Why this course? Our Context.

1. Why this course? Our Context. Module 1b. Measuring Quality in Indian Health

2. IHS Director’s Priorities • To renew and strengthen our partnership with tribes • In the context of national health insurance reform, to bring reform to IHS • To improve the quality of and access to care • To make all our work accountable, transparent, fair and inclusive

3. The Environment We Are In • IOM reports get the ball rolling • Crossing the Chasm • To Error is Human • Performance Measurement—Accelerating Improvement • National Performance Measurement Initiatives, i.e., HEDIS, NCQA* • JCAHO—ORYX Measures • CMS Reporting & Quality Initiatives *Health Effectiveness Data and Information Set National Committee on Quality Assurance

4. Quality Measurement in Health Care Reform

5. Quality Measurement in HealthCare Reform • Many Provisions of PPQCA. • Chronic Care Model & Medical Homes • Payment Reform • Feds and States want to pay for quality, not procedures. • Example: CMS and Re-hospitalization.

6. Quality Improvement and Measurement is taking off in Public Health as well……

7. State health departments have formed the same kind of learning collaborative as clinical facilities do to improve healthcare.

8. Within Indian Health Care:The Initiatives that Surround Us • GPRA, EO, Meaningful Use, and other CRS Adventures. • Special Diabetes Program for Indians • Improving Patient Care Initiative • Patient Safety • Ongoing Injury Surveillance • Other, Other, Other, and Other.

9. The 4 Contexts Continuous Quality Improvement Public Accountability Quality Surveillance Evaluation

10. Four Different Purposes for Measurement

11. Four Different Purposes for Measurement (Cont.)

13. See The Carey and Lloyd RoadmapSPC as a process improvement strategy.

14. Benchmarks vs. Benchmarking • Benchmarking—A complete improvement process “Search for industry best practices that leads to superior performance.” Camp, 1989 • Measure • Identify benchmark performers (companies, clinics) • Learn from them. • Modify and implement best practices • Measure.

15. Model for Improvement

17. The Triple Aim “improving the experience of care, improvingthe health of populations, and reducing per capita costs ofhealth care” Don Berwick- Health Affairs, 2008