IHI Module- Q1 101 Intro Health Care Improvement PDF

Preview

Summary

IHI Module- Q1 101 Intro Health Care Improvement - SUMMARY...

Description

HLSC 3P94

IHI Module- QI 101: Intro to Health Care Improvement

Lesson 1: A Tale of Two Patients Keziah, a 27-year-old nurse, is taking the last ski run of the day on a beautiful March afternoon. With the shadows lengthening, she doesn’t see the protruding stick that catches her ski. Her first feeling is embarrassment (“I’m a better skier than this!”) as she tumbles. Keziah’s second feeling is shock at the snap she hears as she lands, and then at the intense pain shooting from her left leg. Within minutes, an entire system of care is fully engaged. A ski patrol team bundles Keziah into a sled. At the bottom of the hill, an emergency medical technician evaluates her and suspects a fracture of her tibia, fibula, or both. She is transported to a local hospital, where administrative staff, nurses, radiology technicians, emergency physicians, radiologists, and an orthopedist align the bones and put her leg in a cast. Seven hours later, Keziah leaves the emergency department with her roommate. She feels proud of the care system of which, on another day, she would have been a part as a provider. It wasn’t perfect — the wait was too long, the x-ray tech tried to x-ray the wrong leg — but overall she thinks, on behalf of her chosen profession, “We’re pretty good at this healing stuff.” Keziah is right. Our ability to provide superb technical care for acute illness or injury is remarkably better than it was a century ago, and it’s interesting to think about how much better we can get! But, before we congratulate ourselves too much, let’s think about another side of the story. Providing Affordable, High-Quality Care The past decade has seen huge advancements in life-saving health technologies and medicines. But as exciting as they are, these changes can add complication and expense to the health system. Health systems increasingly must face challenges such as:1 Providers are becoming more specialized, contributing to gaps in communication and care. Populations are aging, and the disease burden is shifting toward chronic conditions. Patients and families are better informed and want personalized care. There is growing availability of and demand for complicated procedures and expensive treatments.

HLSC 3P94

IHI Module- QI 101: Intro to Health Care Improvement

In the video, let's hear from IHI's Chief Medical Officer, Dr. Don Goldmann. He'll introduce you to a patient named Anna:  36 year old single mom – works two jobs  Diabetes, obesity, hypertension, obesity  In and out of hospital in past few years  Ana is tired, stressed because of shoe string budget  Ana is not benefiting from medical advancements. Even the most advanced biomedical science doesn't guarantee high-quality care to everyone who needs it. These are international issues, and around the world, nations are seeking to address them in different ways. (We'll look at a few examples in this lesson.) But the road to better health care will require more than policy changes. It will take a host of health professionals — people working on the front lines — making changes to improve the systems in which they work. That’s where you come in. In this course, we'll begin to show you how you could make a difference. In the remainder of the Open School's quality improvement curriculum, we'll give you the practical knowledge and tools you need to do it. The US and Industrialized Nations A computer technology specialist holds a gene-sequencing computer chip that reduces the speed for identifying viral DNA from months to hours. The cost of care has been a growing problem throughout developed nations, and this is true regardless of culture or politics. For example, data from the Organization for Economic Cooperation and Development (OECD) found average per capita spending on health among 34 member countries increased by more than 70 percent between 2000 and 2010.2 Most concerning, perhaps, is that high costs aren't always associated with high-quality care. Data from the Commonwealth Fund found:3 Despite having the most expensive health care system, the United States ranks last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity, and healthy lives … While there is room for improvement in every country, the US stands out for having the highest costs and lowest performance — the US spent $8,508 per person on health care in 2011, compared with $3,406 in the United Kingdom, which ranked first overall. We asked Dr. Goldmann to set the stage for what it is about the US health system that needs improvement. Here’s what he told us:  6 dimensions of high quality healthcare

