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Your initial discussion thread is due on Day 3 (Thursday) and you have until Day 7 (Monday) to respond to your classmates. Your grade will reflect both the quality of your initial post and the depth of your responses. Refer to the Discussion Forum Grading Rubric under the Settings icon above for guidance on how your discussion will be evaluated.
CQI Models
Prior to beginning work on this discussion, read chapters 5 and 6 from the course text. Additionally, review the following resources:
- HEDIS Measures and Technical Resources (Links to an external site.); you must expand the Effectiveness of Care for more details on each topic below.
- Quality and Performance Measurement: National Efforts to Improve Quality of Care Through Measurement Development (Links to an external site.).
- Evidence-Based Health Care Policy in Reimbursement Decisions: Lessons From a Series of Six Equivocal Case-Studies (Links to an external site.).
- Defining Quality: Aiming for a Better Health Care System (Links to an external site.) [Video file]
After reading Chapter 1 through 4, you should be familiar with quality improvement initiatives including the National Committee for Quality Assurance (NCQA) HEDIS Measures. Health plans and physicians must ensure they are meeting standards set by the accreditation agencies, such as NCQA. As a physician practice manager for Dr. Jones, you have just conducted a mock survey of the patient chart data. The data shows that your physician practice is not meeting standards for two HEDIS measures.
- Choose two HEDIS measures from the list below that must be implemented in a physician practice to improve patient outcomes.
- You must describe the sources of data needed to conduct the two measures. What source would you use obtain the data? For example, if we were to look at patients receiving a beta blocker after discharge from the hospital, we would obtain data from pharmacy claims.
- Using one of the quality improvement models (i.e., Lean, PDSA, or Six Sigma), explain how you would use the model to implement one of the chosen HEDIS measures.
- Include information on how the quality initiatives chosen are linked to the rising costs of health care. Consider government mandates that have improved quality initiatives related to implementing the HEDIS measures or added to the burden of increased costs.
Your initial post should be 250 to 300 words and utilize at least one scholarly source from the University of Arizona Global Campus Library to justify your choice of improvement models. Cite all sources in APA format as outlined in the Writing Center’s Introduction to APA (Links to an external site.).
NCQA HEDIS Measures
Anti-Depressant Medication Management (AMM)
- Assesses adults 18 years of age and older with a diagnosis of major depression who were newly treated with antidepressant medication and remained on their antidepressant medications.
- Two rates are reported:
- Effective Acute Phase Treatment: Adults who remained on an antidepressant medication for at least 84 days (12 weeks).
- Effective Continuation Phase Treatment: Adults who remained on an antidepressant medication for at least 180 days (6 months).
Cervical Cancer Screening:
- Assesses women 21–64 years of age who were screened for cervical cancer using either of the following criteria:
- Women aged 21–64 who had cervical cytology performed every 3 years.
- Women aged 30–64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years.
Colorectal Screening:
- Assesses adults 50–75 who had appropriate screening for colorectal cancer with any of the following tests: annual fecal occult blood test, flexible sigmoidoscopy every 5 years, colonoscopy every 10 years, computed tomography colonography every 5 years, stool DNA test every 3 years.
Hypertension/Cardiovascular:
- Assesses patients 18 to 85 with a diagnosis of hypertension whose most recent blood pressure reading was controlled.
- Age 18 to 59 whose BP was <140/90
- Age 60 to 85 with a diagnosis of diabetes whose BP was <140/90
- Age 60 to 85 without a diagnosis of diabetes whose BP was <150/90
Immunization Status:
- Adolescents: Assesses adolescents 13 years of age who had one dose of meningococcal vaccine, one Tdap vaccine and the complete human papillomavirus vaccine series by their 13th birthday.
- Children: Assessed the percentage of children 2 years of age who had a four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday.
Breast Cancer Screening:
- Women aged 50 to 74 years who have had a mammogram during the preceding 24 months. Exclusion of those women who have undergone bilateral mastectomy.
Non- Recommended PSA:
- Assess whether men 70 years of age and older were screened unnecessarily for prostate cancer using prostate-specific antigen (PSA)-based screening.
Osteoporosis Testing and Management in Older Women:
- Osteoporosis Testing in Older Women: This survey-based measure assesses women 65–85 years of age who report ever having received a bone density test to check for osteoporosis.
- Osteoporosis Management in Women Who Had a Fracture: Assesses women 65–85 years of age who suffered a fracture and who had either a bone mineral density test or a prescription for a drug to treat osteoporosis in the six months after the fracture.
Persistence of Beta Blocker treatment after a Heart Attack (BPH):
- Assesses adults 18 years of age and older during the measurement year who were hospitalized and discharged alive with a diagnosis of acute myocardial infarction and who received persistent beta-blocker treatment for six months after discharge.
Medical Assistance with Smoking and Tobacco Use Cessation:
- Assesses current smokers seen by a physician during the year who were advised to quit, and cessation medications were recommended and discussed. Different cessation methods were discussed.
Weight Assessment:
- Assessed patients between the ages of 3 to 17 who had been examined for body mass index (BMI, received counseling on nutrition). Counseling or referral for physical activity or indication physical activity was addressed during an outpatient visit either by a claim or as a medical record entry during the measurement year.
- Assesses the percentage of members 18–74 years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year.
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