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The Health IT Workforce Curriculum was developed for U.S. community colleges to enhance workforce training programmes in health information technology. The curriculum consist of 20 courses of 3 credits each. Each course includes instructor manuals, learning objectives, syllabi, video lectures with accompanying transcripts and slides, exercises, and assessments. The materials were authored by Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, and University of Alabama at Birmingham. The project was funded by the U.S. Office of the National Coordinator for Health Information Technology. All of the course materials are available under a Creative Commons Attribution Noncommercial ShareAlike (CC BY NC SA) License. The course description, learning objectives, author information, and other details may be found at http://archive.org/details/HealthITWorkforce-Comp02Unit07. The full collection may be browsed at http://knowledge.amia.org/onc-ntdc or at http://www.merlot.org/merlot/viewPortfolio.htm?id=842513.
The Health IT Workforce Curriculum was developed for U.S. community colleges to enhance workforce training programmes in health information technology. The curriculum consist of 20 courses of 3 credits each. Each course includes instructor manuals, learning objectives, syllabi, video lectures with accompanying transcripts and slides, exercises, and assessments. The materials were authored by Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, and University of Alabama at Birmingham. The project was funded by the U.S. Office of the National Coordinator for Health Information Technology. All of the course materials are available under a Creative Commons Attribution Noncommercial ShareAlike (CC BY NC SA) License. The course description, learning objectives, author information, and other details may be found at http://archive.org/details/HealthITWorkforce-Comp02Unit07. The full collection may be browsed at http://knowledge.amia.org/onc-ntdc or at http://www.merlot.org/merlot/viewPortfolio.htm?id=842513.
The Health IT Workforce Curriculum was developed for U.S. community colleges to enhance workforce training programmes in health information technology. The curriculum consist of 20 courses of 3 credits each. Each course includes instructor manuals, learning objectives, syllabi, video lectures with accompanying transcripts and slides, exercises, and assessments. The materials were authored by Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, and University of Alabama at Birmingham. The project was funded by the U.S. Office of the National Coordinator for Health Information Technology. All of the course materials are available under a Creative Commons Attribution Noncommercial ShareAlike (CC BY NC SA) License. The course description, learning objectives, author information, and other details may be found at http://archive.org/details/HealthITWorkforce-Comp02Unit07. The full collection may be browsed at http://knowledge.amia.org/onc-ntdc or at http://www.merlot.org/merlot/viewPortfolio.htm?id=842513.
Lecture b This material (Comp2_Unit7b) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. Quality Measurement and Improvement Learning Objectives Define healthcare quality and the major types of quality measures: structural, process, and outcome measures (Lecture a) Describe the current state of healthcare quality in the United States (Lecture a) Discuss the current healthcare quality measures used in various healthcare settings in the US, including those required for the HITECH meaningful use program (Lecture b) Describe the role of information technology in measuring and improving healthcare quality (Lecture c) Describe the results of current healthcare quality efforts in the US (Lecture c) 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b Sampling of Current Quality Programs and Measures Warning: There are many sets and acronyms, and they change constantly We are still early in the science of quality improvement (Berwick, 2008) Science defined in an IOM report (2006) Many measurements in use (Damberg, 2011) but still need improvement (Pronovost, 2011)
Many measures have been developed, reflecting various perspectives AHRQ maintains clearinghouse www.qualitymeasures.ahrq.gov Growing consensus that standard sets are needed for each perspective
We will view them from following perspectives Health plans Outpatient Inpatient Quality measures in HITECH Stage 1 meaningful use program 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b Quality Reporting for Health Plans Called out because of historic role Health Plan Employer Data and Information Set (HEDIS) by NCQA provides 60 measures that evaluate health plans, particularly health maintenance organizations NCQA annual reports calculate lives saved based on outcomes from adherence 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b HEDIS Categories and Example Measures Effectiveness of care Childhood and adult immunizations Use of beta blockers after myocardial infarction Screening for various types of cancer Comprehensive diabetes care
Access/availability of care Access to preventive health services Availability of primary care providers Initiation of prenatal care
Satisfaction with care Member satisfaction surveys
Use of service Rate trends 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b Reporting for Outpatient Setting In US, major efforts led by Centers for Medicare and Medicaid Services (CMS, www.cms.hhs.gov) in Medicare program Physician Quality Reporting System (PQRS, formerly PQRI, http://www.cms.hhs.gov/pqri/) Extra 1% reimbursement for reporting on large number of measures (194 in 2011) Also receive 0.5% for maintenance of certification Bonus changes to penalty starting in 2015 Electronic Prescribing (eRx) Incentive Program (http://www.cms.gov/ERxIncentive/ ) Extra 1% reimbursement for use of e-prescribing Bonus continues through 2013; penalty starts in 2012 These quality measures are separate from meaningful use regulations, for which the Government Accountability Office (GAO, 2011) has criticized CMS for inconsistencies across the programs 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b Some example PQRS measures Hemoglobin a1c poor control in diabetes mellitus Percentage of patients aged 18 to 75 years with diabetes mellitus who had most recent hemoglobin A1c greater than 9.0%
Thoracic surgery: recording of clinical stage for lung cancer and esophageal cancer resection Percentage of surgical patients aged 18 years and older undergoing resection for lung or esophageal cancer who had clinical TNM staging prior to surgery
Weight assessment and counseling for children and adolescents Percentage of children 2 to 18 years of age whose weight is classified based on BMI percentile for age and gender 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b Reporting for inpatient setting Hospital Quality Alliance (HQA, www.hospitalqualityalliance.org) Collaboration among CMS, Joint Commission, and others to create a starter set of quality measures for various conditions In Hospital Compare Project, hospitals voluntarily provide quality information that can be accessed via a Web sitewww.hospitalcompare.hhs.gov Consists of two programs based on reporting to CMS Inpatient Quality Reporting (IQR) for HQA data; not participating results in 2% Medicare reimbursement reduction Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) reporting of patient satisfaction at hospitals 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b HQA Categories and Examples Myocardial infarction Aspirin at arrival and discharge Inpatient mortality
