the ability to deliver high-quality, efficient, well-coordinated care. Source: The Centers for Medicare & Medicaid Services’ Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-for-Service Program, 2009 Key Steps to Succeed Under Value-Based Purchasing 1 | Develop effective quality, utilization, risk and infection management programs. 2 | Implement reliable performance-improvement tools and measures. 3 | Ensure consistent use of best-practice clinical guidelines and pathways. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality Implement effective admission, discharge and transfer protocols. 4 | Enhance ability to improve performance in reducing hospital-acquired conditions, complications, mortality, readmissions and other key performance measures. 5 | Build solid clinical alignment in every aspect of the clinical-improvement process. Source: Huron Healthcare Group, 2011 Key Steps to Succeed Under Bundled Payments* 1 | Construct a framework before beginning. The framework should include quality-improvement initiatives, cost-accounting systems and a robust data warehouse. 2 | Renegotiate contracts with supply vendors. Getting more patient volume isn’t as important as getting market share with supply vendors. 3 | Bring physicians on board early in the process to drive cost-cutting measures, quality metrics and negotiations with suppliers. 4 | Understand that the monetary incentive does not drive patients to the hospital. 5 | Hire a full-time case manager to track all patients in the program from admission to discharge. *Lessons learned from Hillcrest Medical Center, Tulsa, Okla., during the CMS Acute Care Episode Demonstration. Source: Health Research & Educational Trust, Early Learnings from the Bundled Payment Acute Care Episode Demonstration Project, 2011. 25 Value Measures CMS proposed 25 measures for the FY 2013 value-based purchasing program. Seventeen measures are associated with clinical quality and eight are associated with patient experience based on Hospital Consumer Assessment of Healthcare Providers and Systems Survey scores. Additional measures will be added in future years. Process of Care Measures Acute Myocardial Infarction 1. Aspirin prescribed at discharge 2. Fibrinolytic therapy received within 30 minutes of arrival at hospital 3. Primary percutaneous coronary intervention received within 90 minutes of arrival at hospital Heart Failure 4. Discharge instructions 5. Evaluation of left ventricular systolic function 6. ACE inhibitor or ARB for left ventricular systolic function Pneumonia 7. Pneumococcal vaccination 8. Blood cultures performed in the emergency department prior to initial antibiotic received in hospital 9. Initial antibiotic selection for community-associated pneumonia in immunocompetent patient 10. Influenza vaccination Health Care-Associated Infections 11. Prophylactic antibiotic received within one hour prior to surgical incision 12. Prophylactic antibiotic selection for surgical patients 13. Prophylactic antibiotics discontinued within 24 hours after surgery end time 14. Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose Surgeries 15. Surgery patients on a beta blocker prior to arrival who received a beta blocker during the perioperative period 16. Surgery patients with recommended venous thromboembolism prophylaxis ordered 17. Surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery HCAHPS 18. Communication with nurses 19. Communication with doctors 20. Responsiveness of hospital staff 21. Pain management 22. Communication about medicines 23. Cleanliness and quietness of hospital environment 24. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality Discharge information 25. Overall rating of hospital Source: The Federal Register/Vol. 76, No. 9. January 13, 2011 Performance and Payment Reduction Timeline The initial FY 2013 payment for the CMS value-based purchasing initiative will be based on performance from July 1, 2011, to March 31, 2012. The performance will be compared with a baseline established between July 1, 2009, and March 31, 2009. The program will provide hospitals with incentive payments for delivering high-quality care. The incentive payments will be paid for through the reduction in base operating diagnostic-related group payments. Future payments may be based on a 12-month reporting period; 2014 mortality measures may be based on an 18-month reporting period. Incentive payments will be based on a hospital’s performance on each measurement, using the higher of an achievement score or an improvement score. The achievement score will be based on points earned by a hospital along an achievement range, a scale between the achievement threshold (the minimum level of hospital performance required and the benchmark, a mean of the top 10 percent of hospital performance). The improvement score will be based on an improvement range (a scale between the hospital’s prior score on the measure during the baseline period and the benchmark). This article first appeared in the May 2011 issue of H&HN magazine. This information found at: http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/05MAY2 