HLSC 3P94

IHI Module- QI 101: Intro to Health Care Improvement

 US Healthcare was under-reporting  Methods to screen for and control HBP  Emphasize (added dimensions  value, access  Progress in addressing these gaps has been very slow  Not just in US  Magnitude in health disparities  in south America  Disparities between all races We’ll devote the entirety of the next lesson to discussing the six areas for improvement Dr. Goldmann described from the Institute of Medicine (IOM). For now, Dr. Goldmann invited you to become more familiar with data about health care costs and quality in your own area. The following tool is a place to Low Income Nations: Through community mapping, community members are able to make evidence-based recommendations on interventions and policies to improve health and prevent disease in their constituency. So far, we've talked about health care in high-income nations. But what about health care in parts of the world affected by poverty? Compare the numbers on the previous page, showing that it's common for OECD nations to spend $3,000 or more per person per year on health care, to this one: In the lowestincome countries, annual health spending is only about $11 per person.5 (And now compare that figure to the $30-40 annual minimum WHO recommends for essential services.) When it comes to improving health in low-income nations, the best use of limited resources is a difficult topic. Let’s hear from Dr. Sodzi Sodzi-Tettey, IHI Senior Technical Director for the Africa Region:  Bridge is what they need*  No ways of transporting pregnant women in labour  Goes beyond process improvement  More advocacy* Dr. Sodzi-Tettey gave a good example of improving health access. Improving access — usually by offering more affordable (or free) medical care — has typically been policymakers’ focus for communities deprived of basic services. But attention to quality is just as important, especially because patients will avoid seeking care if they perceive it as dangerous or ineffective. Improving health care quality in low-income countries means addressing problems such as:6-8 High adverse event rates Too few and poorly trained providers

HLSC 3P94

IHI Module- QI 101: Intro to Health Care Improvement

Limited diagnostic tools and equipment Delays in accessing medications and other treatments The need to effectively treat growing numbers of patients with non-communicable diseases, such as cancer, heart disease, and diabetes The good news, as Dr. Sodzi-Tettey has witnessed firsthand, is that improvement science and targeted resources can make a big impact where needs are great:  Measurable results – go to the problem Disparities Across and Within Nations: As you're seeing, based on where someone lives and certain characteristics at birth, there are significant differences in the type of health and health care they're likely to experience. This is often true even within the same country or hometown. For example, consider the following differences based on 2015 statistics from the World Health Organization (WHO):9  The lifetime risk of maternal death is 1 in 11 in Afghanistan — compared to 1 in 17,800 in Ireland.  In the US, African Americans represent only 12 percent of the population, but account for almost half of all new HIV infections.  About 80 percent of noncommunicable diseases are in low- and middle-income countries.  In London, when travelling east from Westminster toward Canning Town, each tube stop represents nearly one year of life expectancy lost.  In Japan, life expectancy at birth is more than 80 years; in several African countries, it's fewer than 50 years. The root causes of the differences we see by no means begin or end in the clinical setting. As WHO’s Commission on Social Determinants of Health has put it:10 Water-borne diseases are not caused by a lack of antibiotics but by dirty water, and by the political, social, and economic forces that fail to make clean water available to all; heart disease is caused not by a lack of coronary care units but by lives people lead, which are shaped by the environments in which they live; obesity is not caused by moral failure on the part of individuals but by the excess availability of high-fat and high-sugar foods.

