Quality and Performance Improvement Tools and Resources

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 Tools
Organizations
Documents
Quality Indicators

Tools

2007 Physician Quality Reporting Initiative (PQRI) Tool Kit
The Centers for Medicare & Medicaid Services (CMS) has developed a Tool Kit for the 2007 Physician Quality Reporting Initiative (PQRI) that will assist eligible professionals with successful reporting. This Tool Kit consists of some existing educational resources plus new measure-specific worksheets designed to walk the user step-by-step through reporting for each measure.

Agency for Healthcare Research and Quality (AHRQ), Hospital Survey on Patient Safety Culture
This survey tool can be used to assess the safety culture of a hospital as a whole, or for specific units within hospitals, as well as to track changes in patient safety over time and evaluate the impact of patient safety interventions.

AHRQ Releases Toolkits to Help Providers and Patients Implement Safer Health Care Practices
The 17 toolkits, developed by AHRQ-funded experts who specialize in patient safety research, are free, publicly available, and can be adapted to most health care settings. The toolkits range from checklists to help reconcile medications when patients are discharged from the hospital to processes to enhance effective communication among caregivers and with patients to toolkits to help patients taking medications.

AMA has developed educational materials to help you get your hospital involved in the Strides in Saftey campaign
This article from the American Medical Association provides quick tips about how to improve overall patient safety in your facility. It briefly describes six different programs designed by the Institute for Healthcare Improvement that can be implemented in your hospital to attain the highest quality patient safety standards.

CAH Financial Indicators Report
This report can be used to track your CAH's performance across time in relation to other similar institutions.

Introduction to Physician Performance Measurement Sets: Tools Developed by Physicians for Physicians
This manual was developed by the Physician Consortium for Performance Improvement. The primary purpose of these sets is to encourage physicians to improve patient care and maintain clinical excellence by ensuring that they receive standardized, useful information describing their current practice patterns compared with a minimum set of clinical recommendations.

Key Informant Interview and Assessment Process
This document provides information for planning and preparing for face-to-face interviews. Subject areas are suggested for the development of specific questions. Developed by the Center for Rural Health, University of North Dakota, School of Medicine and Health Sciences.

Measuring Rural Hospital Quality
This paper, from the Rural Health Research Center, presents a model for rural hospital quality measurement as well as the relevancy and issues of quality measures for rural hospitals. The paper also explains how rural hospitals can implement quality measurements into their organization.

Mobilizing for Action through Planning and Partnerships
Four MAPP Assessments, Community Health Status Assessment - The CHSA provides a list of core indicators (data elements) for 11 broad-based categories. Communities may also select additional indicators. By gathering data for each of the categories and assessing changes over time or differences among population subgroups or with peer, state, or national data, health issues are identified.

New AHRQ Tools Help Pharmacies Better Serve Patients With Limited Health Literacy
The pharmacy assessment tool can help raise pharmacy staff awareness of health literacy issues, detect barriers that may prevent individuals with limited literacy skills from using and understanding health information provided by a pharmacy, and may help identify opportunities for improving services. This tool includes a pharmacy assessment tour to be completed by trained, objective auditors; a survey to be completed by pharmacy staff; and a guide for focus groups with pharmacy patients. The three parts are complementary and are designed to form a comprehensive assessment.

Patient Safety Tools: Improving Safety at the Point of Care
These 17 toolkits were produced under AHRQ's Partnerships in Implementing Patient Safety (PIPS) grant program. The projects have produced a variety of evidence-based tools, including training materials, medication guides and checklists, that are easily adapted to other institutions and care settings. The tools were developed in the field and are designed to be implemented by multidisciplinary users.

Quality Indicator Project - Indicator Sets and Services
The QI Project's on-line Data Center allows participants to manage every aspect of the performance measurement process - from data collection and management to transmission and comparative analysis to utilizing a robust set of SPC and charting tools. Because the Data Center is web-based, it's easy-to-use and accessible from multiple points within a facility. Plus, participants can use the same tool to satisfy multiple initiatives - such as the CMS' 7th Scope of Work and the AHA's National Quality Initiative. By streamlining the entire data collection and analysis process, participants can focus on actually using their data to achieve performance goals.

