Week 7 - Access and Quality

availability: the fit between service capacity and individuals' requirements
accessibility: the fit between the locations of providers and patients
accommodation: the fit between how resources are organized to provide services and the individuals' ability to use the arrangement
affordability: individuals' ability to pay
acceptability: the compatibility between patients, attitudes about providers' personal and practice characteristics and providers' attitudes toward the clients' personal characteristics and values

Measurement of access

individual, health plan, delivery system

the individual level of measurement of access

medical services utilization relative to enabling and predisposing factors controlling for need for care

the patients assessment of the interaction with the provider

# of office visits, patient satisfaction, etc.

the delivery system of measurement of accessmeasure access in an environment contexts example: health policies or programs related to access, hospital beds per 1000 population, % of insured, household incomethe health plan of measurement of accessHEDIS: healthcare effectiveness data and information set -performance improvement tools -offered by national committee for quality assurance (NCQA) -goal: improve person-centered care -collect data directly from health plans and PPOs the five domains are: -effectiveness of care -access/availability of care -utilization -risk adjusted utilization -measures collected using electronic clinical data systemsThe ACA and Accessinsurance and access to care have increasedIf a health outcome is seen in a greater or lesser extent between populations, there isdisparityrace or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individuals ability to achievegood healthhot spotter bydr. atul gawandewhy should we pay attention to health disparitybecause it is a preventable issuehealth disparity -hospitalizations ratesresidents from lower income neighborhood>residents of higher income neighborhoodhealth disparity -infant mortality ratenon-hispanic black women > non-hispanic white womenhealth disparity -COVID-19 `discrimination, which includes racism, can lead to chronic and toxic stress, and shape social and economic factors that put some people from racial and ethnicity minority groups at increased risk for COVID-19what are some actions of reduce health disparitiesraise awareness and improve understanding of which groups are most vulnerable invest social determinants of health coordinate with the government, local agencies, and the community develop and implements effective policies and programsquality health care - IOM definitionthe degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledgequality health care - WHO definitionthe extent to which health care services provided to individuals and patient populations improve desired health outcomesNational Quality Strategytriple aims at local, state, and national levels -better care -healthy people / healthy community -affordable carewhy is quality particularly important in health care?direct impact on health outcomes such as mortality, safety, etcwhy does quality of care get paid attention to recently in health carethe difficulty of defining and measuring quality transition to patient-centered careAccording to the IOM's National Quality Strategy, what are the six prioritiesSafe Effective Patient-centered Population Health AffordableIOM Safe prioritymaking care safer by reducing harm caused in delivery of careIOM Effective prioritypromoting effective communication and coordination of care promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular diseaseIOM Patient-centered priorityensuring that each person and family is engaged as partners in their careIOM Population Health priorityworking with communities to promote wide use of best practices to enable healthy livingIOM Affordable prioritymaking quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery modelsDonabedian ModelStructure, Process, and Outcome are the levels used to examine healthcareThe Structure level of Donabedian ModelResource Input -facilities -equipment -staffing levels -staff qualifications -delivery systemthe Process level of Donabedian ModelActual Delivery of Healthcare -technical aspects of care -interpersonal aspects of carethe Outcome level of Donabedian ModelFinal Results -patient satisfaction -health status -post-operative outcomes -mortality -incidence/prevalence of diseasequality assessment (QA)measurement of quality against an established standardQuality Assurance (QA)quality improvement ongoing assessment and results of assessment for continuous quality improvementThe PDSA cycle forms the conceptual basis for continuous improvement.Plan Do Study ActPlan part of PDSA cycleidentification descriptionDO part of PDSA cycleimplement a planStudy part of PDSA cycleevaluationAct part of PDSA cycledecision making implement the changesQuality Indicator - Prevention (PQIs)a set of measures that can be used with hospital inpatient discharge data to identify quality of care for ambulatory care sensitive conditions These are conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more serious disease Example: diabetes short-/long-term complications admission rate, hypertension admission rate, heart failure admission rate, low birth weight admission rate, dehydration admission rate, community acquired admission rate, etc.Quality Indicators - Pediatric (PDIs)a set of measures that can be used with hospital inpatient discharge data to provide a perspective on the quality of pediatric healthcare...problems that pediatric patients experience as a result of exposure to the healthcare system example: neonatal mortality rate, neonatal blood streat infection rate, postoperative sepsis rate, asthma admission rate, etc.Quality Indicators - Inpatient (IQIs)a set of measures that provide a perspective on hospital quality of care using hospital administrative data....include inpatient mortality for certain procedures and medical conditions; utilization of procedures for which there are questions of overuse, underuse, and misuse; and volume of procedures for which there is some evidence that a higher volume of procedures is associated with lower mortality example: coronary artery bypass graft (CABG) mortality rate, hip replacement mortality rate, acute stroke mortality rate, etcQuality Indicators - Patient Safety (PSIs)a set of indicators providing information on potential hospital complications and adverse events following surgeries, procedures, and childbirth The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinical panel, implementation of risk adjustment, and empirical analyses example: death rate among surgical inpatients with serious treatable conditions, in hospital fall with hip fracture rate, postoperative sepsis rate, etc.Under the ACA the National Quality Strategy has three main aims`1. to make health care accessible, safe, ad patient-centered 2. to address environmental, social, and behavioral influences on health and healthcare 3. to make care more affordableUnder the ACA the Value Based Model has four main aimstransition from volume to value in health care reimbursement system based on quality measures performance score is calculated based on some domains of health care services being penalized or being incentivizedUnder the ACA what are the domains of health carepatient experience (HCAHPS) Clinical process of care measures outcomes efficiencyUnder the ACA the Accountable Care Organizations (ACOs) are groups of physicians, hospitals and other health care providers whose goals areto reduce costs, unnecessary duplications of services prevent medical errors provide the right care at the right time improve population healthUnder the ACA Patient-Centered Outcomes Research Institute (PICORI) has a mission toimprove the quality and relevance of evidence abailable to help patients, caregivers, clinicians, employers, and insurersThe American Health Care Act of 2017 had three main aimsno repeal to quality of care measurement no repeal to value-based purchasing no further repeal or replacement for quality improvement for health care