Classmate

Use two classmates’ posts below, and respond to the questions listed below.

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1)  Do you agree or disagree with their choice of CQI Model given the measures they chose?

2)  Give rationale why you either agree or disagree, and give one example that illustrates your answer.

Class 1.

1: Anti-Depressant Medication Management (AMM)

2: Immunization Status

Sources of data needed to conduct the two measures:

When looking at AMM (HEDIS #1), the sources of data that need to be collected would start with a depression screening to see where the patients are and how severe their depression is. They can also look at the different medications, and the effects of those after a patient have been taking them for 12 weeks or six months. Follow-up screening is also another form of data to be able to see how patients are doing every month, and if things are getting better or worse, then changes can be made to the medication or dosage.

For the immunization status (HEDIS #2), there is an easy source to be able to collect that data that’s needed. Electronic medical records (EMR) is a tool that’s available for healthcare providers to collect and be able to communicate information (Dutta & Hwang. 2020). EMRs help tracks the immunization status of each patient, and those would be able to be obtained anywhere since they are in their electronic medical records. This helps patients know every immunization they’ve received and where they need an updated shot. 

 Apply one of the CQI models to implement the two HEDIS measures:  How would you use the CQI model for the measures?

The Pareto analysis would be a beneficial CQI model to use to implement both of the HEDIS measures above. Pareto model can visually show the frequency of the root of causes for the problems that are identified (Moin, Scales & Sinay. 2014). For ANM, Pareto would be able to look at the frequency of different antidepressant medications and the cause of effect they have to be able to see which medication would best suit specific patients. For immunization status, Pareto would be able to see the frequency in specific immunizations and see the cause of effectiveness in preventing diseases and how they are beneficial to have and stay on top of updating them when needed.

 Discuss how the HEDIS quality initiatives are linked to the rising costs of care:

HEDIS #1’s quality initiatives are linked to rising the costs of care since there would be increasing the screenings and appointments to follow-up and check to make sure the medications are working and if they need to be changed. The drug itself can be costly for some people, and depending on what medication works, a specific kind might cost more than other medicines. 

HEDIS #2’s quality initiatives can be considered to be linked to raising the costs of care if you’re immunization status is up to date or not. The cost of going to the appointments, copayment, and paying for the immunizations can be costly for some. Or if someone’s not up to date on vaccinations and there’s an outbreak in something which they end up getting, then the cost of the medical bills to get the proper treatment can raise that cost of care.

 Conclusion:

I believe that both ANM and immunization status are essential for improving patient outcomes. Mental health and depression is something that should be taken seriously, and providers should be able to properly access patients for the correct mediation or change in medicine to help them. Immunization status is a touchy topic but is something I think is essential for everyone to be up to date on immunizations. From babies to elderly, it is something that was created to help prevent illnesses and benefit public health amongst each other.

Class 2.

1: Cervical Cancer Screenings

2: Mammograms

Sources of data needed to conduct the two measures:

·  Source of data for cervical cancer screenings are to check patients age range and check their previous lab testing results to ensure the patients are in the correct age range for specific testing. Checking the patients electronic health record and the patients health insurance claims would show what the patient is being seen for and what was completed in order to get payment for what was done. Talking with the patient to confirm what they are being seen for and how long it has been since they were last screen for cervical cancer is also another important base to tough no one knows better than the patient themselves. I would collect the patients answers to the questions and proceed with our without the procedure that I have informed them about.

·  Source of data for mammograms confirming the patients age range to ensure they are between 50-74 years of age. Reading through the patients electronic health record to ensure they have not underwent a double mastectomy in the past. Confirming with the patient and letting them know the benefits to being screened every 24 months to ensure they are free from breast cancer. I would collect the patients answers to my pre-screening questions and proceed from there whether they want to or decline the procedure. 

Apply one of the CQI models to implement the two HEDIS measures:  How would you use the CQI model for the measures?

The use of a flow chart to show how often a patient was asked the screen questions to see if they are eligible for a mammogram or cervical cancer testing will show all of the hit or misses. According to Moin, Scales, & Sinay (2014) “A flow chart can help illustrate thenumber and order of steps involved in a treatment process.” (section 5.1). Providers can go over each patient who has been seen daily and input whether or not there is a note stating that they went through the screen process for receiving a mammogram or a cervical cancer screen.

 Discuss how the HEDIS quality initiatives are linked to the rising costs of care:

When patients are not properly screened they cannot receive the care that would help prevent or early detect if something was to come back abnormal. Learning that a patient has stage 4 breast cancer or cervical cancer is a hard pill to swallow when it could have been caught at an earlier stage due to a pre-screening. When a patient has not been screened to find out if they fit the proper criteria for the testing they could end up with a cancer (cervical or breast) and then have hospital stays, radiation, chemo, hysterectomy, mastectomy (double or single), as well as emergency situations that they would need to be see in the ED.

 Conclusion:

It is important to screen patients and follow up with care when there is something seen that is abnormal in a cervical screen or in a mammogram. Looking over patient records to ensure that every patient is treated with the same care and same pre-screening questions is a way to ensure patient safety and quality of care. In order to reduce the cost of health care there are measures that need to be taken in order to reduce the risk of patients becoming more ill and have it known that it was preventable.

DUE 3/15/20 @9AM w/ plag report

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