CONTEXT

Health care has undergone a transformation since the release of the Institute of Medicine’s (IOM) report, “To Err Is Human” (IOM, 1999). The report highlighted medical errors as a contributing factor leading to poor patient outcomes. The IOM challenged organizations to implement evidence-based performance improvement strategies in order to improve patient quality and safety. Multiple governmental and regulatory agencies, such as the Center for Medicare and Medicaid Services (CMS), and the Agency for Healthcare Research and Quality (AHRQ) vowed to strengthen and improve incentives for participation, safety, quality, and efficiency in accountable care organizations.

Health information technology (HIT) performs an essential role in improving health outcomes of individuals, the community, and populations. Health organizations, consumer advocacy groups, and regulatory committees have made a commitment to explore current and future opportunities that HIT offers to continue momentum to meet the Institute of Medicine (IOM) goal of improving safety and quality

QUESTIONS TO CONSIDER

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

• What is an ACO?
  • How are Medicare Cost-Sharing ACOs structured?
• How could the Merit-Based Incentive Program System (MIPS) be used to define the quality of health care in the future?
  • Does the MIPS affect advance practice nurses?
  • If so, how?
• How does health care data affect the care coordination process in nursing practice?
• What is the role of nursing informatics and of health care informatics within the broader scope of information technology?
• What is the role of informatics in supporting care management profiles in productivity metrics, quality reporting, health education, and predictive analytics?
• What potential or actual problems with data gathering systems and output could arise within your practice setting?

RESOURCES

REQUIRED RESOURCES

The following resources are required to complete the assessment.

• Vila Health: Quality Metrics Tracking | Transcript.
  • This multimedia simulation will enable you to develop a strategy for tracking quality metrics to help facilitate a hospital’s qualification for ACO status.
• APA Style Paper Template [DOCX].
  • Use this template to develop a quality improvement proposal for expanding the hospital’s HIT.

SHOW LESS

SUGGESTED RESOURCES

The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MSN-FP6612 Emerging Health Care Models and Care Coordination Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.

Improving Care Coordination

• Drake, B. F., Tannan, S., Anwuri, V. V., Jackson, S., Sanford, M., Tappenden, J., . . . Colditz, G. A. (2015). A community-based partnership to successfully implement and maintain a breast health navigation program. Journal of Community Health, 40(6), 1216–1223.
  • Describes a project to implement patient navigation in a partner clinic.
• Madore, S., Kilbourn, K., Valverde, P., Borrayo, E., & Raich, P. (2014). Feasibility of a psychosocial and patient navigation intervention to improve access to treatment among underserved breast cancer patients. Supportive Care in Cancer, 22(8), 2085–2093.
  • Discusses ways to increase the quality of care by combining patient navigation with telephone counseling to guide newly diagnosed breast cancer patients in overcoming treatment barriers.
• Praetorius, T. (2016). Improving care coordination using organisational routines. Journal of Health Organization and Management, 30(1), 85–108.
  • Discusses ways of improving the quality of care coordination through the systematic application of the theory of organisational routines to standardised care pathways.

Accountable Care Organizations

• Center for Medicare and Medicaid Services. (2015). Accountable care organizations (ACO). Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html
  • Provides general information about ACOs and links to additional information and resources.
• Spencer, G. (2014). Making the move to an ACO. Healthcare Financial Management, 68(2), 92–96.
  • Describes how a multispecialty group practice became one of the first physician group practices to be designated a Medicare Shared Savings Program ACO.

Suggested Writing Resources

You are encouraged to explore the following writing resources. You can use them to improve your writing skills, and as source materials for seeking answers to specific questions.

• APA Module.
• Academic Honesty & APA Style and Formatting.
• APA Style Paper Tutorial [DOCX].

Additional Resources for Further Exploration

The following resources provide information about the Merit-based Incentive Payment System (MIPS) program addressed in the Questions to Consider. This system, instituted by the Centers for Medicare and Medicaid Services in 2017, replaced the Physician Quality Reporting System (PQRS). The MIPS is a payment system that emphasizes and rewards exceptional health care delivery and performance.

• Cardona, D., Black-Schaffer, S., Shamanski, F., & Myles, J. (2017). Medicare’s new quality payment program has started—Are you ready? Archives of Pathology & Laboratory Medicine, 141(6), 741–745.
• Centers for Medicare & Medicaid. (n.d.). Quality payment program: Improvement activities. Retrieved from https://qpp.cms.gov/mips/improvement-activities
• Centers for Medicare & Medicaid. (n.d.). Quality payment program: MIPS overview. Retrieved from: https://qpp.cms.gov/mips/overview
• Hayden, R. & Coffin, J. (2016). The components of the merit-based incentive payment system. The Journal of Medical Practice Management: MPM, 32(3), 173–176.

Capella Resources

• ePortfolio.
  • This resource provides information about ePortfolio, including how to use the different features of the product.

  Quality Improvement Proposal Scoring Guide

  CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
  Recommend ways to expand an organization’s HIT to include quality metrics.	Does not recommend ways to expand an organization’s HIT to include quality metrics.	Provides recommendations that only indirectly address the problem or overlook important contextual factors (constraints, resources, attitudes, additional information) affecting the best solution to the problem.	Recommends ways to expand an organization’s HIT to include quality metrics.	Recommends ways to expand an organization’s HIT to include quality metrics. Provides a precise formulation of the issues and clear rationale for proposed solutions.
  Describe the main focus of information gathering in health care and how it contributes to guiding the development of organizational practice.	Does not provide a limited or superficial description of the main focus of information gathering in health care and how it contributes to guiding the development of organizational practice.	Provides a limited or superficial description that overlooks key aspects of information gathering and its application to organizational practice.	Describes the main focus of information gathering in health care and how it contributes to guiding the development of organizational practice.	Describes the main focus of information gathering in health care and how it contributes to guiding the development of organizational practice. Draws well-justified conclusions from an insightful synthesis of credible evidence and insight into the information gathering process. Provides clear, relevant examples.
  Identify potential problems that can arise with data gathering systems and outputs.	Does not identify potential problems that can arise with data gathering systems and outputs.	Identifies potential problems that are not clearly connected to data gathering systems and outputs.	Identifies potential problems that can arise with data gathering systems and outputs.	Identifies potential problems that can arise with data gathering systems and outputs. Provides concise, accurate problem definitions, notes key uncertainties, and offers specific, insightful suggestions for avoiding the problems.
  Write clearly and concisely, using correct grammar and mechanics.	Does not write clearly and concisely, using correct grammar and mechanics.	Writing is not consistently clear or concise, or errors in grammar and mechanics inhibit effective communication.	Writes clearly and concisely, using correct grammar and mechanics.	Writes clearly and concisely. Grammar and mechanics are error-free.
  Support main points, claims, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.	Does not support main points, claims, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.	Evidence is not persuasive or explicitly supportive of main points, claims, or conclusions. Sources lack relevance or credibility, or are incorrectly formatted.	Supports main points, claims, and conclusions with relevant and credible evidence, correctly formatting citations and references using APA style.	Supports main points, claims, and conclusions with relevant, credible, and convincing evidence. Combines the skillful application of error-free source citations with a perceptive and accurate synthesis of the evidence.

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