HLSC 3P94

IHI Module- QI 101: Intro to Health Care Improvement

Where the health care system — and you, as a provider (or future provider) — fit into this complex matrix of factors that determine a person’s chances of living a long, healthy life is something we discuss further in TA 101: Introduction to the Triple Aim for Populations. For now, let's consider how can countries learn from one other based on what different nations do well. International Improvement Efforts: In December 2012, the United Nations General Assembly called on governments to “urgently and significantly scale-up efforts to accelerate the transition towards universal access to affordable and quality health care services.” 11Today, countries around the world of vastly different political, economic, and cultural makeups are working toward this goal in different ways. Because no single system or model exists for achieving universal, high-quality health coverage, health care leaders and organizations have urged countries to study one another, regardless of culture or politics, and look at what works well and where there may be cautionary tales.12 In this spirit, here are several examples of the huge variety of ongoing efforts that have been happening across the globe to improve quality and efficiency and reduce costs:  In 1993, Australia was the first country to implement cost-effectiveness requirements for drug approvals: Before new drugs are eligible for the national formulary, an independent committee must assess their relative clinical value and cost compared to other available treatments. New Zealand, the Netherlands, Sweden, and other countries have since adopted similar policies.13  Since 2005 in Chile, all Chileans have had access to a basic package of health care services, guaranteeing treatments for up to 80 health problems, setting upper limits to waiting times and out-of-pocket payment for treatments.14  In Denmark, every primary care practice’s medical record system is connected to a national network, which allows all practices to electronically send and receive clinical data to and from specialists, hospitals, pharmacies, and other health care providers. Primary care providers also have access to an online medical handbook with updated information on diagnosis and treatment recommendations.

HLSC 3P94

IHI Module- QI 101: Intro to Health Care Improvement

 In 2010, Kenya launched The Health Sector Services Fund, which provides direct cash transfers to primary health care facilities so that local communities can respond to their constituents’ greatest health needs. This initiative has been expanded to nearly 3,000 primary health facilities in the public sector.16  Largely due to aggressive price regulation, Japan has had a relatively cheap universal health insurance system for more than 50 years. Patients can go to the medical institution of their choice and receive services for the same cost.17  Germany made health insurance mandatory for its entire population in 2009. The country limits total out-of-pocket costs as a share of income to 2 percent for the general population and 1 percent for sicker patients.18  In 2003, Turkey launched wide reforms focused on expanding access to services for the poor and underserved. Since then, the country has expanded formal health insurance coverage to more than 95 percent of the population and significantly improved a number of key health outcomes.19  In 2010, the United States passed sweeping health care reform legislation known as The Patient Protection and Affordable Care Act. Some of the changes included: free preventive care services, the ability for children to stay on or join their parents’ health insurance plans up to age 26, and new insurance options for people without health insurance.20 The Role of the Provider: Now that you have a basic understanding of what health care is like today, in the next two lessons of this course, we’ll begin to discuss how you can get involved in making positive changes to the picture we just painted. Before we end this lesson, let's connect one more time with Dr. Goldmann:  US – blame these gaps on broken health care system  Incompletely insured population  Lack of alignment between payment and care delivery  Traumatic changes in healthcare system have un-anticipated consequences  With basic skills in the area of quality improvement — and a lot of will to enact change — you can make a dent in the statistics and inequities we’ve identified. You can lead your peers to better outcomes by the actions you take in every organization in which you practice. In regard to health disparities around the world, which of the following statements is most true?

HLSC 3P94

IHI Module- QI 101: Intro to Health Care Improvement

The best answer is B and C. Where a child is born and raised can significantly change the life expectancy. The root causes of this and other health differences we see around the world are deeply complex and by no means begin or end in the clinical setting. Which of the following is a trend in modern health care across industrialized nations? The best answer is A and C. As medical information and technology increases, demand for complicated procedures is increasing, and providers are becoming more and more specialized (and fragmented). The burden of disease is shifting toward chronic conditions. Which of the following countries has had a relatively inexpensive universal health insurance system for more than 50 years? Japan has had a relatively inexpensive universal health insurance system for more than 50 years. Germany made health insurance mandatory for its entire population in 2009. Chile has given all Chileans access to a basic health care package since 2005. Which of the following statements is true: During the past 15 years, the cost of care has been a growing problem for many developed nations. The cost of care has been a growing problem throughout developed nations during the last 15 years. For example, across 34 nations that make up the Organization for Economic Cooperation and Development (OECD), the average per capita health care expenditure increased by more than 70 percent between 2000 and 2010. However, the biggest spenders — such as the US — don’t necessarily have the highest quality in many areas. Today, countries around the world with vastly different political, economic, and cultural makeups are working toward the goals of improving quality and access in different ways. Which of the following statements is a reason for improving the US health care system? The US government and citizens alike are struggling to afford the cost of care. The US government and citizens alike are struggling to afford the cost of care. We’ve seen in this lesson the US has the means to measure health care quality — the results just often are not what one would hope! Although the US remains a leader in biomedical innovation, even

