Health Care Information Review Proposal – Quality of Diabetes Care Assessment

Health Care Information Review Proposal – Quality of Diabetes Care Assessment

Our physician group is looking to undertake a comprehensive review of quality care for patients with diabetes. This proposal explains how critical information about our diabetes care management will be collected and analyzed. Data on hemoglobin A1c results and test frequency, blood pressure, annual eye exams for retinopathy and nephropathy screening, medication adherence, and complication rates will also be recorded. Most of this information is obtained mainly to analyze our performance in managing diabetes care against established quality benchmarks. Analysis of this data helps find gaps in care, measure compliance with clinical guidelines, compare outcomes against national benchmarks, recognize high-performing physicians, and target specific quality improvement efforts. This will provide an extensive review to validate the quality of care that we have provided for diabetes and open up opportunities for improvement in patient outcomes. This information will, in turn, help us enhance our disease management protocols, adjust workflows when necessary, and provide better quality-based, evidence-based care to our patient population with diabetes.

Data Collection Plan

Implementation Plan and Information Collection

We propose to perform a retrospective review of the data related to diabetes care for all patients with either type 1 or type 2 diabetes who have been treated by our physician group during the last two years, from January 1, 2022, through December 31, 2023. This will provide a broad perspective of recent performance and ensure that the data remains relevant to current practices.

Various system applications will facilitate the collection of this information. The Electronic Health Record (EHR) will serve as the primary source of clinical data. We will also use the Practice Management System to gather demographic information, the Laboratory Information System for A1c and other test results, and our Pharmacy System to collect medication fill and refill data.

Information Life Cycle

The flow of health record information through its life cycle will be as follows: Data creation occurs during patient encounters, which are documented in the EHR. This information is then stored in the EHR database and other relevant systems. For this review, authorized staff will access and retrieve data via system queries. The extracted data will be analyzed using statistical software, and the results will be compiled into dashboard reports. After the review, the raw data and reports will be archived according to our retention policy. Once the retention period has passed, the data will be securely destroyed. Notably, for this assessment, we will primarily base our data on the active storage and access cycle of the life cycle.

Health Information Exchange

We will leverage our affiliation with the local Health Information Exchange to acquire relevant information about diabetes care through encounters outside our physician group, such as hospitalizations and specialist consultations. This additional data will present a more comprehensive view of the overall diabetes management provided to our patients, indicating potential care coordination gaps. HIE data allow for continuing care for the patients, reducing redundant testing, identifying care received from other providers, and improving population health management abilities.

Personnel Requirements

Completion of this health information review will depend on a specialist team with specific skills. The team will include a Project Manager who will provide oversight to implement a study, two Data Analysts who will query systems and extract data that will be analyzed, a Quality Improvement Specialist to interpret the results and recommend particular interventions based on what they have learned, and one IT Support Staff member to make it easier to access the systems and troubleshoot any problems.

The qualifications for these jobs should be someone with experience in data analysis. They should also know quality improvement methods and will need to familiarize themselves with the clinical guidelines on diabetes. We will train them on our specific EHR system as well as our specific data extraction procedures. We will also design job aids like data dictionaries and query templates to have a standardized data collection.

Implementation Plans

We will employ several strategies to assist the staff in implementing the review study. There are numerous of them: kick-off meetings to brief on objectives and timeline, overview training on data collection protocols, test runs to validate accuracy of extraction, weekly check-in meetings to address problems, and celebrating milestones to keep the motivation of the teams working on it.

Data Security Plan

Protecting Patient Health Information

We will implement several measures to protect patient privacy and comply with HIPAA regulations. All extracted data will be encrypted both in transit and at rest. We will implement strict access controls to ensure only authorized personnel have access to PHI. Our reports will use aggregated, de-identified data to protect individual patient privacy. All data will be stored on encrypted, password-protected devices, and we will maintain audit trails to track all data access and usage. Additionally, all staff involved in the study will complete HIPAA compliance training.

Applying Laws Governing Health Information

In implementing the laws related to health information confidentiality, privacy, and security, we will update our policies and procedures with enhanced security features. This is regarding reviewing our policy on access to data, updating the disaster recovery plan as well as new approaches to the destruction of electronic PHI. We also verify Business Associate Agreements are up-to-date with all vendors who transmit PHI

Impact of HIPAA on Personnel, Policies and Procedures

These will impact our staff in terms of more frequent training on the use, handling, and transmission of the PHI, stricter log-on and log-off, and detailed accounting of data accesses and uses. These may slow down certain processes initially, but they are essentially about patients’ trust and regulatory compliance.

Benchmarking Plan

Sources of National Data and Quality Measures

Several sources provide national data regarding diabetes care and quality measures. These include the National Committee for Quality Assurance (NCQA) HEDIS measures, the Centers for Medicare & Medicaid Services (CMS) Quality Rating System, and the American Diabetes Association (ADA) Standards of Medical Care in Diabetes.

