Download Quality Improvement Measures and Reporting and more Exams Nursing in PDF only on Docsity!
PCMH-QI EXAM WITH COMPLETE
SOLUTION
What is QI Concept? - ANSWER-Performance Measurement and Quality Improvement (QI) The practice establishes a culture of data-driven performance improvement on clinical quality, efficiency and patient experience, and engages staff and patient/families/caregivers in quality improvement activities. What is the criteria for QI Competency A: Measuring Performance QI 01-QI 08? - ANSWER-The practice measures to understand current performance and to identify opportunities for improvement. What is the criteria for QI-01 (Core) Clinical Quality Measures:Monitors at least five clinical quality measures across the four categories (must monitor at least one measure of each type: A) Immunization B) Other preventive care measures C) Chronic or acute care clinical measures D) Behavioral health measures - ANSWER-Measuring and reporting clinical quality measures helps practices deliver safe, effective, patient-centered and timely care.; The practice shows that is monitors at least five clinical quality measures, including at least: 1 immunization measure 1 preventive care measure (not including immunizations)-a measure in oral health counts as preventive clinical quality measure 1 chronic or acute care clinical measure 1 behavioral health measure The data must include the measurement period, the number of patients represented by the data, the rate and the measure source (e.g., HEDIS, NQF#, measure guidance). What is the evidence required for QI-01 Clinical Quality Measures? - ANSWER-Report NOT SHAREABLE ACROSS PRACTICE SITES
What is the criteria for QI-02 (Core) Resource Stewardship Measures: Monitors at least two measures of resource stewardship (must monitor at least one measure of each type): A) Measures related to care coordination B) Measures affecting health are costs. - ANSWER-The practice reports at least two measures related to resource stewardship, including a measure related to health care cost and a measure related to care coordination. When pursuing high-quality, cost- effective outcomes, the practice has a responsibility to consider how it uses resources. What is the evidence required for QI-02 (Core) Resource Stewardship Measures? - ANSWER-Report NOT SHAREABLE ACROSS PRACTICE SITES What is the criteria for QI-03 (Core) Appointment Availability Assessment: Assesses performance on availability of major appointment types to meet patient needs and preferences for access? - ANSWER-Patients who cannot get a timely appointment with their primary care provider may seek out-of-network care, facing potentially higher costs and treatment from a provider who does not know their medical history. The practice consistently reviews the availability of major appointment types (e.g., urgent care, new patient, routine exams, follow-up) to ensure that it meets the needs and preferences of its patient, and adjusts appointment availability, if necessary (e.g., seasonal changes, shifts in patient needs, practice resources). A common approach to measuring appointment availability against standards is to determine the third next available appointment for each appointment type. What is the evidence required for QI-03 (Core) Appointment Availability Assessment? - ANSWER-Documented Process AND Report. DOCUMENTED PROCESS IS SHAREABLE ACROSS PRACTICE SITES What is the criteria for QI-04 (Core) Patient Experience Feedback: Monitors patient experience through: A) Quantitative data. Conducts a survey (using any instrument) to evaluate patient/family/caregiver experiences across at least three dimensions such as: *Access *Communication *Coordination *Whole-person care, self-management support and comprehensiveness B) Qualitative data. Obtains feedback from patients/families/caregivers through qualitative means. - ANSWER-The practice gathers feedback from patients and provides summarized results to inform quality improvement activities. Patient feedback must represent the practice population (including all relevant sub-populations)).
What is the criteria for QI-06 (1 Credit) Validated Patient Experience Survey Use: The practice uses a standardized, validated patient experience survey tool with bench- marking data available. - ANSWER-The practice uses the standardized survey tool to collect patient experience data and inform its quality improvement activities. The intent is for the practice to administer a survey that can be bench-marked externally and compared across practices. The practice may use standardized tools such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) PCMH survey, CAHPS-CG or another standardized survey administered through measurement initiatives providing benchmark analysis external to the practice organization. It may not be a proprietary instrument. The practice must administer the entire approved standardized survey (not sections of the survey) to receive credit. What is the evidence required for QI-06 (1 Credit) Validated Patient Experience Survey Use? - ANSWER-Report NOT SHAREABLE ACROSS PRACTICE SITES What is the criteria for QI-07 (2 Credits) Vulnerable Patient Feedback: Obtains feedback from vulnerable patient groups on the experiences of disparities in care or services. - ANSWER-The practice identifies a vulnerable population where data (clinical, resource stewardship, quantitative patient experience, access) show evidence of disparities of care or services. The practice obtains qualitative patient feedback from population representatives to acquire better understanding of disparities and to support quality improvement initiatives to close gaps in care. What is the evidence required for QI-07 (2 Credits) Vulnerable Patient Feedback? - ANSWER-Report NOT SHAREABLE ACROSS PRACTICE SITES What is the criteria for QI Competency B: Setting Goals and Acting to Improve? QI08- QI14 - ANSWER-The practice evaluates its performance against goals or benchmarks and uses the results to prioritize and implement improvement strategies. What is the criteria for QI-08 (Core) Goals and Actions to Improve Clinical Quality measures: Sets goals and acts to improve upon at least three measures across at least three of the four categories: A) Immunization measures B) Other preventive care measures C) Chronic or acute care clinical measures
