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Discussion: Measurement Systems and Methods

NURS 8302 Discussion: Measurement Systems and Methods

Discussion: Measurement Systems and Methods

I have worked in numerous facilities throughout the US and abroad as a travel nurse. But, for the past 16 years, I had been working in the Military Treatment Facilities, where I was stationed in the Army, and the civilian hospitals where I would work alongside civilian nurses.

The Military Treatment Facility where I worked last was at Bayne Jones Army Community Hospital (BJACH) on Fort Polk, Louisiana. This is a 22-bed Mixed Medical Surgical ward hospital. There are a total of 4 OB Beds and 4 Operating Room suites. There is an Emergency Room and an outpatient Patient Centered Medical Home (PCMH). Most specialty services are outsourced to the surrounding civilian facilities. BJACH is one of the smaller hospitals in the Medical Health System (MHS) with very few medical and surgical services.

The MHS uses the MHS Quadruple Aim to represent and display the commitment to quality care to all of its healthcare members and serve to align with its strategic goals. Heath.mil (2017) explains that value proposition and the goals of the Quadruple aim are:

Readiness: Ensuring that the military personnel are mentally, physically and medically ready to deploy and defend the US and its Allies. The Military Medical staff are trained and ready to deliver health care anywhere, and at anytime, to include military operations and humanitarian missions.

Population Health: Provide education and prevention of illness that could prevent readiness. Encourage healthy behaviors and healthy choices and assist in the development of increased resilience.

Per Capita Cost: getting rid of waste reduction, focusing on quality care, cost of lifelong care, and avoiding change in services and care.

Experience of Care: Providing patient and family centered care that is safe, compassionate, equitable, at the highest quality, and convenient.

Experience per capita measures patient satisfaction using patient feedback in the form of survey questions. The questions focus on Access to Acute Care Appointments, Access to Routine Appointments, Care Transition, Cleanliness of Hospital Environment, Communication about Medicines, Communication with Doctors, and Communication with Nurses (Health.mil, n.d). Patient satisfaction is measured by Event-Based surveys and population surveys, which are collected as data. This Data is put into metrics which formulate a graph on a quarterly basis.

Metrics are important in healthcare be it private, community, or federal based facilities. The purpose of metrics is to focus attention on

Discussion Measurement Systems and Methods
Discussion Measurement Systems and Methods

what is important to translate the knowledge obtain into action. According to Stange, et. Al (2014), metrics can prompt us to think about the impact of the activities that are routine that needs “a looking into.” It allows the organization to see the good, the bad, and the ugly of the patient’s experience and guide the course for change in how care is delivered. Campbell, et.al (2009) purports that metrics serves three functions: performance assessment, highlight processes and outcomes, and allows reflection on purpose and goals of the organization.

Overall, BJACH is doing well for a small hospital. The PCMH has done an outstanding job in Patient’s satisfaction and meeting the goals of the Commander and the MHS. In an article written by the Fort Polk Public Affairs Office, “for three out of the last four months, Bayne-Jones Army Community Hospital has been No. 1 in overall patient satisfaction for the entire Regional Health Command — Central, as a result of beneficiary responses from the Joint Outpatient Experience Survey (BJACH Staff, 2019).

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References:

Agency for Healthcare Research and Quality. (n.d).ACTS Supports the Quadruple Aim Retrieved from https://digital.ahrq.gov/acts/quadruple-aim

Campbell, SM., Reeves, D., Kontopantelis, E., Sibbald, B. & Roland M. 2009. Effects of pay for performance on the quality of primary care in England. N. Engl. J. Med 361:368–78

Helath.mil. (n.d). Clinical Quality Measures. Retrieved from https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Quality-And-Safety-of-Healthcare/Clinical-Quality-Management/Clinical-Quality-Measures

Stiefel, M. & Nolan K. (2012). A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement.

Stange, K. C., Etz, R. S., Gullett, H., Sweeney, S. A., Miller, W. L., Jaén, C. R., Crabtree, B. F., Nutting, P. A., & Glasgow, R. E. (2014). Metrics for assessing improvements in primary health care. Annual review of public health, 35, 423–442. https://doi.org/10.1146/annurev-publhealth-032013-182438

United States Army JRTC and Fort Polk. (March, 15,2019). BJACH Ranks NO.1 in Region for Patient Satisfaction. Retrieved from://home.army.mil/polk/index.php/about/garrison-directorates-and-support-offices/public-affairs/design-test-page/news/news-you-can-use/bjach-ranks-no-1-region-patient-satisfaction

