Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.
For many years there has been a steady reduction in rural hospitals and healthcare professionals (HCP) serving rural areas. This leveled off somewhat after the introduction of the Affordable Care Act (ACA), but did not stop altogether. Although it is too early to claim a trend, there are some signs that the process of depletion has resumed, and that we may be seeing an acceleration in closures of rural facilities.
In some zip codes in rural areas, there are now specialties with zero HCPs, and some services are simply not available inb that zip code. This is mainly specialty treatment, but even some primary care services, for women’s health especially, are no longer available in some places.
Hospital closures and service terminations have serious health implications for rural patients, and there are large health gradients and differences in morbidity and mortality rates if one sorts locations by how rural or urban they are. Rural populations have higher rates of preventable illness and death compared to their urban counterparts, and the less choice of facilities and fewer specialties on offer in a location, the higher the health gradient becomes.
The following interesting article has been provided by Physician’s Weekly:
This is an example of one of the many ripple effects of any closure, but in rural areas where the next facility may be some distance away, any closure has large downstream effects.
We will take a QI approach, and discuss the topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.
Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:
- Policies: office, organization, or national policies, including MU, HIPAA, etc
- Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
- Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
- Insurance Models, payer systems
- Vendor policies and processes
- Subsidies and programs to retain HCPs
- Machines (incl equipment, EHR)
- Medical or office equipment
- Home equipment specific to the patient condition
- Integration/interoperation with other office or medical systems, or user personal health records
- Medication dispensing systems
- Personal Health Record and encounter planning systems
- Transportation systems, incl. wheelchairs, lifts, ambulances, etc.
- Access control
- Ergonomics (right size, shape, location, etc)
- WIFI and internet
- Analytical software
- Patient identification
- HCP Identification
- Staffing: sufficient and qualified staff
- Training: base training, ongoing training, CME, and patient or carer training
- Attitudes: staff attitudes to technology, adoption vs resistance, bullying
- Fatigue (especially alert fatigue)
- Peer support
- Friends and family
- Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
- Supplies: medical or office, inferior fax paper,
- Data: ability to securely share with correct patient, specialist, lab, etc
- Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
- Internet sources
- Checklists, SoPs
- Uniforms, footwear, personal protective equipment
- Health outcomes
- KPIs: operational metrics required by practice, local government, state, federal
- Quality and safety metrics
- Targets: set by practice, insurer, etc. as well as patient goals
- Incentives and rewards
- Adverse Eventss reporting
- Effectiveness of measurement
- Noise: distracting noises, sound levels too high, etc. due to computer systems
- Space: Cramped, uncomfortable work space etc.
- Time: Too little time per patient or order, too little time in a day, too many demands
- Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
- Control: the degree to which the individual can control their workload and how to accomplish it
- Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
- Temperature: too cold, too hot, too variable
- Tax revenues
Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.
- What METHODS increase or reduce risks of Rural Hospital Closures or Service Termination
- What MACHINE factors increase or reduce risks of Rural Hospital Closures or Service Termination
- What PEOPLE issues increase or reduce risks of Rural Hospital Closures or Service Termination
- What MATERIALS increase or reduce risks of Rural Hospital Closures or Service Termination
- What MEASUREMENT factors increase or reduce risks of Rural Hospital Closures or Service Termination
- What ENVIRONMENTAL factors increase or reduce risks of Rural Hospital Closures or Service Termination
MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.
To quote the IHI on what the Triple Aim encompasses:
The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:
- Improving the patient experience of care (including quality and satisfaction);
- Improving the health of populations; and
- Reducing the per capita cost of health care.
The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.
The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.