Quality Measures: The Revolution in Patient Safety and Outcomes

Preface
Foreword
Acknowledgment
Contents
Contributors
Chapter 1: The History of Quality Metrics
	References
Chapter 2: Pediatric Quality Measures
	Introduction
	Source of Pediatric Quality Measures
	Classification of Quality Measures
		Process Measures
		Outcome Measures
		Structure Measures
		Other Classification Methods
	Purpose of Quality Measures
	References
Chapter 3: Quality and Safety Improvement in Surgery
	Introduction
	Data Sources
		Intra-institutional
		Extra-institutional Data Sources
			AHRQ Data
			National Surgery Quality Improvement Program (NSQIP)
	Departmental and Institutional Structure
	The Surgical Quality and Safety Committee
	Culture
	Safety and Quality Improvement Tools
		Credentialing and Privileging
		Checklists, Briefings, Debriefings
		Performance Dashboard
	Case Study in Quality Improvement
	Summary and Conclusions
	References
Chapter 4: Infection Prevention Quality Metrics
	History of Infection Prevention Quality Metrics
	Current State: The National Action Plan
	Reporting of Healthcare-Associated Infections
	Diagnostic Stewardship
	Healthcare-Associated Infection Metrics
	Performance Improvement
	References
Chapter 5: Evolution of Modern Cardiovascular Quality Metrics
	Introduction: What Is Good Cardiac Care?
	In the Beginnings: Nightingale’s Impact on Healthcare Quality Measures
	Good Cardiovascular Health: Not Just the Absence of Outcomes?
	Genesis of Cardiovascular Health Quality Measures
	Evaluating Health Services
	Historical Perspectives of Outcome Versus Process-Based Quality Evaluation
		1918–1980s: Early Experience
		Attempts to Evaluate Process Measures
			National Myocardial Infarction Registry (NMIR)
			The Minnesota Heart Survey (MHS) Registry
			The Cooperative Cardiovascular Project
			National Heart Failure (NHF) Project
			Associations with Clinical Outcomes
		Trying to Define and Encourage Quality
			President Clinton and the National Quality Forum
			The Emerging Reality of Pay for Performance
			Value-Based Purchasing
			The Hospital Readmissions Reduction Program (HRRP)
			Merit-Based Incentive Program
	Risk Adjustment: Achilles’ Heel of Quality Assessment
	Conclusion
	References
Chapter 6: Along the Road to Quality in Cancer Care
	Introduction: Framing the Problem
	How Is Quality Measured?
		National Initiative for Cancer Care Quality
		Oncology Demonstration Projects
		Quality Oncology Practice Initiative
	Recent Developments
	What Are the Mechanisms for Measuring, Reporting, and Responding to Errors and Quality Concerns in Cancer Care?
	Discussion
	References
Chapter 7: Quality Measures for Palliative Care
	Importance
	Challenges and Opportunities for Quality Measurement in EOLC
		Challenges
		Opportunities
	List of High-Value Quality Measures (See Table 7.1)
	National and International Organizational Efforts in Operationalizing Measurement Via Registries
		CAPC Registry
		Australian Palliative Care Outcomes Collaboration (PCOC) Registry
	Future Research and Directions
	References
Chapter 8: Developing a Hospital Quality Metrics System and Dashboard
	Introduction: The Quality Conundrum
		Measurement Overload
		Measurement Burden
		Inconsistent Scoring and Validity
		Navigating the Measurement Imperative
	What’s an Organization to Do?
		Setting
		Getting Started
		The Quality Dashboard
		The Harm Bubble
	Using Measures to Drive Quality
		Setting Priorities
		Monitoring Progress and Driving Improvement
	Summary and Conclusion
	References
Chapter 9: Patient Satisfaction Metrics
	Introduction
	Why Measure the Patient Experience?
		To Improve the Human Condition and Relieve Suffering
		Compliance with Treatment Recommendations
		The Business Case
	Validity of the Metrics
	Inpatient Experience Metrics
	Outpatient Experience Metrics
	Patient Experience Improvement
	Potential Pitfalls of Patient Experience Metrics
	References
Chapter 10: Quality Measures in Undergraduate Medical Education
	Background and Current State of QI in Undergraduate Medical Education
		The Purpose and Role of QI in UME
		QI as a Core Competency
	The Role and Purpose of QI in UME (QI Data Science; Generalizability to Future Practice Settings
	Recommended QI Curriculum for Medical Students
		Core Recommendations for Application of QI/PS into UME
		Principles and Methods of QI Safety Incident Analysis: System Approaches
		Ancillary Skill Sets to Prepare Learners for QI Projects
		Assembly of All Stakeholders to Share and Use Data for QI Outcomes
		Communicating Learner Findings to Stakeholders
	Implementation and Challenges
		Combining Classroom Learning with Practical Projects Such as Root Cause Analysis and Safety Incident Analysis
		Longitudinal Assessment of Learners for QI Competency
	References
Chapter 11: Resident Quality Training: More than Metrics
	Introduction
	Graduate Medical Education: The Foundations of Physician Culture
		A Sentinel Event and a Call to Action
		The ACGME Response: Transforming GME in the Era of the Patient Safety Revolution
	Status Report 2019: Quality as a Competency: How Are we Doing?
		Challenges to Success: Relevance, Experience, and Culture
	Measuring Success: Quality Metrics in GME
	Conclusion
	References
Chapter 12: The Role of the Hospital Board of Trustees in Ensuring Quality Care
	Getting Beyond Average: The Hospital Board of Trustees Role
	Do No Harm
		The Board Must Set Clear, Concise, and Measurable Goals
	Appendix A
		Serious Reportable Events
Chapter 13: Quality Improvement and Population Management in Adult Primary Care
	Ambulatory Quality Measures: A History
	Implementation of Quality Improvement in an Academic Primary Care Setting
	Guiding Principles
	Implementation
	Quality Improvement in Practice: Practical Examples in the Primary Care Setting
		Automating Point-of-Care Hemoglobin A1c Testing
	Hypertension Control
	Improving Adherence to Guidelines for Prescribing and Monitoring Opioids
	Conclusion
	References
Chapter 14: Quality of Quality Measures
	Introduction
	Deficiency in the Validity of Quality Metrics
		Intensive Insulin Therapy Among Critically Ill Patients
		Rate of Postoperative Venous Thromboembolism
		Intensive Blood Pressure Control Among Patients with Chronic Kidney Disease
		Use of Perioperative Beta-Blockers in Noncardiac Surgery
	Flawed Technologies that Quantify Outcomes
		Flawed Methodology and Statistical Designs
		The Metric of Patient Satisfaction
		Patient Safety Indicators
	Unanticipated Outcomes of Quality Measures
		Readmission Rates and Mortality Outcomes
	Traditional and Novel Approaches for Quality Measurement
		Expanded Measurement Approach
		Scaling Back Approach
		Novel Targeted Supplemental Data Collection Approach
	Improving the Quality of Quality Measures
		Utilizing Metrics with Reliable Evidence of Efficacy and Safety and Improving Quality Measures Research to the Level of Clinical Research
		Responsiveness to Patient Preference
		Balanced Trade-Off Between Outcomes and Relative Costs
		Generalizability of Measures Across Specialties
		Reduced Reliance on Claims Data
	Conclusions
	References
Index