011/0511HHN_FEA_gatefold&domain=HHNMAG accessed on November 2, 2011 International Journal for Quality in Health Care 2002; Volume 14, Supplement 1: 67–73 A framework for institutionalizing quality assurance DIANA R. SILIMPERI1, LYNNE MILLER FRANCO1, TISNA VELDHUYZEN VAN ZANTEN1 AND CATHERINE MACAULAY2 1 Quality Assurance Project, University Research Co., LLC, Bethesda, MD, 2Martha Elliot Health Center, Boston, MA, USA Abstract Objective. To develop a framework to support the institutionalization of quality assurance (QA). Design. The framework for institutionalizing QA consists of a model of eight essential elements and a ‘roadmap’ for the process of institutionalization. The essential elements are the building blocks required for implementing and sustaining QA activities. Core QA activities include defining, measuring and improving quality. The essential elements are grouped under three categories: the internal enabling environment (internal to the organization or system), organizing for quality, and support functions. The enabling environment contains the essential elements of leadership, policy, core values, and resources. Organizing for quality includes the structure for implementing QA. Three essential elements are primarily support functions: capacity building, communication and information, and rewarding quality. The model can be applied at the level of an organization or a system. The paper also describes the process of institutionalizing QA, starting from a state of preawareness, passing through four phases (awareness, experiential, expansion, and consolidation), and culminating in a state of maturity. The process is not linear; an organization may regress, vacillate between phases, or even remain stagnant. Some phases (e.g. awareness and experiential) may occur simultaneously. Conclusion. The framework has been introduced in nearly a dozen countries in Latin America and Africa. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality The conceptual model has been used to support strategic planning and directing Ministry of Health work plans, and also as a resource for determining the elements necessary to strengthen and sustain QA. The next step will be the development and evaluation of an assessment tool to monitor developmental progress in the institutionalization of QA. Keywords: framework for quality assurance, institutionalization framework, leadership for quality, organizing for quality, quality assurance, sustainability of quality assurance During the last decade, quality of health care has received increasing political and public health attention, fueled in part by growing local autonomy and democratization, decentralization of health systems, and health sector reform. Worldwide, significant efforts are underway to improve the quality of health care being offered to people, and quality assurance (QA) activities are critical to these efforts. However, experience has often shown that the key question is not so much a technical one—how to ‘do’ QA activities—but rather, how to establish and maintain QA as an integral, sustainable part of a health system or organization. Ministries of Health want to know in which components they should invest scarce resources in order to maintain implementation of effective QA interventions throughout their delivery systems. Health organization leaders ask about the process, or the phases they must pass en route to incorporating QA into their structures, and developing organizational cultures that support and sustain QA in their health facilities. The Institutionalization Framework presented in this paper was developed to provide practical information to health organizations (and systems) in their quest for sustainable quality. As such it is both a conceptual model and an operational tool, a roadmap to help organizations produce and sustain quality health care. The framework The framework represents a synthesis of more than 10 years of experience assisting developing country health systems to design and implement QA. It is derived from a combination of the organizational development and quality management literature [1–12], as well as retrospective analysis of QA Address reprint requests to D. Silimperi, Quality Assurance Project, University Research Co., LLC/Center for Human Services, 7200 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA. E-mail: [email protected] C. MacAulay was formerly with the Quality Assurance Project, University Research Co., LLC, Betheseda, MD, USA. Published by Oxford University Press 67 D. R. Silimperi et al. Figure 1 The QA triangle. Note that this QA triangle is contained within the institutionalization model shown in Figure 2. Reproduced with permission from QAP. Project experience implementing QA activities and building QA programs in developing country health systems [13–17, and personal communication with QA Project staff ]. It is this combination of conceptual model and operational process (roadmap) that makes the framework more notable, as well as its basis in developing country health systems. Furthermore, in delineating the process of institutionalizing QA, the framework introduces the possibility of ongoing assessment of developmental stages of quality systems in health care at organizational or macro system levels. The framework depicts the components (which we call essential elements) necessary for the institutionalization of QA within an organization and provides practical information on how to facilitate the process necessary to reach this goal. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality The framework can be applied at any organizational level—from individual health care facilities to national level health systems—and has been developed especially for those involved in the design or improvement of quality of care, or wish to be champions for the introduction of QA into their organization. Figure 2 The QA institutionalization model. QD, defining quality; QI, improving quality; QM, measuring quality. See also Figure 1. Reproduced with permission from QAP. Defining quality means developing expectations or standards of quality, as well as designing systems for quality. Standards can be developed for inputs, processes, or outcomes, and they may be clinical or administrative [18]. Measuring quality consists of quantifying the current level of performance or compliance with expected standards, including patient satisfaction [19,20]. This involves definition of indicators, the development/adaptation of information systems, and the analysis and interpretation of results. Improving quality [21] refers to the application of quality improvement methods and tools to close the gap between current and expected levels of quality by understanding and addressing system deficiencies (as well as enhancing strengths) in order to improve, or in some cases re-design health care processes. A variety of quality improvement approaches exist, from individual problem solving to redesign of systems/ processes to organizational restructuring/re-engineering. Core QA activities Essential elements for institutionalizing quality The QA Project approach to improving health services and individual performance encompasses three core quality assurance activities (Figure 1): defining quality, measuring quality, and improving quality (when referring to these core QA activities on the QA triangle graphic on Figure 1, we reversed the letters to emphasize the activity’s contribution to quality, e.g. QD for defining quality, QM for measuring quality, and QI for improving quality). These three sets of activities work synergistically to ensure quality care as an outcome of the system, and together encompass the range of mutually supportive QA methodologies and techniques. No core activity is sufficient on its own to improve and maintain quality; it is the interaction and synergy of all three that facilitate sustainable improvements. Each core activity encompasses a group of interrelated activities, as briefly described below. The core QA activities, represented by the QA triangle (Figure 1), are the heart of any effort to institutionalize quality care. It is the continuous and synergistic application of these activities that will ensure high quality health care over time. The institutionalization model (Figure 2) contains the QA triangle at its center and depicts eight essential elements or building blocks necessary to support and ensure sustainable implementation of these core QA activities over time. The model’s elements are similar to focal areas noted in other quality audit frameworks [6,11]. These eight essential elements can be grouped within three categories: the internal enabling environment, internal to the organization or system (comprised of leadership, policy, core values, and resources), organizing for quality (structure), and support functions (capacity building, communication and information, and rewarding quality) as listed in Figure 3. 68 QA institutionalization framework national policy set to develop a QA program to achieve quality health care. The policy allocated appropriate resources to drive the QA Initiative and support QA activities. The results from the QA activities set the stage for incorporating quality into the strategic goals of the national health system [14,16]. Organizing for quality Figure 3 The categories and essential elements for the institutionalization of QA. Enabling environment Continuous ap … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality Question: This week you read about health care literacy and several articles about health care quality and costs. Please share one specific example from the readings or personal experience (or both) that demonstrates how a patient’s involvement or lack of involvement impacted the quality of care they received. Second, discuss how patient literacy and involvement can improve health care quality. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality NOTE : You must provide quotes, reference and cite at least two of the articles from this module’s articles in your initial response. In addition, you must provide at least one quote, reference and cite at least one of the articles from this module’s articles in each of your follow-up responses. read articles attach and the following links If the link does not work, here is the URL: http://www.commonwealthfund.org/publications/fund-reports/2010/sep/analysis-of-the-payment-and-system-reform-provisions http://www.kaiserhealthnews.org/stories/2012/octob… value_based_purchasing.pdf a_framework_for_institutionalizing_quality_assurance.pdf patient_literacy_and_health_outcomes_article.pdf Value-Based Purchasing and Bundled Payments What hospitals should know about new federal payment and purchasing strategies Research by Lee Ann Jarousse Payment based on quality and service is not a new concept, but it’s finally coming into play in health care. Delivery system reforms included in the Patient Protection and Affordable Care Act provide incentives for health care organizations to improve care coordination and quality and reduce costs—and penalties if they fail to do so. These provisions include pilot projects to test bundled Medicare payments and new value-based purchasing regulations. The goal is to create integrated delivery systems that are more accountable to their communities and to make providers assume greater financial risk. This isn’t the first attempt at Medicare payment reform, but there is a certain level of optimism that it will succeed in developing a more patient-centered and efficient delivery system. “The law is a significant move toward clinical integration,” says Paul Keckley, executive director of the Deloitte Center for Health Solutions. “This is not Capitation 2.0. This is very different.” The difference lies in the Click here for PDF version of Gatefold. link between cost and quality. Hospitals and health networks will have to deliver high-quality care at a lower cost in concert with physicians and the full continuum of care. “When you combine cost and quality, you get organizational commitment,” says Nancy Carragee, R.N., vice president of quality at Daughter’s of Charity Health System, Los Altos Hills, Calif. “It puts the focus on the patient.” Value-based purchasing seems like the logical next step, says Beth Feldpush, senior associate director for policy for the American Hospital Association, noting that many hospitals already report the proposed quality measures to the Centers for Medicare & Medicaid Services on a voluntary basis. “We’ve seen the field improve steadily over time on these measures,” Feldpush says. “It’s important for organizations to stay the course. They already have the groundwork in place.” Through the value-based purchasing program, Medicare will offer incentive payments to hospitals for delivering high-quality care. The incentives will be funded through a 1 percent deduction in the base operating diagnosis-related group payments for hospitals’ discharges. The reductions will increase over subsequent years. Hospitals must meet or exceed a baseline score on a set of predetermined clinical and patient experience measures. Organizations will need to figure out where they stand relative to the metrics to determine the organization’s risk of losing reimbursement. “The biggest risk that a hospital may have is the damage to its reputation,” says George Whetsell, managing director of Huron Consulting Group, Chicago. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality “The information will be out there and poor performance will lead to both financial and image consequences.” Another aspect of payment reform—bundled payments—presents more of a challenge. “Many organizations are well-positioned to manage under value-based purchasing types of arrangements, but they are not ready for shared-savings arrangements,” says Chad Mulvany, technical director for the Healthcare Financial Management Association. That’s due, in part, to limited data on how to design and administer bundled-payment arrangements. Through demonstration projects, CMS plans to test the use of bundled payments to enhance health care quality and efficiency. “If successful, bundled payments will provide benefits to all parties involved in the care delivery process: the payer, the patient, the hospital and the physician,” says Steve Landgarten, M.D., chief medical officer of Hillcrest Medical Center, Tulsa, Okla. Hillcrest is serving as a pilot site for the Medicare Acute Care Episode Demonstration project for orthopedic and cardiovascular surgery. “We believe we can achieve equal or better-quality care at a better cost,” Landgarten says. This gatefold examines value-based purchasing and bundled payments and the potential implications for hospitals. Why Value-Based Purchasing? CMS has big intensions for value-based purchasing with the ultimate goal being the delivery of patient-centered, high-quality, efficient care. Value-based purchasing would incentivize providers to deliver high-quality care at a lower cost. 1 | Financial viability: The financial viability of the traditional Medicare fee-for-services program is protected for beneficiaries and taxpayers. 2 | Payment incentives: Medicare payments are linked to the value (quality and efficiency) of care provided. 