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Quality and Performance Measurement Module 1 Syllabus Spring 2016 Version 3 -- 1/12/16

THE HELLER SCHOOL FOR SOCIAL POLICY AND MANAGEMENT

BRANDEIS UNIVERSITY

HS505f, Quality and Performance Measurement in Healthcare,

Spring 2016, Module 1

Deborah Garnick

781-736-3840 (Office)

[email protected]

Office hours: By appointment

Class: Thursdays, 2:00 p.m. – 4:50 p.m.

Location: The Heller School – Room 163

COURSE DESCRIPTION

Quality measurement in health care, broadly defined, has a long history, extending over more than the past century. This course is intended to provide a conceptual framework for understanding the field, interpreting contemporary research and policy issues relating to quality, and building broad analytic skills.

Specifically, the purpose of this module is to provide:

A conceptual and analytic framework of the field of quality of healthcare, which includes quality assessment, improvement, management and research

Understanding of contemporary research and policy initiatives related to quality of healthcare

Insights into the ways that quality relates to issues of provider payment, organization of healthcare facilities, costs, access to healthcare and disparities

Examination of how policy decisions can improve or impede quality and safety in healthcare

The first three sessions will be focused on fundamental concepts while the next four sessions will be focused on contemporary issues in health care quality.

OBJECTIVES

By the end of the module, students should have a broad understanding of the centrality of quality of care issues in contemporary health services research, health care policy, and management of healthcare organizations. Students also should gain a coherent conceptuaI framework for understanding the field. In particular, the module will cover the basic topics of healthcare quality including:

The history and evolution of quality measurement and improvement

The influence of past developments on contemporary approaches to assuring high quality care

The use of patient reports on experience, clinical data, administrative data, and electronic health records in measuring quality

The role played by quality information in:

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mailto:[email protected]


o policies and programs that improve access to health care

o guiding consumer choices

o ensuring accountability of health care organizations

o tracking the quality of care patients are receiving

o paying providers for performance

Although the course is offered by the Ph.D. program, masters’ students will benefit from learning about current approaches to quality improvement, accrediting of healthcare institutions, and the conceptual basis for these activities. This information will be valuable for those who plan to work in health care settings where they may be responsible for implementing, overseeing and managing quality oriented activities.

Students with a particular interest in an area (e.g. racial/ethnic disparities, child health, home health care, healthcare for persons with disabilities) can tailor their paper assignments to fit their interests.

The module will focus on domestic quality initiatives, but the conceptual basis for quality measurement as well as methods of continuous quality improvement in healthcare can be broadly applicable to international settings and readings with an international focus are included.

COURSE REQUIREMENTS/GRADING

Grading will be based on:25% Class participation/preparation: The success of this class depends on full preparation by all

students for each class, demonstrated by participation and contribution to class discussions and participation in one LATTE discussion, several short on-line surveys throughout the semester, and presentation/lead discussion of a class reading. Please use this link to sign up to present an article. https://docs.google.com/a/brandeis.edu/document/d/1nVn9lA2lgKK0ufDJ8lmZ7__gjK4d_DCxzKsTATuy2nU/edit?usp=sharing

This entails giving a short (five minute) description of the main points of the article, raising any interesting questions from the article, and leading a brief (10 minute) discussion about the article. Note that this does NOT require powerpoints or a formal presentation.

There are different styles for demonstrating class participation and preparation and no one style is preferred over others. The goal is to demonstrate engagement and investment in the class and evidence of interest in the material under study.

Attendance is required and recorded at every class. Absences will be excused only for exceptional circumstances. If an absence is anticipated, please request it in writing by submitting an e-memo to the professor no later than 5:00 pm the day before the scheduled class. If an unanticipated need to be absent arises, please submit a written memo or email explaining the circumstances as soon as possible before the next class.

10% Two reflective essays: At the beginning of the Module, each student will write a short essay (no longer than two double spaced pages) to address the following:

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https://docs.google.com/a/brandeis.edu/document/d/1nVn9lA2lgKK0ufDJ8lmZ7__gjK4d_DCxzKsTATuy2nU/edit?usp=sharing

https://docs.google.com/a/brandeis.edu/document/d/1nVn9lA2lgKK0ufDJ8lmZ7__gjK4d_DCxzKsTATuy2nU/edit?usp=sharing


1) Why did you elect to take this course?2) What do you hope to get out of this course (e.g., preparation for dissertation, insights

for implementing quality improvement projects, etc.)3) What professional experience do you have that relates to quality and performance

measurement?4) What do you believe to be the most important issues to tackle as relates to quality and

performance measurement – and why?

The first essay is due Tuesday 1/19/16 by 5:00 pm. There are no wrong answers here, but rather the goal is to consider your baseline knowledge and thoughts as the class starts.

Near the end of the semester, each student will write a second essay on:

1) What have you learned about quality and performance measurement that was new or unexpected?

2) What was consistent with your expectations?3) Have your thoughts on the most important issues to tackle as relates to quality and

performance measurement changed? If so, how?

The second essay is due Tuesday 3/1/16 by 5:00 pm. Each of these essays will be graded as pass if turned in on time and show a thoughtful effort.

20% Deep dive on a quality measure. The goal of this assignment is to familiarize you with three major information sources on quality measures and understand how quality measures can be used to consider disparities. Either individually or as a pair:

1. Select a measure from the National HealthCare Quality and Disparities Report -- http://www.ahrq.gov/research/findings/nhqrdr/nhqdr14/intro.html). Please select one specific graph in the area of effective treatment (http://www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/effectivetx/index.html) or patient safety (http://www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/patientsafety/index.html)

Note that there is a wealth of useful information to turn to on types of measures, data, and the National Quality Strategy in the overall Disparity Report website (http://www.ahrq.gov/research/findings/nhqrdr/index.html)

2. Check the National Quality Forum Quality Positioning System (from the general NQF website - http://www.qualityforum.org/Home.aspx search for Quality Positioning System) and find the description of your quality measure.

