using utilization measures to improve quality of care in health systems
DESCRIPTION
Using Utilization Measures to Improve Quality of Care in Health Systems. Stephen M. Davidson, Ph.D. Boston University School of Management Presentation to CHMR Industry Advisory Board Phoenix, AZ October 7, 2005. The Problem. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/1.jpg)
Using Utilization Measures to Improve Quality of Care in
Health Systems
Stephen M. Davidson, Ph.D.Boston University School of Management
Presentation to CHMR Industry Advisory BoardPhoenix, AZ
October 7, 2005
![Page 2: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/2.jpg)
The Problem
It is widely recognized that safety and quality are not high enough or
consistent enough.
Therefore, there is much interest in trying to improve the level of safety and
quality.
![Page 3: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/3.jpg)
First Step
Leaders of health care organizations and health plans need to know the state of quality in their systems:
– The extent to which care provided meets established criteria.
– When it does not meet those criteria, where in the process of care are improvements needed?
![Page 4: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/4.jpg)
Knowing the state of care in their systems will help leaders
– To set specific improvement goals.– To engage clinical professionals in
improvement efforts.– To measure progress.
![Page 5: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/5.jpg)
Organization of the Presentation
1. The suitability of utilization measures to assess quality of care.
• Define quality and its measurement.• Examine 2 sources of utilization data:
medical records and claims.
2. Using utilization measures in a quality-improvement strategy.
![Page 6: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/6.jpg)
Quality of Care
“the degree to which health services… increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
K. Lohr
– Selecting services.– Delivering service with skill.– Producing improved health.
![Page 7: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/7.jpg)
Implications
• Ultimate criterion: the impact of services on health outcomes.
• Other factors besides health services affect a person’s health status.
![Page 8: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/8.jpg)
• Since quality of care cannot be recognized by observing a team of clinicians providing services,
– To measure quality of care for a health plan, studies are needed that compare the care received by groups of similar patients.
– The test: the probability of good outcomes in the two groups.
![Page 9: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/9.jpg)
Questions about Measurement
1. What do we count?
2. How do we know it is related to quality?
3. How do we distinguish between good quality and lesser quality?
![Page 10: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/10.jpg)
Donabedian’s Conceptualization
Chances that care is of good quality improve if
1. Good structural conditions are in place.
2. Processes of care meet certain standards.
3. Outcomes improve after receiving care.
![Page 11: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/11.jpg)
Utilization is a measure of process.
Studies need to relate utilization (process) to outcomes.
![Page 12: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/12.jpg)
Sources of Utilization Data
Medical records.
Claims for services rendered.
![Page 13: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/13.jpg)
Factors Affecting Adequacy
CONTENT1. Completeness
2. Accuracy
USEABILITY BURDEN1. Retrievability
2. Confidentiality
3. Suitability for Analysis
![Page 14: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/14.jpg)
What Utilization Data Can Do
1. Show what services were provided.
2. Identify patterns of services provided.
3. Determine whether indicated follow-up services were provided.
4. Include details of patient visits:• Values from tests.• Progress notes.
![Page 15: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/15.jpg)
Outpatient Visit
Yes
No
Yes
Yes Yes
No
No
No
No
HbA1c Test HbA1c Test
ER Visit orHosp. Admit
PrescriptionContinuity
Level 4 Level 3 Level 1Level 2Level 5
FPOA*
PrescriptionContinuity
Yes Yes
Yes
No No
PrescriptionContinuity
FPOA*FPOA*
3+ <3<3 <33+ 3+
*F=Flu Shot; P=Podiatry Visit; O=Ophthalmology Visit; A = microalbumin test or ARB or ACE inhibitor
Exhibit 1
![Page 16: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/16.jpg)
Caveats
1. Understand the data’s limitations.
2. Use care in transcribing to an analysis file.
3. Understand the nature of the sample.
4. Do not over-interpret the results.
![Page 17: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/17.jpg)
Using Utilization Measures to Improve Quality of Care
Key Fact:
To change the way care is delivered in order to improve quality and outcomes
requires the active participation of clinicians.
![Page 18: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/18.jpg)
Doctors must believe 3 things to be willing to participate
1. Whatever the level of quality and safety in the organization, they can be improved.
2. The consequences of not improving quality will affect not just the organization, but also themselves.
3. Even though they are not to blame, what they do as individuals can help improve care.
![Page 19: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/19.jpg)
Other Obstacles
1. Managers & doctors have different orientations.
2. They have different connections to the organization.
3. Doctors tend to assume managers want to constrain their autonomy.
4. Managers are reluctant to engage doctors on clinical issues.
5. Doctors consider non-clinical activity to be a diversion from seeing patients.
![Page 20: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/20.jpg)
Assets
• Information is the major asset in the process.
• Payoff from success: Patients who are more appreciative of their doctors.
• Opportunity to ease the pain, especially through financial compensation and other benefits.
• An intangible benefit: sense of accomplishment for all participants.
![Page 21: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/21.jpg)
The Process
Step One: Organizational Assessment.
Step Two: Picking a Place to Start.
Step Three: Choosing a Target for Change.
![Page 22: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/22.jpg)
The Process – 2
1. Put together a multi-disciplinary group to lead.
2. State objectives clearly; invite comment; be willing to modify.
3. Share information.
4. Do not work uphill – pick projects that are real and likely to succeed.
5. Set milestones so expectations are clear.
![Page 23: Using Utilization Measures to Improve Quality of Care in Health Systems](https://reader036.vdocuments.net/reader036/viewer/2022062519/56815295550346895dc0bd82/html5/thumbnails/23.jpg)
Conclusion
1. Stakes are high – quality, cost.2. Change is hard – but unavoidable.3. Utilization information can be a major
asset – it shows the problems are real; they are systemic; and therefore, the system needs to change.
4. The process does not end – but significant milestones can be achieved.