3 | Joint accountability: Physicians and providers have joint clinical and financial accountability for health care in their communities. 4 | Effectiveness: Care is evidence-based and outcomes-driven to manage diseases better and prevent complications from them. 5 | Ensuring access: A restructured Medicare fee-for-service payment system provides equal access to high-quality, affordable care. 6 | Safety and transparency: A value-based purchasing-payment system gives beneficiaries information on the quality, cost and safety of their health care. 7 | Smooth transitions: Payment systems support well-coordinated care across different providers and settings. 8 | Electronic health records: Value-driven health care supports the use of information technology to give providers the ability to deliver high-quality, efficient, well-coordinated care. Source: The Centers for Medicare & Medicaid Services’ Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-for-Service Program, 2009 Key Steps to Succeed Under Value-Based Purchasing 1 | Develop effective quality, utilization, risk and infection management programs. 2 | Implement reliable performance-improvement tools and measures. 3 | Ensure consistent use of best-practice clinical guidelines and pathways. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality Implement effective admission, discharge and transfer protocols. 4 | Enhance ability to improve performance in reducing hospital-acquired conditions, complications, mortality, readmissions and other key performance measures. 5 | Build solid clinical alignment in every aspect of the clinical-improvement process. Source: Huron Healthcare Group, 2011 Key Steps to Succeed Under Bundled Payments* 1 | Construct a framework before beginning. The framework should include quality-improvement initiatives, cost-accounting systems and a robust data warehouse. 2 | Renegotiate contracts with supply vendors. Getting more patient volume isn’t as important as getting market share with supply vendors. 3 | Bring physicians on board early in the process to drive cost-cutting measures, quality metrics and negotiations with suppliers. 4 | Understand that the monetary incentive does not drive patients to the hospital. 5 | Hire a full-time case manager to track all patients in the program from admission to discharge. *Lessons learned from Hillcrest Medical Center, Tulsa, Okla., during the CMS Acute Care Episode Demonstration. Source: Health Research & Educational Trust, Early Learnings from the Bundled Payment Acute Care Episode Demonstration Project, 2011. 25 Value Measures CMS proposed 25 measures for the FY 2013 value-based purchasing program. Seventeen measures are associated with clinical quality and eight are associated with patient experience based on Hospital Consumer Assessment of Healthcare Providers and Systems Survey scores. Additional measures will be added in future years. Process of Care Measures Acute Myocardial Infarction 1. Aspirin prescribed at discharge 2. Fibrinolytic therapy received within 30 minutes of arrival at hospital 3. Primary percutaneous coronary intervention received within 90 minutes of arrival at hospital Heart Failure 4. Discharge instructions 5. Evaluation of left ventricular systolic function 6. ACE inhibitor or ARB for left ventricular systolic function Pneumonia 7. Pneumococcal vaccination 8. Blood cultures performed in the emergency department prior to initial antibiotic received in hospital 9. Initial antibiotic selection for community-associated pneumonia in immunocompetent patient 10. Influenza vaccination Health Care-Associated Infections 11. Prophylactic antibiotic received within one hour prior to surgical incision 12. Prophylactic antibiotic selection for surgical patients 13. Prophylactic antibiotics discontinued within 24 hours after surgery end time 14. Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose Surgeries 15. Surgery patients on a beta blocker prior to arrival who received a beta blocker during the perioperative period 16. Surgery patients with recommended venous thromboembolism prophylaxis ordered 17. Surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery HCAHPS 18. Communication with nurses 19. Communication with doctors 20. Responsiveness of hospital staff 21. Pain management 22. Communication about medicines 23. Cleanliness and quietness of hospital environment 24. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality Discharge information 25. Overall rating of hospital Source: The Federal Register/Vol. 76, No. 9. January 13, 2011 Performance and Payment Reduction Timeline The initial FY 2013 payment for the CMS value-based purchasing initiative will be based on performance from July 1, 2011, to March 31, 2012. The performance will be compared with a baseline established between July 1, 2009, and March 31, 2009. The program will provide hospitals with incentive payments for delivering high-quality care. The incentive payments will be paid for through the reduction in base operating diagnostic-related group payments. Future payments may be based on a 12-month reporting period; 2014 mortality measures may be based on an 18-month reporting period. Incentive payments