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VHIG Digest: Volume 2, No. 6

Posted by on Tuesday, April 5, 2011 in Digest, Our Blog and Digest, Uncategorized, Volume 2.

By Mike Miles, OGSM (MBA 2012)

In the News…

 1. Rules Aim to Reshape Medical Practices – WSJ 4/1/2011

The Center for Medicare and Medicaid Services (CMS) this week released a 429-page document covering the rules for accountable care organizations, how they will share risk with CMS, and how they must report quality of care. An additional summary is available from the Deloitte Center for Health Solutions here.

2. Arizona Proposed Medicare Fat Fee – WSJ 4/1/2011

Arizona Governor Jan Brewer proposed charging the state’s Medicaid recipients a $50 fee for unhealthy behaviors, such as obesity and smoking. This mimics the policies of some private insurance companies, but no government-run systems currently practice this. The fee was suggested along with a variety of ideas to raise money and offset recent cuts to the state’s Medicaid program. If the proposal passes, Arizona will reintroduce coverage of organ transplants and increase the number of childless adults covered.

In the Literature…

1. A Resident-Led Quality Improvement Initiative to Improve Obesity Screening

Instruction on quality improvement (QI) methods is required as part of residency education; however, there is limited evidence regarding whether internal medicine residents can improve patient care using these methods. Because obesity screening is not done routinely in clinical practice, residents aimed to improve screening using QI techniques. Residents streamlined body mass index (BMI) documentation, created educational materials about obesity, and launched an obesity screening QI initiative in a residency clinic. Residents designed plan-do-study-act cycles focused on increasing awareness and maintaining improvements in screening over a 1-year period. 
Neda Laiteerapong, Chris E. Keh, Keith B. Naylor, Vincent L. Yang, Lisa M. Vinci, Julie L. Oyler, and Vineet M. Arora. A Resident-Led Quality Improvement Initiative to Improve Obesity Screening American Journal of Medical Quality March 29, 2011 1062860610395930, first published on March 29, 2011 doi:10.1177/1062860610395930 

2. Use of Quality-Improvement Methods to Improve Timeliness of Analgesic Delivery

Despite its high prevalence, pain often is poorly managed in the emergency department. We used improvement science and quality-improvement methods to reduce delays associated with opioid delivery for children presenting to the emergency department with clinically apparent extremity fractures. On the basis of a review of the literature, interviews with key stakeholders, expert consensus, and reviews of isolated examples of patients receiving timely analgesics, a multidisciplinary improvement team identified a set of operational factors, or key drivers, believed to be critical to the performance of appropriate initial pain management for children presenting to the emergency department with acute extremity injury. These key drivers focused the development of an intervention. The intervention, termed the orthopedic evaluation process, addressed all 4 identified key drivers simultaneously by standardizing triage decisions, activating necessary health care providers, aligning the care delivery need with necessary resources, and allowing parallel-task completion between physicians and nursing staff. After implementation of this process, 95% of the patients with long-bone extremity fractures treated with intravenous opioids received a first dose within 45 minutes of arrival, compared with a preintervention baseline average of 20%. By applying quality-improvement and process improvement methodology, we identified key drivers for the rapid delivery of systemic opioids to patients with clinically apparent extremity fractures and significantly improved the timeliness of analgesic delivery for this subgroup of patients.
Iyer, Srikant B., Schubert, Charles J., Schoettker, Pamela J., Reeves, Scott D. Use of Quality-Improvement Methods to Improve Timeliness of Analgesic Delivery Pediatrics 2011 127: e219-e225