3. Check the National Quality Measures Clearinghouse (http://www.qualitymeasures.ahrq.gov/) and find your quality measure.

4. If your measure is not included in the NQF or NQMC, then select a different measure so you can be checking all three sources. Then then be prepared in class to describe:

a) What topic and measure you selected and why?

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http://www.qualitymeasures.ahrq.gov/

http://www.qualityforum.org/Home.aspx


b) How is the measure defined (numerator/denominator, data source, etc.)?c) What information on quality and disparity is the graph is showing (how to read

the graph)?d) How do you categorize the quality measure as structure, process, outcome,

access?e) What is your confidence in the data source and what are its limitations?f) What does the graph mean in terms of disparity in quality and change over

time?

During the third class, Thursday January 28th, 2-3 students (or pairs) will be randomly selected to do a short presentation of their graph to the class (so be able to get to your graph online). Please submit a one-two page document (word or PowerPoint with text in notes is OK) showing your chart and responses to the five questions through LATTE. Upload your assignment by 5:00 on Sunday January 31st. If working in pairs, please make sure both individuals’ names are in the document filename.

20 % Public reporting scenario. This assignment has three parts: working as a group on the scenario and decision, presenting/discussing in class, and submitting an essay.

First, in class on January 21st, we will form “families of 3-4 students. Each family should meet for up to one hour only (preferably in person) to consider the following scenario:

You live Worcester and your widowed and elderly mother has retired from her long-term home in Massachusetts to Florida where she has lived in Miami for 15 years. Until now, she has been healthy and happily living independently in her retirement condo in Miami. But, suddenly she has declined seriously and needs round the clock clinical care – so you and your siblings who all live in in Massachusetts are forced to consider nursing home care. Your two siblings turn to you for advice because you are a physician. Together, you turn to the web and discover the information from CMS (Center for Medicare and Medicaid Services) and other state-specific sites. You discover that there is a plethora of public-reporting sites including the following:

http:// www.floridahealthfinder.gov/LandingPages/NursingHomeGuide.aspx

http :// www.medicare.gov/nursinghomecompare/search.html

Next, come to class on February 4th prepared to briefly (10 minutes max) present as a group your top recommendation and to explain how the information on the websites informs your decision?

Finally, pick one of the four reading focused on public reporting and nursing homes from the assigned readings for February 4th. In about 3-4 pages, discuss the main take home points from that reading and how your interpretation of the reading was influenced by taking part in the scenario. This assignment is due on February 10th at 5:00 pm and is an individual (not group) assignment.

25 % Final paper - This assignment is different depending on whether you are also taking Module 2.

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For students taking only Module 1, write a perspectives paper with an abstract due by February 4th and paper due on March 4rd (the last day of class). The paper should be in the style of a “Perspective” article on a topic of your choice that is related to a quality issues that particularly interests you. A Perspective is a common article format in the health policy and medical literature that is used to disseminate important ideas. Under different names, these articles can be found in the New England Journal of Medicine, JAMA, Annals of Internal Medicine, JAMA Internal Medicine, and other journals. The Perspective: 1) identifies a relevant issue, problem, or challenge in health care quality; 2) Evaluates the key dimensions of the issue, often using data (in this class assignment, calling on secondary data from articles you read or trusted web sources); 3) proposes potential solutions or improvements to health policy or care delivery to address the problem. The paper should be relatively brief, between 1,500 and 2,000 words. See the papers by Berwick (Measuring physicians’ quality and performance: Adrift on Lake Wobegon), Jain (Googling ourselves – What physicians can learn from online rating sites), and Ryan (Grade pending: lessons for quality reporting in health care from the New York City restaurant sanitation inspection program) in the reading list for examples.

When submitting your paper, please answer the following questions as a separate (last) page.

1. In one sentence, what is the main point you are trying to convey? 2. If you had additional time to work on this paper, would you want to change it? Explain. 3. What do you like most about your paper? 4. What do you like least?5. Please ask one question that you would like me to address in my comments.

Check the grading rubric posted on LATTE.

For students also taking Module 2, an abstract is due by February 4th and an outline and reference list is due on March 4th. See the syllabus for Module 2 for instructions about the paper.

PROVISIONS FOR FEEDBACKRegular and timely feedback will be provided to students, in the form of faculty participation in the on-line discussion, meetings to discuss paper abstracts, and written comments on assignments. Ph.D. students will be evaluated on a pass/fail basis while master’s students will be evaluated with letter grades. Please meet with me individually by appointment to discuss class content, make suggestions, or raise any questions or concerns.

DISABILITY STATUSIf you are a student with a documented disability on record at Brandeis University and wish to have a reasonable accommodation made for you in this class, please see me immediately. If you have any questions about learning, or other disabilities, contact Mary Brooks, disability coordinator for The Heller School, at x62816, room 106, or at [email protected].

ACADEMIC INTEGRITY

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Academic integrity is central to the mission of educational excellence at Brandeis University. Each student is expected to turn in work completed independently, except when assignments specifically authorize collaborative effort. It is acceptable to use the words or ideas of another person provided the source is properly acknowledged. This means that you must use footnotes and quotation marks to indicate the source of any phrases, sentences, paragraphs or ideas found in published volumes, on the internet, or created by another student. Violations of the Brandeis University policy on academic integrity may result in failure in the assignment or course, and could end in suspension from the University. If you are in doubt about the instructions for any assignment, ask for clarification. (See Rights & Responsibilities Handbook (http://www.brandeis.edu/studentlife/srcs/rr/index.html I )

CLASSROOM ETIQUETTEClasses will start promptly. Please refrain from parallel conversations, using any kind of noise-emitting devices, and using your laptop for anything other than class-related activity.

