The National Quality Strategy is a very broad guide, there are many meaningful elements that have been impactful already and have the potential to be even more impactful. The areas that were the most interesting for me were the ones that will require a significant change in the culture that exists within the patient-provider relationship. Measuring quality within the patient-provider relationship can be very challenging and it seems that the most impactful federal initiatives are ones that are focused on structures and processes, with the exception of PCORI.
“Ensuring Person and Family-Centered Care” and “Promoting Effective Communication and Coordination of Care” were two priorities that struck me. There are practitioners who already value these goals but, there are many who do not and getting those practitioners on board could require significant work.
The HITECH legislation that requires practitioners and hospitals to have EMR which is used “meaningfully,” is one way of getting practitioners up to speed as far as more effective communication and coordination of care is concerned. Implementation of EMR, also allows for patient empowerment, if patients are able to access their own EMR, which is one of the goals of HITECH.
The changes required by HITECH are in process whether American patients or providers are on board or not, and this will force some changes in the culture of the way that care is provided. Despite the challenges that implementation of EMR systems have placed on practitioners, the concept is a good one which can be of assistance in the aforementioned goals. I am sure we will see many changes within EMR technology as we move down the road of health care reform.
I thought this document on a national strategy for quality improvement was interesting in several ways...
It's encouraging to see that the folks behind this strategy actively sought participation from a wide range of stakeholders -- consumers, providers/practitioners, employers, payers, different levels of government, and other agencies from the public and private sectors.
I'm very curious about how the 10 items listed under "infrastructure needed to support priorities" might play out. This report gives each item a pretty general overview of the strategy, and it would be interesting to see how each of these is operationalized and used by those who deliver care and those who seek care.
I believe this report was a great way to exemplify the point that 'quality is the difference between efficiency and effectiveness.' (Aday et al) While specific problems have been found in the actual clinical structure, process, or outcomes of our healthcare system, this report outlines specific ways to building a more 'ideal' system than the one we currently work with. I was particularly interested in the infectious disease related initiatives which have been discussed ad nauseaum in the hospital setting, such as catheter-related infections and addressing leading causes of mortality such as HIV/AIDS. As an example of how this is playing out in current life, the AHRQ listserve just released that a LOT of money is going into research for prevention of catheter related infections.
More focus, however, seems to be in the structure more than the process or outcomes. For example, there is much mention the Affordable Care Act, which addresses technology and health insurance reform, both systemic structures. This makes sense, to start with reforming structure and by default, process and outcomes will follow.
This report is an encouraging document. I like that it not only acknowledges the gaps that currently exist in our system for assessing quality of care but also that it characterizes the means to address those gaps as an evolving strategy. Granted, government is a gigantic ship to turn around, but at least there's recognition that what is determined as a quantitative measure in 2011 may not be the best measure to use in 2015.
I also like the provision for public reporting. The journalist in me says yeah, these efforts and government sanctions are all fine and good, but public accountability matters, especially for entities that receive such large portions of public funding. How much will we as citizens really be able to find out about the performance of our providers and hospitals? It will be interesting to see how much of this information will be made public, how it ends up being disseminated to consumers and how/whether they choose to use it.
While the provision for stakeholder input is important, I will be interested to see how this system deals with the influence of special interests that will likely be resistant to some of the proposals.
I believe that theoretically, this strategy will greatly improve quality and effectiveness, but I think there may be difficulties implementing it, as this strategy essentially changes the culture of health care and how it is delivered. I wonder how quality and effectiveness improvements in the clinical setting will be implemented given the higher demand that is forecasted with the new health care bill. Quality improvements require a great deal of time, including time to spend with patients to reduce errors and individualize care and also time to train providers and educate them on these changes. In terms of resources, funding will go to reducing risk factors, preventing disease, and carrying out community based programs, but I don’t think that the report really emphasized the resources that will be required to train physicians in terms of increasing health literacy, tailoring healthcare to the individual and so forth. Additionally, resources to help the population realize their role as consumers in health care. I was unsure if all insurance be “Value-based insurance” that provides incentives for consumers to choose high quality, efficient providers, or is this an insurance that comes at a higher cost? Also, with administrative simplification and the introduction of reduced paper-work and electronic funds transfers, will that reduce the need for billing departments or billers in private offices, and how many jobs will be at stake for this?
