Report Cards
It is becoming increasingly clear that physicians and HCOs of the future will be evaluated on their performance of specific core measure sets. The ORYX measures that your hospital is evaluated on can also be applied to the individual practitioner. All the UM folks have to do is drill down into the data and separate it based on the provider.
Many physicians feel that this is unfair and that their patient populations have unique characteristics that don't easily fit the mold of standardized performance measure sets. As a matter of fact, physicians now have to be proactive in their documentation as to why their patient's did not receive a specific treatment. If their patient has heart failure and can't tolerate an ACE inhibitor due to hyperkalemia, then this must be noted in the medical record.
Whether we like it or not, performance measures are here to stay, and will most likely become more extensive. How are we as hospitalists to respond? Obviously we have to embrace the concept at some point, continually seek feedback from UM on our performance, and create systems of care which will lead to success.
Friday, November 7, 2008
Getting to Know the UM Folks...
Getting to Know the Utilization Management (UM) folks...
The Quality Management or Utilization Management department within your hospital is an invaluable resource. The individuals within UM are eager to get to know all the docs and assist you with QI projects. They also have access to gobs of data related to your area of interest. So stop by QM today and get to know these folks! They can also give you data on your hospital's performance on ORYX core measure sets.
When you look good, they look good!
Partnering with QM as a physician champion to improve ORYX core measure sets will get you noticed by hospital administration very quickly. These measures are important to hospital accreditation and more and more of these measures are being scrutinized by the general public. As hospitalists, we are in a good position to be able to identify opportunities for improvement within our organization which influence the outcomes of these measures. This may be in the development of standardized order sets, colleague education, committee involvement, etc.
ABIM Maintenance of Certification-- Get involved with QI and recertify at the same time!
Interestingly, the American Board of Internal Medicine (ABIM) are now including Performance Improvement Modules (PIMs) as part of the recertification process for their physicians. If you are within 4 years of the time you need to recertify in Internal Medicine, you can get involved in a PIM related to ORYX measures. The work you put into this will improve the quality of care for your patients and get your recertified in Internal Medicine all at the same time! Go to the ABIM website for more information (www.abim.org)
The Quality Management or Utilization Management department within your hospital is an invaluable resource. The individuals within UM are eager to get to know all the docs and assist you with QI projects. They also have access to gobs of data related to your area of interest. So stop by QM today and get to know these folks! They can also give you data on your hospital's performance on ORYX core measure sets.
When you look good, they look good!
Partnering with QM as a physician champion to improve ORYX core measure sets will get you noticed by hospital administration very quickly. These measures are important to hospital accreditation and more and more of these measures are being scrutinized by the general public. As hospitalists, we are in a good position to be able to identify opportunities for improvement within our organization which influence the outcomes of these measures. This may be in the development of standardized order sets, colleague education, committee involvement, etc.
ABIM Maintenance of Certification-- Get involved with QI and recertify at the same time!
Interestingly, the American Board of Internal Medicine (ABIM) are now including Performance Improvement Modules (PIMs) as part of the recertification process for their physicians. If you are within 4 years of the time you need to recertify in Internal Medicine, you can get involved in a PIM related to ORYX measures. The work you put into this will improve the quality of care for your patients and get your recertified in Internal Medicine all at the same time! Go to the ABIM website for more information (www.abim.org)
ORYX Performance Measures
Hospitalist Performance Measures: Learning about ORYX
Asking what is important in QI and what your hospitalist group should focus on is a tricky question. The more you get involved in the politics of a healthcare organization, the more you realize that everyone in the hospital has their own ideas about what's most important in QI.
Due to standards for accreditation and publically reported performance measures, most healthcare organizations will focus on the following issues:
1. Patient safety and adherence to National Patient Safety Goals and preventing sentinel events
2. Infection Control (preventing healthcare acquired infections)
3. Credentialing of Providers
4. ORYX Performance measures
Of the four mentioned above, I would like to bring your attention to the ORYX measures which were developed by The Joint Commission in 1997. The idea behind using performance measures was for hospitals to collect data on specific conditions treated at their facility. Currently there are five core measure sets:
1. Acute MI
2. HF
3. Community Acquired Pneumonia (CAP)
4. Pregnancy and related conditions
5. Surgical Infection Prevention (SIP)
Additional measures to follow will include ICU, children's asthma care, and inpatient psychiatric care.