Top 10 Cost Reporting Errors, Stroudwater Associates
This manual is designed to help you prepare an accurate cost report. The cost report is a critical element for critical access hospitals (CAHs) as it is the sole determiner of how mush the hospital will be paid by Medicare. The cost report is also important for general acute hospitals under 100 beds while the outpatient hold harmless is in effect. A well-completed cost report can also be used to facilitate decision-making, with one important caveat: investment decisions should be made on a variable/marginal cost basis.

Transforming Hospitals: Designing for Safety and Quality
Can the design of a hospital affect the quality of your care? Does noise reduction improve patient satisfaction? Will better lighting decrease medical errors? The evidence says yes. HHS. Agency for Healthcare Research and Quality has just released a new DVD that provides evidence to help hospital officials and architects design safer, high quality hospitals. This new two-part DVD illustrates the value of evidence-based hospital design . a phrase used to describe how the physical design of health care environments affects patients and staff.

Use of Sub Acute Care
This performance aid was designed for rural distinct part skilled and swing bed coordinators to provide: Clarification on the transfer rule and expanded list of affected DRGs; specify transfer rule payments for each provider; provide comparisons for payments under the transfer rule vs skilled PPS; and identify possible transfer day based on the expected need for subacute care.



Organizations

AHRQ Patient Safety Network (PSNet)
On the site, in "What's New", you'll find an annotated, carefully selected compilation of the most recent and important news, research, tools, and conferences in patient safety.

American College of Medical Quality (ACMQ)
The specialty medical association for physicians and other professionals in the fields of clinical quality improvement, quality assessment and medical quality management.

The American Health Quality Association: Advancing Quality of Care & Patient Safety Nationwide
The American Health Quality Association represents Quality Improvement Organizations (QIOs) and professionals working to improve the quality of health care in communities across America. QIOs share information about best practices with physicians, hospitals, and nursing homes. Working together with health care providers, QIOs identify opportunities and provide assistance for improvement.

American Medical Association - Pay-for-Performance Principles
This Web site is made available by the AMA and provides information, principles, and guidelines on pay for performance plans. Topics covered include Patient Registries, Evaluating Incentive Plans, and Physician Pay-for-Performance Initiatives.

American Society for Healthcare Risk Management
Established in 1980, the American Society for Healthcare Risk Management is a personal membership group of the American Hospital Association with more than 4,600 members representing health care, insurance, law and other related professions. ASHRM promotes effective and innovative risk management strategies and professional leadership through education, recognition, advocacy, publications, networking and interactions with leading health care organizations and government agencies.

American Society for Quality, Healthcare Division (ASQ)
A world leader in providing resources, training, and networking possibilities to quality professionals in nearly every industry. ASQ is working with leading healthcare organizations, such as the Institute for Healthcare Improvement and the American Hospital Association, to enhance the use of quality improvement theories, methods, and tools in health care.

California Health Care Foundation's Quality Initiative, The
The Quality Initiative coordinates quality measurement and outreach projects in the Health Care Quality program area. The Initiative serves as a catalyst in improving healthcare quality.

Center for Health Care Strategies, Inc. (CHCS)
CHCS strives to continuously improve the quality of health and health related services for beneficiaries of our nation's health coverage safety net -Medicaid and the State Children's Health Insurance Program.

The Commonwealth Fund Hospital Performance Improvement E-Forum
This site features synched audio and slides from presentations by the lead authors of two new Fund reports on hospital improvement, as well as an introduction by Tony Shih, M.D., M.P.H., the Fund's senior program officer for quality improvement and efficiency, and two expert commentaries.

ECRI (formerly the Emergency Care Research Institute)
An independent nonprofit health services research agency. ECRI's mission is to promote the highest standards of safety, quality, and cost-effectiveness in healthcare to benefit patient care through research, publishing, education, and consultation.

Group Practice Improvement Network (GPIN)
A nonprofit organization founded by the Institute for Healthcare Improvement that helps its members achieve and sustain performance excellence by sharing knowledge of best practices.

HCUP QI On-Line, Healthcare Cost Utilization Project
Gives you on-line information about HCUP hospital measures. It is designed to allow policy makers, public health professionals and the public to do interactive searches of national rates of hospital utilization, access and quality.

Hospital Quality Initative (HQI)
Centers for Medicare and Medicaid Services, these initatives build up upon previous CMS and QIO strategies to identify illnesses and / or clinical conditions that affect Medicare beneficiaries in order to promote the best medical practices associated with the targeted clinical disorders; prevent or reduce further instances of these selected clinical disorders; and prevent related complications.