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As a home care nurse and now a home care nurse practitioner, we utilize the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey, which is used to assess and publicly report the perspectives of the patients that utilized a home health care service (Centers for Disease Control and Prevention [CDC], 2020).   The National Quality Forum endorsed the survey in March 2009 (CDC, 2020) and HHCAHPS approved vendors are tasked with conducting the survey for the home care agencies (CDC, 2020). The HHCAHPS is completed by the patient or a proxy and comprises 34-item questions that measure the patient’s perception of the skilled home care they received (CDC, 2020). The questions covered in the survey include pain, care, prescription medication, communication about scheduling, and their overall rating of the home care agency (CDC, 2020). The results of the HHCAHPS are publicly reported and can be viewed on the Medicare website.

Home health ratings are essential to a home care agency as potential patients tend to search up agency profiles to determine if they would utilize their service. A Medicare home health rating offers an official source of the quality of care provided by a skilled agency and can be the difference between patients choosing one agency over another. A home health star rating summarizes an agency’s performance and compares them to other agencies so that potential patients can make a choice (CDC, 2021). The star ratings are calculated based on data analysis and stakeholder input (CDC, 2021). There are two types of star ratings: Quality of Patient Care Star Ratings and Patient Survey Star Ratings (CDC, 2021). The Quality of Patient Care (QoPC) Star Rating is based on Medicare claims data, and the oasis assessments and the patient survey star rating are based on the Home Health CAHPS (CDC, 2021).

All Medicare-certified HHAs may potentially receive a Quality of Patient Care Star Rating. HHAs must have data for at least 20 complete quality episodes for each measure to be reported on Care Compare. Completed episodes are paired with start or resumption of care and end of care OASIS assessments. Episodes must have an end-of-care date within the 12-month reporting period regardless of the start date. To have a Quality of Patient Care Star Rating computed, HHAs must have reported data for 5 of the seven measures used in the quality of the patient care star rating calculation. The current methodology for calculating the Quality of Patient Care Star Rating can be accessed via the Downloads section below. This methodology will be updated periodically as additional refinements are made.

The Quality of Patient Star Rating measures seven key points, including improvement in ambulation (outcome measure), timely initiation of care (process measure), improvement in bed transferring (outcome measure), improvement in bathing (outcome measure), improvement in the management of oral medications (outcome measure), improvement in shortness of breath (outcome measure) and acute care hospitalization (claims-based) (outcome measure) (CDC, 2021). A Medicare-certified home health agency must have returned at least 40 surveys to be eligible to get a star rating. During meetings at our agency, when I was a case manager, we would be tasked to remind our patients to return/mail back their completed surveys as one of the issues with this type of survey is that patients do not fill or mail them back. Ratings are discussed, and our weaknesses are focused on as places to improve upon to ensure that the following survey is better.

 

References

Centers for Disease Control and Prevention (2020). Home Health CAHPS (HHCAHPS)

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/HHCAHPS

Centers for Disease Control and Prevention (2021). Home Health Star ratings.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings

 

vMain Post

As a home care nurse and now a home care nurse practitioner, we utilize the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey, which is used to assess and publicly report the perspectives of the patients that utilized a home health care service (Centers for Disease Control and Prevention [CDC], 2020).   The National Quality Forum endorsed the survey in March 2009 (CDC, 2020) and HHCAHPS approved vendors are tasked with conducting the survey for the home care agencies (CDC, 2020). The HHCAHPS is completed by the patient or a proxy and comprises 34-item questions that measure the patient’s perception of the skilled home care they received (CDC, 2020). The questions covered in the survey include pain, care, prescription medication, communication about scheduling, and their overall rating of the home care agency (CDC, 2020). The results of the HHCAHPS are publicly reported and can be viewed on the Medicare website.

Home health ratings are essential to a home care agency as potential patients tend to search up agency profiles to determine if they would utilize their service. A Medicare home health rating offers an official source of the quality of care provided by a skilled agency and can be the difference between patients choosing one agency over another. A home health star rating summarizes an agency’s performance and compares them to other agencies so that potential patients can make a choice (CDC, 2021). The star ratings are calculated based on data analysis and stakeholder input (CDC, 2021). There are two types of star ratings: Quality of Patient Care Star Ratings and Patient Survey Star Ratings (CDC, 2021). The Quality of Patient Care (QoPC) Star Rating is based on Medicare claims data, and the oasis assessments and the patient survey star rating are based on the Home Health CAHPS (CDC, 2021).

