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Sample Essay Paper on Methods for Measuring Healthcare Quality

Methods for Measuring Healthcare Quality

The National Academy of Medicine describes quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge [3].   Both quality measurement and quality improvement increase the risk of desired health outcomes, using different but mutually supporting mechanisms (CMS, 2016).

The mechanism of quality improvement is standardization (CMC, 2016).  A quality measure is used as a tool for making “good decisions," defined as decisions that make it more likely to experience a good result and less likely to have an unforeseenor ununderstood adverse result. Selection and choice decisions based on sound quality measures increase the likelihood of desired health outcomes. 

Quality indicators are measures based on evidence used to track and examine health care outcomes and performance within an organization. Per the Agency for Healthcare Research and Quality, quality indicators allow health care organizations to determine what problems they may have that may interfere with their quality of care or standardized care(2019).

This paper aims to provide a definition and the numerical description of the measurement's construction (numerator/denominator measure counts, and the formula for the rate) of three chosen measures. It will also discuss how the measures are collected, describe how they are compared to other like settings, and explain whether the measuresare risk-adjusted or not. The paper will also describe how goals might be set for each measure in an aggressive organization that might be seeking to excel in the marketplace. This assignment's chosen measures are catheter-associated urinary infection (CAUTI), Fall risk, and central line-associated blood infection (CLABSI). The acute care hospital setting is the chosen setting for the review.

Catheter-Associated Urinary infection per 1,000 Infections (Definition of Measure)

According to the Center for Disease Control and Prevention(2009), urinary tract infections account for more than 30% of infections reported by acute care hospitalsand are the most common type of healthcare-associated infection.Almost all healthcare-associated UTIs are caused by instrumentation of the urinary tract. Catheter-associated urinary tract infection (CAUTI) has been associated with increased morbidity, mortality, hospital cost, and length of stay. Moreover, bacteriuria commonly leads to unnecessary antimicrobial use, and urinary drainage systems are often reservoirs for multidrug-resistant bacteria and a source of transmission to other patients.

CAUTI can bedefined as an indwelling urinary catheter otherwise regarded as a drainage tube inserted into the urinary bladder through the urethra, left in place, and connected to a closed collection system. Study shows that between 15% and 25% of hospitalized patients may receive short-term indwelling urinary catheters.12,13 [J1] In many cases, catheters are placed for inappropriate indications, and healthcare providers are often unaware that their patients have catheters, leading to prolonged, unnecessary use (CDC 2009). The prevalence of urinary catheter use in residents in long-term care facilities in the United States is 5%, representing approximately 50,000 residents with catheters at any given time. This number appears to be declining over time, likely because of federally mandated nursing home quality measures. However, the high prevalence of urinary catheters in patients transferred to skilled nursing facilities suggests that acute care hospitals should focus more efforts on removing unnecessary catheters prior to transfer (CDC, 2009). According to JCHO, (2012) it is imperative toimplement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI) and reduce the CAUTI infection rate per 1000 patients within a year to less than 5

Numerical Description of Measurement/Formula

This measure calculates the total number of healthcare-associated CAUTI among patients in bedded in-patient care locations, from the total number of indwelling urinary catheter days for each location under surveillance for CAUTI during the associated data period. This measure is risk-adjusted (CMS, 2012)

 

The total number of observed healthcare-associated CAUTI among patients in bedded in-patient care locations divided by the total number of predicted healthcare-associated CAUTI among in-patient carelocations under surveillance for CAUTI during the data period, based on thenational CAUTI baseline data is calculated using the facility’s number ofcatheter days (CMs, 2012).

Collection of Data

The measures’ datawascollected chart audit through [J2] HER, Medical Record, Paper Medical Records, Electronic Clinical Data, and CDC NHSN. The data is collected by tracking patient data, randomly selecting a certain number of patients’ clinical information (patient with an indwelling catheter) over a set amount of time, such as a week or month. Additionally, clinical data, such as labs and the types of antibiotics that are being used. [J3] 

Measurement Compared to like Settings

Comparing to other externally acute care settings, every facility caring for patients with catheter-associated urinary infection according to evidence base might also be tracked in a similar way. Based on the setting, other issues may be involved in tracking CAUTI events.  For instance, though the chosen setting is an acute care hospital, differentsimilar acute care settings might also be tracked in a similar manner. Still, other factors might also be added to the method by which the data is collected, or the exclusion andinclusion criteria for the patients might differ. However, the formula is still used across settings as the results allow the organization to areas that need improvement and where they are compared to other facilities providing similar care.

