wek 3 DQ 1&2

Required TextMoin, T., Scales, C., & Sinay, T. (2014). Principles of healthcare quality management: Tools and applications. San Diego, CA: Bridgepoint Education, Inc.
Chapter 5: Data Resources
Chapter 6: Measuring Performance

ArticlesCloninger, C. R. (2011). Person-centered integrative care. Journal of Evaluation in Clinical Practice, 17(2), 371-372. doi: 10.1111/j.1365-2753.2010.01583

The full-text version of this article can be accessed through the EBSCOhost database in the Ashford University Library. This article contains information on the effects of patient centered care, which will be helpful for both discussions.

Institute of Medicine of the National Academies. (2013). U.S. health in international perspective shorter lives, poorer health[PDF file]. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2013/US-Health-International-Perspective/USHealth_Intl_PerspectiveRB.pdf

This report briefly summarizes the potential reasons for the U.S. health disadvantages and assessment of its larger implications. This will be helpful for both discussions.

Jihan, Q., & Jordan, L. (2014). Quality and performance measurement: National efforts to improve quality of care through measurement development. AANA Journal, 82(3), 184-187. ISSN: 0094-6354

The full-text version of this article can be accessed through the CINAHL database in the Ashford University Library. This article contains information performance measurement, which will be helpful for the first discussion.

U.S. Department of Health and Human Services, Office of Disability, Aging and Long-Term Care Policy. (2002). Confronting the new health care crisis: Improving health care quality and lowering costs by fixing our medical liability system [PDF file]. Retrieved from http://aspe.hhs.gov/daltcp/reports/litrefm.htm.

This paper reviews the healthcare crisis in 2002 relative to the need to improve the healthcare quality and the increasing healthcare costs, which will be helpful with the second discussion.

Van Herck, P., Annemans, L., Sermeus, W., & Ramaekers, D. (2013). Evidence-based health care policy in reimbursement decisions: Lessons from a series of six equivocal case-studies.PLoS One, 8(10), 1-10. doi:10.1371/journal.pone.0078662

The full-text version of this article can be accessed through the EBSCOhost database in the Ashford University Library. This article focuses on reimbursements, which is the focus of the second discussion question.

MultimediaIHI Open School. (2008, October 21). Defining quality: Aiming for a better health care system [Video file]. Retrieved from https://www.youtube.com/watch?v=5vOxunpnIsQ

In this video, Don Berwick describes a 2001 report by the institute of Medicine, Crossing the Quality Chasm that resulted in health care reform. This will be helpful in completing both discussions.

Thomas, T., Simpelo, V., & Pickett N. (2014). HCA 375 Week Three self-checks[Interactivity]. Ashford University, San Diego, California. Retrieved from https://bridgepoint.equella.ecollege.com/curriculum/file/95637913-3a10-4b60-adf9-f3a9f3c394e9/1/HCA375WeekThreeSelf-Check.zip/story.html

WebsiteNational Committee for Quality Assurance (NCQA). (http://www.ncqa.org/HEDISQualityMeasurement/HEDISMeasures.aspx)

The NCQA is an organization dedicated to improving healthcare quality throughout the healthcare system. The website includes information on quality measures, report cards, public policy professional development, and healthcare programs, which will be helpful with both discussions.

Recommended Resources

ArticlesClark, C. (2013). Medical error cost calculator riles AHA. HealthLeaders Media. Retrieved from http://www.healthleadersmedia.com/content/FIN-294581/Medical-Error-Cost-Calculator-Riles-AHA

This article contains information on costs of medical errors, which will be helpful for both discussions.

Crippen, D., & Barnato, A. E. (2011). The ethical implications of health spending: Death and other expensive conditions. Journal of Law and Medical Ethics, 39(2), 121-129. doi: 10.1111/j.1748-720X.2011.00582

The full-text version of this article can be accessed through the Academic Search Complete database in the Ashford University Library. This article contains information on types of payments and reimbursements, which will be helpful for the first discussion.

Jiang, H. J., Friedman, B., & Jiang, S. (2013). Hospital cost and quality performance in relation to market forces: An examination of U. S. community hospitals in the ‘post-managed care era’.International Journal of Health Care Finance and Economics, 13(1), 53-71. doi: 10.1007/s10754-013-9122-9

The full-text version of this article can be accessed through the EBSCOhost database in the Ashford University Library. This article focuses on cost and quality of care, which will be helpful for the second discussion.

Mekel, M. (2012, January). The Health Care Quality Improvement Act of 1986 meets the era of health care reform: Continuing themes and common threads. Journal of Legal Medicine, 33(1), 1-6. ISSN: 0194-7648

The full-text version of this article can be accessed through the CINAHL database in the Ashford University Library. This article contains information on laws that have effected health care reform, which will be helpful for both discussionsNicolay, C., Purkayastha, S. Greenhalgh, A., Benn, J. Chaturvedi, S., Phillips, N., & Darzi, A. (2012). Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare. British Journal of Surgery, 99(3), 324-335. doi: 10.1002/bjs.7803

The full-text version of this article can be accessed through the EBSCOhost database in the Ashford University Library. This article contains information on CQI methodologies, which will be helpful for the first discussion.