These measures have allowed for the evaluation of trends within healthcare facilities and areas in need of improvement. They also allow for the comparison of facilities with each other. The Centers for Medicare and Medicaid Services (CMS) and The Joint Commission have also worked together to align common measures. You can read about each of these measures and their development on The Joint Commission website: www.jointcommission.org
The reason I have gone into detail about ORYX measures is that these are the areas of QI that hospitals accredited by The JC are required to monitor. To date, The JC requires each organization to monitor 3 core measure sets for accreditation. The majority of the core measure sets are the "bread and butter" of hospitalist medicine and areas where we can make a difference.
Asking what is important in QI and what your hospitalist group should focus on is a tricky question. The more you get involved in the politics of a healthcare organization, the more you realize that everyone in the hospital has their own ideas about what's most important in QI.
Due to standards for accreditation and publically reported performance measures, most healthcare organizations will focus on the following issues:
1. Patient safety and adherence to National Patient Safety Goals and preventing sentinel events
2. Infection Control (preventing healthcare acquired infections)
3. Credentialing of Providers
4. ORYX Performance measures
Of the four mentioned above, I would like to bring your attention to the ORYX measures which were developed by The Joint Commission in 1997. The idea behind using performance measures was for hospitals to collect data on specific conditions treated at their facility. Currently there are five core measure sets:
1. Acute MI
2. HF
3. Community Acquired Pneumonia (CAP)
4. Pregnancy and related conditions
5. Surgical Infection Prevention (SIP)
Additional measures to follow will include ICU, children's asthma care, and inpatient psychiatric care.
These measures have allowed for the evaluation of trends within healthcare facilities and areas in need of improvement. They also allow for the comparison of facilities with each other. The Centers for Medicare and Medicaid Services (CMS) and The Joint Commission have also worked together to align common measures. You can read about each of these measures and their development on The Joint Commission website: www.jointcommission.org
The reason I have gone into detail about ORYX measures is that these are the areas of QI that hospitals accredited by The JC are required to monitor. To date, The JC requires each organization to monitor 3 core measure sets for accreditation. The majority of the core measure sets are the "bread and butter" of hospitalist medicine and areas where we can make a difference.
Thursday, October 30, 2008
A Hospitalist's Quality Journey
Beginning My Quality Improvement Journey
In previous blogs I've talked about being involved with continuous quality improvement as part of your hospitalist practice. I've also discussed patient safety as the foundation of all QI efforts. This may sound...(Yawn)...boring, but these concepts must become part of who you are as a hospitalist. If you aren't interested in making things better, then maybe QI isn't for you.
Yes, it's going to take extra time and effort.
Yes, some of your colleagues (maybe most) will not see much value in what you do initially. There may be some that even resist your efforts, tease you, or call you names.
Yep, the road to CQI is not a journey for the faint of heart. Then again, I wouldn't be doing it if I didn't think it was going to make a world of difference for my patients (yours too!). That's what this is all about; the patient...or your mom, dad, sister, etc.
In previous blogs I've talked about being involved with continuous quality improvement as part of your hospitalist practice. I've also discussed patient safety as the foundation of all QI efforts. This may sound...(Yawn)...boring, but these concepts must become part of who you are as a hospitalist. If you aren't interested in making things better, then maybe QI isn't for you.
Yes, it's going to take extra time and effort.
Yes, some of your colleagues (maybe most) will not see much value in what you do initially. There may be some that even resist your efforts, tease you, or call you names.
Yep, the road to CQI is not a journey for the faint of heart. Then again, I wouldn't be doing it if I didn't think it was going to make a world of difference for my patients (yours too!). That's what this is all about; the patient...or your mom, dad, sister, etc.