Risk Adjustment

According to the Centers for Medicare and Medicaid Services (2017), quality reporting measures and quality indicators are adjusted by the respective hospital. Health facilities are responsible and accountable for adhering to guidelines or policies relating to tracking and reporting data. Individual facilities do not make their adjustments but must follow the instructions set forth by the agency (CMS, 2017).

The setting of Goals for Measure in an Aggressive Organization

In an aggressive organization, understanding what quality means to the organization is vital before setting the goals for specific measures. The organization must be mindful of areas in which care practices need improvement and follow the recommendations of various governmental agencies, such as the Center for Medicare and Medicaid Services and the Center for Disease and Preventions. The patrons are an essential element for the success of the facility and the quality of care. An aggressive organization must be accurate with its documentation, allow its data to be tracked, and be transparent and report problems concerning care, such as CAUTI rate, mortality, readmissions, and infection rates.

Fall

Each year, between 700,000 and 1,000,000 people in the United States fall in the hospital (AHRQ, 2016). A patient fall is defined as an unplanned descent to the floor with or without injury to the patient.Even when a patient lands on a surface, one does not expect to find a patient,all unassisted and assisted falls are to be included, whether they result from physiological reasons (fainting) or environmental reasons (slippery floor). Moreover, patients that roll off a low bed onto a mat are to be reported as falls.  A fall may result in fractures, lacerations, or internal bleeding, leading to increased health care utilization (AHRQ, 2016). As of 2008, the Centers for Medicare & Medicaid Services (CMS) does not reimburse hospitals for certain types of traumatic injuries that occur while a patient is in the hospital. Many of these injuries could occur after a fall. Nevertheless, research shows that close to one-third of falls can be prevented (AHRQ, 2016). Fall is the amount of in-patient hospital falls per 1,000 occupied bed days by month (Institute for Healthcare Improvement, 2019). The goal is to reduce it by 85% fall per 1,000 days within 12 months period (NDNQI, 2012). 

Numerical Measurement/Formula

The formula is constructed by taking the total number of cases within a specific time frame (IHI, 2019). The number in-patient of falls occurring divided by the total number of falls by the number of occupied bed days for the month (AHRQ, 2012).

Data Collection

The data is collected by tracking the fall rates for several months. The organization's quality control department and/or hospital educator follows the information and a chart created to keep the data flow. The data is then tracked and updated for CMS and other agencies to survey during the reporting of the data.

Measurement Compared to like Settings

As mentioned earlier, the measures are calculated using the same formula in the organization's other in-patient rehabilitation hospitals. Using the same formulas makes it easier to see and compare the clinical data of the other hospitals providing similar care. If other hospitals have a lower rate of falls, the organizations may oblige to share their methods of prevention with other facilities to help in reducing or eliminating such cases, as they can affect a facility's quality measure scores.

Risk-Adjusted Measurement

Again, the risk adjustments, if any, are carried out by the Centers for Medicare and Medicaid Services (CMS, 2017). Individual health care facilities have to keep abreast of changes if any are made to the measures. It is also in the interest of health care facilities to be updated or adjust their policies and procedures for tracking the measures as they might also affect the quality of care provided and received.

Measurement in an Aggressive Organization

An organization that is seeking to excel within the healthcare market needs to have standards of practice in place. The organization must adopt core or quality measures set by the Centers for Medicare and Medicaid Services and efficiently and effectively track the measures. It also has to perform research and/or consult with other entities providing similar services to gain insight into benchmarks and the success or failures of certain aspects of care.