Nukols, T., Escarce, J., & Asch, S. (2013, June). The Effects of quality of care on costs: A Conceptual framework. Milbank Quarterly, 91(2), 316-353. doi: 10.1111/milq.12015

The full-text version of this article can be accessed through the Business Source Elite database in the Ashford University. This article contains information on the cost of delivering quality care, which will be helpful for the first discussion.

Simon, R., & Canacari, E. (2014, January). Surgical scheduling: A Lean approach to process improvement. AORN Journal, 99(1), 147-59. ISSN: 0001-2092 PMID: 24369979

The full-text version of this article can be accessed through the CINAHL database in the Ashford University Library. This article contains information on the CQI Model – Lean, which will be helpful for the first discussion.

Wiedemann, L. A. (2012, February). A look at unintended consequences of EHRs. Health Management Technology, 33(2), 24-25. ISSN: 1074-4770 PMID: 22397117

The full-text version of this article can be accessed through the CINAHL database in the Ashford University Library. This article contains information on HMT, which will be helpful for both discussions.

WebsitesAgency for healthcare Research and Quality (AHRQ). (http://www.ahrq.gov/)

Centers for Medicaid & Medicare Services Regulations and Guidance.(http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html)

Fallon Health. (2014). 2015 HEDIS® measures. Retrieved from http://www.fchp.org/providers/resources/hedis-measures.aspx

Healthy People. (2020). ( http://www.healthypeople.gov/2020/About-Healthy-People)

Optima Health. (2013.) 2014 HEDIS® measures: Healthcare effectiveness data and information set [PDF]. Retrieved from http://public.optimahealth.com/Lists/OptimaFormsLibrary/qi-HEDIS-definitions.pdf

Discussions
To participate in the following discussions, go to this week’s Discussion link in the left navigation. CQI Models

After reading Chapter 1 through 4, you should be familiar with quality improvement initiatives including NCQA’s HEDIS® measures. Health plans and physicians must ensure they are meeting standards set by the accreditation agencies, such as NCQA. As a physician practice manager for Dr. Jones, you have just conducted a mock survey of the patient chart data. The data shows that your physician practice is not meeting standards for two HEDIS® measures.

Choose two HEDIS® measures (from the list below either a, b, c, d, e or f) that must be implemented in a physician practice to improve patient outcomes.

Describe the sources of data needed to conduct the two measures.

Using one of the quality improvement models (Lean, PDSA, or Six Sigma), explain how you would use the model to implement the two chosen HEDIS® Measures.
Your initial post should be 250-300 words and utilize at least one scholarly source from the Ashford University Library to justify your choice of improvement models. Cite all sources in APA format as outlined in the Ashford Writing Center.

HEDIS® Measures
Hypertension/Cardiovascular:
           a. Patients who were hospitalized and discharged alive after an acute Myocardial Infarction (heart attack) who received treatment with beta-blockers for six months
               after discharge.
           b. Patients 18-85 with a diagnosis of hypertension whose most recent blood pressure reading was controlled.
               Age 18-59 whose BP was <140/90
               Age 60-85 with a diagnosis of diabetes whose BP was <140/90
               Age 60-85 without a diagnosis of diabetes whose BP was <150/90
Smoking Cessation:
         c. Current smokers seen by a physician during the year who were advised to quit, and cessation medications were recommended and discussed. Different
               cessation methods were discussed.
Weight Assessment:
           d. Patients between the ages of 3-17 who had been examined for body mass index (BMI, received counseling on nutrition. Counseling or referral for physical activity
               or indication physical activity was addressed during an outpatient visit either by a claim or as a medical record entry during the measurement year.
Mammograms:
           e. Women age 50-74 years, who have had a mammogram during the preceding 24 months. Exclusion of those women who have undergone bilateral mastectomy.
Prostate Screening:
           f. Male 50 years and greater who have received an annual PSA and/or Digital Rectal Exam.

Guided Response: Choose two classmates’ posts and respond to the following question: Do you agree or disagree with their choice of CQI Model? Give rationale why you either agree or disagree, and give one example that illustrates your answer. List at least one scholarly source to support your rationale.

Mandates and Cost

The Department of Health and Human Services has oversight of several agencies (i.e., FDA, CDC, AHRQ, NIH, CMS) that regulate health care in the United States. Regulation encompasses insurance plans, cost, research, safety, all in the name of delivering quality care in a cost effective manner. These agencies are responsible for monitoring compliance and enforcing legislative mandates. However, the debate continues on government regulation and its effect on ensuring quality care. After completing this week’s reading, review the following articles listed below, which were published 11 years apart. Analyze the cost-quality paradigm noted in the articles. Considering the many governmental mandates and regulations to reduce costs and ensure the delivery of quality care that have been implemented over the years, discuss your opinion regarding why costs have continued to rise without improving quality. List two examples that illustrate your point.

DHHS Article related to Cost and Quality (2002)Institute of Medicine article (2013)
Your initial post should be 250-300 words and utilize at least one scholarly source from the Ashford University Library that supports your point. Cite all sources in APA format as outlined in theAshford Writing Center.

Guided Response: Choose two classmates and respond to this question: Do you agree or disagree with their rationale for the disparity between cost and quality in health care. Explain your answer. List at least one scholarly source that justifies your statements.

DQ2

Your initial post should be 250-300