The National Quality Strategy is a very broad guide, there are many meaningful elements that have been impactful already and have the potential to be even more impactful. The areas that were the most interesting for me were the ones that will require a significant change in the culture that exists within the patient-provider relationship. Measuring quality within the patient-provider relationship can be very challenging and it seems that the most impactful federal initiatives are ones that are focused on structures and processes, with the exception of PCORI.
ReplyDelete“Ensuring Person and Family-Centered Care” and “Promoting Effective Communication and Coordination of Care” were two priorities that struck me. There are practitioners who already value these goals but, there are many who do not and getting those practitioners on board could require significant work.
The HITECH legislation that requires practitioners and hospitals to have EMR which is used “meaningfully,” is one way of getting practitioners up to speed as far as more effective communication and coordination of care is concerned. Implementation of EMR, also allows for patient empowerment, if patients are able to access their own EMR, which is one of the goals of HITECH.
The changes required by HITECH are in process whether American patients or providers are on board or not, and this will force some changes in the culture of the way that care is provided. Despite the challenges that implementation of EMR systems have placed on practitioners, the concept is a good one which can be of assistance in the aforementioned goals. I am sure we will see many changes within EMR technology as we move down the road of health care reform.
I thought this document on a national strategy for quality improvement was interesting in several ways...
ReplyDeleteIt's encouraging to see that the folks behind this strategy actively sought participation from a wide range of stakeholders -- consumers, providers/practitioners, employers, payers, different levels of government, and other agencies from the public and private sectors.
I'm very curious about how the 10 items listed under "infrastructure needed to support priorities" might play out. This report gives each item a pretty general overview of the strategy, and it would be interesting to see how each of these is operationalized and used by those who deliver care and those who seek care.
I believe this report was a great way to exemplify the point that 'quality is the difference between efficiency and effectiveness.' (Aday et al) While specific problems have been found in the actual clinical structure, process, or outcomes of our healthcare system, this report outlines specific ways to building a more 'ideal' system than the one we currently work with. I was particularly interested in the infectious disease related initiatives which have been discussed ad nauseaum in the hospital setting, such as catheter-related infections and addressing leading causes of mortality such as HIV/AIDS. As an example of how this is playing out in current life, the AHRQ listserve just released that a LOT of money is going into research for prevention of catheter related infections.
ReplyDeleteMore focus, however, seems to be in the structure more than the process or outcomes. For example, there is much mention the Affordable Care Act, which addresses technology and health insurance reform, both systemic structures. This makes sense, to start with reforming structure and by default, process and outcomes will follow.
This report is an encouraging document. I like that it not only acknowledges the gaps that currently exist in our system for assessing quality of care but also that it characterizes the means to address those gaps as an evolving strategy. Granted, government is a gigantic ship to turn around, but at least there's recognition that what is determined as a quantitative measure in 2011 may not be the best measure to use in 2015.
ReplyDeleteI also like the provision for public reporting. The journalist in me says yeah, these efforts and government sanctions are all fine and good, but public accountability matters, especially for entities that receive such large portions of public funding. How much will we as citizens really be able to find out about the performance of our providers and hospitals? It will be interesting to see how much of this information will be made public, how it ends up being disseminated to consumers and how/whether they choose to use it.
While the provision for stakeholder input is important, I will be interested to see how this system deals with the influence of special interests that will likely be resistant to some of the proposals.
I believe that theoretically, this strategy will greatly improve quality and effectiveness, but I think there may be difficulties implementing it, as this strategy essentially changes the culture of health care and how it is delivered. I wonder how quality and effectiveness improvements in the clinical setting will be implemented given the higher demand that is forecasted with the new health care bill. Quality improvements require a great deal of time, including time to spend with patients to reduce errors and individualize care and also time to train providers and educate them on these changes. In terms of resources, funding will go to reducing risk factors, preventing disease, and carrying out community based programs, but I don’t think that the report really emphasized the resources that will be required to train physicians in terms of increasing health literacy, tailoring healthcare to the individual and so forth. Additionally, resources to help the population realize their role as consumers in health care.
ReplyDeleteI was unsure if all insurance be “Value-based insurance” that provides incentives for consumers to choose high quality, efficient providers, or is this an insurance that comes at a higher cost? Also, with administrative simplification and the introduction of reduced paper-work and electronic funds transfers, will that reduce the need for billing departments or billers in private offices, and how many jobs will be at stake for this?