Improving care with portfolio of physician-led cancer quality measures at an academic center.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 49-49
Author(s):  
Julie Porter ◽  
Andrea Segura Smith ◽  
Marcy Winget ◽  
Eben Lloyd Rosenthal ◽  
Sridhar Belavadi Seshadri ◽  
...  
Keyword(s):  
Financial Incentives ◽  
Team Building ◽  
Quality Measures ◽  
Quality Data ◽  
Full Time ◽  
Data Systems ◽  
Full Time Equivalent ◽  
Quality Reporting ◽  
Academic Center ◽  
Physician Leaders

49 Background: Development and implementation of robust reporting processes to systematically provide quality data to care teams in a timely manner is challenging. National cancer quality measures are useful, but the required manual data collection is slow and resource-intensive. We designed a largely automated measurement system with our multidisciplinary cancer care programs (CCP). Methods: CCP physician leaders (MD) identified two measures that were meaningful to their team and patients. The quality team worked with hospital and university analytics teams to develop metrics and reports. Hospital leadership provided financial incentives (FI) for each CCP if jointly set targets were met. Results: 16 metrics were identified and measured for 13 CCPs (Table). Measures spanned from new diagnosis (ND) through end of life or survivorship care, and were a mix of process and outcome measures. To build and manage metrics required 2 full-time equivalent data analysts and quality specialists over 12 months. CCP MDs received monthly reports for dissemination to their team. Almost all measures improved or maintained initial high levels (*). FI awards will be used for quality improvement, education, and team-building, as determined by CCP MDs. Conclusions: A successful quality reporting system with measured improvements takes considerable engagement and resources, including FI, data systems, and staff to build, manage, and improve measures. This may not be feasible or sustainable for centers in the current fiscal environment. [Table: see text]

scholarly journals Improving Care With a Portfolio of Physician-Led Cancer Quality Measures at an Academic Center

2017 ◽  
Vol 13 (8) ◽  
pp. e673-e682 ◽  
Author(s):  
Julie Bryar Porter ◽  
Eben Lloyd Rosenthal ◽  
Marcy Winget ◽  
Andrea Segura Smith ◽  
Sridhar Belavadi Seshadri ◽  
...  
Keyword(s):  
Financial Incentive ◽  
Quality Measures ◽  
Extraction Methods ◽  
Essential Elements ◽  
Quality Data ◽  
Cancer Center ◽  
Academic Center ◽  
Quality Program ◽  
Timely Feedback ◽  
Physician Leaders

Purpose: Development and implementation of robust reporting processes to systematically provide quality data to care teams in a timely manner is challenging. National cancer quality measures are useful, but the manual data collection required is resource intensive, and reporting is delayed. We designed a largely automated measurement system with our multidisciplinary cancer care programs (CCPs) to identify, measure, and improve quality metrics that were meaningful to the care teams and their patients. Methods: Each CCP physician leader collaborated with the cancer quality team to identify metrics, abiding by established guiding principles. Financial incentive was provided to the CCPs if performance at the end of the study period met predetermined targets. Reports were developed and provided to the CCP physician leaders on a monthly or quarterly basis, for dissemination to their CCP teams. Results: A total of 15 distinct quality measures were collected in depth for the first time at this cancer center. Metrics spanned the patient care continuum, from diagnosis through end of life or survivorship care. All metrics improved over the study period, met their targets, and earned a financial incentive for their CCP. Conclusion: Our quality program had three essential elements that led to its success: (1) engaging physicians in choosing the quality measures and prespecifying goals, (2) using automated extraction methods for rapid and timely feedback on improvement and progress toward achieving goals, and (3) offering a financial team-based incentive if prespecified goals were met.

