Health Quality Innovation

Welcome to Health Quality Innovation

Health quality improvement is a national priority.  Getting there will take fresh approaches to health care delivery.  It will also take breakthrough approaches to leadership and teamwork. Health Quality Innovation provides ideas, knowledge, and tools to help your team achieve breakthrough results in quality improvement and patient outcomes.

Improving Asthma Outcomes in Minority Children: A Randomized, Controlled Trial of Parent Mentors

An experimental program in Milwaukee that uses trained parent mentors to help other parents care for their young child's asthma led to a reduction in wheezing, asthma exacerbations, emergency room visits, and missed work days, while improving parents' competence in recognizing breathing problems that are controllable at home, all at a reasonable cost.

Author(s): Glenn Flores, M.D., Christina Bridon, Sylvia Torres, Ruth Perez, Tim Walter, Jane Brotanek, M.D., M.P.H., Hua Lin, Ph.D., M.S., and Sandy Tomany-Korman, M.S.
Journal: Pediatrics, December 2009 124(6):1522–32
Contact: Glenn Flores, M.D., University of Texas Southwestern Medical Center, Division of General Pediatrics, glenn.flores@utsouthwestern.edu
Summary Writer(s): Mark Foggin and Deborah Lorber

View the Article on the Pediatrics website

Changing Policy: The Elements for Improving Childhood Asthma Outcomes

Asthma is the single most common chronic condition among children, with one in every seven children diagnosed with the disease that causes attacks of wheezing, shortness of breath, chest tightness and coughing.

The U.S. spends about $8 billion a year treating childhood asthma – more than almost any other childhood condition—in part because more than 1 million children with asthma lack health insurance.

George Washington University School of Public Health and Health Services researchers Sara Rosenbaum and Anne Markus, Ph.D. ’00, spent last year identifying what policy reforms could be made to improve the lives of children with asthma and their families.

Read a full summary of the report at the GWU website...

 

 

Case Study: The Mount Auburn Cambridge Independent Practice Association (MACIPA)

The Commonwealth Fund (Quality Matters, JUNE/JULY) offers this case study that follows the development of an independent practice association (IPA) in an urban setting. It provides a description of the design/development process and lessons learned from this organization's experience. Although the case study describes an urban center, the lessons learned can translate to other geographic health care settings. 

These include:

1. Mutual respect of partners is key element for overall success.
2. Physician leadership is critical.
3. The value of primary care and a shared incentive to retain the loyalty of patients is a core value.

IMPLICATIONS (from article):  MACIPA's experience demonstrates that it is possible to create a physician-led accountable care organization that finds common ground with a hospital when they have a joint interest in preserving and expanding their patient base by providing better care. This in turn requires that physicians prepare to take a leadership role and that hospital administrators partner with them to do so. It also requires a willingness to invest resources in building a shared local infrastructure for data analysis, care management, and quality improvement...

Read or download case study from The Commonwealth Fund...

 

Building Accountable Care Organizations That Improve Quality and Lower Costs

 Building Accountable Care Organizations That Improve Quality and Lower Costs - A View from the Field, published on-line by The Commonwealth Fund, Quality Matters, June/July 2009, provides a description of 'Accountable Care Organizations' and the potential role they may play within implementation of National Health Care Reform. 

In addition, this article includes 'lessons learned' and advice from participants of the recently concluded five-year Physician Group Practices Demonstration Project conducted by the Centers for Medicare and Medicaid Services' (CMS) which looked at quality and cost reduction models within group practices. Feedback from groups outlines practice innovations implemented by participating organizations and 'next steps' for these practices.

SUMMARY (from article):  In less than 18 months, Medicare will launch a shared savings program to reward primary care physicians, specialists, and hospitals that form accountable care organizations and collaborate in the redesign of care processes, improve care coordination, and promote high-quality, cost-efficient care. To receive payment, providers must demonstrate the impact their efforts have on specific quality-of-care and cost-reduction goals. Doing so is no small task. Quality Matters asked organizations that have been working toward these goals what advice they have for others.

Read or download this article from The Commonwealth Fund...