Heart failure Discharge instructions Evaluation of left ventricular systolic function
Pneumonia Time to blood cultures and antibiotics Pneumococcal and influenza vaccinations
Surgical infection prevention Prophylactic antibiotics Prophylaxis for deep venous thrombosis
Childrens asthma care Reliever medication while hospitalized Home Management Plan of Care Document 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b Other Inpatient Quality Initiatives National Surgical Quality Improvement Program (NSQIP www.acsnsqip.org) Effort of American College of Surgeons to measure, risk-adjust, and improve quality of surgical care University HealthSystem Consortium (UHC www.uhc.edu) Quality measurements to benchmark academic medical centers Measured by green dots and red dots ( to 2) 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b Clinical Quality Measures and Meaningful Use (Blumenthal, 2010) One of the five healthcare goals for meaningful use is improving quality, safety, and efficiency One of the 15 core measures for eligible professionals (EPs) is reporting of clinical quality measures to CMS or the states One of the 14 core measures for eligible hospitals (EHs) is reporting of clinical quality measures to CMS or the states 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b Specific Quality Measures in Meaningful Use Criteria EPs must report on 3 core measures Can substitute alternate core measures if denominator of any core measure is 0 3 of 38 additional measures EHs must report on 15 measures Reporting by attestation in 2011 and provision of data in 2012 and beyond CMS aims to align all quality reporting programs, i.e., PQRI, CHIPRA, IQR, etc. 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b EP core/alternative quality measures Core Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention Adult Weight Screening and Follow-up Alternative Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older Childhood Immunization Status
13 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b EP additional quality measures (1-12) 1. Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment 2. Appropriate Testing for Children with Pharyngitis 3. Asthma Assessment 4. Asthma Pharmacologic Therapy 5. Breast Cancer Screening 6. Cervical Cancer Screening 7. Chlamydia Screening for Women 8. Colorectal Cancer Screening 9. Controlling High Blood Pressure 10. Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) 11. Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL- Cholesterol 12. Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b EP additional quality measures (13-25) 13. Diabetes: Blood Pressure Management 14. Diabetes: Eye Exam 15. Diabetes: Foot Exam 16. Diabetes: Hemoglobin A1c Control (<8.0%) 17. Diabetes: Hemoglobin A1c Poor Control 18. Diabetes: Low Density Lipoprotein (LDL) Management and Control 19. Diabetes: Urine Screening 20. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care 21. Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy 22. Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 23. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 24. Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation 25. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b EP additional quality measures (26-38) 26. Ischemic Vascular Disease (IVD): Blood Pressure Management 27. Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control 28. Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic 29. Low Back Pain: Use of Imaging Studies 30. Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer 31. Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients 32. Pneumonia Vaccination Status for Older Adults 33. Prenatal Care: Anti-D Immune Globulin 34. Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) 35. Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation 36. Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients 37. Smoking and Tobacco Use Cessation, Medical Assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies 38. Use of Appropriate Medications for Asthma 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b EH quality measures Anticoagulation overlap therapy Emergency Department Throughput admitted patients Admission decision time to ED departure time for admitted patients Emergency Department Throughput admitted patients Median time from ED arrival to ED departure for admitted patients Incidence of potentially preventable venous thromboembolism Intensive Care Unit venous thromboembolism prophylaxis Ischemic or hemorrhagic stroke Antithrombotic therapy by day 2 Ischemic or hemorrhagic stroke Rehabilitation assessment Ischemic or hemorrhagic stroke Stroke education Ischemic stroke Anticoagulation for atrial fibrillation/flutter Ischemic stroke Discharge on anti-thrombotics Ischemic stroke Discharge on statins Ischemic stroke Thrombolytic therapy for patients arriving within 2 hours of symptom onset Platelet monitoring on unfractionated heparin Venous thromboembolism discharge instructions Venous thromboembolism prophylaxis within 24 hours of arrival 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b Quality Measurement and Improvement Summary Lecture b Many different healthcare quality measures are used in a variety of settings from health plans to inpatient to outpatient Health plans most commonly have quality assessed using the HEDIS measures of NCQA Outpatient settings most often use measures in the PQRS program Inpatient settings have a variety of measures, but most commonly used are those of the HQA One of the core meaningful use criteria for EPs and EHs is a series of quality measures
18 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b Quality Measurement and Improvement References Lecture b References Anonymous. (2006). Performance Measurement: Accelerating Improvement. Washington, DC: National Academies Press. Anonymous. (2011). CMS Should Address Inconsistencies in Its Two Incentive Programs That Encourage the Use of Health Information Technology. Washington, DC: Government Accountability Office. Retrieved from http://www.gao.gov/new.items/d11159.pdf Berwick, D. (2008). The science of improvement. Journal of the American Medical Association, 299, 1182-1184. Blumenthal, D., & Tavenner, M. (2010). The meaningful use regulation for electronic health records. New England Journal of Medicine, 363, 501-504. Damberg, C., Sorbero, M., Lovejoy, S., Lauderdale, K., Wertheimer, S., Smith, A., . . . Schnyer, C. (2011). An Evaluation of the Use of Performance Measures in Healthcare. Santa Monica, CA: RAND Corp. Retrieved from http://www.rand.org/pubs/technical_reports/TR1148.html Pronovost, P., & Lilford, R. (2011). A road map for improving the performance of performance measures. Health Affairs, 30, 569-573.
19 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Quality Measurement and Improvement Lecture b