Recruitment, Readiness, and Retention of Providers at a Field Hospital during the Pandemic

2022 ◽  
pp. 1-21
Author(s):  
Ishaan Gupta ◽  
Zishan K. Siddiqui ◽  
Mark D. Phillips ◽  
Amteshwar Singh ◽  
Shaker M. Eid ◽  
...  
Keyword(s):  
Team Building ◽  
Well Being ◽  
Just In Time ◽  
Multidisciplinary Teams ◽  
Full Time ◽  
Full Time Equivalent ◽  
Field Hospital ◽  
Convention Center ◽  
Key Steps ◽  
Experienced Personnel

Abstract In response to the coronavirus disease 2019 (COVID-19) pandemic, the State of Maryland established a 250-bed emergency response field hospital at the Baltimore Convention Center to support the existing healthcare infrastructure. To operationalize this hospital with 65 full-time equivalent (FTE) clinicians in less than four weeks, more than 300 applications were reviewed, 186 candidates were interviewed, and 159 clinicians were credentialed and onboarded. The key steps to achieve this undertaking involved employing multidisciplinary teams with experienced personnel, mass outreach, streamlined candidate tracking, pre-interview screening, utilizing all available expertise, expedited credentialing, and focused onboarding. To ensure staff preparedness, the leadership developed innovative team models, applied principles of effective team building, and provided ‘just in time’ training on COVID-19 and non-COVID-19 related topics to the staff. The leadership focused on staff safety and well-being, offered appropriate financial remuneration and provided leadership opportunities that allowed retention of staff.

scholarly journals Implementing SNOMED CT for Quality Reporting: Avoiding Pitfalls

2011 ◽  
Vol 02 (04) ◽  
pp. 534-544 ◽  
Author(s):  
G. Wade
Keyword(s):  
Financial Incentives ◽  
Reporting Quality ◽  
Quality Measures ◽  
Clinical Findings ◽  
Snomed Ct ◽  
Quality Reporting ◽  
Critical Issues ◽  
Hospital Systems ◽  
Data Elements

SummaryObjective: To implement the SNOMED CT electronic specifications for reporting quality measures and to identify critical issues that affect implementation.Background: The Centers for Medicare and Medicaid (CMS) have issued the electronic specifications for reporting quality measures requiring vendors and hospital systems to use standardized data elements to provide financial incentives for eligible providers.Methods: The electronic specifications from CMS were downloaded and extracted. All SNOMED CT codes were examined individually as part of the creation of a mapping table for distribution by a vendor for incorporation into electronic health record systems. A qualitative and quantitative evaluation of the SNOMED CT codes was done as a follow up to the mapping project.Results: A total of 10643 SNOMED codes were examined for the 44 measures. The approved SNOMED CT code sets contain aberrancies in content such as incomplete IDs, the use of description IDs instead of concept IDs, inactive codes, morphology and observable codes for clinical findings and the inclusion of non-human content.Conclusion: Implementers of these approved specifications must do additional rigorous review and make edits in order to avoid incorporating errors into their EHR products and systems.

ANALISIS BEBAN KERJA DENGAN METODE FULL TIME QUIVALENT UNTUK MENGOPTIMALKAN KINERJA PADA BAGIAN PRODUKSI DI ERLANGGA KONVEKSI, MALANG

2020 ◽  
Vol 10 (2) ◽  
pp. 55-59
Author(s):  
Irgi Achmad Fahrezy ◽  
ST. Salmia L. A ◽  
Soemanto Soemanto
Keyword(s):  
Quality Control ◽  
Full Time ◽  
Full Time Equivalent

