Section2.3 Utilize – Effective Use

Section 2.3 Utilize – Effective Use – Quality Measurement, Reporting, and Improvement - 1

Quality Measurement, Reporting, and Improvement

Quality measurement, reporting, and improvement is one of the key goals of the federal incentive program for making meaningful use of certified electronic health record (EHR) technology. The program requires use of National Quality Forum (NQF) endorsed measures, which are further described at Many of the requirements to be eligible formeaningful use incentive paymentsthrough the Centers for Medicare & Medicaid (CMS), do need seem geared to chiropractors but most fit within your scope of practice.

Chiropractic physicians qualify for three reporting measures in the CMS Physician Quality Reporting System (PQRS): use of a qualified electronic health record (EHR) system, pain assessment, and functional outcome assessment,(American Chiropractic Association 2011 PQRS Toolkit).

You may also choose to conduct other quality measurement activities, such as patient satisfaction and care appropriateness. Although not yet required by the Centers for Medicare & Medicaid (CMS) under the federal incentive program, approach quality reporting from both a measurement andimprovement perspective. Ultimately, CMS and other organizations will expect a measure to be reported and to have improved over time.

This tool helps you to consider how to best measure quality in your office and how to effect improvements beyond mere reporting of measures.

Evaluating and Using Clinical Interventions

Evaluate the reported measures required under the meaningful use incentive program. Consider adding other improvement goals that may be suitable for your office.

  1. Understand the processes impacted by the measures. For example, if you reportNQF 0013Hypertension: Blood Pressure Measurement, determine who should take the blood pressure and when it should be taken during the patient visit in order to get the most accurate reading.
  2. Identify the intervention you intend to apply in order to improve.Look for reminders to check on the patient’s status with respect to their goals. Perform proactive follow up with your patients, such as providing them with educational materials or a referral for more intense counseling.
  3. Cite the purpose of the measurement, reporting, and improvement. In some cases, this may be driven by an external body; in other cases, it may be an internal goal. For example, evaluateif patients with chronic back pain report agreement with and adherence to home exercise and nutrition recommendations.
  4. Identify the desired goal, such as all patients presentingwith low back pain will have an imaging study to support NQF 0052 Use of Imaging Study: Low Back Pain. This is neither a core measure nor an alternate core measure, but may be a measure that is easy for chiropractors to report.
  5. Identify the metrics you will use to collect data on the measures.For example, you may feel that some of your patients would benefit from depression management. Even though you may not provide the treatment and would not necessarily qualify to report NQF 0105 Depression Management, you may still wish to include referrals for depression management as part of your own quality improvement program, initiating and tracking their benefits.
  6. Monitor and record improvement with the intervention you are using. Determine the timeframe in which you will measure for improvement and document results. If you are meeting your target goals, celebrate success and monitor your progress to ensure you are sustaining the desired level of success and determine if your rates are improving. If you are not meeting your target goals, you may need to consider other interventions. Most interventions are not solely based in health information technology. People, policy, and other process issues factor in as well.

Quality Tool

Use the following tool to identify the measures you plan to adopt. Include those specifically for the meaningful use incentive program, as well as others you may desire. The example provided relates to one of the core functional criteria (recording and charting changes in vital signs) required for meaningful use that you may find is difficult for your office to perform.

Processes Impacted / Intervention / Purpose / Metrics / Goals / Achieved
Q 1 / Q 2
Patient intake & documentation of vitalsigns / Context-specific template-based charting / Improve accuracy to reduce repetitive interviewing to improve provider productivity / # missed entries on audit / every 5 patients / <2 / Yes
Patient satisfaction through fewer repetitive questions & procedures / # procedures repeated via process mapping (PM)
% satisfaction on survey / No unjustified repeats on quarterly PM
98% score / Yes
97% / No
99%

Copyright © 2011 Stratis Health. Funded by Chiropractic Care of Minnesota, Inc. (ChiroCare),

Adapted from Stratis Health’s Doctor’s Office Quality – Information Technology Toolkit, © 2005, developed by Margret\A Consulting, LLC. and produced under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.

For support using the toolkit

Stratis Health Health Information Technology Services

952-854-3306 

Section 2.3 Utilize – Effective Use – Quality Measurement, Reporting, and Improvement - 1