Quality improvement. The reference for this presentation, unless otherwise noted, is Chapter 17 of the optional Hoyt text. When compared to other countries, health care in the US is expensive. However, healthcare spending in the US is not associated with increased longevity, when compared to other countries. A national quality strategy has been launched in the US to address concerns about these high costs. Less than optimal care, and patient safety in the US healthcare system. In this presentation we'll consider national healthcare goals and some informatic strategies for achieving them. The key points we'll cover are National Strategy goals, also known as the triple aim. Inter-professional multi-level technology-based intervention, changing payment models, and informatics solutions. Key point one, in March 2011 on national strategy for quality improvement and healthcare was created. To improve the delivery of healthcare services, patient health outcomes, and population health. The three major goals of the national quality strategy are, Better Care, to improve the overall quality of care by making health care more patient centered, reliable, accessible, and safe. Healthy People and Communities, to improve the health of the US population. By supporting proven interventions to address behavioral, social and environmental determinants of health in addition to delivering higher quality care. Affordable Care, to reduce the cost of quality heathcare for individuals, families, employers and government. Improving healthcare quality is a complex challenge. And health IT offers promising strategies. However, measuring quality is difficult, and many data sources may be required to measure quality indicators. A comprehensive unified approach, brings together health and human services agencies and programs and the private sector. Using the national quality strategy as a framework for quality measurement, measure development, and analysis of quality improvement. All of this in an attempt to tackle the biggest healthcare quality issues in a coordinated way. They've begun this process with heart disease and stroke. Two of the leading causes of death in the United States. Key point two, a multi-faceted technology based intervention called Million Hearts. Is a national initiative that was launched by the Department of Health and Human Services in September of 2011. The goal is to prevent one million heart attacks and strokes by 2017. Million Hearts brings together communities health systems non-profit organizations , federal agencies and private sector partners from across the country. To fight heart disease and stroke. Check it out. Heart 360 was a study within the Million Hearts program. In this pharmacist-led, home blood pressure monitoring program, participants uploaded their home blood pressure measurements. Three to four times a week to the American Heart Association's Hearth 360 website. Clinical pharmacy specialists monitored the patients' blood pressure readings and adjusted medication therapy as needed. This program led to improved blood pressure control as well as increased reduction in blood pressure and improved patient satisfaction with care. This was all among patients with uncontrolled hyper, hypertension. According to Dr McGee/g, the study PI, the specific challenge was getting the data into our electronic health record. We have an electronic health record that's easy to get data out, for security reasons, very hard to get data in. As a result, the pharmacists who did this had to work in two systems. A homegrown tracking system, as well as the electronic medical record. This comment is notable, we still have a long way to go in order to use the EHR to gather important clinical information for patient monitoring. Key point 3, the triple aim goals to reduce costs while improving quality align with the notion of changing payment methods from fee for service to outcome based health care purchasing. To promote payment for quality, access, efficiency, and successful outcomes. Centers for Medicare and Medicaid Services devised quality improvement and reimbursement methodology such as pay per performance. But how should performance be defined in health care? A central goal of the National Quality Strategy is to build consensus on how to measure quality so that stakeholders can align their efforts for maximum results. In the Pay4Performance approach, in which an incentive is paid to clinicians whose patients achieve an outcome. Examples can include the number of women with a, within the target group who have had mammograms. The number of emergency room visits for asthma patients, and the percent of patients questioned about allergic reactions. Most EHRs are not able to generate Pay4Performance reports due to the complexity of the measures. Clearly a standardized approach would improve the data collection and reporting process. Hoyt and colleagues lamented the lack of standardized data for clinical reporting as follows. Ideally, data would be automatically generated from the EHR, if the data were inputted into data fields via structured templates rather than free text. Unfortunately, most clinical notes are not written using structured templates. Free text is the judicional documentation method of many of the health professions. And to date, data retrieval from free text is in its infancy, until the full functional interoperable EHR is available. Disease registries, clinical data repositories, and health information exchange may bridge the data reporting gap for outcome-based purchasing. The generation of data-driven quality improvement strategies will require robust information technology to record and transmit quality measures. Even with widespread EHR adoption, this may be challenging. Key point 4, an overarching data architecture for quality improvement is needed to advance the quality improvement agenda using EHR data. Ontologies are particularly useful in this regard. Because they create standardized data, meaningful measures, and linkages for outcomes evaluation. In this presentation we examined four key points. National quality strategy goals, a Multifaceted, multilevel technology based intervention, Changing payment models, and Informatic solutions. These key points are essential background for developing interprofessional health care informatic solutions to healthcare quality problems. [SOUND]