D) Behavioral health measures - ANSWER-Review and evaluation offer an opportunity to identify and prioritize areas for improvement, analyze potential barriers to meeting goals and plan methods for addressing the barriers. The practice has an ongoing quality improvement strategy and process that includes regular review of performance data and evaluation of performance against goals or benchmarks. Measures selected for improvement are chosen from the set of measures identified in QI-01. The goal is for the practice to reach a desired level of achievement based on a self-identified standard of care. The practice may participate in or implement a rapid-cycle improvement process, such as Plan-Do-Study-Act (PDSA), that represents a commitment to ongoing quality improvement. The Institute for Healthcare Improvement is a resource for the PDSA cycle. What is the evidence required for QI-08 (Core) Goals and Actions to Improve Clinical Quality Measures? - ANSWER-Report OR Quality Improvement Worksheet NOT SHAREABLE ACROSS PRACTICE SITES What is the intent for QI-09 (Core) Goals and Actions to Improve Resource Stewardship Measures:? - ANSWER-Sets goals and acts to improve performance on at least one measure of resource stewardship. A) Measures related to care coordination B) measures affecting health care costs What is the criteria for QI-09 (Core) Goals and Actions to Improve Resource Stewardship Measures? - ANSWER-The practice has an ongoing quality improvement strategy and process that includes regular review of performance data and evaluation of performance against goals or benchmarks. Review and evaluation offer an opportunity to identify and prioritize areas for improvement, analyze potential barriers to meeting goals and plan methods for addressing the barriers. Measures selected for improvement may be chosen from the same set of measure identified in QI-02. The goal is for the practice to reach a desired level of achievement based on its self-identified standard of care. The practice may participate in or implement a rapid-cycle improvement process, such as Plan-Do-Study-Act (PDSA), that represents a commitment to ongoing quality improvement. The Institute for Healthcare Improvement is a resource for the PDSA cycle. What is the evidence required for QI-09 (Core) Goals and Actions to Improve Resource Stewardship Measures? - ANSWER-Report OR Quality Improvement Worksheet NOT SHAREABLE ACROSS PRACTICE SITES
What evidence is required for QI-12 (2-Credits) Improved Performance? - ANSWER- Report OR Quality Improvement Worksheet. NOT SHAREABLE ACROSS PRACTICE SITES What is the intent for QI-13 (1 Credit) Goals and Actions to Improve Disparities in Care/Service:? - ANSWER-Sets goals and acts to improve performance on at least one measure of disparities in care or services. What is required evidence for QI-13 (1 Credit) Goals and Actions to Improve Disparities in Care/Service? - ANSWER-Report OR Quality Improvement Worksheet. NOT SHAREABLE ACROSS PRACTICE SITES What is the criteria for QI-13 (1 Credit) Goals and Actions to Improve Disparities in Care/Services? - ANSWER-After assessing performance in care or services among vulnerable populations (QI-05), the practice identifies disparities, sets goals and acts to improve performance. What is the intent for QI-14 (2 Credits) Improved Performance for Disparities in Care/Service? - ANSWER-Achieves improved performance on at least one measure of disparities in care or services. What is the criteria for QI-14 (2 Credits) Improved Performance for Disparities in Care/Service? - ANSWER-The practice demonstrates that it has improved performance on at least one measure related to disparities in care or service. Demonstration of improvement is determined by the goals set in QI-13. What is the required evidence for QI-14 (2 Credits) Improved Performance for Disparities in Care/Services? - ANSWER-Report OR Quality Improvement Worksheet. NOT SHAREABLE ACROSS PRACTICE SITES What is the criteria for QI-Competency C: Reporting Performance? QI15-QI19 - ANSWER-The practice is accountable for performance and shares data within the practice, with patients and/or publicly for the measures and patient populations identified in the previous section. What is the intent of QI-15 (Core) Reporting Performance within the Practice:? - ANSWER-Shares clinician-level or practice-level performance results with clinicians and staff for measures it reports.
What is the criteria for QI-15 (Core) Reporting Performance within the Practice:? - ANSWER-The practice provides individual clinician or practice-level reports to clinicians and practice staff. Performance results reflect care provided to all patients in the practice (relevant to the measure), not only to patients covered by a specific payer. The practice may use data that it produces or data provided by affiliated organizations (e.g., a larger medical group, individual practice association or health plan). What is the required evidence for QI-15 (Core) Reporting Performance within the Practice? - ANSWER-Documented process AND Evidence of Implementation SHAREABLE ACROSS PRACTICE SITES What is the intent for QI-16 (1 Credit) Reporting Performance Publicly or with Patients:?
- ANSWER-Shares clinician-level or practice-level performance results publicly or with patients for measures it reports. What is the criteria for QI-16 (1 Credit) Reporting Performance Publicly or with Patients?
- ANSWER-The practice shares individual clinician or practice-level reports with patients and the public. Reports reflect the care provided by the care team. Performance results reflect care provided to all patients in the practice (relevant to the measure), not only to patients covered by a specific payer. The practice may use data that it produces or data provided by affiliated organizations, such as a larger medical group, individual practice association or health plan. What is the required evidence for QI-16 (1 Credit) Reporting Performance Publicly with Patients? - ANSWER-Documented process AND Evidence of Implementation SHAREABLE ACROSS PRACTICE SITES What is the intent for QI-17 (2 Credits) Patient/Family/Caregiver Involvement in Quality Improvement? - ANSWER-Involves the patient/family/caregiver in quality improvement activities. What is the criteria for QI-17 (2 Credits) Patient/Family/Caregiver Involvement in Quality Improvement? - ANSWER-The practice has a process for involving patients and their families in its quality improvement efforts or on the practices's patient advisory council (PFAC). At a minimum, the process specifies how patients are families are selected, their role on the quality improvement team and the frequency of team/PFAC meetings. The ongoing inclusion of patients/families/caregivers in quality improvement activities provides the voice of the patient to patient-centered care.
What is the required evidence for QI-19 (Maximum 2 Credits) Value-Based Contract Agreements? - ANSWER-Agreement OR Evidence of implementation SHAREABLE ACROSS PRACTICE SITES
