9.3 Measuring and Improving Quality
Now that we have discussed the various ways that quality health care is defined, let’s discuss how quality care is measured, evaluated, and improved.
Utilization Review
Thinking back to value-based reimbursement models discussed in the “Health Care Economics” chapter, recall how quality performance measures relate to the reimbursement health care agencies receive from Medicare, Medicaid, and private insurance. A utilization review is an investigation of health care services performed by doctors, nurses, and other health care team members to ensure money is not wasted covering things that are unnecessary for proper treatment or are inefficient. Utilization review also allows organizations to objectively measure how their health care services and resources are being used to best meet their patients’ needs. Information from patients’ medical records are analyzed, along with patient demographics, to evaluate resource allocation, efficiency, and quality of health promotion initiatives.[1] See Figure 9.2[2] for an illustration of utilization review related to costs.
Using Informatics to Promote Quality
Utilization review relies on the collection of meaningful data from health records to analyze if quality metrics are being met. Informatics is defined by QSEN as using information and technology to communicate, manage knowledge, mitigate error, and support decision-making.[3] Informatics allows members of the health care team to share, store, and analyze health-related information. Nurses have an important role in informatics. Nursing informatics is the science and practice of integrating nursing knowledge with information and communication technologies to promote the health of people, families, and communities worldwide.[4] See Figure 9.3[5] for an illustration of informatics.
These are several benefits of using informatics in health care:[6]
- Improvement of Patient Safety: Informatics allows for up-to-date information sharing by both the patient and members of the health care team. Using informatics can help to reduce the occurrence of medication errors, as well as monitor patient side effects and overall health status.
- Reduction of Delays in Care: Some health care informatics systems allow for direct communication between health care team members and the patients. The ability to ask and answer questions without needing to schedule an office appointment promotes the ability for care to be delivered in an efficient and reduced cost manner.
- Reduction of Waste: The use of informatics to share information between the care team members reduces waste associated with duplication of tests or exams when more than one provider is on the care team. Additionally, patients can request their records be shared with other health providers from other health organizations that helps to reduce duplication and unnecessary spending across the nation.
- Promotion of Patient Centered Care: Many informatics systems have “patient portal