Using National Data as Benchmarks

We will use these national data sources as benchmarks against which to compare data from our facility. Specifically, we will compare our performance on key diabetes measures for the percentage of patients with A1c > 9.0% poor control, the percent of patients with BP < 140/90 mmHg, the percent of patients receiving annual eye exams, and the percentage of patients with annual nephropathy screening.

Ensuring Data Compatibility

All data definitions from the collected data are to be harmonized to national standards and ensure compatibility with national benchmarks, e.g., lab results defined using LOINC codes. We will use standardized time frames for measurement periods and apply consistent inclusion and exclusion criteria for patient cohorts. Additionally, we will normalize our data to account for demographic differences between our patient population and national samples.

Comparing Collected Data to Benchmarks

Our data analyst will calculate our performance rates using the same methodology as the national measures to ensure valid comparisons. We will present our results alongside national averages and top-performer rates to contextualize our performance.

Quality and Change Management Strategies

Using Data Outcomes for Quality Improvement

We will use the collected data to drive quality improvement through several strategies. We will conduct root cause analysis for measures falling below benchmarks to identify underlying factors. We will implement rapid-cycle improvements using Plan-Do-Study-Act (PDSA) cycles, testing interventions on a small scale before broader implementation. High-performing physicians will be identified, and their workflows will be analyzed to uncover replicable best practices. We will optimize EHR alerts, and order sets based on identified care gaps and enhance our patient education and self-management support programs based on areas of need identified in the data.

Best Practices for Departmental Workflow

Based on our analysis, we recommend several best practices for departmental workflow. These include implementing a pre-visit planning process to review diabetes care gaps before patient appointments, developing standing orders for routine diabetes tests to reduce physician burden, expanding the use of nurse care managers for between-visit monitoring and education, and piloting shared medical appointments for diabetes education and peer support.

Evidence-Based Best Practices

Recent literature highlights several evidence-based best practices that could facilitate needed changes in our diabetes care management. Orabone et al. (2022) emphasize the crucial role of pharmacists in diabetes care, demonstrating clear benefits in both clinical and non-clinical outcomes. Integrating pharmacists into our primary care team for medication management could significantly improve treatment adherence and patient outcomes.

The American Diabetes Association’s Standards of Care (ElSayed et al., 2022) recommend aligning diabetes management with the Chronic Care Model, emphasizing person-centered team care and integrated long-term treatment approaches. This model suggests utilizing patient registries and decision support tools, which we could implement to enhance our care delivery.

Gerber et al. (2023) provide evidence for the effectiveness of mobile health (mHealth) interventions in improving glycemic control, particularly among African American and Latinx populations. Implementing a similar approach with clinical pharmacists and health coaches using telehealth and text messaging could help us better serve diverse patient populations and reduce disparities.

Abdulrhim et al. (2020) conducted an umbrella review showing that pharmacist interventions in primary care settings significantly improved clinical outcomes and cost savings. Educational interventions by clinical pharmacists within the healthcare team were particularly effective, suggesting we should focus on enhancing our patient education programs. By incorporating these evidence-based practices, we can improve our diabetes care management and patient outcomes.

Implementation

The implementation of this information review study will follow a 12-week timeline. In the first two weeks, we will finalize the project team and roles, develop a detailed project charter, and obtain necessary approvals. Weeks 3-4 will focus on configuring data extraction queries, testing and validating the data collection process, and conducting staff training. During weeks 5-8, we will extract historical data from the past two years, perform initial data cleaning and analysis, and generate baseline performance reports. In weeks 9-10, we will compare our results to benchmarks, identify top priorities for improvement, and develop action plans for key measures. The final two weeks will be dedicated to presenting findings to leadership, finalizing recommendations, and planning the ongoing monitoring process.

Conclusion

This proposed study will significantly improve our physician group’s quality of patient care in several ways. It will provide objective data on our diabetes care performance, allowing us to identify specific areas for improvement in our practices. By learning from high-performing physicians and evidence-based best practices, we can drive targeted quality improvement initiatives. This systematic review of our diabetes care processes and outcomes will enhance our ability to meet and exceed national care standards, ultimately leading to better glycemic control, reduced complications, and improved overall health outcomes for our patients with diabetes.

References

Abdulrhim, S., Sankaralingam, S., Ibrahim, M. I. M., & Awaisu, A. (2020). The impact of pharmacist care on diabetes outcomes in primary care settings: An umbrella review of published systematic reviews. Primary Care Diabetes. https://doi.org/10.1016/j.pcd.2019.12.007

ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons, S. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., Stanton, R. C., & Gabbay, R. A. (2022). Improving care and promoting health in populations: Standards of care in diabetes—2023. Diabetes Care, 46(1), 10–18. https://doi.org/10.2337/dc23-s001

Gerber, B. S., Biggers, A., Tilton, J. J., Smith, D. E., Lane, R., Mihăilescu, D., Lee, J.-A., & Sharp, L. K. (2023). Mobile Health Intervention in Patients With Type 2 Diabetes. JAMA Network Open, 6(9), e2333629–e2333629. https://doi.org/10.1001/jamanetworkopen.2023.33629

Orabone, A. W., Do, V., & Cohen, E. (2022). Pharmacist-Managed Diabetes Programs: Improving Treatment Adherence and Patient Outcomes. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Volume 15, 1911–1923. https://doi.org/10.2147/dmso.s342936

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Write a proposal (5–7 pages) for a health care information review of the quality of care given to a specific patient population.