COMMUNICATIONS/ SNOW POLICYGenerally, in the event of a snow day, please assume that we will hold an online session during the regularly-scheduled class time, utilizing Blue Jeans. This link will take you to the BlueJeans online meeting:https://bluejeans.com/1571119490

To use a regular phone for audio (rather than a microphone in your computer), mute your speakers in the meeting and use this call in:

Call in number -- 888 240-2560Meeting ID: 1571119490Participant Passcode:1937

For student presentations, you will be able to share your screen through the Blue Jeans meeting. For guest speakers/surprise activity, there will be a back-up day scheduled in case the campus is closed.

WEB RESOURCES

There are excellent web sources on quality and performance measurement as noted below.

National Quality Forum website at http://www.qualityforum.org. Check for information on the process of getting performance measures approved.

Check http://www.ahrq.gov/health-care-information/topics/topic-quality.html for materials on quality concepts, measurement, national quality measures clearinghouse and quality and disparity reports. Sign up for the AHRQ Electronic Newsletter and other mailings at http://www.ahrq.gov/news/newsletters/e-newsletter/index.html?year=2015

Sign up for Quality Matters, a bi-monthly e-mail newsletter on news, opinion on quality and efficiency, information technology, performance improvement initiatives, and policy innovations. http://www.commonwealthfund.org/publications/newsletters/quality-matters

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http://www.commonwealthfund.org/publications/newsletters/quality-matters

http://www.ahrq.gov/news/newsletters/e-newsletter/index.html?year=2015

http://www.ahrq.gov/health-care-information/topics/topic-quality.html

http://www.qualityforum.org/

https://bluejeans.com/1571119490

http://www.brandeis.edu/studentlife/srcs/rr/index.htmlI


Leapfrog Group website and Fact Sheets at http://www.leapfroggroup.org/ This is the business group behind quality improvement.

National Committee for Quality Assurance http://www.ncqa.org which accredits health plans and other organizations in the US

Joint Commission http://www.jointcommission.org/ Accrediting organization and also includes Joint Commission International

Institute for HealthCare Improvement http://www.ihi.org

On electronic health records, John Halamka's blog http://geekdoctor.blogspot.com written from perspectives as Chief Information Officer of Beth Israel Deaconess Medical Center and Chairman of the New England Healthcare Exchange Network (NEHEN) and as a farmer.

The Incidental Economists blog, has occasional posts on quality/performance measures. You may want to sign up to get this every few days. http://theincidentaleconomist.com

University of California San Francisco (UCSF). Excellent list of journals related to quality - http://medicine.ucsf.edu/safety/resources/journals.html and of resources focused on quality http://medicine.ucsf.edu/safety/resources/other.html

COURSE READING

Readings for class are listed below along with “additional reading for students interested in pursuing the topic further. Explore all reading on-line before printing large volumes of text!

COURSE SCHEDULE

Session 1 – Thursday, January 14th: Healthcare Quality: History, Definitions and Conceptual Framework

The first part of this session will provide an overview of the course. We will discuss why quality and performance measurement are important in the current environment and review the history of quality of health care, from the first discussions of quality in the early 20th century, to the origins of the basic framework proposed by Donabedian in the mid 20 th century, to current approaches to quality measurement and improvement, to the role of quality in The Affordable Care Act. We will consider the topic from a range of perspectives, including those of consumers, clinicians, health care purchasers and policymakers.

We will review the frameworks outlined in the 2001 Institute of Medicine report and the 2011 US National Quality Strategy. We also will discuss the central thesis of the Institute of Medicine report that the health care system must change in order to ensure high quality care.

We will discuss students’ interests and expectations for the course, assignments, and paper requirements.

Reading

Berwick, D. (1999). Escape Fire: Lessons for the Future of Health Care. New York, NY: Commonwealth Fund.

Donabedian, A. (2005) (reprinted from 1966). Evaluating the quality of medical care. Milbank Q, 83(4), 691-729. (Classic article marking the birth of the “modern” quality of care era.)

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http://medicine.ucsf.edu/safety/resources/other.html

http://medicine.ucsf.edu/safety/resources/journals.html

http://theincidentaleconomist.com/

http://geekdoctor.blogspot.com/

http://www.ihi.org/

http://www.jointcommission.org/

http://www.ncqa.org/

http://www.leapfroggroup.org/


Scott, K.W. and Jha, A.K. (2014). Putting quality on the global health agenda. N Engl J Med, 371(1), 3-5.

2015 Annual Progress Report to Congress. National Strategy for Quality Improvement on Health Care. http://www.ahrq.gov/workingforquality/reports/annual-reports/nqs2015annlrpt.htm . Accessed on December 23, 2015.

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academies Press. http://books.nap.edu/books/0309072808/html/2.html#pagetop

Methods Articles

Fan, E., Laupacis, A., Pronovost, P.J., Guyatt, G.H., Needham, D.M. (2010). How to use an article about quality improvement. JAMA, 30(20): 2279-2287.

Alexander, J.A., & Hearld, L.R. (2009). Review: What can we learn from quality improvement research? A critical review of research methods. Med Care Res and Rev, 66, 235-271.

