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Applying Measurement Tools

Applying Measurement Tools

Applying Measurement Tools

QUESTION
Applying Measurement Tools

One example of a measurement tool is the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive care measures. Review the components of HEDIS comprehensive diabetes care; then consider the following scenario.

You are a staff nurse working in a private primary care practice. It is a small practice with 2 MDs (internists), 2 nurses, 1 medical assistant, and an office staff for billing. There are approximately 1,000 patients in the practice. You have had no EHR until the last year, but all charts are manual, historically. Your physicians are starting to inquire about quality incentives, particularly regarding patients with diabetes.

By Day 3

Take on the role of the staff nurse in the scenario, and post an explanation of how you would go about finding out how many diabetics are in your practice and how many meet all components of HEDIS comprehensive diabetes care.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist).

Notes for Initial Post: A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone
Applying Measurement Tools

ANSWER
Applying Measurement Tools
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(HEDIS) Is a set of measures of performance in managed healthcare industry that is used widely. This performance measures was put in place and is consistently monitored by the National Committee for Quality Assurance. Under some special programs such as Medicare Advantage, it’s a requirement for health maintenance organizations to submit Medicare HEDIS data so as to access some Medicare services. A majority of HEDIS data is acquired through a variety of means such as surveys, medical charts as well as insurance claims recording hospitalizations, office visits and procedures (Gray et al., 2018).
As a staff nurse in the above situation I would adopt the use of surveys. This comprises of the use of administrative or hybrid data collection methodology. In the case of the absence of EHR statements, developing a survey plan is useful in collecting the facts and figures. For instance, in a measure entitled Immunizations status for children, requires the identification of two-year-old children who are under the immunization program in the given clinic. In our case the plan would be Diabetic Patients. Further recording the percentage of patients suffering from the disease as well as the specific type of disease they are suffering from (insipidus or mellitus). In addition, the age of the patient would be a useful element in the diabetic plan of action. Affirmative action also involves the assessment of adults of between 18 and 75 years of age, having diabetes type 1 and type 2.
These patients would have testing for the following tests; Hemoglobin A1c, retinal exam, nephropathy as well as blood pressure. In order for healthcare institutions to provide quality care especially to diabetic patients, it’s a requirement for them to have high delivery structured order sets as well as standards for quality assurance for process improvement (Ng-Mak & Rajagopalan, 2018). Quality incentives in healthcare which is also referred to as value-based purchasing is model of payment that provides incentives that are financial to healthcare institutions, doctors, groups that are medical and other stakeholder institutions for attaining certain quality performance measures. Results such as long survival rate for instance are challenging to quantify therefore models that advocate for performance are frequently adopted to ascertain quality as well as efficiency for carrying out activities such as measurement of blood pressure as well as counselling patients for smoking cessation.
Further quality incentives are also responsible for rebuking healthcare institutions and physicians in the instance of medical errors and poor outcomes. Quality incentives such as financial support accorded to physicians who are in primary care who are successful in management of key targets as well as clinical outcomes has been lauded to support the fulfilment of diabetic patient care. Scholarly research in the effect of incentives in the United Kingdom demonstrates advances in outcomes of objective processes.
This includes statistics such as cholesterol levels, blood pressure and glycated hemoglobin targets (Jackson et al., 2017). Research work outside the United Kingdom was limited according to the journal, but there was an indication among physicians who were participating in programs of enhanced billing incentives were completing the guidelines to the recommended care prior to the introduction of this incentive. The impact of pay for performance would undeniably have a positive effect on professionalism as well as patient care that is centered. It is important, for policy makers to look beyond addressing physician behaviors and addressing the factors and systemic barriers in diabetes management.

References

Gray, B., Vandergrift, J., Landon, B., Reschovsky, J., & Lipner, R. (2018). Associations
Between American Board of Internal Medicine Maintenance of Certification Status
and Performance on a Set of Healthcare Effectiveness Data and Information Set
(HEDIS) Process Measures. Annals Of Internal Medicine, 169(2), 97.
Jackson, T., Shields, M., Heaney, L., Kendall, M., Pearce, C., Hui, C., & Pinnock, H. (2017).The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review. PLOS ONE, 12(11)
Ng-Mak, D., & Rajagopalan, K. (2018). Examining quality of care for individuals treated formental health using the HEDIS mental health quality measures. Current MedicalResearch And Opinion, 35(1), 87-95.

Applying Measurement Tools

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