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Introduction
You now know:

What information or data you will be reviewing.
From where the information or data will come.
Which standards or goals you are trying to reach.
You now need to determine how to make all of this happen. In this part of the process, you will put together your action plan. Who is going to do the work? What type of skills will they need? How long will it take them to do the work? This is your game plan. Each and every step needs to be clearly laid out and explained.

Keep in mind that you are writing a proposal. You are telling your physician group what you would like to do, why you want to do it, and how you are going to do it. You are not buying new devices or starting a new process. You are reviewing documentation that is already present in the office, or potentially in hospital records, to identify whether your group’s physicians provided quality care.

This assessment will complete your proposal for the health information review that you recommend. Throughout this assessment, explicitly state the reasons for each and all of your choices.

Please carefully review this assessment’s scoring guide to better understand the performance levels relating to each criterion on which you will be evaluated.

Instructions
You do not need to write your proposal in APA format. You do need to complete a cohesive, coherent, organized, and well-written proposal. Much of the information you include in your proposal will come from your previous assessments. Be sure your proposal includes all of the following headings and your narrative addresses each of the bullet points.

Introduction
Explain what information you propose to collect.
Provide the reasons for collecting this information.
Describe how this information could be used to validate or improve the quality of care at your facility.
Data Collection Plan
Propose an implementation plan and detail the information you plan to collect at your facility, including where and how it will be collected.
Specify the following:
The time period you propose to review.
The system applications you will use to collect the health information.
Write a narrative, create a timeline, build a flowchart, or use any other method of your choosing to demonstrate the flow of health record information through the information life cycle from creation to destruction. Identify those sections within the life cycle from which you will retrieve information.
Explain the use of information from an HIE and describe how it may affect patient care, clinical knowledge, and population health data.
Detail the personnel required to complete the health information review, including their needed skills and required training and job aids.
Describe strategies that will be employed to help personnel implement the review study.
Data Security Plan
Plan measures to protect PHI.
Apply laws governing health information confidentiality, privacy, and security.
Plan for the impact of HIPAA on health care personnel, policies, and procedures.
Benchmarking Plan
Identify the sources of national data and quality measures.
Describe how you will use the national data and quality measures as benchmarks to compare with data from your facility.
Explain how you will ensure data standardization, along with any other factors you need to take into account, so the data from these sources is compatible with the data you plan to collect.
Explain how the collected data will be compared to the benchmarking and quality standards.
Quality and Change Management Strategies
Explain how data outcomes could be used to perform quality improvement reviews and recommend evidence-based best practices for policies and procedures based on outcomes.
Recommend best practices for departmental workflow that will support the information review you are proposing.
Describe relevant evidence-based best practices and procedures from peer-reviewed articles or Internet resources that could facilitate needed changes.
Implementation
Detail the steps for implementing the information review study along with the expected time frames.
Conclusion
Summarize how the proposed study will improve the quality of patient care for your physician group.
Additional Requirements
Written communication: Your paper needs to be clear and well organized, with correct spelling, grammar, and syntax, to support orderly exposition of content.
Title page: Develop a descriptive title of 5–15 words. It should stir interest yet maintain professional decorum.
References: Include a minimum of two citations of peer-reviewed sources in APA format.
Length: 5–7 typed and double-spaced content pages, not including the title page and references page.
Font and font size: Times New Roman, 12 point.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

Competency 1: Determine stages of the information lifecycle embedded within health information management technology functions.
Map the flow of health record information.
Detail steps and time frames for implementing a study.
Competency 2: Apply laws governing health information confidentiality, privacy, and security.
Plan data security measures.
Competency 3: Assess system applications used to operationalize health information.
Explain rationale for proposed health care information review procedures.
Plan procedures and human resource requirements to manage the information.
Competency 4: Determine how a health information exchange (HIE) or other external health care databases affect the management of patient data, clinical knowledge, and population data.
Plan evidence-based best practices or procedures to ensure data meet standards for interoperability with an HIE.
Competency 5: Apply quality and change management concepts to health care information management.
Plan evidence-based quality and change management strategies.
Competency 6: Communicate in a manner that is scholarly, professional, respectful of the diversity, dignity, and integrity of others, and is consistent with the expectations for healthcare professionals.
Write clearly, with correct spelling, grammar, and syntax, and good organization.
Apply proper APA formatting and style to citations and references.