August 2014 | Quality Improvement
Thursday, August 28, 2014
What is Quality Improvement?

According to the Health Resources and Services Administration, quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. Quality is directly linked to an organization's service delivery approach or underlying systems of care. To achieve a different level of performance (i.e., results) and improve quality, an organization's current system needs to change. Aligning Forces for Quality Alliances may differ in the ways they seek to bring about change, but they share a common goal: improving the quality of services in measurable ways.

Sharing Data to Raise the Value of Care
The Oregon Health Care Quality Corporation, an Aligning Forces for Quality Alliance, has been analyzing and reporting claims data from insurers and Medicaid organizations in order to offer consumers, hospitals, and clinics an unbiased comparison of provider ratings. The goal of this public reporting initiative is to improve quality of care through transparency.
The data collected now covers about 3.1 million of the state’s 4 million residents and has helped clinicians identify gaps in patient care, decrease ER visits, and avoid medical overuse.
Creating Regional Partnerships to Improve Care Transitions
As patients move from one care setting to another, problems such as lack of follow-up care and miscommunication among clinicians often occur and can put patients at risk for serious complications and hospital readmission. Some patients have additional problems such as depression, social isolation, or a lack of housing or transportation that may increase their risk of hospital readmission. Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days, at a cost of more than $26 billion every year. 
Several Aligning Forces for Quality (AF4Q) Alliances have implemented or are partnering in care transitions programs using care transition coaches to ensure patient care that is coordinated across care settings. This series of briefs highlights the successes of Alliances that have developed relationships with organizations and providers in the community so they can collaborate to achieve the shared goal of reducing hospital readmissions through participating in a 30-day care transitions program.
South Central Pennsylvania Improves Quality and Reduces Super-Utilizer Re-Hospitalizations
Certain patients present a health care conundrum. “Super-utilizers” account for only five percent of patients, but they accrue more than 60 percent of health care costs. These patients make frequent trips to hospital emergency rooms or have repeated inpatient hospital stays, resulting in costly health care, but not necessarily good-quality care. For example, one Pennsylvania woman had more than 50 CAT scans within a short span of time at various area hospitals. Super-utilizers often have multiple chronic medical conditions and social complexities that make their care difficult in a fragmented care setting.
Aligning Forces for Quality South Central Pennsylvania (AF4Q SCPA) wanted better for their patients. Clearly, emergency room visits for acute episodes would not address the larger issues that repeat visitors face. By enhancing primary care, emergency room overuse will decrease, as well as costs. AF4Q SCPA also aims to improve the quality of care and reduce re-hospitalizations.
Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s (RWJF) signature effort to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities in health care and provide models for national reform. Alliance teams represent the people who get care, give care, and pay for care.
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