All Medicare-certified HHAs may potentially receive a Quality of Patient Care Star Rating. HHAs must have data for at least 20 complete quality episodes for each measure to be reported on Care Compare. Completed episodes are paired with start or resumption of care and end of care OASIS assessments. Episodes must have an end-of-care date within the 12-month reporting period regardless of the start date. To have a Quality of Patient Care Star Rating computed, HHAs must have reported data for 5 of the seven measures used in the quality of the patient care star rating calculation. The current methodology for calculating the Quality of Patient Care Star Rating can be accessed via the Downloads section below. This methodology will be updated periodically as additional refinements are made.

The Quality of Patient Star Rating measures seven key points, including improvement in ambulation (outcome measure), timely initiation of care (process measure), improvement in bed transferring (outcome measure), improvement in bathing (outcome measure), improvement in the management of oral medications (outcome measure), improvement in shortness of breath (outcome measure) and acute care hospitalization (claims-based) (outcome measure) (CDC, 2021). A Medicare-certified home health agency must have returned at least 40 surveys to be eligible to get a star rating. During meetings at our agency, when I was a case manager, we would be tasked to remind our patients to return/mail back their completed surveys as one of the issues with this type of survey is that patients do not fill or mail them back. Ratings are discussed, and our weaknesses are focused on as places to improve upon to ensure that the following survey is better.

 

References

Centers for Disease Control and Prevention (2020). Home Health CAHPS (HHCAHPS)

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/HHCAHPS

Centers for Disease Control and Prevention (2021). Home Health Star ratings.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings

Main Post

As a home care nurse and now a home care nurse practitioner, we utilize the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey, which is used to assess and publicly report the perspectives of the patients that utilized a home health care service (Centers for Disease Control and Prevention [CDC], 2020).   The National Quality Forum endorsed the survey in March 2009 (CDC, 2020) and HHCAHPS approved vendors are tasked with conducting the survey for the home care agencies (CDC, 2020). The HHCAHPS is completed by the patient or a proxy and comprises 34-item questions that measure the patient’s perception of the skilled home care they received (CDC, 2020). The questions covered in the survey include pain, care, prescription medication, communication about scheduling, and their overall rating of the home care agency (CDC, 2020). The results of the HHCAHPS are publicly reported and can be viewed on the Medicare website.

Home health ratings are essential to a home care agency as potential patients tend to search up agency profiles to determine if they would utilize their service. A Medicare home health rating offers an official source of the quality of care provided by a skilled agency and can be the difference between patients choosing one agency over another. A home health star rating summarizes an agency’s performance and compares them to other agencies so that potential patients can make a choice (CDC, 2021). The star ratings are calculated based on data analysis and stakeholder input (CDC, 2021). There are two types of star ratings: Quality of Patient Care Star Ratings and Patient Survey Star Ratings (CDC, 2021). The Quality of Patient Care (QoPC) Star Rating is based on Medicare claims data, and the oasis assessments and the patient survey star rating are based on the Home Health CAHPS (CDC, 2021).

All Medicare-certified HHAs may potentially receive a Quality of Patient Care Star Rating. HHAs must have data for at least 20 complete quality episodes for each measure to be reported on Care Compare. Completed episodes are paired with start or resumption of care and end of care OASIS assessments. Episodes must have an end-of-care date within the 12-month reporting period regardless of the start date. To have a Quality of Patient Care Star Rating computed, HHAs must have reported data for 5 of the seven measures used in the quality of the patient care star rating calculation. The current methodology for calculating the Quality of Patient Care Star Rating can be accessed via the Downloads section below. This methodology will be updated periodically as additional refinements are made.

The Quality of Patient Star Rating measures seven key points, including improvement in ambulation (outcome measure), timely initiation of care (process measure), improvement in bed transferring (outcome measure), improvement in bathing (outcome measure), improvement in the management of oral medications (outcome measure), improvement in shortness of breath (outcome measure) and acute care hospitalization (claims-based) (outcome measure) (CDC, 2021). A Medicare-certified home health agency must have returned at least 40 surveys to be eligible to get a star rating. During meetings at our agency, when I was a case manager, we would be tasked to remind our patients to return/mail back their completed surveys as one of the issues with this type of survey is that patients do not fill or mail them back. Ratings are discussed, and our weaknesses are focused on as places to improve upon to ensure that the following survey is better.

