LSUS MHA 707 Ch 7 - Health Care System Performance (Exam C) latest actual questions with accurate expert solutions + rationales ( LATEST RELEASE )

Health Care System Performance

Critical for organizations and the system as a whole, assessed for confidence and support

How can insights gained from evaluating health systems help?

They help drive change in professional roles, practice, and training

3 criteria for health care systems

1. Quality

2. Equity

3. Efficiency

Health care systems evaluated at the micro level

For organizations including hospitals, physician practices, long term care facilities, and other health care settings

Health care systems evaluated at the macro level

For regions, states common nations, and other large population groups

How are many health care providers and organizations assessed?

Using global measures of health outcomes such as life expectancy and mortality rates

Gold standard

A recognized best performance

Benchmark

A starting point from which to begin the comparison

structure

Meant to designate the conditions under which care is provided

Examples of structure oriented questions

- What is the nurse to patient ratio on a hospital floor?

- What is the age of the facility?

- What proportion of hospital patients do not have insurance?

Process

Activities that constitute health care usually carried out by professional personnel but also including other contributions to care, particularly by patients and their families

Outcomes

Changes, desirable or undesirable, in the health of individuals and populations that can be attributed to health care

Two types of outcomes used to assess healthcare systems

- Population health outcomes

-Clinical or healthcare associated outcomes

Population health outcomes

Generalized outcomes that are not attributed to a specific medical intervention

Clinical outcomes

Result from medical interventions for particular health conditions

Examples of population health outcomes

Population mortality or morbidity rates, used in macro level performance evals, Life expectancy, premature death rate, time loss to premature death

Life expectancy

The number of years of life that individuals in a population can be expected to live, on average

Premature death

death before the expected age of death for an individual's population

Mortality (or death) rates

Measures of the frequency of death in a defined population during a given time, often a year

crude death rate

Number of deaths from all causes for a population during a defined time period; 100,000 per population

Cause specific death rate

Number of deaths from a particular health condition (i.e. stroke) for a given population; 100,000 people

Age specific death rate

Number of deaths among individuals in a specific age group in the population; out of 100,000 people

age-adjusted death rate

Takes into account the population's age distribution when calculating mortality rate

Infant mortality rate

The number of deaths among infants between birth and exactly one year of age per all births in the population; out of 1,000 babies

Healthy Life Expectancy (HALE)

Average number of years expected to live in 'full health' by taking into account years lived in less than full health due to disease and/or injury

Quality adjusted life years (QALYs)

Emphasize the individuals perceived health status as the indicator of quality life

Disability adjusted life years (DALYs)

Combine mortality and disability measures

years of healthy life (YHL)

combines perceived health and disability activity limitation measures from the National Health Interview Survey

Who does the OECD include?

Wealthy, developed nations such as the United States, Germany, Japan, and Australia

The United States rates one of the lowest between OECD countries in which indicators?

Life expectancy, infant mortality, and years of potential life lost

Life expectancy for women in the United States

81.1 years, 30th in OECD

Life expectancy for men in the United States

76.1 years

Years of potential life lost for the United States compared to OECD countries

4296 years versus the US with 5909 years

What other factors outside of the health system contribute directly to health status and affect access to medical care?

Poverty, diet, exercise, substance use, environmental factors, and social policies

What are clinical outcomes?

Consequences of health care interventions specific to individuals who have received care

Describe the process of clinical outcomes.

It starts with the provider-patient interaction and progresses through the clinical process to outcomes

Healthcare providers and patients have been found to differ in there...

Assessment

What do clinical outcome studies indicate?

the quality of the health care received by patients

What is the first explicit step in the process of evaluating health care quality?

designing and conducting clinical outcome studies

Evidence-based medicine

The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients

What is the purpose of a systemic review?

Attempts to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer specific research question

clinical practice guidelines

statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options

The process of developing Clinical practice guidelines

- Identify and refine the subject area

-Convene and run guideline development groups

- The group assesses the evidence about the clinical question or condition

- evidence is translated into a recommendation within a clinical practice guideline

- External review of the guideline

What happens when scientific evidence is absent or inconclusive?

clinical practices are developed by consensus of experienced clinicians and other experts

Four criteria for all outcome measure....o hold providers accountable for care

- Strong evidence should exist that good medical care leads to improvement in the outcome

- the outcome should be measurable with a high degree of precision

- The risk factors should be accurately measured and associated with the outcome

- Implementation of the outcome must have little chance of inducing unintended consequences

The country's largest healthcare accreditation organization

The Joint Commission

Who are one of the largest payers of health care services in the country?

CMS

What does CMS pay for?

The covered health care services of Medicare and Medicaid beneficiaries and hospitals, nursing homes, home health agencies, end stage renal disease, hospice, and other facilities serving these beneficiaries

Number of beneficiaries under CMS

Over 100 million

CMS Quality Strategy 2016

1. Better care

2. Healthier people, healthier communities

3. Smarter spending

Quality improvements (QIs)

call Ashton prove the quality of services for Medicare and Medicaid recipients through provider accountability and public disclosure

Quality measures

Tools that help us measure or quantify healthcare processes, as outcomes, patient perceptions, and organizational structure or systems that are associated with ability to provide high quality healthcare

CMS "meaningful measures" initiative

Only assessing those core issues that are the most critical to providing high quality care and improving individual outcomes

Center for Clinical Standards and Quality (CCSQ)

Coordinates quality related activities with outside organizations, monitors the quality of Medicare and Medicaid programs, and evaluates the success of interventions

Center for Medicare Innovation (CMI)

Purpose is to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care

What is the designated federal agency for improving the safety and quality of the US health care systems?

