Overview of core measures
Core measures were first initiated in the year 2003 (Booth, 2009). During their inception, the processes comprised of ten acute myocardial infarction indicators, four congested heart failure indicators, twelve pneumonia indicators, three surgical care improvement indicators, and two pregnancy-related measures. In the year 2006, three more measures were added (Booth, 2009). In the year 2008, two more indicators were added. The national inpatient and outpatient quality measures are standardized performance systems used in the evaluation of health care delivered in specified focus areas. As such, the existing core measures symbolize the outcomes of the efforts from a number of stakeholders. The stakeholders include physicians, health care centers, clients, and medical communities. To enhance these measures and encourage precise expansion in consumer safety, the National Patient Safety was formed.
In spite of the widespread distribution of the core measures, it is worrying to note that there is a considerable disparity in their applications across the health care centers (Booth, 2009). Rationales behind this disparity are complicated and may comprise dissimilarities in guideline acquaintance, provider education, and devices and procedures aimed at ensuring that the suggested care is offered and documented. Equally, health care type, size, and setting have been found to be having a relationship with conformity rates. In addition, other health care factors such as physician leadership and managerial support might affect the consistent use of evidence-based procedures of care.
Definition of core measures
Based on the above illustrations, core measures can be defined as a national quality plan authorized by the Center for Medicare and Medicaid Services and The Joint Commission towards monitoring detailed health care processes and how well health care institutions can offer recommended care (Rainer, 2013). Inpatient processes improve the contribution of certain healthcare sets. The sets are acute myocardial infarction, pneumonia, heart failure, stroke, venous thromboembolism, surgical care improvement project, children’s asthma care, emergency department, and preventive immunization (Rainer, 2013). On the other hand, outpatient patient measures improve the contribution of some specified healthcare sets. The sets may include emergency department measures focused on discharged patients, surgery, and acute myocardial infarction.
The quality of care can be established using core measures. The above can be achieved by monitoring the use of suggested interventions, which scientific facts indicate that result inappropriate outcomes. Physicians and researchers have confirmed that these interventions lessen the threats associated with complications, thwart recurrences, and care for a number of patients who visit the healthcare centers for the cure conditions or sickness (Singer & Willman, 2010). Physicians and researchers are continually assessing facts to make certain that the measures and strategies are advanced.
How organizations are increasing awareness of the evidenced-based practice that underlines the core measures
A major factor contributing to the unstable compliance of national inpatient and outpatient quality measures with safety goals is the absence of substantial evidence linking the procedures of care to enhanced outcomes. For instance, research aimed at identifying compliance with ventilator-related pneumonia care procedures has illustrated that physicians usually have limited familiarity with the facts behind the proposed intervention (Couvillon, 2005). Compliance got better following the verification of these interventions and when the possible benefits for patients were passed on to the health care personnel.
To increase awareness of the evidenced-based practices that underline core measures, organizations must change the way their personnel and the system behave (Couvillon, 2005). Usually, implementing core measures in the organization leads to many changes. Just as in any organization, change in health care organizations can be met with enormous resistance. Therefore, hospital executives must plan how to implement evidence-based practices that underline core measures. To lessen the resistance, the knowledge transfer framework has been adopted in the organizations. The framework aids the physicians and hospital executives to collaborate in coming up with a better understanding of the changes resulting from implementing evidence-based practices (Couvillon, 2005). Similarly, to increase awareness organizations can build partnerships. Through this, healthcare personnel, health care executives, and researchers are brought together with the aim of coming up with a common perception and a sense of purpose. Equally, organizations employ the use of change agents. To achieve this, organizations appoint leaders to support the changes that will be realized because of implementing evidence-based practices. The leaders should be credible to be respected and trusted by the employees they seek to persuade. Another means of increasing awareness is by the distribution of relevant information. Facts about evidenced-based practices are made available to health care personnel. The information is passed on through various means. The medium of transfer is selected based on the targeted audience. In addition, education and training initiatives can increase awareness. Continuing education modules, tutorials, and one-on-one coaching are also employed to keep the health personnel up to date with progress in core measures (Couvillon, 2005).