 

 

California Health Care Foundation Offers Leadership Learning Resources for Health IT

The California Health Care Foundation (CHCF) website articulates the thoughts of many safety net health care leaders:  "Information technology is still fairly new and untested in health care, making experimentation, analysis and evaluation critically important".

CHCF.org offers web-based resources for health care safety-net leaders looking to learn more about health information technology (HIT).  CHCF regularly conducts research and commissions surveys and reports on emerging technology trends and related policy and regulatory issues and the results are available electronically on CHF.org. 

Here are some the recent publications available from CHCF.org:

Chart Abstraction: EHR Deployment Techniques

March 2010:  Entering clinical data from paper files into electronic health records (EHRs) causes a temporary loss in clinic productivity. In this issue brief, networks of community clinics share insights about effective chart abstraction.

Speeding Adoption of Electronic Health Records in Community Clinics

January 2010:  Seven grantees representing four models of EHR deployment were funded to accelerate the adoption of EHRs in the safety net. CHCF is publishing a series of issue briefs to highlight lessons learned.

Telepsychiatry in the Emergency Department: Overview and Case Studies

December 2009:  Telepsychiatry is used in some emergency departments to make the process of evaluating and treating patients with mental health issues more efficient. This paper examines seven ED telepsychiatry programs in terms of structure, financing, and challenges.

Creating EHR Networks in the Safety Net

April 2008:  This issue brief explores the network approach to the implementation of electronic health records (EHRs) and its potential to increase EHR adoption rates among California's community clinics and health centers.

Electronic Health Records versus Chronic Disease Management Systems: A Quick Comparison

March 2008:  This fact sheet compares the key features of these essential health IT systems and examines the pros and cons of different approaches for a new implementation. A video discusses disease registry tools.

Click here to go to CHCF.org to view additional Health IT Reports and Resources

Challenges and Barriers to Clinical Decision Support (CDS)

Clinical Decision Support (CDS) has been demonstrated to help safety-net health care clinicians with their efforts to improve efficiency and effectiveness of care for the patients they serve.  But the challenge facing safety-net clinic leaders is how to develop an effective CDS system?

This March 2010 AHRQ report, Challenges and Barriers to Clinical Decision Support (CDS) Design and Implementation Experienced in the AHRQ CDS Demonstration briefly describes the two AHRQ CDS demonstrations, as well as the challenges and barriers that the contractors encountered during the initial periods of their CDS demonstration project, how they addressed these obstacles, and the effectiveness of their strategies. The goal of this report is to share the experiences of the contractors throughout the planning, design, and implementation phases to aid others who are considering funding or undertaking similar efforts.

Lessons learned by health care provider organizations:

• The goals of CDS development and implementation projects should align with organizational priorities to promote buy-in from both management and staff.
• The organizational working environment should foster meaningful EMR usage, including not only software and hardware needs but also the attitudinal changes needed to support adoption.
• Engaging a well-respected clinician “champion” to lead CDS education, training, and implementation efforts will promote clinician adoption.
• Institutions wishing to utilize a knowledge management process will need access to personnel with specialized knowledge in clinical informatics and experience in designing new tools or using existing tools to support CDS development.

Read or download the full report from AHRQ ....

Collaborating with Health Centers to Leverage HIT for System Improvement

In this policy brief published on-line May 2010 by National Academy for State Health Policy (NASHP), authors Elizabeth Osius and Shaun Alfreds summarize the efforts of three states (Massachusetts, Oregon, and Tennessee) to promote interstate and public-private partnerships between state governments, FQHC's and other stakeholders to leverage HIT investments and tools to accomplish  shared goals of not only IT adoption but health care delivery improvement.

Key points/Lessons Learned: 

• share lessons and work in collaboration, offering information from multiple perspectives; organizations
  such as the PCA and Health Center Controlled Networks (HCCNs) make for natural partners with the state due to their on-the-ground experience with CHCs and HIT adoption;
• partner in ARRA-related applications because support and partnering are necessary to attain clinical transformation;
• encourage and leverage the leadership of the safety net, where innovations can spur activity throughout
  states’ delivery systems;
• overcome policy and legal roadblocks;
• assure that technologies are not being implemented for technology’s sake, but are being implemented
  with an eye toward outcomes;
• move, when appropriate, from a focus on EMR adoption to how effectively the EMRs empower providers to truly improve the delivery of care; and,
• assure alignment between state health care policies and delivery systems serving the states’ vulnerable populations.