Wednesday, October 29, 2008
The Hospitalist Practice Patient Safety Review
Performing a Patient Safety Review
It may be reasonable to say that patient safety is the foundation of all medical quality practices. Making sure the right structures (i.e. staffing levels, equipment, and environment of care) and processes (policy, training, safety procedures) are in place for hospitalist practices is a good place to start in your efforts of quality improvement. This can become part of your practice by performing a "Patient Safety Review" at each of your administrative meetings. This way, everyone in your practice is aware of current patient safety goals as well as any problematic areas. In order to do this most effectively, a member of the hospitalist team should serve as a champion for patient safety and quality. This individual can serve as a liaison with hospital administration and keep everyone up to date.
Safety and Quality Standards
By far, the Joint Commission is the most well known organization that has set standards for healthcare in the area of safety and quality (http://www.jointcommission.org/). The Joint Commission is an independent, not-for-profit organization which evaluates more than 15,000 health care organizations and provides a framework which standardizes quality practices in U.S. hospitals as well as internationally. Organizations which earn Joint Commission accreditation have been evaluated in the last 3 years by an onsite survey.
Any hospitalist which has been a part of this process understands how involved a survey can be! However, instead of looking at the JC efforts as a policing body which is looking to penalize organizations which don't measure up, we should see it as an organization which has our patients (and our) best interests in mind. The JC are champions of the continuous quality improvement (CQI) process which I mentioned in a previous blog. Part of their philosophy is that safety and quality are ongoing efforts in every healthcare facility and should be continuously evaluated. They also want to ensure that the appropriate committee and administrative structures are in place to address quality and safety issues.
Next Steps
If your hospital is not JC accredited, consider meeting with your hospital administration and discuss the benefits that would occur as a result. In the meantime, visit the Joint Commission website (http://www.jointcommission.org/) and review their national patient safety goals for hospitals. Determine how you can apply these goals to your practice in hospital medicine and share this information with your colleagues!
It may be reasonable to say that patient safety is the foundation of all medical quality practices. Making sure the right structures (i.e. staffing levels, equipment, and environment of care) and processes (policy, training, safety procedures) are in place for hospitalist practices is a good place to start in your efforts of quality improvement. This can become part of your practice by performing a "Patient Safety Review" at each of your administrative meetings. This way, everyone in your practice is aware of current patient safety goals as well as any problematic areas. In order to do this most effectively, a member of the hospitalist team should serve as a champion for patient safety and quality. This individual can serve as a liaison with hospital administration and keep everyone up to date.
Safety and Quality Standards
By far, the Joint Commission is the most well known organization that has set standards for healthcare in the area of safety and quality (http://www.jointcommission.org/). The Joint Commission is an independent, not-for-profit organization which evaluates more than 15,000 health care organizations and provides a framework which standardizes quality practices in U.S. hospitals as well as internationally. Organizations which earn Joint Commission accreditation have been evaluated in the last 3 years by an onsite survey.
Any hospitalist which has been a part of this process understands how involved a survey can be! However, instead of looking at the JC efforts as a policing body which is looking to penalize organizations which don't measure up, we should see it as an organization which has our patients (and our) best interests in mind. The JC are champions of the continuous quality improvement (CQI) process which I mentioned in a previous blog. Part of their philosophy is that safety and quality are ongoing efforts in every healthcare facility and should be continuously evaluated. They also want to ensure that the appropriate committee and administrative structures are in place to address quality and safety issues.
Next Steps
If your hospital is not JC accredited, consider meeting with your hospital administration and discuss the benefits that would occur as a result. In the meantime, visit the Joint Commission website (http://www.jointcommission.org/) and review their national patient safety goals for hospitals. Determine how you can apply these goals to your practice in hospital medicine and share this information with your colleagues!
Tuesday, October 28, 2008
Where to Start: Developing a Hospitalist QI Plan
Defining Quality
The Institute of Medicine report To Err Is Human: Building a Safer Health System (IOM 1999) defines quality of care as the "degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." As hospitalists interested in quality improvement we should seek to identify and define successful practice processes with "desired health outcomes". This concept can be attributed to Donabedian who described the structure-process-outcome linkage model of healthcare quality.
Hospitalist Motto: Safety First!
