Reference no: EM13978663

DQ 1: CQI Models

You should be familiar with quality improvement initiatives including NCQA's 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.

o Choose two HEDIS measures (from the list below either a, b, c, d, e or f) that must be implemented in a physician practice to improve patient outcomes.

o Describe the sources of data needed to conduct the two measures.

o Using one of the quality improvement models (Lean, PDSA, or Six Sigma), explain how you would use the model to implement the two chosen HEDIS® Measures.

Your initial post should be 250-300 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.

HEDIS Measures

Hypertension/Cardiovascular:

a. 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.

b. Patients 18-85 with a diagnosis of hypertension whose most recent blood pressure reading was controlled.

Age 18-59 whose BP was <140/90

Age 60-85 with a diagnosis of diabetes whose BP was <140/90

Age 60-85 without a diagnosis of diabetes whose BP was <150/90

Smoking Cessation:

c. 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:

d. Patients between the ages of 3-17 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:

e. Women age 50-74 years, who have had a mammogram during the preceding 24 months. Exclusion of those women who have undergone bilateral mastectomy.

Prostate Screening:

f. Male 50 years and greater who have received an annual PSA and/or Digital Rectal Exam.

DQ 2: Mandates and Cost-

The Department of Health and Human Services has oversight of several agencies (i.e., FDA, CDC, AHRQ, NIH, CMS) that regulate health care in the United States. Regulation encompasses insurance plans, cost, research, safety, all in the name of delivering quality care in a cost effective manner. These agencies are responsible for monitoring compliance and enforcing legislative mandates. However, the debate continues on government regulation and its effect on ensuring quality care. After completing this week's reading, review the following articles listed below, which were published 11 years apart. Analyze the cost-quality paradigm noted in the articles. Considering the many governmental mandates and regulations to reduce costs and ensure the delivery of quality care that have been implemented over the years, discuss your opinion regarding why costs have continued to rise without improving quality. List two examples that illustrate your point.

o DHHS Article related to Cost and Quality (2002)

o Institute of Medicine article (2013).