Health Care Quality

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1. What are the components of high-quality care? 

   • Access to care

     • Adequate scientific knowledge

   • Competent health care providers

     • 4% of the hospital admissions, the patient experienced a medical injury due to the mismanagement of the disease

     • Failure to meet the standard of practice 

   • Separation of financial and clinical decisions

     • Fee-for-service reimbursement encourages physicians to perform more services

     • Prepaid health plans result in the underuse

   • Organization of health care institutions to maximize quality

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2. Are there informatics interventions that could enable each of these components?

• Traditional quality assurance: peer review

  • Not work:

  • Many guidelines are unreliable and tainted by monetary interests

  • Practice guidelines are not appropriate for many clinical situations

• Measuring practice patterns

• Continuous quality improvement

• Computerized information systems

  • EHR provides opportunity to manage the patients conditions

  • Computerized physician order entry system would alert physician about inappropriate medication doses

  • This could help improve the competent of health care providers

• Public reporting of quality

  • Provide internal feedback to clinicians and health organizations

• Pay for reporting

  • Physicians who report certain quality measures received a small increase in their Medicare fees

• Pay for performance

  • Health practitioners or hospital would receive extra money if their quality measures exceed certain benchmarks 

• NLP in health care: 

  • NLP leverages artificial intelligence (AI) to help analytics systems understand and work with unstructured data so that physicians get extra information and provide better service

  • Triage chatbot: Microsoft invented a self-checker that comprises an artificial intelligence-powered online chatbot. By asking a series of demographic and medical questions to assess users' risk of having contracted COVID-19,  this would suggest patients to contact a healthcare provider or self-isolate if necessary, which improve the access to service.

 3.  How might health systems work to improve quality? 

• Malpractice liability system

  • To financially compensation people who have suffered medical injuries

  • To prevent health practitioners from negligently

  • This is considered as burdened and expensive.

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(make my part of reflection as the last)

Reflection from Xiruo:

The four actors, provider, insurer, supplier, and purchaser, are constantly changing roles to make up the flow of the healthcare system: from service provider to customer. Health management organization, insurance company, preferred provider organization, are functionally different entities with changing roles from those four main actors, and they basically served their purposes in specific eco sociological environments, some good some bad… It always seems that purchasers are the least involved actor in the history of revolution in healthcare, because all those consolidation, either horizontally or vertically, seem to happen based on solid and strong ecological or political power. And only recently with HMOs do I find a rise in power in negotiation with other actors, even though it is because more and more people are not willing to pay so much due to the economy.

 

I could be classified as a healthcare supplier, and I am also a purchaser in this process. From what the author said, it seems that hospitals, insurance companies, and pharmaceutical companies are more evil, trying to push physicians and mining money from purchasers. Inevitably, what I’ve done could also increase the cost of healthcare, with the result I cannot really guarantee of great help. But I could also choose not to. There should be some programs that are promoting general care and overall health. It is definitely a challenge to choose between broader perspectives and individual patients, but the question is more for physicians, not us who are trained to be scientists to solve a broader problem. I am not trying to get away from responsibilities as part of healthcare, but to be clear on our unique aims which could also face a lot of ethical issues.

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Breaking down Health Care Quality 

There are 5 main components of health care quality.

1. Access to care - Access to health care means having "the timely use of personal health services to achieve the best health outcomes" (IOM, 1993)

2. Adequate scientific knowledge - Use of current scientific knowledge and it's subsequent integration into care

3. Competent health care providers - Well educated and properly certified providers

4. Separation of financial and clinical decisions - Putting patient health as a priority above financial concerns

5. Organization of health care institutions to maximize quality - Properly organize care to benefit the patient

 

There are also quality aims from the Institute of Medicine (IOM) as described by the IOM.

• Safe—avoiding injuries to patients from the care that is intended to help them

• Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively)

• Patient-centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

• Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care

• Efficient—avoiding waste, including waste of equipment, supplies, ideas, and energy

• Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status

 

Proposals for improving quality

Here are several proposals for improving quality

1. Licensure, accreditation, peer review - to establish competent health care providers

2.Clinical practice guidelines - Establishing a common standard of care

3. Measuring practice patterns - measure inequities

4. Continuous quality improvement - a new view of the health care practice as a constantly improving entity

5. Computerized information systems - reduce errors with EHR's and CPOE

6. Public reporting of quality - Providing the public of outcomes

7. Pay for performance - instead of fee for service model

8. Financially neutral clinical decision making - doctor's don't benefit for services, such as ordering an MRI when they've invested in the machine

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Reflection from Yue:

Event: Read Understanding Health Policy: A clinical Approach

What did I learn:

            The issues in current U.S health care system: cost but low efficient. It takes time to realize the origins of the problem and make changes. Roma was not build in one day. Health care quality includes everything in health care. Everything that health care practitioners practice everyday is related to the quality. But it is hard to meet each single patient’s need. 

What went well?

            Each of us read the preface and quality chapters and add our own thoughts on the primer.  

What could I have done better?

            Make the primer more interesting and attractive. Maybe including some short videos or pictures instead of text. 

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Reflection from Jake

Event: Read Understanding Health Policy: A clinical Approach

What did I learn:

            I learned about health care successes and failures in the readings. I learned that there are many ways to improve quality as listed above. 

What went well?

            Reading the chapters and re-iterating different view points from the chapters gave our team an overall view on health care quality.

What could I have done better?

            I could have deviated from the organization of the chapter more. By not using my own organization for my thoughts the inferences are limited. However, it did stay on topic.