Additional/Optional Reading

Mangione-Smith, R., DeCristofaro, A.H., Setodji, C.M., Keesey, J. et al. (2007). The quality of ambulatory care delivered to children in the United States. N Engl J Med, 357(15), 1515-1523.

McLellan, A.T., Chalk, M., Bartlett, J. (2007). Outcomes, performance, and quality – What’s the difference? JSAT, 32, 331-340.

McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J.,et al. (2003). The quality of health care delivered to adults in the United States. N Engl J Med, 348(26), 2635-2645.

Session 2 Thursday, January 21st: Measurement Concepts

With the use of performance measures as context, this session will introduce basic measurement concepts (types of measures, reliability, validity, variation, sensitivity to change). In addition, we will discuss the basic data sources for quality measurement (e.g., administrative data from health plans, medical records, patient reports, and electronic health records. We will note the process of creating quality and performance measures and locus of quality measurement and improvement (individual practitioners, patient care teams, health care organizations, and communities). Last, we will discuss the “deep dive” assignment due next class session.

Reading

Lee, T.H. (2007). Eulogy for a quality measure. N Engl J Med, 357(12), 1175-1177.

Chassin, M.R. and Loeb, J.M. (2010). Accountability measures – Using measurement to promote quality improvement. NEJM, 363(7), 683-688.

Krumholz, H.M., Normand, S-L.,T., Spertus, J.A., (2007). Measuring performance for treating heart attacks and heart failure: The case for outcomes measurement. Health Aff, 26(1), 75-85.

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http://books.nap.edu/books/0309072808/html/2.html#pagetop

http://www.ahrq.gov/workingforquality/reports/annual-reports/nqs2015annlrpt.htm


Kellermann, A.L. and Jones, S.S. (2013) What will it take to achieve the as-yet-unfulfilled promises of health information technology. Health Aff, 32(1), 63-68.

NCQA. (2015). State of Health Care Quality 2015, Retrieved December 23, 2015 from http://www.ncqa.org/ReportCards/HealthPlans/StateofHealthCareQuality.aspx

Wu, A.W., Kharrazi, H., Boulware, L.E., and Synder, C.F. (2013). Measure once, cut twice – adding patient-reported outcome measures to the electronic health record for comparative effectiveness research. J Clin Epidemiol, 66, S12-S20.

Bettigole, C. (2015). An Uninsured Immigrant Delays Needed Care. Health affairs (Project Hope), 34(12), 2192.

Span, P, (March 2, 2015) A Surgery Standard Under Fire, New York Times, http://www.nytimes.com/2015/03/03/health/a-30-day-surgical-standard-is-under-scrutiny.html

Article for LATTE Discussion

Herrin, J., da Graca, B., Nicewander, D. et al. (2012). The effectiveness of implementing an Electronic Health Record on diabetes care and outcomes. Health Serv Res, 47(4): 1522-1540.


Blumenthal D. (2011). Wiring the health system--origins and provisions of a new federal program. N Engl J Med, [Lectures]. 2011 Dec 15; 365(24), 2323-9.

Blumenthal D. (2011). Implementation of the federal health information technology initiative. N Engl J Med, 2011 Dec 22; 365(25), 2426-31.

Chan, K.S., Fowles, J.B. & Weiner, J.P. (2010). Review: Electronic health records and reliability and validity of quality measures: A review of the literature. Med Care Res Rev, 67(5): 503-527.

McGlynn, E.A. (1998). Choosing and evaluating clinical performance measures. Jt Comm J Qual Improv, 24(9), 470-479.

Wong, R., and Bradley, H. (2009). Developing patient registration and medical records management system in Ethiopia. Int J Qual Health Care, 21(4), 253-258.

Session 3 – Thursday, January 28th: Patient Experience, Disparities, and Risk Adjustment

We will begin class with student presentations of their “deep dives” into specific quality measures. Then, we will focus on the role of patients’ reports as indicators of quality. Finally, we will discuss disparities and risk adjustment, a method used to account for differences in patient characteristics (age, race, income, type of illness) that are likely to influence patients’ outcomes regardless of the treatment they receive. We will review the rationale for risk adjustment, major approaches to risk adjustment, and when risk adjustment of quality measures is appropriate. We will also focus on how race/ethnicity and gender differences are addressed in quality studies.

It time, as a preview on public reporting, we will discuss “The Bell Curve” article. (If not time, may suggest scheduling an optional lunchtime brownbag discussion.) We also will review the expectations for the small group assignment on using public information on nursing homes.

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http://www.nytimes.com/2015/03/03/health/a-30-day-surgical-standard-is-under-scrutiny.html

http://www.ncqa.org/ReportCards/HealthPlans/StateofHealthCareQuality.aspx


Reading

Chakkalakal, R. J., Green, J. C., Krumholz, H. M., & Nallamothu, B. K. (2015). Standardized data collection practices and the racial/ethnic distribution of hospitalized patients. Medical care, 53(8), 666-672.

Kressin, N. R. (2015). Race/Ethnicity Identification: Vital for Disparities Research, Quality Improvement, and Much More Than “Meets the Eye”. Medical care, 53(8), 663-665.

Attanasio, L., & Kozhimannil, K. B. (2015). Patient-reported Communication Quality and Perceived Discrimination in Maternity Care. Medical care, 53(10), 863-871.

National Quality Forum. Technical Report. Risk adjustment for socioeconomic status or other sociodemographic factors. August 15, 2014.

Jha, A.K., Zaslavsky, A.M. (2014). Quality reporting that addresses disparities in health care. JAMA, 312(3), 225-226.

Trivedi, A.N., Wato, N., Hausmann, L.R.M., et al. (2014). Quality and equity of care in U.S. hospitals. N Engl J Med, 371(24), 2298-2308.