Central Line-Associated Blood Stream Infection

CDC (2020)and Hadaddin, Annamaraju, and Regunnat (2020)describe a central line-associated bloodstream infection (CLABSI) as a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of central line placement. Of all the healthcare-associated infections, CLABSIs are associated with high-cost burden, accounting for approximately $46,000 per case. Most cases are preventable with proper aseptic techniques, surveillance, and management strategies. Based on the National Healthcare Safety Network (NHSN) data from January 2006 to October 2007, the order of selected pathogens associated with causing CLABSI are as follows. Gram-positive organisms (coagulase-negative staphylococci, 34.1%; enterococci, 16%; and Staphylococcus aureus, 9.9%) are the most common, followed by gram negatives (Klebsiella, 5.8%; Enterobacter, 3.9%; Pseudomonas, 3.1%; E.coli, 2.7%; Acinetobacter, 2.2%), Candida species (11.8%), and others (10.5%) (Hadaddin, Annamaraju, and Regunnat, 2020). In the United States, the CLABSI rate in intensive care units (ICU) is estimated to be 0.8 per 1000 central line days. Although a 46% decrease in CLABSIs occurred in hospitals across the U.S. from 2008-2013, an estimated 30,100 central line-associated bloodstream infections (CLABSI) still occur in intensive care units and wards of U.S. acute care facilities each year. CLABSIs are serious infections, typically causing a prolongation of hospital stay and increased cost and risk of mortality (CDC, 2020).Over time, the goal is to decrease the number of catheter-associated infections by 85% per 1000events (CDC 2020).

Compared to Like Settings

The method for tracking and monitoring CLABSI is standard across the organization’s hospitals. A laboratory-tracked and confirmed bloodstream infection where an eligible BSI organism is identified, and an eligible central line is present on the LCBI DOE or the day before. [J4] The information is tracked using the same method, as the computer system automatically tracks the information and alerts technicians of the possible presence of pathogens. The nurse on the unit is then called to report “Critical lab. Findings” on the catheter sent for evaluation. The CLABSI rate per 1000 central line days is calculated by dividing the number of CLABSIs by the total number of central line days and multiplying the result by 1000. Likewise, the Central Line Utilization Ratio is calculated by dividing the number of central line days by the number of patient days CDC, 2020).

Risk Adjustment

Risk adjustments, if any, are performed by the Centers for Medicare and Medicaid Services. The organization has its internal adjustments made to workplace-related CLABSI, but in relation to tracking quality measures and indicators, the hospital follows CMS and its recommendations. It is up to the organization to ensure it follows updated information for guidelines and complying with CMS's rules and regulations.

Goal-setting Measures

An organization working to excel in the market might want to have its vision, mission, and goals in alignment with the rules of the regulatory agencies. The rules of governmental agencies will have to be adhered to as well as ensuring that accurate reporting and improvements are made. The organization will also have to comply with its own set of rules and regulations to ensure the safety of the patients and others entrusted into its care.

Generally, the need for quality indicators and measures are crucial to health care and across the health care continuum. Health care facilities must be transparent with their data as it can and may impact the care given and care received. Tracking and reporting information with the right agency or government-designated facility is significant for improving the quality of care for the health organization, its surrounding communities, and the population in which it serves.

 

References

AHRQ. (2013).Overview: Preventing falls in hospitals. https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtkover.html.

Agency for Healthcare Research and Quality. (2019). Get to know the AHRQ quality indicators.https://www.qualityindicators.ahrq.gov/

CDC, (2019). Guideline for prevention of catheter-associated urinary tract infections.     

           https://www.cdc.gov/infectioncontrol/guidelines/cauti/background.html

CMS. (2016). National Healthcare Safety Network (NHSN) catheter-associated urinary tract infection (CAUTI) outcome measure. Measure Inventory tools.   https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Acute-InpatientPPS/HAC-Reduction-Program.

Hadaddin Y, Annamaraju P, and Regunnat H. (2020). Central line associated blood stream infections (CLABSI)  StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK430891/

Institute for Healthcare Improvement. (2019). High-alert adverse drug events per 1,000 doses.http://www.ihi.org/resources/Pages/Measures/HighAlertAdverseDrugEventsper1000Doses.aspx

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