After reading Chapter 1 through 4, you should be familiar with quality improvement initiatives including the National Committee for Quality Assurance (NCQA) HEDIS & Quality Measurement: 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.
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 the two 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 Ashford University Library to justify your choice of improvement models. Cite all sources in APA format as outlined in the Ashford Writing Center’s Introduction to APA.
Patients who were hospitalized and discharged alive after an acute Myocardial Infarction (heart attack) who received treatment with beta-blockers for six months after discharge.
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 Smoking Cessation: 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: 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. Mammograms: Women age 50 to 74 years who have had a mammogram during the preceding 24 months. Exclusion of those women who have undergone bilateral mastectomy. Prostate Screening: Male 50 years and greater who have received an annual PSA and/or digital rectal exam. Guided Response: Choose two classmates’ posts, and respond to the questions listed below. Your guided response posts should be a minimum of five well-developed sentences. Do you agree or disagree with their choice of CQI Model given the measures they chose? Give rationale why you either agree or disagree, and give one example that illustrates your answer