This essay examines how outcome and process measures for health care quality improvement initiatives can be used for CQI. The paper considers the outcome and process measures that can be used for CQI (Continuous Quality Improvement).
Continuous Quality Improvement (CQI) – Outcomes and Process Measures Paper for NUR-630-Benchmark – Outcome and Process Measures
Continuous Quality Improvement (CQI)
Outcomes and Process Measures
The need to apply health information technology (HIT) with a specific bias to EM/HRs as one way to improve the quality of healthcare across the healthcare delivery continuum rhymes with the goal of almost all stakeholders in the health care industry. Among these stakeholders is health IT developers, policymakers at the local, state, and national level, and health care providers offering healthcare services at different levels of care, all of which endeavor to improve patient care quality and safety. Since the Institute of Medicine (IOM) report focuses on a novel healthcare system suited for the 21st century, the emphasis has leaned towards the design and implementation of HIT to support quality improvement and quality monitoring mechanisms throughout all levels of systems that deliver healthcare. While many strategies of QI exist, Continuous Quality Improvement (CQI) is described as a quality management process that facilitates all teams in healthcare to continuously ask questions live how they are doing and in what ways they can do it better. To address these and other related questions, the nursing practice requires structured clinical and administrative data whose design and successful implementation would effectively capture the data and transform patient care in ways that would be impossible or challenging with paper records. Therefore, this essay aims to examine how outcome and process measures for health care quality improvement initiatives can be used for CQI.
Definition and Examples of Different Types of Healthcare Quality Measures
According to the Donabedian model, the types of health care quality measures can be categorized as either structural, process, or outcome measures (Allen- Duck et al., 2017). Structural measures refer to those measures that give consumers who are primary patients in this context a sense of a healthcare provider’s capacity, systems, and processes to offer high-quality care as a clinical facility’s use of EM/HRs the ratio of providers to patients. On the other hand, process measures describe those measures that indicate what the provider in context does to either maintain or enhance healthy individuals’ health or those diagnosed with a health care condition. Ann apt example would be the percentage of people with diabetes who had their blood glucose levels tested and controlled or the percentage of people receiving immunizations as preventive services. Lastly, outcome measures capture those measures that reflect a healthcare intervention or a healthcare service on the patient’s health status. Examples of such measures include the rate of surgical complications or the percentage of patients who died due to surgery.
Two Process Measures and One Outcome Measure That Can Be Used For CQI
Premised on poor outcomes as far as patient experience and health are concerned, there is a need for healthcare professionals to identify healthcare quality measures that can be used for CQI initiatives seeking to reduce AKI rates. Like in most parts of the world, acute kidney impairment (AKI) is increasingly recognized as an in-hospital complication of either sepsis, cardiovascular diseases, or surgery (Pavkov et al., 2014). Statistics indicate that AKI affects as many as 20% of the patients, where the in-hospital mortality rate is estimated to range between 20%-25%. Additionally, Silver & Chertow (2017) opine that patients who survive an AKI episode have an increased risk of chronic kidney disease, end-stage renal disease, cardiovascular events, and decreased quality of life. The first process measure that could be used for a hospital’s critical care unit (CCU) effectiveness of developing and testing nurse training on AKI knowledge within their facility. The design and development of an AKI sniffer manual where the nurses’ readiness to use would lead to better patient outcomes. The second process measure is the percentage of correctly identified patients as being at risk of AKI within the selected hospital while using an EHR tool (Kashani et al., 2019). On the other hand, the outcome measure selected is the rate of AKI diagnosis.
Why Each of the Three Measures Was Chosen
Using a CQI whose component entails staff training on AKI’s knowledge and the diagnosis was guided by the logic that improving provider awareness that advancing age, hypertension, and diabetes are closely connected to AKI would be translated to the patients. This translation may decrease the occurrence and improvement of the underlying comorbidities, especially among the aging population (Pavkov et al., 2018). The choice of the second process measure of the use of EHR tool within the facility to prevent and effectively AKI emanates from the fact that using clinical information contained in EHRs has offered insight into the role AKI plays in the natural course of CKD progression (Hsu & Siew, 2017). The outcome measure of the number of patients correctly identified and diagnosed with AKI is significant because it is a hospital-acquired infection between 22- 67% of critically ill patients, resulting in increased healthcare costs, increased mortality, and morbidity, but early identification can treat the condition.
