Rethinking Health Care (Issue #6)

CMO message from Amy Scanlan, MD

Quality in Healthcare

What is quality in healthcare? There are many different specific definitions published by nationally recognized medical organizations, but I have always liked the Agency for Healthcare Research and Quality definition: “doing the right thing for the right patient, at the right time, and in the right way to achieve the best possible results.” In 2016, the Centers for Medicare and Medicaid Services (CMS) added 6 goals to that definition of quality:

Make care safer by reducing harm caused in the delivery of care.
Strengthen individual and family engagement as partners in their care.
Promote effective communication and coordination of care.
Promote effective prevention and treatment of chronic disease.
Work with communities to promote best practices of healthy living.
Make care affordable.

Quality in healthcare ultimately helps our patients to live their best lives possible.

Measurement of quality in healthcare has always been a challenge. Despite good evidence of what some clinical treatments can accomplish, these best practices often take years to be used widely. Additionally, each patient presents a different set of challenges and goals around their own health. Physicians often feel powerless to address the most important barriers to a patient achieving good health – environment, poverty, support systems, financial issues. Care is fragmented across multiple systems, with little visibility to all the factors. Data is not well integrated and does not allow us to adequately identify where things are failing.

Quality measurement plays a central role in improving our healthcare system. As we’ve often heard, we cannot manage what we don’t measure. By measuring quality, we can identify best practices, track progress, and reveal areas for improvement. However, quality measurement is also fraught with challenges – choosing what should be measured often conflicts with what can be measured. Data availability, accuracy, and completeness can undermine clinicians’ trust in the outcomes. Variations in definitions and standards across settings make alignment of results difficult to interpret.

We must continue to strive to achieve better outcomes for our patients. A recent study by the Commonwealth Fund calls us out as “the failing US health system.”[1] We rank last in a group of 10 highly-developed nations for our health outcomes. Measuring quality, with all its challenges, plays a crucial role in our ability to improve our healthcare system, and our patients’ outcomes. It holds us all accountable to a higher standard. It shows our patients we are continually trying to improve their care.

[1] https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024

Spotlight: Mountain View Family Medicine

Mountain View Family Medicine is a unique, independent practice in Northern Colorado with three doctors and three midlevel providers. The practice takes a team approach to value based care and quality which has afforded the practice with improved patient outcomes.

Examples of this team approach include: quick adaptation when a new or adjusted HEDIS measure is introduced, from there, workflows are quickly modified and providers are briefed on the changes. Then, team members are trained and everyone participates in identifying preventative screenings and monitoring tests that are due.

In early in 2023 an opportunity was identified to improve upon workflows in Epic. The appropriate preventative screenings and monitoring tests were being ordered and completed but the data was not always being captured in Epic. The Trinsic population health network managers worked closely with Ruth, head RN, to identify the pertinent dynamic fields in Epic to ensure data was documented and captured appropriately. Ruth learned how to use the Trinsic Provider dashboard tool in Epic and trained the staff to use the dashboard to identify patients with upcoming appointments and care gaps. The time invested by Ruth and the practice to standardize Epic workflows as well as the use of the Trinsic tools has paid off. The results: improved patient outcomes and outstanding performance on the Trinsic Single Scorecard.

Celebrate: Awareness Weeks in October

Oct 9-15 National Case Management Week

Oct 16-20 Medical Assistant Week

Oct 20-26 National Healthcare Quality Week

Oct 21-27 National Pharmacy Week