Institute for Clinical Systems Improvement (ICSI)
A collaboration of health care organizations, an objective voice dedicated to championing health care quality and to helping its members identify and accelerate the implementation of best clinical practices for their patients. The ICSI program has four components: improvement commitment, scientific groundwork for health care, support for improvement, and the Minnesota health quality agenda.

Institute for Healthcare Improvement (IHI)
A not-for-profit organization driving the improvement of health by advancing the quality and value of health care. Founded in 1991 and based in Cambridge Massachusetts, IHI offers comprehensive products and services.

Institute for Medical Quality (IMQ)
A 501 (c) (6) non-profitorganization dedicated to improving the quality of care provided to patients across the continuum of health care. IMQ offers a wide range of educational, accreditation, consultation, and certification programs.

International Society for Quality in Health Care
A non-profit independent organization with members in over 70 countries. ISQua works to provide services to guide health professionals, providers, researchers, agencies, policy makers and consumers, to achieve excellence in healthcare delivery to all people, and to continuously improve the quality and safety of care.

kaiserEDU.org
This Web site was developed by the Kaiser Family Foundation. kaiserEDU provides easy access to data, literature, news and developments regarding major health policy topics and debates. Designed for health care students and faculty.

Leapfrog
The Leapfrog Group is made up of more than 160 companies and organizations that buy health care. Leapfrog and its members work together to: reduce preventable medical mistakes and improve the quality and affordability of health care; reward doctors and hospitals for improving the quality, safety and affordability of health care; encourage public reporting of health care quality and outcomes so that consumers and purchasing organizations can make more informed health care choices; and help consumers reap the benefits of making smart health care decisions.

MidMichigan Health Web site
A family of organizations dedicated to providing a quality comprehensive health care throughout the middle of Michigan and beyond.

Medical Outcomes Trust
A not for profit organization dedicated to improving health and health care by promoting the science of outcomes measurement, and the development, evaluation and distribution of standardized, high quality instruments that measure health and the outcomes of medical care. The Trust supports the use of these instruments with services and publications.

National Association for Healthcare Quality
Committed to developing and promoting professional expertise in the art and science of healthcare quality.

National Association for Healthcare Quality Association Journal
Publishes the Journal for Healthcare Quality. NAHQ is a professional forum that continuously advances healthcare quality practice in diverse and changing environments. JHQ is the first choice for creative and scientific solutions in the pursuit of healthcare quality.

National Business Coalition on Health, NBCH
A national, non-profit, membership organization of employer-based health coalitions. NBCH and its members are dedicated to value-based purchasing of health care services through the collective action of public and private purchasers. NBCH seeks to accelerate the nation's progress towards safe, efficient, high quality health care and the improved health status of the American population.

National Committee for Quality Assurance (NCQA)
An independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, including health maintenance organizations (HMOs).

National Patient Safety Foundation, (NPSF)
Accomplishes their mission through: Identifying and creating a core body of knowledge; identifying pathways to apply the knowledge; developing and enhancing the culture of receptivity to patient safety; raising public awareness and fostering communications about patient safety; and improving the status of the Foundation and its ability to meet its goals.

National Safety Council The National Quality Forum
A private, not-for-profit membership organization created to develop and implement a national strategy for healthcare quality measurement and reporting. The mission of the NQF is to improve American healthcare through endorsement of consensus-based national standards for measurement and public reporting of healthcare performance data that provide meaningful information about whether care is safe, timely, beneficial, patient-centered, equitable and efficient.

National Quality Forum (NQF)
A not-for-profit membership organization created to develop and implement a national strategy for healthcare quality measurement and reporting. A shared sense of urgency about the impact of healthcare quality on patient outcomes, workforce productivity and healthcare costs prompted leaders in the public and private sectors to create the national Quality Forum as a mechanism to bring about national change.

Patient Safety Institute (PSI)
Combines the power of technology with the strength of patient-provider relationships to improve care and lower the costs of health care.

Qual-IT
While public and private health care purchasers have focused on quality measurement and reporting, they do not typically provide specific incentives for the adoption of HIT as part of an overall value-based health care plan. As this issue of Qual-IT describes, however, several policy initiatives focused on employer-based health plans could provide the needed impetus to dramatically increase HIT adoption and use.