Pertumbuhanydan permintaan akan sandang yangysemakin meningkat menuntutbperusahan konveksi untuk memiliki tingkat produktifitas yang tinggi, dimana proses ini dapat dilakukan dengan cara meningkatkanbproduktifitas karyawannya. Erlangga Konveksi adalah salah satu perusahaan konveksi yang berdiri tahun 2010. Masalah yang terjadi di Erlangga Konveksi adalah tidak seimbangnya waktu proses produksi pada tiap stasiun kerja yang menyebabkan terjadinya penambahan jumlahpwaktu kerja dan menyebabkan penumpukanfdan banyak kegiatan dari operator yang menghabiskantwaktu dimana operator banyak melakukan kegiatan di luar dari stasiun kerja mereka sendiri untuk membantu operator di stasiun kerja lainya. Untuk itu perlu dilakukan pengukuran beban kerja sebagai dasar perhitungan kebutuhan tenaga kerja yang sesuai pada bagian produksi. Metode yang digunakan dalam penelitian ini adalah metode Full Time Equivalent. Hasil pengukuran menunjukkan beban kerja adalah sebesar 0,33 pada operator gambar pola; 0,29 pada operator  pemotongan 1; 0,31 pada operator pemotongan 2; 0,21 pada operator sablon 1 dan 2; 0,22 pada operator press sablon; 1,24 pada operator jahit obras 1; 1,27 padaooperator jahit obras 2; 0,34 pada operator jahit rantai; 0,25 pada operator cutting sebelumnoverdeck; 0,55 pada operator overdeck 1 dan 2; 0,57 pada operator overdeck 3; 0,18 pada operator quality control 1 dan 2; 0,14 pada operator steam; 0,42 pada operatorpsetrika dan 0,20 pada operator packaging. Berdasarkan beban kerja yang telah dihitung pada masing-masing operatorybagian produksi Erlangga Konveksi, Malang, jumlah tenaga optimal pada bagian produksi adalah sebanyak 7 orang yang terbagi ke dalam 7 stasiun kerja.

scholarly journals Effects of coronavirus disease 2019 (COVID-19) pandemic on antimicrobial prevalence and prescribing in a tertiary hospital in Singapore

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Tat Ming Ng ◽  
Sock Hoon Tan ◽  
Shi Thong Heng ◽  
Hui Lin Tay ◽  
Min Yi Yap ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Quality Indicators ◽  
Survey Methodology ◽  
Tertiary Hospital ◽  
Full Time ◽  
Full Time Equivalent ◽  
Prevalence Survey ◽  
Antimicrobial Prescribing ◽  
Point Prevalence Survey ◽  
Prescribing Quality

Abstract Background The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing. Methods One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017–2019. Results The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p = 0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p < 0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p = 0.08). Conclusion During the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators.

scholarly journals Review of the Health, Welfare and Care Workforce in Tasmania, Australia: 2011–2016

2021 ◽  
Vol 18 (13) ◽  
pp. 7014
Author(s):  
Belinda Jessup ◽  
Tony Barnett ◽  
Kehinde Obamiro ◽  
Merylin Cross ◽  
Edwin Mseke
Keyword(s):  
Oral Health ◽  
Rural Communities ◽  
Health Workforce ◽  
Census Data ◽  
Care Service ◽  
The State ◽  
Full Time ◽  
Full Time Equivalent ◽  
Diverse Range ◽  
Per Capita

Background: On a per capita basis, rural communities are underserviced by health professionals when compared to metropolitan areas of Australia. However, most studies evaluating health workforce focus on discrete professional groups rather than the collective contribution of the range of health, care and welfare workers within communities. The objective of this study was therefore to illustrate a novel approach for evaluating the broader composition of the health, welfare and care (HWC) workforce in Tasmania, Australia, and its potential to inform the delivery of healthcare services within rural communities. Methods: Census data (2011 and 2016) were obtained for all workers involved in health, welfare and care service provision in Tasmania and in each statistical level 4 area (SA4) of the state. Workers were grouped into seven categories: medicine, nursing, allied health, dentistry and oral health, health-other, welfare and carers. Data were aggregated for each category to obtain total headcount, total full time equivalent (FTE) positions and total annual hours of service per capita, with changes observed over the five-year period. Results: All categories of the Tasmanian HWC workforce except welfare grew between 2011 and 2016. While this growth occurred in all SA4 regions across the state, the HWC workforce remained maldistributed, with more annual hours of service per capita provided in the Hobart area. Although the HWC workforce remained highly feminised, a move toward gender balance was observed in some categories, including medicine, dentistry and oral health, and carers. The HWC workforce also saw an increase in part-time workers across all categories. Conclusions: Adopting a broad approach to health workforce planning can better reflect the reality of healthcare service delivery. For underserviced rural communities, recognising the diverse range of workers who can contribute to the provision of health, welfare and care services offers the opportunity to realise existing workforce capacity and explore how ‘total care’ may be delivered by different combinations of health, welfare and care workers.

Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry-Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

2021 ◽  
pp. 019459982110119
Author(s):  
Jeremy J. Michel ◽  
Seth R. Schwartz ◽  
Douglas E. Dawson ◽  
James C. Denneny ◽  
Eileen Erinoff ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Practice ◽  
Head And Neck ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Care ◽  
Quality Measures ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Quality Reporting

Background and Significance Quality measurement can drive improvement in clinical care and allow for easy reporting of quality care by clinicians, but creating quality measures is a time-consuming and costly process. ECRI (formerly Emergency Care Research Institute) has pioneered a process to support systematic translation of clinical practice guidelines into electronic quality measures using a transparent and reproducible pathway. This process could be used to augment or support the development of electronic quality measures of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) and others as the Centers for Medicare and Medicaid Services transitions from the Merit-Based Incentive Payment System (MIPS) to the MIPS Value Pathways for quality reporting. Methods We used a transparent and reproducible process to create electronic quality measures based on recommendations from 2 AAO-HNSF clinical practice guidelines (cerumen impaction and allergic rhinitis). Steps of this process include source material review, electronic content extraction, logic development, implementation barrier analysis, content encoding and structuring, and measure formalization. Proposed measures then go through the standard publication process for AAO-HNSF measures. Results The 2 guidelines contained 29 recommendation statements, of which 7 were translated into electronic quality measures and published. Intermediate products of the guideline conversion process facilitated development and were retained to support review, updating, and transparency. Of the 7 initially published quality measures, 6 were approved as 2018 MIPS measures, and 2 continued to demonstrate a gap in care after a year of data collection. Conclusion Developing high-quality, registry-enabled measures from guidelines via a rigorous reproducible process is feasible. The streamlined process was effective in producing quality measures for publication in a timely fashion. Efforts to better identify gaps in care and more quickly recognize recommendations that would not translate well into quality measures could further streamline this process.

FRI0524 THE ACR’S RHEUMATOLOGY INFORMATICS SYSTEM FOR EFFECTIVENESS (RISE) REGISTRY SUPPORTS SMALL RHEUMATOLOGY PRACTICES FOR FEDERAL QUALITY REPORTING PROGRAM

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 861-862
Author(s):  
Z. Izadi ◽  
T. Johansson ◽  
J. LI ◽  
G. Schmajuk ◽  
J. Yazdany
Keyword(s):  
Quality Measures ◽  
Quality Reporting ◽  
Practice Characteristics ◽  
Informatics System ◽  
Group Practices ◽  
Status Assessment ◽  
And Performance ◽  
Reporting Programs

