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Current Issue
#5 - Error Reporting Systems: Feedback and Communication
Previous Issues
#1: Communication: Handoffs & Transitions
#2: The Case for Leadership Support
#3: Moving From A Culture of Blame
#4: Becoming Comfortable With Error Reporting
You may also discuss or comment using our online discussion forum.In the 8th Scope of Work, IPRO is working with a select group of hospitals (Identified Participant Group) to achieve system-level changes through the use of four strategies. They are: clinical performance measurement and reporting, process improvement, systems improvement, and organization cultural change.
Several distinct efforts are aligned with each strategy. For performance measure reporting and results, IPRO is assisting urban and rural Prospective Payment System (PPS) hospitals with improving the Appropriate Care Measure (ACM). The ACM is a composite of the ten-measure starter set outlined in the Medicare Modernization Act (five acute myocardial infarction measures, two heart failure measures, and three pneumonia measures). These measures are combined at a patient level into one rate that provides a more accurate desciption of how a hospital treats patients across a spectrum of care. This aggregation underscores the gaps that exist between the care provided to a patient, and optimal patient care management.
The ACM measures are completely aligned with the measures required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Improving care described by the ACM components and other related measures will decrease the morbidity and mortality associated with these diseases among Medicare beneficiaries.
In addition, IPRO is supporting hospitals in their submission of the full Hospital Quality Alliance (HQA) measure set and helping increase the validity of all data submitted to the QIO Clinical Data Warehouse.
The Appropriate Care Measure (ACM) Identified Participant Group (IPG) is a hospital initiative designed to bring transformational change to the health care arena and raise the bar for performance to provide the right care for every patient, every time.
The ACM is a composite measure based upon five AMI measures, two Heart Failure measures, and three Pneumonia measures. All patients eligible for at least one of the ten measures are counted in the denominator. To be counted in the numerator, the patient must receive all of the care specified by the measures that the patient is eligible for. There is no weighting in this calculation.
For example:Mr. S is admitted with an AMI, and by chart abstraction, is eligible for aspirin and Beta Blockers but is not eligible for ACEI or ARB upon discharge. Mr. S is eligible for
Mr. S fails the ACM because a single element of care for which he is eligible was not provided, namely the Beta Blocker at discharge.
The move to a patient-centric measure rather than a process-centric measure is in keeping with the CMS mantra of "The Right Care for Every Person Every Time." Given this change, it is important to realize that if you are doing well at every process but one, your score CANNOT exceed your weakest score.
Statewide ACM Report Bar Graph: Opportunity to Improve ACM by Performance MeasureAll project updates and events can be accessed on the ACM Online Forum on JENY (Joint Effort New York).
Project Manager, IPRO
518-426-3300, extension 105
wgardiner@nyqio.sdps.org Marguerite Shaffer, RN, CPHQSenior Director, IPRO
518-426-3300, extension 108
mshaffer@nyqio.sdps.org Charles Stimler, MD, MPHMedical Director, IPRO
(516) 209-5514
cstimler@nyqio.sdps.org