Quality Healthcare: Measuring the NP Performance
The National Committee for Quality Assurance (NCQA) was formed to ensure quality of patient care and measurement of patient outcomes with set standards.
Healthcare Effectiveness Data and Information Set (HEDIS) is a performance measurement tool used by millions of health insurance plans. There are 6 domains of care:
Effectiveness of Care.
Access/Availability of Care.
Experience of Care.
Utilization and Risk Adjusted Utilization.
Health Plan Descriptive Information.
Measures Collected Using Electronic Clinical Data Systems
You may access the 6 domains of care by clicking this link:
(NCQA, n.d. https://www(dot)ncqa(dot)org/hedis/ (Links to an external site.))
As an APN, productivity will be an important measurement for the practice to determine reimbursement and salary. Fee-for-service practices will require a set number of patients per day to maintain productivity. A capitated practice will require the APN to have a large panel of patients but also will focus on controlling costs. This can be accomplished through effective primary care that is accessible, convenient for the patients and has a method of measuring quality of care.
Write a formal paper in APA format with title page, introduction, the three required elements below, conclusion and reference page.
You are now employed as an NP in primary care. Choose one performance measure from one of the six domains of care, i.e. Adult BMI Assessment, Prenatal and Postpartum care, etc.
Develop three different patient interventions for that one performance measure and how you would specifically implement the intervention and measure the outcomes for that particular performance measure in clinical practice.
How would these primary care interventions result in improved patient outcomes and health care cost savings?
How can these interventions result in improved NP patient ratings?
Quality Healthcare: Measuring NP Performance
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Quality Healthcare: Measuring NP Performance
Nurse Practitioners (NPs) play significant roles in ensuring that patients have access to high-quality and affordable care and achieve optimal health. Healthcare organizations must have quality measures to ensure the adequate provision of healthcare services. These measures prove whether or not NPs deliver quality care. The National Committee for Quality Assurance (NCQA) was established to promote healthcare quality by measuring healthcare performance and identifying areas that need improvement (NCQA, 2020).
The Healthcare Effectiveness Data and Information Set (HEDIS) is a performance measurement tool that incorporates six care domains. This paper identifies one performance measure from the six domains and then develops three different patient interventions from the selected performance measure. Next, it discusses how a Nursing Practitioner would implement the intervention and measure the outcomes for the chosen performance measure. The paper further analyzes how primary care interventions promote patient outcomes and healthcare cost savings. Finally, the piece highlights how the interventions improve NP patient ratings.
Patient Intervention
As noted, HEDIS has six care domains used to measure healthcare performance. The selected performance measure is comprehensive diabetes care from the effectiveness of care domain (NCQA, 2020). The three interventions developed from the comprehensive diabetes care help in managing diabetes patients. They include educating patients about diabetes prevention, making referrals, and monitoring a patient's hemoglobin. These interventions fall under the effectiveness of care domain because they directly affect patients in standard clinical conditions. Once a patient is diagnosed with diabetes, NPs should implement the stated interventions to help the patient achieve disease control and prevent disease progression.
The first intervention under the effectiveness of care is educating patients about diabetes. The clinic's diabetic educator should conduct this education upon diagnosis. It entails discussions, brochures, and short videos that demonstrate how to use a glucometer to check blood sugar levels (Lee et al., 2019). Instructors should also educate patients about the causes, risk factors, and effects of this chronic condition. This intervention will help patients learn more about the disease and proper management, including practicing a healthy lifestyle like eating a proper diet and exercising regularly.
Research shows that poor diet and lack of physical activities increase the risk of diabetes. For that reason, diabetic patients must implement lifestyle changes to manage this chronic illness. Implementing diabetes education will ensure the patients are well-informed of their diagnosis. It will also allow them to ask questions and develop a care plan with their diabetic educator and healthcare provider (Lee et al., 2019). The NP and the educator will evaluate the patient's understanding and preparedness to adopt healthy lifestyle changes to manage their diabetes through the teach-back method.
The second intervention is referrals. The NP must make suitable referrals to enable patients to receive quality care from advanced specialists that can manage the patients' blood sugar levels. The NP would refer the client to a nutritionist, who would educate the patient regarding a healthy diet for a diabetic patient. Another referral would be made to an ophthalmologist for routine eye exams. The American Diabetes Association (ADA, 2019) stated that a diabetic patient should visit an ophthalmologist during the initial stages of diabetes, preferably within the first five years of diagnosis.
An NP would also refer the patient to the podiatrist. Diabetic patients may experience foot complications like peripheral neuropathy. According to Johnson et al. (2018), this condition can be life-threatening or disturbing. It compromises healing and prevents the patient from feeling injuries or temperatures to their feet. When such situations arise, NP should advise the patients to see the podiatrist for pedicures.