Implementing Quality Measures in Healthcare- Process and Outcome Measures for Continuous Improvement

Implementing Quality Measures in Healthcare- Process and Outcome Measures for Continuous Improvement

In the healthcare delivery industry, continuous quality Improvement (CQI) is a deliberate and defined process aimed at activities that focus on patients’ needs and improve population healthcare (McCalman et al., 2019). CQI aims to implement programs continuously to improve healthcare services. Outcomes measures indicate the effects of healthcare interventions on the health status of patients (Kampstra et al., 2018). An example of an outcome measure would be the rate of hospital-acquired infections. On the other hand, process outcomes indicate what healthcare conditions do to improve the health of their patients (Akmaz et al., 2019). An example of a process measure is the percentage of diabetic patients who have controlled blood sugar levels.

Process Measures Utilized for CQI

The two process measures that may be used in CQI are related to preventive healthcare services, and process measures signify the recommended healthcare practices in clinical settings (Akmaz et al., 2019). The first process outcome selected is the percentage of patients receiving preventive healthcare services such as vaccinations. Preventive healthcare services involve screening, wellness check-ups, and patient education, which prevent diseases and other adverse healthcare outcomes (Musich et al., 2016). The second process measure that can be used in a CQI is the percentage of diabetic patients whose blood sugars have been tested and controlled.  Diabetes is a chronic condition with serious complications such as diabetic ketoacidosis, hyperglycemia, and even mortality if the blood sugar levels are not effectively controlled (Wang et al., 2018).

These two process measures can inform patients about the healthcare services they should receive for the medical conditions they are suffering from. This may help them contribute towards improving their healthcare outcomes. These two process measures can be used for quality reporting. These two measures have been defined by their relationship between the process and outcomes of healthcare services. They can provide data on the efficiency of healthcare services (Akmaz et al., 2019). Process measures are used to assess whether the healthcare organization uses the correct clinical guidelines when providing healthcare services. Process measures result in outcome measures (Akmaz et al., 2019). They are used to determine where the processes used were effective and indicate the next steps to be followed to improve the healthcare processes.

Outcome Measures Utilized for CQI

Outcome measures develop standards for healthcare outcomes and help quantify healthcare processes. They are mostly used for public reporting to insurance companies and the government (Kampstra et al., 2018). Some of the outcome measures include readmission rates, hospitalization rates, and surgical site infections. An outcome measure that can be used for a CQI is the rate of surgical site infections. Surgical site infections can result in healthcare complications, increase healthcare costs and result in loss of reimbursement for healthcare organizations (Abbas et al., 2020). This outcome measure will be used to monitor whether the healthcare process will result in the expected result. That is, whether surgery will result in low surgical site infections. Surgical site infections may be due to different factors, such as failure to use perioperative antibiotic prophylaxis (Abbas et al., 2020). Failure to achieve outcome measures will lead to a lack of outcome measures.

Reason for Selection of Each Measure

The percentage of people who receive vaccination was selected since the healthcare delivery industry is moving towards patient-centered healthcare services. Healthcare services are shifting from traditional pay-for-service volume-based payments to value-based healthcare reimbursements (Saleh & Shaffer, 2016). Healthcare organizations are being reimbursed based on providing quality healthcare services and reducing healthcare costs. Most of them are thus focusing on preventive healthcare services. The Affordable Care Act also advocates for preventive healthcare services (McIntyre & Song, 2019). The second process measure of the percentage of diabetic patients whose blood sugar is being tested and monitored was selected since diabetes is a chronic condition that may have serious complications if the blood sugar levels are not kept within the optimum levels (Wang et al., 2018). Poor glycemic control can also result in death. It is thus critical to measure this process outcome to identify patients at risk of poor glycemic control. This will help to implement interventions to manage their blood sugar levels effectively.

The outcome measure of surgical site infections was selected because it results in serious healthcare complications, increases hospital stay length, increases healthcare costs, and leads to loss of reimbursements (Abbas et al., 2020). Healthcare organizations are mandated to report this on the CMS website, and they must thus be aware of this and implement necessary interventions to reduce surgical site infections. This can improve their reputation, reduce healthcare costs, and improve patient outcomes.

Data Collection

The data for the number of patients who receive vaccinations will be obtained through primary sources of information. This data will be collected from patients’ health records, and the health records will reveal the patients who receive preventive vaccination and the type of vaccines they get. Primary physicians will also be interviewed, and they will provide data on the number of patients they vaccinate and those against vaccination. The data for the diabetic patient will be collected through interviews and a review of the patient’s medical records. Healthcare professionals such as nurses, physicians, and laboratory technicians will be interviewed to determine the number of diabetic patients under their care. Diabetic patients will also be interviewed on how often their blood glucose is monitored or whether they do self-monitoring at home. Finally, patient health records will be reviewed for blood sugar levels. Finally, data on surgical site infections will be collected through interviews and review of patient records. Surgeons and nurses will be interviewed to see whether they have implemented any perioperative strategies to prevent SSIs. Patients’ medical records will be evaluated to see whether they have developed surgical site infections after surgery.