Gaskin, D.J., Spencer, C.S., Richard, P., et. al. (2008). Do hospitals provide lower-quality care to minorities than to whites? When minority patients receive hospital care, they receive the same standard of care that white patients receive. Health Aff, 27(2), 518-527.

Manary, M.P., Boulding, W., Staelin, R., and Glickman, S.W. (2013). The patient experience and health outcomes. N Engl J Med, 368(3), 201-203.

Gawande, A. (2004). The Bell Curve: What Happens When Patients Find Out How Good Their Doctors Really Are? New Yorker (December 6), 82-91.

Methods

Weissman, J.S., Betancourt, J.R. et al. Commissioned Paper: Healthcare Disparities Measurement, October 4, 2011, The Disparities Solutions Center, Mass General Hospital and Harvard Medical School (This is a long and interesting work focused on methods – read it if you are interested in the details.)

Web Resources

National Healthcare Quality and Disparities Report. (2014). Accessed December 23, 2015 from http://www.ahrq.gov/research/findings/nhqrdr/nhqdr14/index.html

Please note that the entire report can be accessed on the web – 231 pages – don’t print this)

Consumer Assessment of Health Plans Surveys, https://www.cahps.ahrq.gov


Varagunam, M., Hutchings A., Black N. (2014). Do patient-reported outcomes offer a more sensitive method for comparing the outcomes of consultants than mortality? A multilevel analysis of routine data. BMJ Qual Saf, 0, 1-8.

Ulmer, C., McFadden, B., and Nerenz, D.R., Editors; Subcommittee on Standardized Collection of Race/Ethnicity Date for Healthcare Quality Improvement: Institute of Medicine. Race, Ethnicity, and Language Date: Standardization for Health Care Quality Improvement. National Academies Press.

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https://www.cahps.ahrq.gov/

http://www.ahrq.gov/research/findings/nhqrdr/nhqdr14/index.html


http://www.nap.edu/catalog/12696.html (Not included on course website - this is a very long report – DO NOT PRINT!!) Excerpt on LATTE - IOM – race ethnicity and language data (extracts) 01 13 11].

Greene, J., Hibbard, J.H., Sacks, R., and Overton, V. (2013). When seeing the same physician, highly activated patients have better care experiences than less activated patients. Health Aff, 32(7), 1299-1305.

Li, Y., Cai, Y., Glance, L.G., Harrington, C., and Mukamel, D.B. (2013). Satisfaction with Massachusetts nursing home care was generally high during 2005-09, with some variability across facilities. Health Aff, 32(8), 1416-1425.

Trivedi, A.N., Grebla, R.C., Wright, S.M. and Washington, D.L. (2011). Despite improved quality of care in the veterans affair health system, racial disparity persists for important clinical outcomes. Health Aff, 30(4), 707-715.

Jha, A.K., Orav, J. and Epstein, A.M. (2011). Low-quality, high-cost hospitals, mainly in South, care for sharply higher shares of elderly Black, Hispanic, and Medicaid patients. Health Aff, 30(10), 1904-1911.

Agha, S., and Do, M. (2009). The quality of family planning services and client satisfaction in the public and private sectors in Kenya. Int J Qual Health Care, 21(2), 87-96.

Session 4 – Tuesday, February 4th: Public Disclosure and Report Cards

In this session, each group will report on the information they gained from public report sites. Their focus will be on the decision their “family” made, types of comparative information they used, a critique of the content/presentation of information, and barriers to use. Next, we will discuss public reporting methodology, the impact of public reporting on quality and providers’ reactions to public reporting.

Reading -- Nursing Home Public Reporting Focus

Mukamel, D. B., Ye, Z., Glance, L. G., & Li, Y. (2015). Does Mandating Nursing Home Participation in Quality Reporting Make a Difference? Evidence From Massachusetts. Medical Care, 53(8), 713-719.

Werner, R., Stuart, E., and Polsky, D. (2010). Public reporting drove quality gains at nursing homes. Health Aff, 29(9), 1706-1713.

Williams, A., Straker, J. K., & Applebaum, R. (2014). The nursing home five star rating: How does it compare to resident and family views of care?. The Gerontologist, gnu043.

Werner, R. M., Norton, E. C., Konetzka, R. T., & Polsky, D. (2012). Do consumers respond to publicly reported quality information? Evidence from nursing homes. Journal of health economics, 31(1), 50-61.

Reading

Austin, J. Matthew, Ashish K. Jha, Patrick S. Romano, Sara J. Singer, Timothy J. Vogus, Robert M. Wachter, and Peter J. Pronovost. "National hospital ratings systems share few common scores and may generate confusion instead of clarity." Health Affairs 34, no. 3 (2015): 423-430. (Note – top 10 paper in Health Affairs in 2015)

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http://www.nap.edu/catalog/12696.html


Ryan, A. M., & Detsky, A. S. (2015). Grade pending: Lessons for hospital quality reporting from the New York City restaurant sanitation inspection program. Journal of Hospital Medicine, 10(2), 116-119.

Howell, M.D. (2009). A 37-year-old man trying to choose a high-quality hospital: Review of hospital quality indicators. JAMA, 302(21), 2353-2360.

McNamara, P. (2006). Provider-specific report cards: a tool for health sector accountability in developing countries. Health Policy and Planning, 21(2), 101-109.

Ettinger, W.H., Hylka, S.M., Philips, R.A., Harrison, Jr., L.H., Cyr, J.A., and Sussman, A.J. (2008). When things go wrong: The impact of being a statistical outlier in publicly reported coronary artery bypass graft surgery mortality data. American Journal of Medical Quality, 23, 90-95.


