After Reading Chapters 1 Through 4, You Should Be Familiar W

After Reading Chapter 1 Through 4 You Should Be Familiar With Quality

After reading Chapters 1 through 4, you should be familiar with quality improvement initiatives including NCQA’s HEDIS® measures. Healthcare organizations, including health plans and physician practices, must meet standards set by accreditation agencies such as NCQA to ensure quality patient care. As a physician practice manager for Dr. Jones, you have conducted a mock survey of patient chart data indicating that your practice is not meeting standards for two HEDIS® measures. Your task is to select two measures, describe the data sources needed for each, and explain how you would apply a quality improvement model (Lean, PDSA, or Six Sigma) to implement these measures effectively. You must justify your choice of improvement model using at least one scholarly source, cite all references in APA format, and ensure your discussion is thorough and well-supported.

Paper For Above instruction

Ensuring quality in healthcare delivery remains an ongoing challenge, particularly in the context of meeting specific, measurable standards such as those defined by the Healthcare Effectiveness Data and Information Set (HEDIS®). For physician practices aiming to improve patient outcomes, selecting appropriate HEDIS® measures and applying effective quality improvement (QI) models are critical steps. This discussion focuses on two specific HEDIS® measures: the follow-up care after hospitalization for myocardial infarction (MI) with beta-blocker treatment and the measurement of blood pressure control among hypertensive patients. The data sources for these measures, as well as the application of the Plan-Do-Study-Act (PDSA) cycle—supported by scholarly literature—will be discussed in detail.

Selection of HEDIS® Measures and Data Sources

The first measure selected is the treatment of patients who were hospitalized for acute myocardial infarction (AMI) with beta-blockers for six months post-discharge. The data needed to evaluate this measure include hospital discharge records, pharmacy records indicating prescription of beta-blockers, and outpatient follow-up documentation confirming ongoing medication management. These data can be gathered from electronic health records (EHRs), pharmacy claim data, and patient visit documentation, providing a comprehensive picture of adherence to treatment protocols.

The second measure involves blood pressure control in hypertensive patients. To assess this measure, the practice must collect blood pressure readings documented during outpatient visits, either manually recorded or obtained via electronic monitoring devices integrated into the EHR system. Additional data sources include laboratory results, medication adherence records, and patient self-reports during consultations. For patients aged 60-85 with diabetes or without it, the measurements of systolic and diastolic blood pressures and information regarding antihypertensive medication use are crucial, often documented in EHRs.

Application of the PDSA Model

The PDSA cycle is an iterative Four-phase process—Plan, Do, Study, Act—that facilitates continuous quality improvement. To implement the two selected HEDIS® measures, I would employ the PDSA cycle as follows:

Plan: First, identify the specific gaps in patient care relative to both measures. For the beta-blocker post-MI measure, the plan involves establishing a protocol for medication reconciliation and follow-up appointments to ensure continued beta-blocker therapy. For blood pressure control, the plan includes standardizing measurement procedures and patient education on hypertension management. Setting measurable goals, such as a 10% improvement in adherence rates within three months, is essential.

Do: Implement the intervention, including staff training on new protocols, updating EHR prompts for medication management, and scheduling follow-up blood pressure measurements. During this phase, data is collected systematically to monitor progress.

Study: After the implementation period, analyze the collected data to determine if improvement goals were met. For instance, assess medication adherence rates, blood pressure control percentages, and patient compliance feedback. Identifying barriers, such as lack of patient education or inconsistent data recording, helps clarify the causes of poor performance.

Act: Based on the analysis, refine the protocols to address identified barriers. For example, if medication adherence improves but blood pressure control does not, additional patient education or lifestyle counseling may be integrated. Once refined, the cycle repeats to sustain gains and drive continuous improvement.

Justification of Model Choice

The PDSA cycle is particularly suited for small-scale, incremental changes often necessary in physician practices. Its iterative nature encourages continuous feedback and adaptation, which is essential for addressing the complex factors influencing patient adherence to treatment and accuracy in data collection (Taylor et al., 2014). A scholarly source supporting this choice emphasizes PDSA’s flexibility and effectiveness in primary care settings to improve clinical outcomes systematically (Langley et al., 2009).

Conclusion

In conclusion, selecting accurate data sources such as EHRs and pharmacy records is fundamental for assessing HEDIS® measures like post-MI beta-blocker treatment and blood pressure control. Employing the PDSA cycle provides a structured yet adaptable framework for implementing targeted quality interventions. This approach supports continuous learning and refinement, essential for aligning practice outcomes with accreditation standards and ultimately improving patient care quality.

References

Langley, G. J., Moen, R. D., Nolan, T. W., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd ed.). Jossey-Bass.

Taylor, M. J., McNicholas, C., Nicolay, C., et al. (2014). Systematic Review of the application of the Plan-Do-Study-Act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290–298.