Healthcare Systems Continuous Quality Improvement Lecture 4 - Fall 2024 PDF

9/23/24 Healthcare Systems Continuous Quality Improvement LECTURE 4 – FALL 2024 1 1 Healthcare Settings v Inpatient o Acute care (hospital)...

9/23/24 Healthcare Systems Continuous Quality Improvement LECTURE 4 – FALL 2024 1 1 Healthcare Settings v Inpatient o Acute care (hospital) § General (teaching vs community vs public) § Specialty (ex: pediatric, cancer) § Rehabilitation o Long-term care § Assisted living § Independent living facility § Nursing facility § Residential care facility § Retirement community (rental or condo or co-op) 2 1  9/23/24 Healthcare Settings v Ambulatory Care Facilities o Hospital-based ambulatory care facilities § Ambulatory surgery § Clinics § Emergency department § Observation services o Freestanding ambulatory care facilities § Birthing centers § Neighborhood health clinics § Physician practices § Urgent care centers § School health clinics § Dialysis centers 3 Healthcare Professions o Physician o Audiologist o Physician assistant o Speech therapist o Registered nurse (also, nurse clinicians o Registered dietitian and nurse practitioners) o Social worker o Medical assistant o Physical therapist o Surgical tech o Occupational therapist o Dental hygienist o Respiratory therapist o Pharmacist o Radiation therapist o Pharm tech o More (Jones & Barlett article) o Clinical psychologist 4 2  9/23/24 Physician Specialties o Family practice o Orthopedic surgery o Anesthesiology o Plastic surgery o Pediatrics o Dermatology o Obstetrics, gynecology o Pathology o Cardiology o Neurology o Gastroenterology o Oncology o Rheumatology o Nephrology o Ophthalmology o More (Jones & Barlett article) 5 Ancillary Services v Healthcare services that support work of primary physician/team v Interdisciplinary Care Team o Speech therapist (SLP) o Physical Therapy o Occupational Therapy o Psychology o Nutrition o Social Work/Case Manager o Pain Management o Palliative Care 6 6 3  9/23/24 Continuum of Care v Primary care o Prevention and wellness o Goal is to decrease risk of illness in community o Usually in outpatient setting o Primary care provider: GP, pediatrician, NP, RDN § Vaccinations § Diet counseling § Exercise Programs § Physical exams § Wellness programs 7 Continuum of Care v Secondary care o Diagnosis and treatment of disease o Detect illness at early stage, expedite treatment o Both inpatient and outpatient services o Includes: § Colonoscopies § MRI § CT scan § Mammograms § Surgery 8 4  9/23/24 Continuum of Care v Tertiary care o Restorative or rehabilitative care o Decrease risk of permanent disability related to disease or illness o Both inpatient and outpatient services o Includes: § Physical therapy § Occupational therapy § Speech therapy § Respiratory therapy § Nutrition 9 Licensure, Accreditation, and Certification v Licensure: o Legal authority granted to perform specific acts or provide specific services, granted by government agencies usually at the state level. Both individual health care professionals and facilities (hospitals, skilled nursing facilities) require licensure. v Accreditation: o Recognition granted to an institution after it has met standards and qualifications. Accreditation is a voluntary process (but highly recommended). Accrediting agencies have been established (e.g. Joint Commission) to monitor the quality and commitment of various healthcare facilities to maintain optimal standards of care. v Certification: o Individuals and facilities have met predetermined standards of care. o Ex: RDN status, CDE, CNSC 10 5  9/23/24 Healthcare agencies, organizations, and associations (examples) v Federal Agencies; US Department of Health and Human Services o Centers for Medicare and Medicaid Services (CMS) o Food and Drug Administration (FDA) o Centers for Disease Control and Prevention (CDC) o National Institutes of Health (NIH) v Organizations and Associations o American Medical Association o American College of Surgeons o Academy of Nutrition and Dietetics (AND) o American Society for Parenteral and Enteral Nutrition (ASPEN) o American Diabetes Association o American Heart Association o American Hospital Association o World Health Organization (WHO) 11 Quality of Healthcare v Goal in healthcare is to improve patient safety and quality of of care v Six Dimensions of Care: Providing high-quality care involves o Safety o Timeliness o Effectiveness o Efficiency o Equitability o Patient-centeredness 12 6  9/23/24 Quality Indicators 13 Dimensions of Quality Relating to Nutrition Care 14 7  9/23/24 Quality Improvement v Quality Improvement (QI) projects can be initiated when clinical audits demonstrate trends or practice gaps o Define goals to be reached o Measure current performance levels to establish a baseline for comparison o Analyze current performance, focusing on which factors affect quality o Improve these factors through the implementation of appropriate performance improvement strategies v Goal is to improve a process, program, system, or performance of an individual practitioner by comparing current processes, programs, systems or performances to a set of published standards Ø Enhances overall quality of care Ø Delivery of consistent, effective, safe, patient-centered care v Examples of quality improvement projects o Evidence-based protocols o Bundled care o Order sets o Policy and procedure refinement 15 Plan-Do-Study-Act Cycle v One of the most common improvement strategies used in healthcare o PLAN: create a plan; formulate specific aims; plan for data collection and analyses; determine project timelines o DO: test the change; execute the plan; document problems, challenges, barriers; track progress against benchmarks o STUDY: review the plan; analyze data; compare results to project aims; summarize and present the data o ACT: implement the changes; go through the cycle again or implement what you learned 16 8  9/23/24 Quality Improvement vs Outcome Research v Resembles outcome research o Identify outcomes of interest o Measure è Intervene è Re-measure o Interventions: (new) protocol, bundle, order set, etc v Quality improvement v Outcome research o Data management o Data management o Focus on program, process, o Hypothesis driven protocol, systems to improve and o Requires IRB review (and identified outcome therefore takes more time) o Intended for internal (facility) use o Rigid subject protection o Can involve vulnerable o Results can be published populations so ethical considerations are important 17 Benchmarking v Organizations measure their performance against best practice organizations, internal or external to their industry v Goal: improve performance by identifying strengths and weaknesses v Benchmarking is a continuous process: best practices change with implementation of new evidence; requires continuous surveillance v Examples of benchmarking efforts headed by nutrition clinicians: o Programs to reduce the number of NPO hours after surgery o Efforts to reduce weight loss among ambulatory oncology patients by implementing a malnutrition screening tool o At NYU DPD: tracking RDN exam pass rates against a 90% first time pass- rate benchmark for excellence 18 9