Paddock, S.M., Adams, J.L., de la Guardia, F.H. (2014). Better-than-average and worse-than-average hospitals may not significantly differ from average hospitals: An analysis of Medicare Hospital Compare ratings. BMJ Qual Saf, 0, 1-7.

Lindenauer, P.K., Lagu, T., Ross, J.S., Pekow, P.S., Shatz, A., Hannon, N., Rothberg, M.B., Benjamin, E.M. (2014). Attitudes of hospital leaders toward publicly reported measures of health care quality. JAMA Intern Med, E1-E8. Published online October 6, 2014.

Mukamel, D.B., Weimer, D.L. , Zwanziger, J., Gorthy, SF. H., and Mushlin, A.I. (2004,2005). Quality report cards, selection of cardiac surgeons, and racial disparities: A study of the publication of the New York State Cardiac Surgery Reports, Inquiry, 41, 435-446.

Friedberg, M.W., Steelfisher, G.K., Karp, M., & Schneider, E.C. (2011). Physician group’s use of data from Patient Experience Surveys. J Gen Intern Med, 26(5), 498-504.

United States Government Accountability Office (GAO). October 2014. Healthcare Transprency – Actions needed to improve cost and quality information for consumers. http://www.gao.gov/products/GAO-15-11

Sherman, K.L, Gordon, E.J., Mahvi, D.M., Chung, J., Bentrem, D.J., Holl, J.L., and Bilimoria, K.Y. (2013). Surgeons’ perceptions of public reporting of hospital and individual surgeon quality. Med Care, 51(12), 1069-1075.

Lamb, G.C., Smith, M.A., Weeks, W.B., and Queram, C. (2013). Publicly reported quality-of-care measures influenced Wisconsin Physician groups. Health Aff, 32(3), 536-543.

Jain, S. (2010). Googling ourselves – What physicians can learn from online rating sites. N Engl J. Med, 362(1), 6-7.

Public Reporting as a Quality Improvement Strategy; Closing the Quality Gap: Revisiting the State of the Science. Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services Contract No. 290-2007-10057-I. Prepared by: Oregon Evidence-based Practice Center Portland, OR. Investigators: Annette M. Totten, Ph.D.,Jesse Wagner, M.A.,Arpita Tiwari, M.H.S.,Christen O’Haire, Ph.D., Jessica Griffin, M.S., Miranda Walker, M.A., AHRQ Publication No. 12-E011-EF, July 2012 http://effectivehealthcare.ahrq.gov/ehc/products/343/1199/EvidReport208_CQGPublicReporting_FinalReport_20120724.pdf

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http://effectivehealthcare.ahrq.gov/ehc/products/343/1199/EvidReport208_CQGPublicReporting_FinalReport_20120724.pdf


http://www.gao.gov/products/GAO-15-11


Hibbard, J.H., Greene, J. et al. (2012). An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care. Health Aff, 31(3), 560-568.

Bardach, N. S., et al. (2011). Users of public reports of hospital quality: Who, what, why, and how? AHRQ Publication No. 12-0016-EF, December 2011.

Romano, P.S., Marcin, J.P., Dai, J.J., Yang, X.D. et al. (2011). Impact of public reporting of coronary artery bypass graft surgery performance data on market share, mortality, and patient selection. Med Care, 49(12), 1118-1125.

Spinks, T.E., Walters, R., Feeley, T.W., Albright, H.W. et al. (2011). Improving cancer care through public reporting of meaningful quality measures. Health Aff, 30(4), 664-672.

Ross, J.S., Sheth, S., & Krumholz, H.M. (2010). State-sponsored public reporting of hospital quality: Results are hard to find and lack uniformity. Hlth Aff, 29(12): 2317-2322.

Glance, L.G., Dick, A.W., Mukamel, D.B., Li, Y., & Osler, T.M. (2010). How well do hospital mortality rates reported in the New York State CABG report card predict subsequent hospital performance?

Ferris, T.G., & Torchiana, D.F. (2010). Public release of clinical outcomes data – Online CABG report cards. NEJM, 1-3.

Tu, J.V., Donovan, L.R., Lee, D.S. et al. (2009). Effectiveness of public report cards for improving the quality of cardiac care: The EFFECT Study: A randomized trial. JAMA, 302(21), 2330-2337.

Session 5 Thursday, February 11th: Quality Improvement in Organizations

In the first part of this session we will explore the concepts of continuous quality improvement (CQI) and will focus on additional examples of how various organizations (hospitals, provider groups) have identified quality problems, undertaken quality improvement initiatives, and used the results for ongoing quality improvement activities.

Sean Uiterwick - Medical Director of Quality for Atrius. –Confirmed for this date – will get bio and readings will be posted soon.

Guest-Suggested Reading

Reading

Chassin, M.R. and Loeb, J.M. (2011). The ongoing quality improvement journey: Next stop, high reliability. Health Aff, 30(4), 559-568.

Taylor, M.J., McNicholas, C., Nicolay, C., et. al. (2013). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf, 0, 1-9.

Reed, J. E., & Card, A. J. (2015). The problem with Plan-Do-Study-Act cycles. BMJ quality & safety, bmjqs-2015.

Bradley, E., Hartwig, K.A., Rowe, L.A., et al. (2008). Hospital quality improvement in Ethiopia: A partnership-mentoring model. International Journal for Quality in Health Care, 20(6), 392-399.

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Landon, B.E., Hicks, L.S., O’Malley, A.J., Lieu, T.A., et. al.. (2007). Improving the management of chronic disease at community health centers. N Engl J Med, 356(9), 921-934.


Look at the section on process improvement in the website for The Network for The Improvement of Addiction Treatment (NIATx) https://www.niatx.net.