Quality Interagency Coordination Task Force (QuIC)
Works to ensure that all Federal agencies that purchase, provide, study or regulate healthcare services are working in a coordinated way toward the common goal of improving the quality of care. The QuIC seeks to provide information to help people make choices, to improve the care purchased and delivered by the government and to develop the infrastructure needed to improve the healthcare system.

Rural Assistance Center's Health Care Quality Information Guide
An in-depth information guide that includes FAQs, tools, funding, documents, journals, organizations, bibliographies, news and events on health care quality.



Documents

Advances in Patient Safety: From Research to Implementation
Volumes 1-4, AHRQ Publication Nos. 050021 (1-4). February 2005. Agency for Healthcare Research and Quality, Rockville, MD.

AHRQ State Snapshots
The State Snapshots provide State-specific health care quality information including strengths, weaknesses, and opportunities for improvement. The goal is to help State officials and their public- and private-sector partners better understand health care quality and disparities in their State.

Aiming Higher: Results from a State Scorecard on Health System Performance
Developed to follow the National Scorecard on U.S. Health System Performance, published in 2006, the State Scorecard assesses state variation across key dimensions of health system performance: access, quality, avoidable hospital use and costs, equity, and healthy lives. The findings document wide variation among states and the potential for substantial improvement "in terms of access, quality, costs, and lives" if all states approached levels achieved by the top states.

Chartered Value Exchanges: Local Networks with National Standards
Author(s): Agency for Healthcare Research and Quality (AHRQ)
Chartered Value Exchanges are community-based multistakeholder collaboratives on the forefront of implementing cutting-edge ways to transform health care at the local level. Providers, employers, insurers, and community leaders achieve this special Federal distinction for their strong commitment to improving quality and value in health care.

Corporate Responsibility and Health Care Quality: A Resource for Health Care Boards of Directors
This resource seeks to assist directors of health care organizations in carrying out their important oversight responsibilities in the current challenging health care environment.

First National Report Card on Quality of Health Care in America
Elizabeth McGlynn led a team of experts in the largest and most comprehensive examination ever conducted of health care quality in the United States. Called the Community Quality Index Study, it assessed the extent to which recommended care was provided to a representative sample of the U.S. population for a broad range of conditions in 12 metropolitan areas.

Health Care Quality: The Rural Context
This report seeks to examine the current state of debate over health care quality and patient safety and how it affects rural communities.

Hospital Performance Improvement And The Balanced Scorecard, by Terry J. Hill, Program Director, Rural Health Resource Center
This paper, presented by Terry Hill, Executive Director of the Rural Health Resource Center, offers a brief overview of the Balanced Score Card as well as information on comprehensive hospital performance improvement focusing specifically at the Delta Rural Hospital Performance Improvement Program. Material used with permission. Source: Press Ganey Associate, Inc. 2005.

Hospital Performance Improvement: Are things getting better?
Interest in improving health care quality has increased palpably in recent years. We have seen this interest play out in numerous ways, including greater emphasis on collecting and publicly disseminating performance data.

Hospital Quality: Ingredients for Success - Overview and Lessons Learned
This study was conducted by the Economic and Social Research Institute in July by The Commonwealth Fund. How top U.S. hospitals effectively develop and maintain quality-improvement programs is examined. The study identifies models for best practices and lays out specific actions that hospitals can take to emulate them.

The Implementation of Pay-For-Performance in Rural Hospitals: Lessons from the Hospital Quality Incentive Demonstration (HQID) Project
The report found that the conditions for successful participation in pay-for-performance (P4P) initiatives affect rural health care providers differently than urban providers. The study calls for future P4P programs to include a range of incentives independent of patient volume.

Making Performance Work in Rural Hospitals, Terry Hill, Executive Director, Rural Health Resource Center
Terry Hill, the Executive Director of the Rural Health Resource Center, provides this Power Point Presentation. The presentation focuses on Performance Improvement and outlines how the Balanced Score Card approach can help rural hospitals successfully reach their objectives.

Measuring the Quality of Life in Rural Areas: A Report from the Center of Rural Affairs
From the Center for Rural Affairs. The key to quality of life is the ability to enjoy it. Few doubt that rural areas provide an enormous opportunity for quality of life amenities, but are we able to enjoy them like we should?