 

References

Centers for Disease Control and Prevention (2020). Home Health CAHPS (HHCAHPS)

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/HHCAHPS

Centers for Disease Control and Prevention (2021). Home Health Star ratings.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings

Main Post

As a home care nurse and now a home care nurse practitioner, we utilize the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey, which is used to assess and publicly report the perspectives of the patients that utilized a home health care service (Centers for Disease Control and Prevention [CDC], 2020).   The National Quality Forum endorsed the survey in March 2009 (CDC, 2020) and HHCAHPS approved vendors are tasked with conducting the survey for the home care agencies (CDC, 2020). The HHCAHPS is completed by the patient or a proxy and comprises 34-item questions that measure the patient’s perception of the skilled home care they received (CDC, 2020). The questions covered in the survey include pain, care, prescription medication, communication about scheduling, and their overall rating of the home care agency (CDC, 2020). The results of the HHCAHPS are publicly reported and can be viewed on the Medicare website.

Home health ratings are essential to a home care agency as potential patients tend to search up agency profiles to determine if they would utilize their service. A Medicare home health rating offers an official source of the quality of care provided by a skilled agency and can be the difference between patients choosing one agency over another. A home health star rating summarizes an agency’s performance and compares them to other agencies so that potential patients can make a choice (CDC, 2021). The star ratings are calculated based on data analysis and stakeholder input (CDC, 2021). There are two types of star ratings: Quality of Patient Care Star Ratings and Patient Survey Star Ratings (CDC, 2021). The Quality of Patient Care (QoPC) Star Rating is based on Medicare claims data, and the oasis assessments and the patient survey star rating are based on the Home Health CAHPS (CDC, 2021).

All Medicare-certified HHAs may potentially receive a Quality of Patient Care Star Rating. HHAs must have data for at least 20 complete quality episodes for each measure to be reported on Care Compare. Completed episodes are paired with start or resumption of care and end of care OASIS assessments. Episodes must have an end-of-care date within the 12-month reporting period regardless of the start date. To have a Quality of Patient Care Star Rating computed, HHAs must have reported data for 5 of the seven measures used in the quality of the patient care star rating calculation. The current methodology for calculating the Quality of Patient Care Star Rating can be accessed via the Downloads section below. This methodology will be updated periodically as additional refinements are made.

The Quality of Patient Star Rating measures seven key points, including improvement in ambulation (outcome measure), timely initiation of care (process measure), improvement in bed transferring (outcome measure), improvement in bathing (outcome measure), improvement in the management of oral medications (outcome measure), improvement in shortness of breath (outcome measure) and acute care hospitalization (claims-based) (outcome measure) (CDC, 2021). A Medicare-certified home health agency must have returned at least 40 surveys to be eligible to get a star rating. During meetings at our agency, when I was a case manager, we would be tasked to remind our patients to return/mail back their completed surveys as one of the issues with this type of survey is that patients do not fill or mail them back. Ratings are discussed, and our weaknesses are focused on as places to improve upon to ensure that the following survey is better.

 

References

Centers for Disease Control and Prevention (2020). Home Health CAHPS (HHCAHPS)

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/HHCAHPS

Centers for Disease Control and Prevention (2021). Home Health Star ratings.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings

. The post is informative and interesting to read. However, I am surprised that your current work environment of air medical transport does not track the patient’s experience. Essentially, understanding patient experience is a major step in achieving patient-centered care. By considering different aspects of patient experience enables health care organizations to assess the level to which patients are given responsive and respectful care based on individual patient’s values, preferences, and needs (Larson et al., 2019). Therefore, it is imperative for your current environment to consider assessing patient experience together with other vital elements such as safety and effectiveness of care, which are critical in providing a full picture of quality of health care. As such, the organization can reintroduce standardized surveys to track patient experience (Zhang et al., 2020). In particular, the previously used CAHPS surveys program should be brought back. CAHPS surveys program is critical tool requests the patients to report the elements of their experience that are essential to them rather than asking them how satisfied they are with the care. The survey contains well-tested questions using reliable methodology which is essential in producing validated and standardized patient experience measures (Martino et al., 2017).

References

Larson, E., Sharma, J., Bohren, M. A., & Tunçalp, Ö. (2019). When the patient is the expert: measuring patient experience and satisfaction with care. Bulletin of the World Health Organization, 97(8), 563. doi: 10.2471/BLT.18.225201

Martino, S. C., Shaller, D., Schlesinger, M., Parker, A. M., Rybowski, L., Grob, R., … & Finucane, M. L. (2017). CAHPS and comments: how closed-ended survey questions and narrative accounts interact in the assessment of patient experience. Journal of patient experience, 4(1), 37-45. doi: 10.1177/2374373516685940

Zhang, Y., Li, Q., & Liu, H. (2020). From patient satisfaction to patient experience: A call to action for nursing in China. Journal of nursing management, 28(2), 450-456. https://doi.org/10.1111/jonm.12922