When performing a quality analysis of your hospitalist practice, a good place to start is with the area of Patient Safety. Patient safety can be viewed as the foundation of quality in healthcare and it goes hand in hand with all other quality improvement initiatives. A good motto for hospitalists and all healthcare providers is, "Safety first!". The bottom line is, "If you ain't got safety, you ain't got nothin but trouble". All of us in hospitalist medicine will experience a failed healthcare process. When this happens, we need to get off the sidelines, roll up our sleeves, and be involved in the process of improving the parts of the failed system.
Until we deal with basic patient safety issues and make this our first priority, we should not move forward to improve other elements of quality in our practice. The other elements of quality (timeliness, desired outcomes, "patient centeredness") will all follow our efforts in the area of patient safety.
Is your practice ready for a "Safety Review"? We will discuss patient safety in future blogs as well as the other indicators of quality.
The Institute of Medicine report To Err Is Human: Building a Safer Health System (IOM 1999) defines quality of care as the "degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." As hospitalists interested in quality improvement we should seek to identify and define successful practice processes with "desired health outcomes". This concept can be attributed to Donabedian who described the structure-process-outcome linkage model of healthcare quality.
Hospitalist Motto: Safety First!
When performing a quality analysis of your hospitalist practice, a good place to start is with the area of Patient Safety. Patient safety can be viewed as the foundation of quality in healthcare and it goes hand in hand with all other quality improvement initiatives. A good motto for hospitalists and all healthcare providers is, "Safety first!". The bottom line is, "If you ain't got safety, you ain't got nothin but trouble". All of us in hospitalist medicine will experience a failed healthcare process. When this happens, we need to get off the sidelines, roll up our sleeves, and be involved in the process of improving the parts of the failed system.
Until we deal with basic patient safety issues and make this our first priority, we should not move forward to improve other elements of quality in our practice. The other elements of quality (timeliness, desired outcomes, "patient centeredness") will all follow our efforts in the area of patient safety.
Is your practice ready for a "Safety Review"? We will discuss patient safety in future blogs as well as the other indicators of quality.
Getting Involved in Continuous Quality Improvement
Hospitalists are in a Unique Position to Influence Quality
As Hospitalists we are in a unique position to influence the processes of care for our patients. This is due to the fact that we are in the trenches of bedside medicine and have a good understanding of how the hospital runs. We are experts at the "nuts and bolts" of the admission process, patient hospitalization issues, and discharge processes. We also pride ourselves on providing exceptional care for our patients based on the best medical evidence.
How are we doing with monitoring our quality of care?
Having been in the practice of hospital medicine for over 6 years, I know how easy it is to go along with the current processes of care. We are creatures of habit and we find our routines very comfortable. However, if we want to be exceptional providers of inpatient care, shouldn't we be continuously monitoring our practices and striving for better results? How do we do this?
This is what Continuous Quality Improvement (CQI) is all about. It is the process of continuously evaluating our practices to improve the care for our patients. This is a cycle that never ends, but continues indefinitely with the goal of striving for excellence in our field. This blog is dedicated to the concept of CQI in the field of Hospitalist Medicine. I hope that this blog will provide a forum for discussing topics on quality. I also would like to share my experiences in QI as well as ongoing projects.
As Hospitalists we are in a unique position to influence the processes of care for our patients. This is due to the fact that we are in the trenches of bedside medicine and have a good understanding of how the hospital runs. We are experts at the "nuts and bolts" of the admission process, patient hospitalization issues, and discharge processes. We also pride ourselves on providing exceptional care for our patients based on the best medical evidence.
How are we doing with monitoring our quality of care?
Having been in the practice of hospital medicine for over 6 years, I know how easy it is to go along with the current processes of care. We are creatures of habit and we find our routines very comfortable. However, if we want to be exceptional providers of inpatient care, shouldn't we be continuously monitoring our practices and striving for better results? How do we do this?
This is what Continuous Quality Improvement (CQI) is all about. It is the process of continuously evaluating our practices to improve the care for our patients. This is a cycle that never ends, but continues indefinitely with the goal of striving for excellence in our field. This blog is dedicated to the concept of CQI in the field of Hospitalist Medicine. I hope that this blog will provide a forum for discussing topics on quality. I also would like to share my experiences in QI as well as ongoing projects.
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