Look at the website for the Institute for Healthcare Improvement (IHI) https://www.ihi.org

Needleman, J., and Hassmiller, S. (2009). The role of nurses in improving hospital quality and efficiency: Real-world results. Health Aff – Web Exclusive, w625-w633.

Stanback, J., Griffey, S., Lynam, P., Ruto, C., & Cummings, S. (2007). Improving adherence to family planning guidelines in Kenya: An experiment. Int J Qual Health Care, 19(2), 68-73.

Mohammadi, S.M., Mohammadi, S.F., Hedges, J.R., Zohrabi, M., & Ameli, O. (2007). Introduction of a quality improvement program in a children’s hospital in Tehran: Design, implementation, evaluation and lessons learned. Int J Qual Health Care, 19(4), 237-243.

Session 6 – Thursday February 25th: Medical Errors and Patient Safety

During the first part of this session we will discuss the concept that medical errors arise largely from systemic issues in the health care system. To illustrate this concept, we will review case studies of medical errors and patient safety problems drawn from the Agency for Healthcare Research and Quality (AHRQ) web-based morbidity and mortality reports. We will also discuss the fast growing “check list” approach.

During the second part of this session, our guest speaker will be a soon to be PhD alum from Heller. Katherine T. Fillo, RN-BC, MPH, MA is currently pursuing her doctoral degree at Brandeis University’s Heller School of Social Policy and Management. She is studying hospital organization responses to adverse events in Massachusetts in order to determine if there are underlying factors that influence how an organization learns after an adverse event occurs. Her dissertation study has a mixed methods approach and utilizes two state databases. Her hearing for the dissertation defense is planned for January 2016.

Katherine received a Bachelor of Science in Nursing from the University of Pennsylvania and has been a registered nurse since 2004. She for over ten years she worked in a large academic medical center in a variety of roles including: as an acute care nurse with vulnerable populations, overseeing patient education programming and leading the organization's research and evidence-based practice committee. She received a Master in Public Health from Tufts University in 2007 and a Master of Art in Public Policy in 2012 while pursuing her doctoral degree at Brandeis University. In 2009 she was recognized as a member of the Massachusetts Institute of Community Health Leaders. Most recently Katherine has worked for the Massachusetts Department of Public Health where she has led several patient safety initiatives to reduce adverse events across the Commonwealth.

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https://www.ihi.org/

https://www.niatx.net/


Reading

Urbach, D.R., Govindarajan, A., Saskin, R., Wilton, A.S., & Baxter, N.N. (2014). Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med, 370(11), 1029-1038.

Leape, L.L. (2014). The checklist conundrum. N Engl J Med, 370(11), 1063-1064.

Horwitz, L.I. (2013). Does improving handoffs reduce medical error rates? JAMA, 310(21), 2255-2256.

Gawande, A. (2007). The checklist. If something so simple can transform intensive care, what else can it do? The New Yorker, 86-95.

Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H. et al (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. NEJM, 355(26), 2725-2732.

Birkmeyer, J.D. (2010). Strategies for improving surgical quality – checklists and beyond. N Engl J Med 363(20), 1963-1965.

Dudzinski, D.M., Hebert, P.C., Foglia, M.B. and Gallagher, T.H. (2010). The disclosure dilemma – Large-scale adverse events. N Engl J Med 363(10), 978-986.

Pronovost, P.J., Marsteller, J.A. and Goeschel, C.A. (2011). Preventing bloodstream infections: A measurable national success story in quality improvement. Health Aff, 30(4), 628-634.

Ofri, D. (2010). Ashamed to admit it: Owning up to medical error. Hlth Aff, 29(8): 1549-1551.

Pronovost, P. J., & Bienvenu, O. J. (2015). From Shame to Guilt to Love. JAMA, 314(23), 2507-2508.

Guest Speaker readings

Overview of state-based adverse event reporting from Betsy Lehman Center: http://www.chiamass.gov/assets/Uploads/blc-research/blc-nashp-research.pdf

Updated To Err is Human Report from NPSF (2015):

http://c.ymcdn.com/sites/www.npsf.org/resource/resmgr/PDF/Free_from_Harm.pdf

Web Resources

Agency for Healthcare Research and Quality – link to error and patient safety page with many references to literature and new initiatives, accessed on December 23, 2015, http://effectivehealthcare.ahrq.gov/ehc/products/343/1199/EvidReport208_CQGPublicReporting_FinalReport_20120724.pdf

When things go wrong. Responding to adverse events. A consensus statement of the Harvard Hospital. March 2006, see the website –

http://www.macoalition.org/documents/respondingToAdverseEvents.pdf


Schiff, G., Griswold, P., Ellis, B.R.,Puopolo A.L., Brede, N., Nieve, H.R., Federico, F., et al. (2014). Doing right by our patients when things go wrong in the ambulatory setting. The Joint Commission on Quality and Patient Safety, 40(2), 91-96, A1-A4.

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Starmer, A. J., Sectish, T.C., Simon, D.W., Keohane, C., McSweeney, M.E., Chung, E.Y. et al. (2013). Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA, 310(21), 2262-2270.

Kohn, L., Corrigan, J., & MS, D. (Eds.). (2000). To Err Is Human: Building a Safer Health System. Washington, DC: Institute of Medicine, National Academies Press. http://books.nap.edu/books/0309068371/html/

Classen, D.C., Resar, R., Griffin, F., Federico, F., Frankel, T. Kimmel, N. et al. (2011). ‘Global Trigger Tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff, 30(4), 581-589.

Watcher, R.M. (2010). Patient safety at ten: Unmistakable progress, troubling gaps. Health Aff, 29(1), 165-173.

