Practice Based Learning - Quality Improvement

UPDATE: Root Cause Analysis \| Deming Cycle-PDSA \| Announcements \| PBLI-Curriculum \| Inst. of Medicine \| Needle Stick \| Mass Patient Safety \| ABIM-recert \| Error Reduction \| PBLI-Begins At Home \| ICU low BS \| Oops-Res Ipsa \| EOL as QI--PDSA \| Neat Handwriting \| Quality-Adobe-PDF1 \| Research-PIM \| Error Reduction-PDF3 \| Photos/Docs7 \| EBM2(see Amb) \| Handwriting Errors \| Quality at SBH \| QI starts at home \| Calendar \| FAQ \| NYT-DoNoHarm \| JCAHO prep 2004 \| Chaissin-Errors \| Rocket Science \| Berwick Conversation \| Children's Hospital \| NYT-CQI-denominator \| NYT-claimant's view \| Occupational HIV \| Deming-PDSA&God \| Too much steroid \| Error help -patients \| ACP-outpt med errors \| Links \| Quality Links2 \| Quality Links3 \| ABIM-PIM-SEP-MOC \| Resident Errors \| JCAHO-NYT 2004 \| DanaFarber-JustCult \| AHRQ/Error Reduction \| SBH -QA/QI-HEDIS \| NEJM-Duke Error \| UpdateIndex \| Help

VIEW: Home \| Root Cause Analysis \| Deming Cycle-PDSA \| Announcements \| PBLI-Curriculum \| Inst. of Medicine \| Needle Stick \| Mass Patient Safety \| ABIM-recert \| Error Reduction \| PBLI-Begins At Home \| ICU low BS \| Oops-Res Ipsa \| EOL as QI--PDSA \| Neat Handwriting \| Quality-Adobe-PDF1 \| Research-PIM \| Error Reduction-PDF3 \| Photos/Docs7 \| EBM2(see Amb) \| Handwriting Errors \| Quality at SBH \| QI starts at home \| Calendar \| FAQ \| NYT-DoNoHarm \| JCAHO prep 2004 \| Chaissin-Errors \| Rocket Science \| Berwick Conversation \| Children's Hospital \| NYT-CQI-denominator \| NYT-claimant's view \| Occupational HIV \| Deming-PDSA&God \| Too much steroid \| Error help -patients \| ACP-outpt med errors \| Links \| Quality Links2 \| Quality Links3 \| ABIM-PIM-SEP-MOC \| Resident Errors \| JCAHO-NYT 2004 \| DanaFarber-JustCult \| AHRQ/Error Reduction \| SBH -QA/QI-HEDIS \| NEJM-Duke Error