will be based on a hospital’s performance on each measurement, using the higher of an achievement score or an improvement score. The achievement score will be based on points earned by a hospital along an achievement range, a scale between the achievement threshold (the minimum level of hospital performance required and the benchmark, a mean of the top 10 percent of hospital performance). The improvement score will be based on an improvement range (a scale between the hospital’s prior score on the measure during the baseline period and the benchmark). This article first appeared in the May 2011 issue of H&HN magazine. This information found at: http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/05MAY2 011/0511HHN_FEA_gatefold&domain=HHNMAG accessed on November 2, 2011 International Journal for Quality in Health Care 2002; Volume 14, Supplement 1: 67–73 A framework for institutionalizing quality assurance DIANA R. SILIMPERI1, LYNNE MILLER FRANCO1, TISNA VELDHUYZEN VAN ZANTEN1 AND CATHERINE MACAULAY2 1 Quality Assurance Project, University Research Co., LLC, Bethesda, MD, 2Martha Elliot Health Center, Boston, MA, USA Abstract Objective. To develop a framework to support the institutionalization of quality assurance (QA). Design. The framework for institutionalizing QA consists of a model of eight essential elements and a ‘roadmap’ for the process of institutionalization. The essential elements are the building blocks required for implementing and sustaining QA activities. Core QA activities include defining, measuring and improving quality. The essential elements are grouped under three categories: the internal enabling environment (internal to the organization or system), organizing for quality, and support functions. The enabling environment contains the essential elements of leadership, policy, core values, and resources. Organizing for quality includes the structure for implementing QA. Three essential elements are primarily support functions: capacity building, communication and information, and rewarding quality. The model can be applied at the level of an organization or a system. The paper also describes the process of institutionalizing QA, starting from a state of preawareness, passing through four phases (awareness, experiential, expansion, and consolidation), and culminating in a state of maturity. The process is not linear; an organization may regress, vacillate between phases, or even remain stagnant. Some phases (e.g. awareness and experiential) may occur simultaneously. Conclusion. The framework has been introduced in nearly a dozen countries in Latin America and Africa. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality The conceptual model has been used to support strategic planning and directing Ministry of Health work plans, and also as a resource for determining the elements necessary to strengthen and sustain QA. The next step will be the development and evaluation of an assessment tool to monitor developmental progress in the institutionalization of QA. Keywords: framework for quality assurance, institutionalization framework, leadership for quality, organizing for quality, quality assurance, sustainability of quality assurance During the last decade, quality of health care has received increasing political and public health attention, fueled in part by growing local autonomy and democratization, decentralization of health systems, and health sector reform. Worldwide, significant efforts are underway to improve the quality of health care being offered to people, and quality assurance (QA) activities are critical to these efforts. However, experience has often shown that the key question is not so much a technical one—how to ‘do’ QA activities—but rather, how to establish and maintain QA as an integral, sustainable part of a health system or organization. Ministries of Health want to know in which components they should invest scarce resources in order to maintain implementation of effective QA interventions throughout their delivery systems. Health organization leaders ask about the process, or the phases they must pass en route to incorporating QA into their structures, and developing organizational cultures that support and sustain QA in their health facilities. The Institutionalization Framework presented in this paper was developed to provide practical information to health organizations (and systems) in their quest for sustainable quality. As such it is both a conceptual model and an operational tool, a roadmap to help organizations produce and sustain quality health care. The framework The framework represents a synthesis of more than 10 years of experience assisting developing country health systems to design and implement QA. It is derived from a combination of the organizational development and quality management literature [1–12], as well as retrospective analysis of QA Address reprint requests to D. Silimperi, Quality Assurance Project, University Research Co., LLC/Center for Human Services, 7200 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA. E-mail: [email protected] C. MacAulay was