Determining Success

Measuring the success of a CQI is important for the success of a project. QCI is likely to be successful when the initiators take an active role in the process. For the process measure of the percentage of patients being vaccinated, the success of this measure will be determined by evaluating the data of the number of patients being vaccinated. An increase in the number of patients being vaccinated will indicate success. The success of the measure of diabetic patients being monitored will be evaluated by the number of diabetic patients who have optimum glycemic control and a reduction in the number of diabetic complications. The success of the outcome measure of surgical site infections will be evaluated by reducing the number of surgical site infections, increasing the implementation of perioperative prophylaxis, and reducing hospitalization rates within 30 days.

Cost-Effective Solutions

The cost-effective solution for increasing the number of vaccinated patients would be to educate patients and the general public on the importance of vaccination. The public will be aware of the importance of vaccinations, and they will enroll in vaccination programs. The cost-effective solution for diabetic monitoring is telemonitoring, and telemonitoring is an effective approach to patient education, medication compliance, and access to healthcare providers (Andrès et al., 2019). Telemedicine is cost-effective since it will reduce the number of hospital visits and increase communication between patients and their physicians. For surgical site infections, the solution will be the perioperative use of alcohol-based antiseptic solutions. Alcohol-based solutions such as chlorhexidine are more effective than alcohol-free antiseptic solutions (Woodruff & Hohler, 2018).

In conclusion, QCIs are critical since they ensure healthcare organizations implement strategies to improve healthcare outcomes. Thus, healthcare organizations must implement evidence-based CQIs to reduce healthcare costs and improve healthcare outcomes.

References

Abbas, M., Holmes, A., & Price, J. (2020). Surgical site infections following elective surgery. The Lancet Infectious Diseases, 20(8), 898-899. https://doi.org/10.1016/s1473-3099(20)30524-7

Akmaz, B., Zipfel, N., Bal, R. A., Rensing, B. J., Daeter, E. J., & Van der Nat, P. B. (2019). Developing process measures in value-based healthcare: The case of aortic valve disease. BMJ Open Quality, 8(4), e000716. https://doi.org/10.1136/bmjoq-2019-000716

Andrès, E., Meyer, L., Zulfiqar, A. A., Hajjam, M., Talha, S., Bahougne, T., … & El Hassani, A. H. (2019). Telemonitoring in diabetes: evolution of concepts and technologies, with a focus on results of the more recent studies. Journal of medicine and life, 12(3), 203. https://dx.doi.org/10.25122%2Fjml-2019-0006

Kampstra, N. A., Zipfel, N., Van der Nat, P. B., Westert, G. P., Van der Wees, P. J., & Groenewoud, A. S. (2018). Health outcomes measurement and organizational readiness support quality improvement: A systematic review. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3828-9

McCalman, J., Bainbridge, R., & Bailie, R. (2019). Continuous quality improvement and comprehensive primary healthcare: A systems framework to improve service quality and health outcomes. International Journal of Integrated Care, 19(4), 436. https://doi.org/10.5334/ijic.s3436

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLOS Medicine, 16(2), e1002752. https://doi.org/10.1371/journal.pmed.1002752

Musich, S., Wang, S., Hawkins, K., & Klemes, A. (2016). The impact of personalized preventive care on health care quality, utilization, and expenditures. Population Health Management, 19(6), 389-397. https://doi.org/10.1089/pop.2015.0171

Saleh, K. J., & Shaffer, W. O. (2016). Understanding value-based reimbursement models and trends in orthopedic health policy. Journal of the American Academy of Orthopaedic Surgeons, 24(11), e136-e147. https://doi.org/10.5435/jaaos-d-16-00283

Wang, Q., Zhang, X., Fang, L., Guan, Q., Guan, L., & Li, Q. (2018). Prevalence, awareness, treatment, and control of diabetes mellitus among middle-aged and elderly people in a rural Chinese population: A cross-sectional study. PLOS ONE, 13(6), e0198343. https://doi.org/10.1371/journal.pone.0198343

Woodruff, J., & Hohler, S. E. (2018). Take the initiative to reduce surgical site infections. Nursing, 48(12), 62-64. https://doi.org/10.1097/01.nurse.0000546454.56122.93

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At least two process measures that can be used for CQI.
At least one outcome measure that can be used for CQI.

Implementing Quality Measures in Healthcare- Process and Outcome Measures for Continuous Improvement

A description of why each measure was chosen.
An explanation of how data would be collected for each (how each will be measured).
An explanation of how success would be determined.
One or two data-driven, cost-effective solutions to this challenge.