Quality in Indian Health Service

1
Quality in Indian Health Service

• Alette Thompson, MT(ASCP), CPHQ
• Quality Manager
• Whiteriver Service Unit
• Phoenix Area Indian Health Service

1
2
Indian Health Service
Visit www.IHS.gov
2
3
Phoenix Area Indian Health Service
3
4
Aspects of Quality

• Clinical Care
• Available and Accessible
• Culturally Sensitive
• Evidence based
• Data Quality
• Accurate, Complete, Timely, Accessible

4
5
Importance of data quality and clinical care

• Patient care and safety!
• Regulatory requirements for accreditation
• ORYX, IHPES-Indian Health Performance Evaluation
  System
• Third party billing
• Compliance with Office of Inspector General
  regulations
• Office of Management Budget wants accuracy
  confirmed
• Government Performance Results Act (GPRA)
• Peer review organizations requirements (HSAG)
• Indian Health Service Strategic Plans and
  Priorities

5
6
Clinical Care

• Available at locations convenient to patients
• Accessible hours or alternatives provided
• Culturally sensitive, specific to health care
  needs and diseases of patients
• Use of clinical practice guidelines or standards
  of care
• Quality based on JCAHO, AAAHC, CMS, CAH
  accreditation standards and regulations
• Quality based on customer satisfaction

6
7
IHS Backbone of Data

• RPMS (Resource Patient Management System)
  database using numerous software packages
• Daily patient activities from registration to
  patient care data to billing
• Reporting mechanisms from daily
  admissions/discharges to ORYX(IHPES) and GPRA
  reports on a national level

7
8
RPMS software

• PCC-patient care component
• PCC individualized point of care entry
• Patient registration
• Scheduling
• Ambulatory care
• Contract health
• Dental data
• QA/utilization review
• Credentials
• Medical staff profiles

• Womens Health
• Nutrition/dietetics
• Laboratory
• Pharmacy
• Mental health/social services
• 3rd party billing
• Admissions, discharges, transfers
• Immunizations
• GPRA Plus
• QAI management

8
9
Data Quality

• Patient care component
• Information about the patient entered into the
  database demographics, statistics, procedures,
  immunizations, medications, laboratory results,
  etc. yields health summary
• Links to other facilities within the Service
  Units
• Links to national IHS databases
• IHPES-Indian Health Performance Evaluation System
• GPRA-Government Performance Results Act
• Future links between facilities IHS wide?

9
10
Phoenix Area Network Indicators

• Indicators for performance improvement at Service
  Unit level
• Indicators based on
• JCAHO/AAAHC/CAH required measures
• Ambulatory, Hospital , Behavioral Health
• Health, Clinical Financial Status, Customer
  Satisfaction
• IHPES Indicators
• GPRA Indicators
• HSAG Indicators, CMS 6th 7th Scope of Work
• Disease specific IHS indicatorsDiabetes
• Clinical Practice Guidelines, Evidence Based
  Medicine

10
11
Patient Safety

• Proactive patient safety initiatives
• Improve Incident Report mechanisms
• Data aggregation and analysis
• Intensive investigations if needed
• Staff training
• Patient responsibility
• Involved in care
• Patient/family education about patient safety
  issues such as JCAHO-SPEAK UP program

11
12
JCAHO Required measures

• Patient/family needs expectations
• Patient safety
• Medication Use
• MedMarx
• Pain
• Operative, invasive procedures
• Blood utilization
• Utilization management

• Staffing effectiveness
• High risk, high volume, problem prone care
  processes
• Ongoing chart reviews
• Quality Control
• Infection control
• Outcomes of care
• Others

12
13
ORYX-IHPESIndian Health Performance Evaluation
System

• Required by JCAHO
• IHPES vendor is IHS based
• Automatically downloads data from each
  participating service unit
• Manages data and submits to JCAHO
• Reports on IHS website
• Individual service units incorporate into
  performance improvement
• Comparisons for all participating IHS facilities
• Contacts to share successful processes
• IHS exempt from CORE measures

13
14
GPRAGovernment Performance Results Act

• Act signed in 1993, in effect 1997
• ALL government programs are held accountable,
  including Indian Health Service
• Evaluation of performance measures to prove
  effective use of funds allocated by Congress

14
15
How are indicators chosen?

• Strategic plans and priorities of IHS
• Evidence based/health outcomes
• Cost effective analysis
• Target populations
• Data sources available and reliable
• Defined data query logic possible
• Scale of application
• Interpretation, calculations
• Linkages with other indicators
• Diabetes, immunizations, hypertension

15
16
GPRA Indicator Categories

• Treatment
• Diabetes cancer Well child substance abuse
  oral health family violence, abuse information
  technology accreditation
• Prevention
• Public health nursing immunization injury
  prevention suicide prevention cardiovascular
  tobacco HIV/AIDS environmental surveillance
• Capital Programming/Infrastructure
• Partnerships, Core Functions, Advocacy
• Quality of Work Life administrative efficiency
  effectiveness

16
17
Use of GPRA Indicators

• Service Units incorporate GPRA indicators and
  frequent reports into performance improvement
• Annual reports to Area and National IHS offices
  used for
• Performance improvement
• Strategic planning
• Budget process

17
18
GPRA IndicatorsPilot Projects

• Special projects to test effective performance
  improvement processes
• Whiteriver Service Unit
• Pneumococcal vaccinations for diabetic and elder
  patients
• Data quality
• Immunizations
• Cost 30,000 4-5 hospitalizations for pneumonia

18
19
HSAGHealth Services Advisory Group (PRO)

• Pneumonia
• Only indicator with significant numbers for
  comparison
• Atrial fibrillation
• Stroke/TIA
• CHF

19
20
Disease/Process Specific

• Diabetesuse of staged diabetes management
  guidelines
• Patient Educationstandardized codes and
  educational materials
• Hypertension management

20
21
How are results of indicators used?

• Performance improvement at service units
• Timely feedback
• Sharing successful processes changes
• Encourage innovative, creative approaches to care
• Customer satisfaction

21
22
How are results of indicators used?

• Software enhancements by IHS for data collection,
  transmissions between local and IHS data center
• Identify potential solutions to problems
  encountered at local levels applicable to IHS
• Effective use of funds
• Enhance data collection at point of service
• Improve accuracy and completeness of data

22
23
Goal is to Provide

• Best quality of care outcomes,
• Most cost effective efficient processes,
• Excellent care service to the American Indian/
• Alaska Native people served by IHS

23