Background:The Rheumatology Informatics System for Effectiveness (RISE) Registry was developed by the ACR to help rheumatologists improve quality of care and meet federal reporting requirements. In the current quality program administered by the U.S. Centers for Medicare and Medicaid services, rheumatologists are scored on quality measures, and performance is tied to financial incentives or penalties. Rheumatoid arthritis (RA)-specific quality measures can only be submitted through RISE to federal programs.Objectives:This study used data from the RISE registry to investigate rheumatologists’ federal reporting patterns on five RA-specific quality measures in 2018 and investigated the effect of practice characteristics on federal reporting of these measures.Methods:We analyzed data on all rheumatologists who continuously participated in RISE between Jan 2017 to Dec 2018 and who had patients eligible for at least one RA-specific measure. Five measures were examined: tuberculosis screening before biologic use, disease activity assessment, functional status assessment, assessment and classification of disease prognosis, and glucocorticoid management. We assessed whether or not rheumatologists reported specific quality measures via RISE. We investigated the effect of practice characteristics (practice structure; number of providers; geographic region) on the likelihood of reporting using adjusted analyses that controlled for measure performance (performance in 2018; change in performance from 2017; and performance relative to national average performance). Analyses accounted for clustering by practice.Results:Data from 799 providers from 207 practices managing 213,757 RA patients was examined. The most common practice structure was a single-specialty group practice (53%), followed by solo (28%) and multi-specialty group practice (12%). Most providers (73%) had patients eligible for all five RA quality measures. Federal reporting of quality measures through RISE varied significantly by provider, ranging from no reporting (60%) to reporting all eligible RA measures (12.2%). Reporting through RISE also varied significantly by quality measure and was highest for functional status assessment (36%) and lowest for assessment and classification of disease prognosis (20%). Small practices (1-4 providers) were more likely to report all eligible RA quality measures compared to larger practices (21%, 6%; p<0.001). In adjusted analyses, solo practices were more likely than single-specialty group practices to report RA measures (42%, 31%; p<0.027) while multispecialty group practices were less likely (18%, 31%; p<0.001). Additionally, higher performance in 2018 and performance ≥ the national average performance was associated with federal reporting of the measures through RISE (p≤0.004).Conclusion:Forty percent of U.S. rheumatologists participating in RISE used the registry for federal quality reporting. Physicians using RISE for reporting were disproportionately in small and solo practices, suggesting that the registry is fulfilling an important role in helping these practices participate in national quality reporting programs. Supporting small practices is especially important given the workforce shortages in rheumatology. We observed that practices reporting through RISE had higher measure performance than other participating practices, which suggests that the registry is facilitating quality improvement. Studies are ongoing to further investigate the impact of federal quality reporting programs and RISE participation on the quality of rheumatologic care in the United States.Disclaimer: This data was supported by the ACR’s RISE Registry. However, the views expressed represent those of the authors, not necessarily those of the ACR.Disclosure of Interests:Zara Izadi: None declared, Tracy Johansson: None declared, Jing Li: None declared, Gabriela Schmajuk Grant/research support from: Pfizer, Jinoos Yazdany Grant/research support from: Pfizer

First and foremost, physicians: the clinical versus leadership identities of physician leaders

2016 ◽  
Vol 30 (4) ◽  
pp. 711-728 ◽  
Author(s):  
Joann Farrell Quinn ◽  
Sheri Perelli
Keyword(s):  
Health Care ◽  
Skills Training ◽  
Leadership Role ◽  
Organizational Level ◽  
Care Organization ◽  
Full Time ◽  
Clinical Expertise ◽  
Physician Leadership ◽  
Content Type ◽  
Physician Leaders

Purpose – Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues. Design/methodology/approach – Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory. Findings – These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis. Research limitations/implications – Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale. Practical implications – These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role. Social implications – This work points to a broader and more fundamental need – a modified mindset about the nature and value of physician leadership. Originality/value – This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer and organizational level in the creation of their own leadership identity.

An Input Adjustment Method for Challenging Privatization: A Case from Michigan Prison Health Services

2016 ◽  
Vol 42 (2) ◽  
pp. 85-98
Author(s):  
Roland Zullo
Keyword(s):  
Best Practice ◽  
Full Time ◽  
Managed Competition ◽  
Physical And Mental Health ◽  
Full Time Equivalent ◽  
The Public ◽  
Prison Health ◽  
Good Government ◽  
Personnel Practice ◽  
Price Differences

I investigate the feasibility of completely privatizing prison physical and mental health service. The study is based on bid documents from Michigan’s 2012 exploration of privatized health care, along with historical documents. Five lessons are reported: (1) Price differences are largely attributable to staffing strategies, with private agents using fewer full-time equivalent (FTE) and less-qualified staff; (2) privatization ushers in personnel practice that is less structured for long-term employee retention; (3) managed competition is impractical due to qualified provider scarcity and desirability of client-patient continuity; (4) tension between best practice medicine and the profit motive is unresolvable, which necessitates diligent monitoring; and (5) privatization ideology is a powerful force that is external to the public interest but one that can be challenged by “good government” coalitions.

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