Modest Health Care Quality Gains Outpaced by Spending
Author(s): Agency for Healthcare Quality and Research (AHRQ)
The quality of health care improved by an average 2.3 percent a year between 1994 and 2005, a rate that reflects some important advances but points to an overall slowing in quality gains, according to annual reports released in March, 2008 by AHRQ.

Performance Improvement Consultation Data Request Spreadsheet
This document is a spreadsheet designed to capture specific data elements that have proven effective in the preparation for the consulting team. It also facilitates completion and reply in electronic format. It is designed to help the consulting team analyze information prior to arrival and thus maximize use of time with hospital administration, leadership, department managers, staff and physicians while actually on site. First developed by Stroudwater Associates in 2001 for the Delta RHPI Project.

Preventing Chronic Disease by Translating Recommendations Into Reality: Community Voices
The Centers for Disease Control and Prevention (CDC) recognizes the importance of integrating voices from all communities, including those with mixed incomes, differing races and ethnicities, and diverse cultures.

Physicians Want To Learn from Medical Mistakes but Say Current Error-reporting Systems Are Inadequate
The perception that U.S. doctors are unwilling to report medical errors and learn how to prevent them is untrue, according to a new study funded by the Department of Health & Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ).

Quality Improvement Strategies and Best Practices in Critical Access Hospitals
The purpose of this study is to describe the continuing evaluation and maturation of CAH QI activities, and to document the best practices of two CAH's that have developed innovative QI Programs. University of Minnesota Rural Health Research Center Working Paper #52.

Quality Through Collaboration - The Future of Rural Health
This report assessed the quality of health care in rural areas; developed a conceptual framework for a core set of services and infrastructure necessary to deliver those services to rural communities; recommend priority objectives and changes in policies and programs required to achieve those objectives; consider implications for federal programs and policy.

To Err Is Human: Building a Safer Health System
Institute of Medicine report brief. November 1999 "Errors are costly in terms of loss of trust in the health care system by patients and diminished satisfaction by both patients and health professionals."

Transforming Care at the Bedside
Innovation Series 2004, Institute For Healthcare Improvement To respond to the urgent need for change on the nation's medical/surgival units, the Institute for Healthcare Improvement (IHI), in partnership with The Robert Wood Johnson Foundation (RWJF), has launched an ambitious, expansive initiative to resesign medical/surgical care. This effort draws on IHI's experience mobilizing teams of frontline workers to make significant changes in care processes, as well as its expertise in health system redesign. Through this work, IHI is developing models of care at the bedside on medical and surgical units that will result in improved quality of patient care and service, more effective care teams, improved staff satisfaction and retention, and greater efficiency.

Trends in Potentially Preventable Hospitalizations among Adults and Children, 1997-2004
This Statistical Brief presents data from the Healthcare Cost and Utilization Project on changes in the rates of potentially preventable hospitalizations.

Quality Indicators

The Premier Hospital Quality Incentive Demonstration: Clinical Conditions and Measures for Reporting
The CMS/Premier quality measures are based on clinical evidence and industry recognized metrics.

Agency for Healthcare Research and Quality (AHRQ) Quality Indicators
The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data.

Healthy People
Leading Health Indicators (LHIs) established by Healthy People 2010 will be used to measure the health of the Nation over the next 10 years.

Hospital Quality Alliance (HQA) Hospital Quality Measures 2004-2007
The Hospital Quality Alliance is a private-public cooperation striving to improve the quality of care provided by nationwide hospitals through assessing and publicly reporting on the measurements of hospital care. There are currently twenty measures on the Hospital Compare chart.

Illinois Department of Public Health - Health Indicators
This Web site provides leading health indicators and disparities among states and races/ethnicities.

National Quality Measures Clearinghouse
This website is a public repository for evidenced-based quality measures and measure sets.

Centers for Medicare & Medicaid Services - Health Care Indicators
Contains data and analysis of recent trends in health care spending, employment, and prices. The National Health Statistics Group tracks trends in health care related industries and presents this information quarterly.

Quality Indicator Project, The
Formed in 1985 as a voluntary pilot project of seven Maryland acute care hospitals that wanted to test a handful of clinical performance measures for data collectability and usefulness in quality improvement activities. Today, the Project has more than 1,800 participants across four different indicator sets: Acute care, psychiatric care, long-term care and home care.