Click here to go to NASHP website to view article.

Policy challenges in building the medical home: do we have a shared blueprint?

J Am Board Fam Med. 2010 May-Jun;23(3):384-92. Stenger RJ, Devoe JE.Department of Family Medicine, Oregon Health and Science University, Portland, OR 97239, USA.

Abstract

BACKGROUND: The notion of a patient-centered medical home features prominently in policy reform initiatives across the country, with both state and federal legislation focusing on this new model. We sought to understand the views of key stakeholders and to examine the challenging landscape facing policymakers and practitioners as they attempt to translate the medical home concept into widespread practice change.

METHODS: We reviewed legislative documents from state legislative sessions in the year 2007 to identify pieces of legislation that included the medical home concept. Concurrently we conducted an in-depth qualitative analysis of de-identified field notes from a purposeful sample of semistructured interviews conducted with key stakeholders in Oregon after the passage of health reform legislation in 2007.

RESULTS: Legislation that further defined and expounded on the medical home concept was introduced in states across the country in 2007, and some federal and state demonstration projects were already underway. However, we identified a number of barriers to widespread implementation of the medical home, most notably lack of a clear operational definition. Key stakeholders had widely disparate views about elements central to the success of medical home demonstrations, including delivery system reform, payment reform, and performance incentives for providers.

CONCLUSIONS: Since 2007 the concept of the medical home has gained increasing attention in health care reform debates. Our findings suggest that translating this concept into successful, widespread reform will require that policymakers build further consensus among key stakeholders and require them to address critical barriers to avoid repeating pitfalls of past reform efforts.

Read or download the full article from the Journal of the American Board of Family Medicine...

Features of the Chronic Care Model (CCM) associated with behavioral counseling and diabetes care in community primary care.

J Am Board Fam Med. 2010 May-Jun;23(3):295-305.Strickland PA, Hudson SV, Piasecki A, Hahn K, Cohen D, Orzano AJ, Parchman ML, Crabtree BF. Department of Biostatistics, University of Medicine and Dentistry of New Jersey, School of Public Health, Piscataway. ohmanpa@umdnj.edu

Abstract

BACKGROUND: The Chronic Care Model (CCM) was developed to improve chronic disease care, but it may also inform delivery of other types of preventive care. Using hierarchical analyses of service delivery to patients, we explored associations of CCM implementation with diabetes care and counseling for diet or weight loss and physical activity in community-based primary care offices.

METHODS: Secondary analysis focused on baseline data from 25 practices (with an average of 4 physicians per practice) participating in an intervention trial targeting improved colorectal cancer screening rates. This intervention made no reference to the CCM. CCM implementation was measured through staff and clinical management surveys and was associated with patient care indicators (chart audits and patient questionnaires).

RESULTS: Overall, practices had low levels of CCM implementation. However, higher levels of CCM implementation were associated with better diabetes assessment and treatment of patients (P = .009 and .015, respectively), particularly among practices open to "innovation." Physical activity counseling for obese and, particularly, overweight patients was strongly associated with CCM implementation (P = .0017), particularly among practices open to "innovation"; however, this association did not hold for overweight and obese patients with diabetes.

CONCLUSIONS: Very modest levels of CCM implementation in unsupported primary care practices are associated with improved care for patients with diabetes and higher rates of behavioral counseling. Incremental incorporation of CCM components is an option, especially for community practices with stretched resources and with cultures of "innovativeness."

Read or download the full article from the Journal of the American Board of Family Medicine...

2009 National Healthcare Quality & Disparities Reports

For the seventh year in a row, the Agency for Healthcare Research and Quality (AHRQ) has produced the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. The reports present, in chart form, the latest available findings on quality of and access to health care.

The National Healthcare Quality Report tracks the health care system through quality measures, such as the percentage of heart attack patients who received recommended care when they reached the hospital or the percentage of children who received recommended vaccinations. The National Healthcare Disparities Report summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as children and older adults.

Click here to view and download both reports.