The agency for Healthcare Research and quality (AHRQ)

National Quality Strategy

a national effort to align public and private sector stakeholders to achieve better health and health care for all Americans

Medical Expenditure Panel Survey (MEPS)

Is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States.

Consumer assessment of health care providers and systems (CAHPS)

Supports research on the patient experience with health care and assist organizations to improve the quality of care

Healthcare costs and utilization project (HCUP)

A family of health care databases that enable research on a broad range of health policy issues, including cost and quality of health services

Centers for Disease Control and Prevention (CDC)

located in the DHHS; The nation's primary government agency for developing disease prevention and control initiatives and health promotion and educational activities

Division of health care quality promotion (DHQP)

Charged with protecting patients and health care personnel and promoting safety, quality, and value in the health care system

National Institutes of Health (NIH)

Funds abroad array of external projects, is the source of much funding for clinical outcome studies that are used for evidence based medicine and clinical practice guidelines

Conditions of Participation (CoP)

Federal regulations that health care organizations must be certified as meaning

How many hospitals does the joint commission accredit?

About 77% of all US hospitals and about 88% of accredited hospitals

How are the joint commission standards developed?

With input from health care professionals, providers, subject matter experts, consumers, and government agencies

ORYX system

a tool developed by the joint commission for assessing quality in healthcare organizations

Medicare health outcomes survey (HOS)

Goal is to gather valid, reliable, and clinically meaningful health status data from the Medicare Advantage program to use in quality improvement activities

Who accredits health plans and helps government and private sector clients measure and improve quality?

National Committee for quality assurance

What has become a national standard in all organizations related to health care quality?

Transparency through publicly available reports

National Quality Forum (NQF)

A non profit organization created to improve the quality of American health care by building consensus on national priorities and goals for performance improvement

What has NQF developed?

- Standardized performance measures developed through evidence-based research and input from a broad array of stakeholders

- Building consensus among public and private health care leaders in providing proactive advice about the first national quality strategy

Does NQF have any authority to implement in standards?

No. Pairs of hospital services such as insurance companies and the Medicare program can demand compliance with these standards

Leapfrog Group

Aims at mobilizing employer purchasing power to alert America's health industry that big leaps in healthcare safety, quality, and customer value will be recognized and rewarded.

Four major programs of the leapfrog group

1. Leapfrog hospital survey

2. Leapfrog hospital safety grade

3. Leapfrog value based purchasing program

4. Leapfrog ambulatory surgery center survey

Institute for Healthcare Improvement (IHI)

A nonprofit with a mission to improve health and health care worldwide

A 100,000 lives campaign

An 18-month initiative in 2005 to decrease morbidity and mortality in US hospitals by encouraging the adoption of six safety practices

Cochran Collaboration

A nonprofit who tries to promote evidence informed health decision making by producing high quality, relevant, accessible systemic reviews and other synthesized research evidence

patient centered outcomes research institute (PCORI)

Helps people make informed health care decisions, and improve healthcare delivery and outcomes by producing and promoting high integrity evidence based information

How many people die every year from hospital errors, injuries, accidents, and infections?

440,000

How often do hospital patients develop a preventable infection?

One out of every 25 patients

Chances that a Medicare patient has of experiencing injury, harm calm or death while being hospitalized?

One in 4 chance

Patient Safety

freedom from accidental injury

To Err is Human

Brought a new perspective to health care quality assurance by supporting the importation of industrial quality improvement practices into health care settings

Healthcare associated infections (HAIs)

Infections caused by bacteria, fungi, viruses, or other pathogens and acquired by patients receiving care for another condition

nosocomial infections

Infections that were not present or incubating in the patient at the time of admission to the health care facility

How many patients have an infection related to hospital care?

one in 25

What compounds the problem of HAI control?

The increasing rate of antimicrobial ....among the major infective organisms

What has caused the development of antimicrobial resistance?

Antibiotic overuse or misuse through the prescription of the wrong drug or the wrong dose or the wrong duration

What are the foundation of efforts to prevent HAIs?

Infection control programs

Study on the effectiveness of nosocomial infection control (SENIC)

A rigorous assessment of infection control effectiveness that compared outcomes in hospitals with and without cdc style infection control programs

What did the SCENIC study find?

Infection rates were reduced by 32% among hospitals with a strong commitment to infection control

What is the joint commission now mandate as a part of infection control in each facility?

Accredited hospitals must have infection control programs similar to those recommended by cdc

national health care safety network (NHSN)

The nation's most widely used HAI tracking system; Used by more than 25,000 health care facilities

what are two major explanations for why the HAI rate is still not near zero?

- Infection control guidelines are not fully implemented in all health care facilities

- Some HAI's may not be 100 percent preventable with our current knowledge

What would be remarkably affected in reducing HAI's in US hospitals?

Improving compliance with the guidelines, but it's not always easy

Why do some hospitals struggle with reducing HAI's?

Competing priorities, declining budgets, and entrenched behaviors and beliefs about infection control

How many cases of CABSI and CAUTI are preventable with current evidence based strategies?

65 to 70% of cases

How many cases of VAP are preventable with current evidence based strategies?

55%

Equity or distributive justice

concerned with the fair allocation of benefits and burdens among those who are deserving of care and those who are in a position to pay for it