HLSC 3P94

IHI Module- QI 101: Intro to Health Care Improvement

the most advanced biomedical science and technology can’t guarantee high-quality care. Which of the following countries has implemented costeffectiveness requirements for drug approvals? Australia

Lesson 2: Two IOM Reports: Have you ever received a piece of negative feedback — maybe it was a poor grade on a school assignment, or an unfavorable job performance evaluation — but felt unsure of what you needed to improve? For example, did you receive a failing grade on your history paper because of your writing style, your research methods, or because you turned it in late? Or was it a combination of all three? In 1999, the Institute of Medicine (IOM) published To Err Is Human: Building a Safer Health Care System, an alarming report that drew tremendous public attention toward health care. It said 44,000 to 98,000 Americans were dying due to medical errors each year. (Learn more in PS 101: Introduction to Patient Safety.)1 The need to treat patients better was obvious, and it was clear that something had to be done. But what? No one had yet defined the dimensions of quality that needed to be improved. Then, in 2001, the IOM released another report: Crossing the Quality Chasm: Health Care in the 21st Century.2 This report built on the previous one, identifying six key dimensions of the United States health care system and setting aims for each dimension. These six aims are so comprehensive that today they’re still the dominant framework for thinking about improving health care quality in the US and in many other countries, as well.

HLSC 3P94

IHI Module- QI 101: Intro to Health Care Improvement

The IOM 6 Aims for Improvement: Thanks to the Quality Chasm report, we now know that care should be safe, timely, effective, efficient, equitable, and patient-centered (“STEEEP” can be a helpful mnemonic device), and we know what each of these categories entails:

Of course, the IOM did not say exactly how inspired doctors, nurses, pharmacists, and workers in other health care fields could achieve these aims. Rather, the report provided some initial guidance and concluded it would be “… neither useful nor possible to specify a blueprint for 21st-century health care delivery systems. Imagination abounds at all levels, and all promising routes for innovation should be encouraged.”2 That’s where you come in. In this lesson, you’ll see how with a strong sense of direction, there’s no reason you can’t begin to address the challenges in health care today that we discussed in Lesson 1. We’ll go over the problems we face with each of the six dimensions of health care, and then we’ll give you a real example of ordinary people working together, with passion and skill, to completely transform how they deliver care. Aim 1: Safe: Avoid Injuries to patients from the care that is intended to help them* The Problem The first IOM aim addresses the dimension of safety: Patients shouldn’t be harmed by the care intended to help them. You might think this goes without saying, but the reality is even in developed nations, as many as 1 in 10 hospital patients is harmed while receiving care.

HLSC 3P94

IHI Module- QI 101: Intro to Health Care Improvement

For example, a 2011 study that looked at medical and medication errors in Australia, Canada, New Zealand, the United Kingdom, the US, Germany, and the Netherlands found 11 percent of patients had experienced an error within the last two years. Researchers concluded: “Despite years of patient safety research and intervention, better communication among multiple health care providers and more structured organization of care remain the major challenge for all countries for error prevention.” 3 One Country’s Solution The Scottish Patient Safety Programme (SPSP) is a national initiative that aims to improve the safety and reliability of health care. Jason Leitch, National Clinical Director of Healthcare Quality for the Scottish government, describes why the SPSP program set an ambitious goal to reduce mortality by 15 percent across the country:4,5 The work Leitch described started in the acute care setting in 2008 and has spread to maternity and child care, mental health, and primary ca...