After reading Chapter 1 through 4, you should be familiar with quality improvement initiatives including the National Committee for Quality Assurance (NCQA) HEDIS & Quality Measurement: HEDIS Measures (Links to an external site.). 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.
- Choose two HEDIS measures from the list below that must be implemented in a physician practice to improve patient outcomes.
- Describe the sources of data needed to conduct the two measures. What source would you use obtain the data? For example, if we were to look at patients receiving a beta blocker after discharge from the hospital, we would obtain data from pharmacy claims.
- Using one of the quality improvement models (i.e., Lean, PDSA, or Six Sigma), explain how you would use the model to implement the two chosen HEDIS measures.
- Include information on how the quality initiatives chosen are linked to the rising costs of health care. Consider government mandates that have improved quality initiatives related to implementing the HEDIS measures or added to the burden of increased costs.
Your initial post should be 250 to 300 words and utilize at least one scholarly source .
- 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.
- Patients 18 to 85 with a diagnosis of hypertension whose most recent blood pressure reading was controlled.
Age 18 to 59 whose BP was <140/90
Age 60 to 85 with a diagnosis of diabetes whose BP was <140/90
Age 60 to 85 without a diagnosis of diabetes whose BP was <150/90
- 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.
- Patients between the ages of 3 to 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.
- Women age 50 to 74 years who have had a mammogram during the preceding 24 months. Exclusion of those women who have undergone bilateral mastectomy.
- Male 50 years and greater who have received an annual PSA and/or digital rectal exam.
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