Visit the TeacherWeb® videos to learn about the features, modifications, and customizations available on your website. Click here to learn more. PBLI-Begins At Home You are currently using the Homework With Text Formatting page type. This is an old page type with limited formatting options. We would recommend switching to the Enhanced Text page, a more advanced page type with many more options. Click here for more information on the different page types. Please note: You may continue to use this page type if you desire. <P><B><FONT size=5>PBLI ("The Mirror"), SBP ("The Village") </FONT></B></P> <P><I><FONT size=5> meets</FONT></I></P> <P><I><FONT size=5>CAP, CHF, and AMI</FONT></I></P> <P><FONT size=5> </FONT></P> <P><U><FONT size=5>1. Introduction (What is PBLI and SBP?)</FONT></U></P> <P><FONT size=5></FONT></P> <P><FONT size=5>Sometimes you wonder about the ACGME/ABMS concepts of </FONT></P> <P><FONT size=5>Practice-based Learning and Improvement (PBLI) and</FONT></P> <P><FONT size=5>Systems-based Practice (SBP). Why do you need to learn</FONT></P> <P><FONT size=5>this seemingly extraneous material? How does it fit in</FONT></P> <P><FONT size=5>with your care of patients? </FONT></P> <P><FONT size=5>Let me respond:</FONT></P> <P><A href="http://www.teacherweb.com/NY/StBarnabas/Quality/Bar-PBLI-1.pdf"><FONT size=5>PBLI</FONT></A><FONT size=5> has been likened to a mirror that allows the </FONT></P> <P><FONT size=5>individual physician to reflect upon the quality of</FONT></P> <P><FONT size=5>the care they personally provide (using</FONT></P> <P><FONT size=5>evidence-based medicine as a guide, of course). </FONT></P> <P><FONT size=5>As an example, in the ambulatory setting, your analysis </FONT></P> <P><FONT size=5>of your population of patients with diabetes for </FONT></P> <P><FONT size=5>documentation of monitoring of urine microalbumin, HbA1c,</FONT></P> <P><FONT size=5>etc would be a </FONT><A href="http://www.teacherweb.com/NY/StBarnabas/Quality/JGIM-2004-Ogrinc-PBLI.pdf"><FONT size=5>PBLI activity </FONT></A><FONT size=5>. If you were assigned to</FONT></P> <P><FONT size=5>the ER, a PBLI activity could involve reviewing patients</FONT></P> <P><FONT size=5>you saw who presented with community acquired pneumonia to</FONT></P> <P><FONT size=5>determine if blood cultures were obtained and </FONT></P> <P><FONT size=5>antibiotics given within a specified period of time. </FONT></P> <P><FONT size=5>How is SBP different?</FONT></P> <P><FONT size=5>"</FONT><A href="http://www.simonsays.com/content/content.cfm?sid=33&pid=406135&agid=13"><FONT size=5>It Takes a Village</FONT></A><FONT size=5>" is a book about how it requires</FONT></P> <P><FONT size=5>more than one individual to raise a child. And</FONT></P> <P><FONT size=5>SBP has been likened to the village of system resources</FONT></P> <P><FONT size=5>(and system monitors) needed to provide quality care to</FONT></P> <P><FONT size=5>patients. Programs that provide funding for the </FONT></P> <P><FONT size=5>health care of the older patient (Medicare) and</FONT></P> <P><FONT size=5>the care of patients who can not afford </FONT></P> <P><FONT size=5>insurance (Medicaid) are part of this system. </FONT></P> <P><FONT size=5>Understanding what these system resources provide for</FONT></P> <P><FONT size=5>your patients, your hospital, and you is part of</FONT></P> <P><FONT size=5>SBP. (Note: Medicare and Medicaid are now part of</FONT></P> <P><FONT size=5>"CMS".)</FONT></P> <P><FONT size=5></FONT></P> <P><FONT size=5></FONT></P> <P><U><FONT size=5>2. Background on national quality improvement activities</FONT></U></P> <P><FONT size=5>The public has an interest in knowing that it is receiving</FONT></P> <P><FONT size=5>"high quality" health care. Employers and those who provide</FONT></P> <P><FONT size=5>health insurance (e.g., Medicare & Medicaid) have an interest</FONT></P> <P><FONT size=5>making certain that that patients receive high quality health care. </FONT></P> <P><FONT size=5>Thus, both </FONT><A href="http://www.jcaho.org/"><FONT size=5>JCAHO</FONT></A><FONT size=5> and </FONT><A href="http://www.cms.hhs.gov/"><FONT size=5>CMS</FONT></A><FONT size=5> are cooperating to document and improve</FONT></P> <P><FONT size=5>the quality of care provided to patients. </FONT></P> <P><FONT size=5>To start with, JCAHO and </FONT><A href="http://www.cms.hhs.gov/media/press/release.asp?Counter=955"><FONT size=5>CMS</FONT></A><FONT size=5> have decided to look at the</FONT></P> <P><FONT size=5>quality of care provided to patients admitted with the following</FONT></P> <P><FONT size=5>diagnoses: </FONT></P> <P><FONT size=5>Community Acquired Pneumonia (CAP), </FONT></P> <P><FONT size=5>Congestive Heart Failure (CHF),</FONT></P> <P><FONT size=5>Acute Myocardial Infarction (AMI),.