Using Data to Address Quality Measures
Using Data to Address Quality Measures
The “Hospital Compare” website provides information related to the quality of health for more than 4000 Medicare-certified hospitals in the United States (CMS.gov, 2020). This website further provides data for over fifty military hospitals and over 130 VA medical facilities (CMS.gov, 2020). The data and information on the website compare a specific hospital with other hospitals in the state and the country. This information helps patients select a healthcare facility that will suit their medical and surgical needs (Sen, 2020).
Paradise Valley Hospital
Data Table
| Category From Scenario | List the Measure Used to Represent the Category | Statistic for Hospital Measure | Statistic for State Measure | Statistic for National Measure |
| Use of Medical Imaging | This measure represents the percentage of patients in the outpatient department subjected to an MRI without trying other recommended interventions such as physical therapy. (Medicare.gov, n.d.)
The fewer the MRIs, the better |
Not available | 38.5% | 38.5% |
| Timely and Effective Care | This measure represents the percentage of patients who left the emergency department without seeing a physician or a healthcare practitioner (Medicare.gov, n.d.).
The fewer, the better
|
2% | 2% | 2% |
| Patient Satisfaction: Communication from Nurses | This measure represents the proportion of patients who reported that their nurses always communicated well (Medicare.gov, n.d.) | 75% | 76% | 80% |
Sources of Information
The first source of data is peer-reviewed journal articles. These articles have undergone a rigorous evaluation process by expert scholars and journal editors who critically evaluate the scientific merit and quality of the article’s research (NLM, n.d.). These articles include research by scholars who have collected primary data from surveys, experimental studies, and other study methods. They can also present the work of researchers who have done novel analyses of existing data, such as the ones described. Peer-reviewed articles can be obtained from multiple academic databases such as PubMed, CINAHL, ScienceDirect, and Embase. They can also be accessed from healthcare-related journals such as Health Affairs, Epidemiologic Reviews, and the American Journal of Public Health. The advantages of peer-reviewed articles include high-quality and validated research findings, highly detailed information, and ease of retrieval from online databases (NLM, n.d.). It, however, has some disadvantages. One disadvantage is requiring a subscription from online databases before accessing them (National Library of Medicine (NLM), n.d.).
The second source of information is medical records. Medical records are utilized to track transactions between healthcare providers and patients. They contain lab tests, imaging tests, diagnoses, procedures, patient data, and past medical history (Honavar, 2020). Therefore, these records can help measure healthcare trends, patient characteristics, and healthcare quality. The current popular medical records are electronic health records (EHR), making it easier to access healthcare information (Honavar, 2020). Information from EHRs can be used for research, such as comparing the effectiveness of healthcare providers. Medical records are detailed and accurate since they come from the healthcare providers. The information is automatically collected, including information that patients may not easily share through other sources such as surveys. The only limitation of this information source is that the data may be interpreted, and only authorized individuals can access the information (Honavar, 2020).
Quality Measure of Use of Medical Imaging
The patient in the scenario waited in the emergency department for two hours with no healthcare professional seeing her. She was then told that the in-house MRI was down for maintenance, so she should reschedule her appointment. The patient stayed in the emergency department for over 280 minutes after she arrived and was discharged. Later she got her MRI, but her insurance told her that the MRI was not precertified correctly. She got a large MRI bill since her doctor did not try other interventions like physical therapy. This measure will negatively affect the hospital in the case scenario. The patient may stop seeking services from the hospital since she feels that they overcharge their patients by ordering unnecessary imaging tests. This information may spread in the community and lower the patient ratings for this hospital. The hospital may lose clients, which may cost them financially. In addition to this, hospitals that offer quality and cost-effective healthcare services will receive incentives from Medicare (CMS.gov, 2020). This hospital will not get these benefits.
Conclusion
When patients research a hospital, they look for facilities that offer them quality and cost-effective healthcare services. One such resource is “Hospital Compare,” which has different parameters to help patients determine the hospital that suits their needs. This information is also important to hospitals since it can help them improve their healthcare services.
References
CMS.gov. (2020, October 1). Hospital compare. Centers for Medicare & Medicaid Services | CMS. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalCompare
CMS.gov. (2020, January 6). CMS’ value-based programs. Centers for Medicare & Medicaid Services | CMS. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs
Honavar, S. (2020). Electronic medical records – The good, the bad, and the ugly. Indian Journal of Ophthalmology, 68(3), 417. https://doi.org/10.4103/ijo.ijo_278_20
Medicare.gov. (n.d.). Medicare.gov. Medicare.gov: the official U.S. government site for Medicare | Medicare. https://www.medicare.gov/care-compare/
National Library of Medicine (NLM). (n.d.). Peer-reviewed literature. National Library of Medicine – National Institutes of Health. https://www.nlm.nih.gov/nichsr/stats_tutorial/section3/mod6_peer.html
Sen, S. (2020). An evaluation of Medicare’s hospital comparison as a decision-making tool for patients and hospitals. e-Service Journal, 12(1), 42. https://doi.org/10.2979/eservicej.12.1.02
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Question 
Read the following scenario. San Diego, California 92101
The patient is a 40-year-old female who presents to the emergency department for low back pain. The pain has been present for 2 weeks, and no injury has been noted. The patient has no history of previous low back pain. The emergency department immediately ordered an MRI of the lumbar spine for lower back pain. The patient waited in her room in the emergency department for 2 hours without anyone checking on her. She is finally told that the in-house MRI is down for maintenance, so she schedules an appointment for another day. The patient is at the emergency department for more than 280 minutes from arrival to discharge.
Using Data to Address Quality Measures
Two days later, the patient goes to her appointment for her MRI at the radiology department. She must register and provide all the same information that she has already given at the emergency department regarding her history and other pertinent information. The patient’s appointment was scheduled for 1 p.m., and at 1:45 p.m., she still has not been called back for her test. No one has updated her regarding the delay. Finally, the patient is taken back for her test at 2 p.m. and is not given any explanation for the delay except that the department is short-staffed. The patient is not happy about her experience at the radiology department.
When the patient receives her Explanation of Benefits from her insurance company, she realizes the MRI was not pre-certified correctly. Now, she owes a large portion of the bill because the physician did not try other means, such as physical therapy, prior to receiving a costly MRI.
Access Medicare’s Hospital Compare website and complete the following steps:https://www.medicare.gov/care-compare/?providerType=Hospital&redirect=true
Locate the Find a Hospital box.
Enter the ZIP Code and hospital name provided by your faculty member.
Select search. San Diego, California 92101
Review the category tabs (e.g., General Information) at the top of the hospital’s profile to complete this assignment.
Complete the chart on the Using Data to Address Quality Measures worksheet using the data from Hospital Compare.
You are provided with 3 categories relevant to the scenario. If you would like to identify an additional measure(s) and data from Hospital Compare that relate to the scenario, please use the blank line item in the table or add another row(s).
Note: An example of how to pull data has been provided for you to review.
Write a 350- to 700-word paper that analyzes the measures that have an influence on the facility in the scenario.
Include the following in your paper:
Explain the measures and corresponding data listed in the table.
Provide the data table listing the measures and corresponding data points within the presentation.
Analyze 2 sources, in addition to Hospital Compare, that you would use to find public information on facilities regarding the measures presented in the scenario.
Select 1 measure from the data table and analyze how the quality of this measure could affect the facility in the scenario.
Cite 3 peer-reviewed or similar references to support your presentation on the references slide.
Format your assignment according to APA guidelines.
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