The National Committee for Quality Assurance (NCQA) (https://www.ncqa.org/)
It 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
(NCQA, n.d. https://www.ncqa.org/hedis/)
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.
You are now employed as an FNP in primary care. Choose one performance measure from one of the six domains of care. List and discuss three different patient interventions and how you would specifically measure the outcomes for that particular performance measure. How would these primary care interventions result in improved patient outcomes and cost savings for the practice? How can these interventions result in improved patient ratings?
(You need to go to the website and click on HEDIS measures. That will take you to the domains of care. If you click on the plus sign in the domain of care, you will find the performance measures. You can choose a performance measure and then think about what interventions would allow you to measure that performance measure. The interventions are not listed in the website, you would need to think of those yourself.)
