Quality Assurance and Control Flashcards

Quality Improvement Frameworks

• Quality represents the sum of product or service properties that satisfy consumer needs and increase the likelihood of desired health outcomes consistent with current professional knowledge.

• Quality Improvement (QI) is an continuous, organization-wide responsibility regardless of position or hierarchy.

• Plan-Do-Study-Act (PDSA) cycle:

  • Plan: State the intervention clearly, set schedules, create process visuals, conduct root cause analysis (RCA), review literature, and set SMART goals (Specific, Measurable, Achievable, Realistic, Time-bound).

  • Do: Begin intervention, record observations, and implement qualitative or quantitative measurement tools (surveys, focus groups, interviews).

  • Study: Analyze data to identify trends, patterns, successes, barriers, and meaning in results.

  • Act: Modify the intervention using data analysis and repeat the cycle.

• Six Sigma uses the DMAIC process (Define, Measure, Analyze, Improve, Control) to systemically monitor and reduce natural variation in process output.

The Triple Aim Framework

• Developed by the Institute for Healthcare Improvement (IHI) to simultaneously address three primary dimensions:

  • Experience of Care: Measured via patient surveys and delivery of safe, effective, timely, efficient, equitable, and patient-centered care.

  • Population Health: Measured by health outcomes (mortality, life expectancy) and disease burden of chronic conditions.

  • Healthcare Cost: Measured by total healthcare cost per member per month and utilization rates.

• controversial additions include a fourth aim focused on joy at work or health equity.

Healthcare System Cost and Disparities

• Healthcare spending in the US is projected to reach $5.96\, \text{trillion}$ of gross domestic product by 2027.

• US healthcare performance ranks 10th overall among high-income countries, ranking 9th in administrative efficiency and 10th in health outcomes.

• High expenditure does not guarantee optimal outcomes due to misallocation of care, including ordering non-indicated care or omitting indicated therapies.

• Spending concentration:

  • $5\%$ of the US population accounts for $50\%$ of all health spending.

  • $90\%$ of these high costs stem from chronic conditions (such as cardiovascular and respiratory diseases) and mental health conditions.

• Inpatient hospital costs are the largest portion of expenditures; interventions reducing length of stay, ICU stay, or mechanical ventilation duration significantly lower costs.

• High-cost regions correlate with higher concentrations of medical specialists in large cities rather than differences in outcomes.

System Access and Accountability

• Cardiopulmonary priority areas for reducing health disparities include asthma, cystic fibrosis, congestive heart failure, coronary artery disease, hypertension, COPD/smoking, lung cancer, pneumonia, tuberculosis, occupational lung disease, and sleep disorders.

• Framework for reducing health disparities focuses on improving medical care, living and working conditions, personal behavior, and economic/social opportunities.

• Centers for Medicare/Medicaid Services accountability programs:

  • Hospital Value-Based Purchasing Program: Rewards high-performing facilities and penalizes poor performance, utilizing penalty funds for reward payouts.

  • Hospital Readmissions Reduction Program: Withholds a percentage of CMS reimbursement if a facility has excess readmissions within $30\, \text{days}$ of discharge compared to the national mean.

Respiratory Care Quality, Safety, and Legal Duties

• Disease Management uses population-based strategies to identify at-risk patients, intervene with coordinated care programs, and measure outcomes using integrated healthcare systems and continuous QI.

• Institutional Quality Monitoring:

  • Utilizes annual skills checks, low/high-fidelity simulation trainers, and protocol efficacy checks.

  • Joint Commision (JCo) requires a quality assurance plan and monitors sentinel events (events resulting in death, permanent harm, or severe temporary harm).

• Safety and Disaster Preparedness:

  • Maintain direct patient environments free of impediments and secure medical gas cylinders in appropriate racks or chained containers.

  • Respiratory care roles in disaster response include triage, oxygen therapy, airway management, mechanical ventilation, infection control, and healthcare worker protection.

• Mandatory Reporting Laws establish a legally enforceable duty for healthcare workers to report suspected or confirmed abuse of vulnerable populations (minors, elderly, disabled) and criminal acts (gunshot wounds, stabbings, poisonings).