Benchmark Using Data To Address Quality Measures

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The patient is a 40-year-old female who presents to the emergency department for low back pain. The pain has been present for 2 weeks, and no injury has been noted. The patient has no history of previous low back pain. The emergency department immediately orders an MRI of the lumbar spine for low back pain. The patient waits in her room in the emergency department for 2 hours without anyone checking on her. She is finally told that the in-house MRI is down for maintenance, so she schedules an appointment for another day. The patient is at the emergency department for more than 280 minutes from arrival to discharge.

Two days later, the patient goes to her appointment for her MRI at the radiology department. She must register and provide all the same information that she has already given at the emergency department regarding her history and other pertinent information. The patient’s appointment was scheduled for 1 p.m., and at 1:45 p.m. she still has not been called back for her test. No one has updated her regarding the delay. Finally, the patient is taken back for her test at 2 p.m. and is not given any explanation for the delay except that the department is short-staffed. The patient is not happy about her experience at the radiology department.

When the patient receives her Explanation of Benefits from her insurance company, she realizes the MRI was not pre-certified correctly. Now she owes a large portion of the bill because the physician did not try other means, such as physical therapy, prior to receiving a costly MRI.

Access Medicare’s Hospital Compare website and complete the following steps:

Locate the Find a Hospital box.
Enter the ZIP Code and hospital name provided by your faculty member.
Select search.
Review the category tabs (e.g., General Information) at the top of the hospital’s profile to complete this assignment.
Complete the chart on the Using Data to Address Quality Measures worksheet using the data from Hospital Compare.

You are provided with 3 categories relevant to the scenario. If you would like to identify an additional measure(s) and data from Hospital Compare that relate to the scenario, please use the blank line item in the table or add another row(s).
Note: An example of how to pull data has been provided for you to review.

Write a 350- to 700-word paper that analyzes the measures that have an influence on the facility in the scenario.

Include the following in your paper:

Explain the measures and corresponding data listed in the table.
Provide the data table listing the measures and corresponding data points within the presentation.
Analyze 2 sources, in addition to Hospital Compare, that you would use to find public information on facilities regarding the measures presented in the scenario.
Select 1 measure from the data table and analyze how the quality of this measure could affect the facility in the scenario.

Sample Solution

This paper analyzes the patient experience in the scenario through the lens of quality measures provided by Medicare’s Hospital Compare website, focusing on areas relevant to the described issues. Additionally, we explore two external sources for further information and delve into the potential impact of a specific measure on the facility.

Data Table:

Measure Category Data Source
Overall Hospital Rating General Information 3 out of 5 stars Hospital Compare
Emergency Care Timeliness Timely & Effective Care 35% of ED patients seen within 30 minutes Hospital Compare
Patient Satisfaction with Communication Care Experiences 68% of patients reported good or very good communication from doctors Hospital Compare
Outpatient Imaging Appointment Wait Time Access to Care Average wait time not available Hospital Compare (data not provided)
Pre-certification Rate for Advanced Imaging Cost of Care Not available Hospital Compare (data not provided)

Analysis of Measures:

  1. Overall Hospital Rating: A 3-star rating indicates “average” performance compared to other hospitals. This raises concerns about the overall patient experience, aligning with the dissatisfaction expressed in the scenario.

  2. Emergency Care Timeliness: While 35% of patients seen within 30 minutes falls within national averages, the 2-hour wait experienced by the patient in the scenario deviates significantly and highlights a potential issue with access to timely care.

  3. Patient Satisfaction with Communication: Though 68% reporting good/very good communication is promising, it also leaves a significant portion of patients with less positive experiences. In the scenario, the lack of updates during the long wait in both the emergency department and radiology department suggests room for improvement in communication protocols.

  4. Outpatient Imaging Appointment Wait Time: The absence of data on average wait time hinders analysis. However, the patient’s 45-minute wait beyond her scheduled appointment raises concerns about operational efficiency and patient satisfaction.

  5. Pre-certification Rate for Advanced Imaging: Lack of data renders analysis impossible. However, the billing issue faced by the patient underscores the importance of proper diagnosis and exploring less expensive treatment options before resorting to costly exams.

Additional Sources for Public Information:

  1. Hospital websites: Often provide information on patient care policies, quality initiatives, and patient satisfaction surveys.

  2. Patient experience websites: Platforms like Healthgrades and Yelp offer patient reviews and ratings on hospitals and specific departments, providing valuable insights into real-world experiences.

Deep Dive: Emergency Care Timeliness:

This measure directly impacts the scenario and has significant implications for the facility. Prolonged wait times in the emergency department can lead to:

  • Decreased patient satisfaction: Frustration and anxiety due to waiting can contribute to negative perceptions of care.
  • Worse health outcomes: Delayed treatment for urgent conditions can have detrimental consequences.
  • Increased operational costs: Overcrowding and inefficient workflows can strain resources and inflate overhead.

To improve this measure, the facility could:

  • Implement triage protocols: Prioritize patients based on severity to ensure timely care for critical cases.
  • Optimize staffing: Ensure adequate personnel throughout the day to manage patient flow effectively.
  • Improve communication: Keep patients informed about wait times and provide updates regularly.

By addressing these issues, the facility can improve patient experience, enhance health outcomes, and reduce operational costs associated with prolonged wait times.

Conclusion:

The analysis of quality measures reveals gaps in patient experience at the facility, aligning with the issues presented in the scenario. While some measures show positive trends, areas like wait times and communication require attention. Utilizing additional resources like hospital websites and patient experience platforms can further illuminate patient perspectives. Focusing on improving Emergency Care Timeliness through effective triage, efficient staffing, and transparent communication can address the concerns raised and lead to a more positive patient experience.

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