formerly with the Quality Assurance Project, University Research Co., LLC, Betheseda, MD, USA. Published by Oxford University Press 67 D. R. Silimperi et al. Figure 1 The QA triangle. Note that this QA triangle is contained within the institutionalization model shown in Figure 2. Reproduced with permission from QAP. Project experience implementing QA activities and building QA programs in developing country health systems [13–17, and personal communication with QA Project staff ]. It is this combination of conceptual model and operational process (roadmap) that makes the framework more notable, as well as its basis in developing country health systems. Furthermore, in delineating the process of institutionalizing QA, the framework introduces the possibility of ongoing assessment of developmental stages of quality systems in health care at organizational or macro system levels. The framework depicts the components (which we call essential elements) necessary for the institutionalization of QA within an organization and provides practical information on how to facilitate the process necessary to reach this goal. Assignment: Improvement of Patient Literacy and Involvement on Health Care Quality The framework can be applied at any organizational level—from individual health care facilities to national level health systems—and has been developed especially for those involved in the design or improvement of quality of care, or wish to be champions for the introduction of QA into their organization. Figure 2 The QA institutionalization model. QD, defining quality; QI, improving quality; QM, measuring quality. See also Figure 1. Reproduced with permission from QAP. Defining quality means developing expectations or standards of quality, as well as designing systems for quality. Standards can be developed for inputs, processes, or outcomes, and they may be clinical or administrative [18]. Measuring quality consists of quantifying the current level of performance or compliance with expected standards, including patient satisfaction [19,20]. This involves definition of indicators, the development/adaptation of information systems, and the analysis and interpretation of results. Improving quality [21] refers to the application of quality improvement methods and tools to close the gap between current and expected levels of quality by understanding and addressing system deficiencies (as well as enhancing strengths) in order to improve, or in some cases re-design health care processes. A variety of quality improvement approaches exist, from individual problem solving to redesign of systems/ processes to organizational restructuring/re-engineering. Core QA activities Essential elements for institutionalizing quality The QA Project approach to improving health services and individual performance encompasses three core quality assurance activities (Figure 1): defining quality, measuring quality, and improving quality (when referring to these core QA activities on the QA triangle graphic on Figure 1, we reversed the letters to emphasize the activity’s contribution to quality, e.g. QD for defining quality, QM for measuring quality, and QI for improving quality). These three sets of activities work synergistically to ensure quality care as an outcome of the system, and together encompass the range of mutually supportive QA methodologies and techniques. No core activity is sufficient on its own to improve and maintain quality; it is the interaction and synergy of all three that facilitate sustainable improvements. Each core activity encompasses a group of interrelated activities, as briefly described below. The core QA activities, represented by the QA triangle (Figure 1), are the heart of any effort to institutionalize quality care. It is the continuous and synergistic application of these activities that will ensure high quality health care over time. The institutionalization model (Figure 2) contains the QA triangle at its center and depicts eight essential elements or building blocks necessary to support and ensure sustainable implementation of these core QA activities over time. The model’s elements are similar to focal areas noted in other quality audit frameworks [6,11]. These eight essential elements can be grouped within three categories: the internal enabling environment, internal to the organization or system (comprised of leadership, policy, core values, and resources), organizing for quality (structure), and support functions (capacity building, communication and information, and rewarding quality) as listed in Figure 3. 68 QA institutionalization framework national policy set to develop a QA program to achieve quality health care. The policy allocated appropriate resources to drive the QA Initiative and support QA activities. The results from the QA activities set the stage for incorporating quality into the strategic goals of the national health system [14,16]. Organizing for quality Figure 3 The categories and essential elements for the institutionalization of QA. Enabling environment Continuous ap … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10