It should be noted that targeting sensitive compliance with national inpatient and outpatient quality measures without extensive progress in inpatient care procedures and employee education has inadequate benefits. In some instances, it can lead to unwelcome consequences. Research undertaken on 86 patients confirmed this allegation. The patients had been diagnosed with pneumonia (Spiegler, 2007). The researchers noted that up to 21% of the cases had contemporary presentations. It was clear that there were suitable reasons to postpone antibiotic administrations. Based on this diagnostic ambiguity, it is apparent that gratifying one hundred adherences to antibiotic administration within 6 hours to all the 86 patients would not be appropriate (Spiegler, 2007). Such interventions may result in unsuitable use of antibiotics and may redirect limited resources for patients who are more severely sick. In this regard, initiatives meant to enhance the performance of national inpatient and outpatient quality measures are synchronized with care pathways. Physicians may be encouraged to conform to these practices if awareness is enhanced. Therefore, they must be informed about the importance of evidence-based practice.
How core measures are documented
More often, it has been very hard to do measure clinical care processes. As such, physicians have little time to carry out additional measurements, paperwork, and computer data entry. Currently, information for quantifying core measures is collected in two ways. The first method is the clinical chart abstraction. Through this, qualified and trained human abstractors evaluate charts to identify if the core measures were achieved. During these processes, abstractors search for facts to ascertain that a core measure was realized by providing timely interventions and reviewing the charts for possible documentation of valid exception conditions when interventions could not be possible. When an applicable exclusion has been documented, the core measure is considered a complaint. Through the second way coding of diagnoses and procedures are analyzed to identify the quantity of the core measures. During the second method of documentation, chart abstraction is also undertaken. However, while carrying out chart abstraction during the second method different sets of individuals are required to abstract the most suitable diagnosis, procedures, and billing codes.
The most appropriate way of ensuring that caregivers document quality data is to ensure that all the documentation processes are made part of their daily workflow. A number of quality-related parameters such as the time of intervention can be identified from the electronic chart. In this regard, organizations should note that performance would not be enhanced until it has been documented and evaluated. Therefore, the realization of quality processes without documentation is an empty gesture that is likely to fail in the enhancement of patient care. To make certain that appropriate results are documented, it is essential that all healthcare practitioners give the most precise and expressive admission evaluation records possible.
What I have learned about core measures
From the above analysis of core measures, I have learned a number of benefits of adopting these measures. I have noted that the implementation of the measures would be of benefit to patients. As such, healthcare centers exist to provide the appropriate care to patients. Therefore, if the means of providing care are enhanced, patients will be the biggest beneficiaries. Through this, the cost of providing health care would lessen. Equally, mortality rates, morbidity rates, disability rates, length of stay, and readmission rates would be reduced. With respect to organizations, being engaged in quality measure coverage offers an opportunity to guarantee the public that they are offering high-quality care. With increased competition in the healthcare industry, an organization that complies with the core measures would have a competitive advantage over its rivals. Similarly, I have learned that if the individuals are allowed to share quality measures and cost of services in different health care centers, the public can be able to make informed decisions and select the best suitable hospital for their patients. Similarly, I have noted that core measures lessen the threats associated with complications, thwart recurrences, and care for a number of patients who visit the healthcare centers for the cure conditions or sickness.
In addition, I have learned that hospitals that uphold elevated percentages of conformity with the core measures are given more compensation from Medicare and other financiers compared to hospitals that record lower percentages. With more remuneration, these hospitals can improve their services. As such, they can purchase better tools, improve services, increase employees’ remuneration (Spiegler, 2007). Through this, the hospitals can gain an added advantage over their competitors.
Apart from the importance of core measures, I have also learned that despite widespread distribution of the core measures, there is a substantial disparity in their applications across the health care centers. The causes for these differences are multifaceted and may comprise of dissimilarities in guideline acquaintance, provider education, and devices and procedures to make certain that the suggested care is offered and documented (Spiegler, 2007). Equally, I learned that health care type, size, and setting have been found to be having a relationship with conformity rates. Above all, I learned that other health care factors such as clinician leadership and managerial support might affect the reliable use of evidence-based procedures of care (Spiegler, 2007).
References
Booth, J. (2009). The SCIP core measures. Nursing Management (Springhouse), 40(3), 10-14.
Couvillon, J. S. (2005). How To Promote Or Implement Evidenced-Based Practice In A Clinical Setting. Home Health Care Management & Practice, 17(4), 269-272.
Rainer, J. (2013). Core measures. Nursing Management (Springhouse), 44(10), 13-15.
Singer, N., & Willman, J. (2010). Tools for meeting core measures for heart failure best practice. Heart & Lung: The Journal of Acute and Critical Care, 39(4), 364-365.
Spiegler, P. (2007). Core Measures and Pneumonia: Are They Doing What They’re Supposed To?. Clinical Pulmonary Medicine, 14(5), 308-309.