</FONT></P> <P><FONT size=5>Since JCAHO and CMS are very busy, the actual montitoring</FONT></P> <P><FONT size=5>of our hospital for compliance with the quality of care</FONT></P> <P><FONT size=5>"core measures" is actually performed by </FONT><A href="http://www.ipro.org/"><FONT size=5>IPRO</FONT></A><FONT size=5>. </FONT></P> <P><FONT size=5>And the results of IPRO findings are reported to the public</FONT></P> <P><FONT size=5>and are </FONT><A href="http://www.cms.hhs.gov/media/press/release.asp?Counter=1343"><FONT size=5>used by CMS to determine reimbursement </FONT></A><FONT size=5>to the</FONT></P> <P><FONT size=5>Hospital. Fortunately, we have the assistance of our</FONT></P> <P><FONT size=5>own QA and UM departments to provide feedback to us</FONT></P> <P><FONT size=5>about our progress in documenting quality of care as</FONT></P> <P><FONT size=5>"reflected" by the core measures. </FONT></P> <P><FONT size=5></FONT></P> <P><U><FONT size=5>3. What-you-talkin'-'bout, Willis?</FONT></U></P> <P><FONT size=5>But I hear you say: "What is CMS, JCAHO and IPRO and what is a 'core measure'?</FONT></P> <P><FONT size=5>Check the following links for the answers:</FONT></P> <P><A href="http://www.jcaho.org/pms/core+measures/cr_hos_cm.htm"><FONT size=5>Who is JCAHO? (And what are "Core Measures"</FONT></A><FONT size=5> and what does JCAHO have</FONT></P> <P><FONT size=5>to do with them?</FONT></P> <P><A href="http://www.cms.hhs.gov/quality/hospital/#Premier%20Hospital%20Quality%20Incentive%20Demonstration"><FONT size=5>Who is CMS and what is the Hospital Quality Alliance?</FONT></A></P> <P><A href="http://www.cms.hhs.gov/quality/hospital/HospitalQualityMeasures.pdf"><FONT size=5>What are the CMS Hospital Quality Measures?</FONT></A></P> <P><A href="http://providers.ipro.org/index/ami-quality-measures"><FONT size=5>What are IPRO's core measures for AMI?</FONT></A></P> <P><A href="http://providers.ipro.org/shared/chf/chfbook.pdf"><FONT size=5>What does IPRO expect you to teach your patients about CHF?</FONT></A></P> <P><A href="http://providers.ipro.org/index/pneumonia-quality-measures"><FONT size=5>What does IPRO use as core measures of quality for treatment of community acquired pneumonia?</FONT></A></P> <P><A href="http://www.medicare.gov/Hospital/Home.asp?Type=City&City=BRONX&submitCity=Search+by+City+%3E&pagelist=Home&dest=NAV%7CHome%7CHome%7CMeasHospSelect%7CSelectState%7ENarrowSearch&language=English&version=default&browser=IE%7C6%7CWinXP&State=NY%7CNew+York&search_dest=Nav%7CHome%7CHome%7CNarrowSearch%7CSelectState"><FONT size=5>How are WE doing?</FONT></A><FONT size=5> (You will need to do a search.)</FONT></P> <P><FONT size=5>Now aren't you glad you have our own QA Department to help us!</FONT></P> <P><FONT size=5>Please complete sections of the chart that apply to the core indicators</FONT></P> <P><FONT size=5>of quality, including:</FONT></P> <P><FONT size=5> <A href="http://www.teacherweb.com/NY/StBarnabas/Quality/SBH-QA-PatPlanPostHosp.pdf"><FONT color=#ff0000>'The Patient Plan For Post Hospital Care'</FONT></A></FONT></P> <P><FONT size=5>and take advantage of our own: </FONT></P> <P><FONT size=5> <A href="http://www.teacherweb.com/NY/StBarnabas/Quality/SBH-QA-reminder.pdf"><FONT color=#ff0000>'SBH QA Reminder Tool'</FONT></A></FONT></P> <P><FONT size=5> *****</FONT></P> <P><FONT size=5>In summary, competency in PBLI means that residents can</FONT></P> <P><FONT size=5>use a "mirror" to reflect upon their own provision of </FONT></P> <P><FONT size=5>evidence-based quality care. Organizations that comprise</FONT></P> <P><FONT size=5>part of our health care system (such as JCAHO and CMS)</FONT></P> <P><FONT size=5>are now challenging us to show that we are up to the task</FONT></P> <P><FONT size=5>of showing we can do this for CAP, CHF, and AMI.</FONT></P> <P><FONT size=5>care. If we do well, they will shower us with rewards</FONT></P> <P><FONT size=5>and announce our success to the world. </FONT></P> <P> </P> <P> </P> <P><FONT size=5> </FONT></P> <P><FONT size=5> </FONT></P> <P><FONT size=5> </FONT></P> <P><FONT size=5> </FONT></P> <P><FONT size=5> </FONT></P><FONT face=Arial size=5> <P> </P></FONT> Or, would you like to view and optionally restore one of these previous versions? Password: Forgot your password?

Practice Based Learning - Quality Improvement

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