How Data for Each Measure Will be Collected and Measured
The process measure on staff training data will be collected through an evidence-based survey to gather the stakeholders (who include nurses, physicians, and pharmacists) in the CCU through emails. The email survey will be designed in a manner that evaluates AKI knowledge through an online automated program. The survey will be emailed to the CCU interprofessional healthcare team at the commencement of the CQI project and later at the end of the implementation to compare knowledge. The AKI Awareness survey will be used to measure the increase in staff knowledge or lack of it. Data on the second process measure of the use of AKI tools will be collected using an AKI –sniffer tool, which is an AKI identification tool originally developed by Almed et al. (2015) which is used to automatically diagnose AKI using a patient’s chart within the clinical facility’s EHR system. The Renal Protection Order Set EHR tool will be used to measure the process outcome. The third and last measure, this time focusing on outcomes, will have its data collected through an Excel spreadsheet created for AKI diagnosis and protocols on EHR renal protection. The AKI diagnosis rate will be measured using a simple chi-square comparison calculation for pre-and-post–CQI intervention.
How Success of the CQI Intervention Would Be Determined
The outcomes of the proposed three-month intervention period would have the CQI project deemed a success. At the end of the intervention, a significant increase in AKI knowledge among the participating staff is noted. Similarly, an increase in AKI diagnosis rate would prove that staff training and use of HER- based tools would significantly improve the quality of healthcare services offered to patients within the selected facility’s CCU.
A Data-Driven, Cost-Effective Solutions to the Challenge of AKI Diagnosis
The author of this essay proposes developing EHR tools by staff within the CQI selected project site to improve AKI recognition and diagnosis. As Hsu & Siew (2017) note, the vast clinical information in the data warehouse that is easily accessible has hastened the use of EM/HRs in CQIs. By using the Plan. Do, Study. Act (PDSA) rapid cycle improvement process, the proposed CQI would lead to a systems change in the AKI recognition, diagnosis staging, treatment, and management more efficiently.
In conclusion, this essay has established that CQI projects utilize rapid cycle reviews to effect real-time changes while utilizing scientific models to predict the anticipated results. In the subsections that followed, two process measures and one outcome measure that can be utilized for CQI were explored in d in detail with a specific focus on increasing of staff AKI knowledge, the facilities use of EHR-based based as process measures, and increase in the rate of AKI- recognition, and diagnosis. Additionally, the rationale for each of the measures taken is given together with an account of how each measure’s data would be collected and how the CQI initiative success would be measured. Most importantly, all healthcare professionals’ early diagnosis of AKI facilitates the Institute for Healthcare Improvement Triple’s realization.
Aim to improve the patient’s care experience, improve populations’ health, and reduce the per capita costs of care for populations.
Allen‐Duck, A., Robinson, J. C., & Stewart, M. W. (2017, October). Healthcare quality: A concept analysis. In nursing forum (Vol. 52, No. 4, pp. 377-386).
Counts, C.S. (Ed.). (2015). Core Curriculum for Nephrology Nursing. The APRN’s approaches to care in nephrology. (6th Ed). Pitman, New Jersey: American Nephrology Nurses Association.
Hsu, R. K., & Siew, E. D. (2017). The growth of AKI: half empty or half full. It’s the size of the glass that matters. Kidney International, 92(3), 550-553.
Kashani, K., Rosner, M. H., Haase, M., Lewington, A. J., O’Donoghue, D. J., Wilson, F. P., & Mehta, R. L. (2019). Quality improvement goals for acute kidney injury. Clinical Journal of the American Society of Nephrology, 14(6), 941-953.
Pavkov, M. E., Harding, J. L., & Burrows, N. R. (2018). Trends in hospitalizations for acute kidney injury—the United States, 2000–2014. Morbidity and Mortality Weekly Report, 67(10), 289
Silver, S. A., & Chertow, G. M. (2017). The economic consequences of acute kidney injury. Nephron, 137(4), 297-301.
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The paper considers the outcome and process measures that can be used for CQI (Continuous Quality Improvement).
In a 1,000-1,250 word paper, consider the outcome and process measures that can be used for CQI. Include the following in your essay:
- At least two process measures that can be used for CQI.
- At least one outcome measure that can be used for CQI.
- A description of why each measure was chosen.
- An explanation of how data would be collected for each (how each will be measured).
- An explanation of how success would be determined.
- One or two data-driven, cost-effective solutions to this challenge.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
Benchmark – Outcome and Process Measures Instructions
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