Nanji, K.C., Rothschild, J.M., Salzberg, C., Keohane, C.A., Zigmont, K. et al. (2011). Errors associated with outpatient computerized prescribing systems. J Am Med Inform Assoc 18, 767-773.

Rivard, P.E., Luther, S.L., Christiansen, C.L., Zhao, S., Loveland, S., Elixhauser, A., Romano, P.S. and Rosen, A.K. (2008). Using patient safety indicators to estimate the impact of potential adverse events on outcomes. Med Care Res Rev, 65(1), 67-87.

Drosler, S.E., Klazinga, N.S., Romano, P.S., Tancredi, D.J., Gogorcena Aoiz, M.A., Hewitt, M.C., Scobie, S., et al. (2009). Application of patient safety indicators internationally: a pilot study among seven countries. Int J Qual Health Care, 21(4), 272-278.

Latimer, K.L., Pendleton, C., Olivi, A., Cohen-Gadol, A.A. et al. (2011). Harvey Cushing’s open and thorough documentation of surgical mishaps at the dawn of neurologic surgery. Arch Surg, 146(2), 226-232.

Flores, G. (2006). Language barriers to health care in the United States. N Engl J Med, 355(3), 229-231.

Session 7 – Tuesday, March 3rd: Future of Quality Measurement and Class-Selected Topic – Module 1 Wrap Up

In this session, we will first focus on performance measures used by “value-based health care purchasing,” (also known as P-4-P, Pay for Performance) in which buyers should hold providers of health care accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. During the last part of class, we will discuss the future of quality measurement in terms of goals, new measurement approaches and challenges.

Reading

Evaluating Pay For Performance Initiatives and Consequences

Roland, M. & Campbell, S. (2014). Successes and failures of pay for performance in the United Kingdom. N Engl J Med, 370(20), 1944-1948.

Campbell S.M., Reeves D., Kontopantelis E., Sibbald B., Roland M. (2009). Effects of pay for performance on the quality of primary care in England. N Engl J Med, 361(4), 368-378.

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http://books.nap.edu/books/0309068371/html/


Sutton, M., Nikolova, S. et al. (2012). Reduced mortality with hospital pay for performance in England. N Eng J Med, 367(19), 1821-1828.

Epstein, A.M. (2012). Will pay for performance improve quality of care? The answer is in the details. N Eng J Med, 367(19), 1852-1853.

Bardach, N.S., Wang,J.L., DeLeon, S.F., Shih, S.C., Boscardin, J., Goldman, L.E., Dudley, R.A. (2013). Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: A randomized trial. JAMA, 310(10), 1051-1059.

Brown, J.R., Sox, H.C., Goodman, D.C. (2014). Financial incentives to improve quality: Skating to the puck or avoiding the penalty box? JAMA, 311(10), 1009-1010.

Jauhar, Sandeep. (2008) Essay – The pitfalls of linking doctors’ pay to performance. The New York Times.

Friedberg, M.W., Safran, D.G., Coltin, K., Dresser, M. & Schneider, E.C. (2010). Paying for performance in primary care: Potential impact on practices and disparities. Hlth Aff, 29(5): 926-932.

Future of Quality Measurement

McGlynn, E.A.,Schneider, E.C., & Kerr, E.A. (2014) Reimagining quality measurement. N Engl J Med, 371(23), 2150-2153.

Cassel, C.K., Conway, P.H., Delbanco, S.F., Jha, A.K., Saunders, R.S. & Lee, T.H. (2014). Getting more performance from performance measurement. N Engl J Med, 371(23), 2145-2147.

Chien, A.T. & Rosenthal, M.B. (2013). Medicare’s physician value-based payment modifier – Will the tectonic shift create waves? N Engl J Med, 1-3.

Panzer, R.J., Gitomer, R.S., Greene, W.H. Webster, P.R., Landry, K.R., and Riccobono, C.A. (2013). Increasing demands for quality measurement. JAMA, 310(18), 1971-1980.

Conway, P.H., Mostashari, F., Clancy, C. (2013). The future of quality measurement for improvement and accountability. JAMA, 309(21), 2215-2216.

Chassin, M.R. (2013). Improving the quality of health care: What’s taking so long? Health Aff, 32(10), 1761-1765.

Wharam, J.F., and Sulmasy, D. (2009). Improving the quality of health care: Who is responsible for what? JAMA, 301(2), 215-217.

Landon, B.E. (2012). Use of quality indicators in patient care, A senior primary care physiciantrying to take good care of his patients. JAMA, 307(9), 956-964.

Young, G. (2010). Pay-for-performance in safety net settings: Issues, opportunities, and challenges for the future. J Healthc Manag, 55(2), 132-142.

Pronovost, P.J. and Lilford, R. (2011). Analysis & Commentary – A road map for improving the performance of performance measures. Health Aff, 30(4), 569-573.

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Blustein, J., Weissman, J.S., Ryan, A.M., Doran, T. and Hasnain-Wynia. (2011). Analysis raises questions on whether pay-for-performance in Medicaid can efficiently reduce racial and ethnic disparities . Health Aff, 30(6), 1165-1175.

Tompkins, C. (2009). Measuring outcomes and efficiency in Medicare Value-Based Purchasing. Hlth Aff, Web Exclusive w251-w261.

Powell, A.A., White, K.M. et al. (2012). Unintended consequences of implementing a National Performance Measurement System into local practice. J Gen Intern Med, 27(4), 405-412.

Kizer, K.W. and Kirsh, S.R. (2012). Double edged sword of performance measurement. J Gen Intern Med, 27(4), 395-397.

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