Transcript Quality Issues in Cardiac care - BREATHE Heart Failure Nurses

D.P.Suresh, MD,F.A.C.C., F.S.C.A.I.,
Director, Heart and Vascular,
St Elizabeth Physicians
OBJECTIVES
♥ Define Core Measures
♥ Use of Core measures
♥ Core measures as a guide for
Patient Care
♥ Core measures to Improve
Cardiovascular care
Core Measures :What are they?
 A variety of evidence-based, scientifically
researched standards of care implemented
in order to improve clinical outcomes for
patients.
 Clinical pathways and standard orders
have been developed from the attention
placed on core measures.
 Core Measure implementation encourages
consistent application of evidenced based
medical practices.
Importance of Core Measures
 Improved outcomes for patients as
evidenced by:




Decreased Mortality and Morbidity
Decreased Disability
Decreased length of stays
Reduction in readmissions
 Reasons to improve Core Measures:
 Assure Community that facilities are providing high quality
care
 Assure Boards that optimal care is achieved
 Allow Facilities to receive higher reimbursement from
Medicare and other payers
Core Measures:
Which ones are most often evaluated ?
Existing Core measures:
1. Acute Myocardial Infarction (AMI)
2. Heart Failure (HF)
3. Pneumonia (PN)
4. Surgical Care Improvement Project (SCIP)
5. Venous Thromboembolism (VTE)
Core Measure Set (CMS)
1. ACUTE MYOCARDIAL INFARCTION
Aspirin at Arrival or at Discharge:
Give w/in 24hrs before or after arrival or document reason for No aspirin on
arrival.
Reasons: -Allergy
-Pre-arrival Coumadin/warfarin
-Other explicitly documented reason by Phys/PA/APN/Pharmacist
ACEI/ARB at Discharge for LVSD: (Includes RAS/RAAS blockers/inhibitors)
Prescribe EITHER at discharge for pts with < 40% EF or moderate/severe LVSD;
or document reason for No ACEI AND No ARB at discharge.
Reasons:
-Allergy
-Moderate or severe aortic stenosis [Counts for BOTH]
-Other explicitly documented reason by Phys/APN/PA/Pharmacist
-Phys/APN/PA/Pharmacist documentation that either an ACEI or an ARB was not given due to one of
the following 5 conditions [Counts for BOTH]:
1) Angioedema
2) Hyperkalemia
3) Hypotension
4) Renal artery stenosis
5) Worsening renal function/renal disease/dysfunction
ACUTE MYOCARDIAL INFARCTION continued
Beta-Blocker Prescribed At Discharge
Prescribe at discharge or document reason for No beta-blocker at discharge.
Reasons: -Allergy
-2nd or 3rd degree heart block on ECG on arrival or during stay w/o pacemaker
-Other explicitly documented reason [including bradycardia] by
Phys/APN/PN/Pharmacist
-A Conditional Hold with parameters (re: HR or BP) counts as a reason
Fibrinolytic Therapy Received Within 30 Minutes Of Hospital Arrival
If provided w/in 6hrs of hospital arrival & is primary reperfusion therapy
Clear documentation is important: Applies to pts with ST-segment elevation/LBBB noted on
ECG performed closest to arrival.
Give w/in 30 min of hospital arrival or *document reason for the delay.
Reasons: -Balloon pump; Cardiopulmonary arrest; Intubation
-Pt/Caregiver refusal [No further documentation needed]
-Other reasons that include BOTH the notation of delay + underlying (non-system) reason
ACUTE MYOCARDIAL INFARCTION continued
Primary PCI Received Within 90 Minutes to Hospital
(PCI/Reperfusion/Cath/Transfer to Cath Lab)
If performed w/in 24hrs of hospital arrival- Clear documentation is important:
Applies to pts with ST-segment elevation/LBBB noted on ECG performed
closest to arrival.
Perform w/in 90 min of hospital arrival or *document reason for delay.
Reasons:
-Balloon pump; Cardiopulmonary arrest; Intubation
-Pt/Caregiver refusal [No further documentation needed]
-Other reasons that include BOTH the notation of delay + underlying (non-system) reason
ACUTE MYOCARDIAL INFARCTION continued
Adult Smoking Cessation Advice/Counseling in hospital
Adult Smoking Cessation Advice/Counseling:
Give to pts with clear history of cigarette smoking anytime during the past year prior
to arrival.
Always inquire.
Prescribe Statin Therapy at discharge
Prescribe at discharge or document reason for No statin at
discharge.
Reasons:
-Allergy to or complication related to statins
-LDL < 100 mg/dL [either direct or calculated] w/in 24hrs after hospital arrival
-Other explicitly documented reason by Phys/APN/PA/Pharmacist, i.e., statins
contraindicated due to:
**Hepatic failure
**Myalgias
**Rhabdomyolysis
Core Measure Set (CMS)
2. HEART FAILURE
Important areas needing to be documented prior to Discharge
Discharge Instructions
Left Ventricular Function Assessment
 ACEI Or ARB Prescribed For LVSD At Discharge
 Adult Smoking Cessation Advice/Counseling
HEART FAILURE continued
Discharge Instructions
 Materials Provided to patient or
caregiver at discharge or during
hospital stay:
 Written Instructions:
Activity level
Diet
Medication lists
Follow up
Weight monitoring
Symptoms worsening

Educational Materials:
Handouts
Brochures
Booklets
Include: What To Do If Symptoms Worsen
Important: All
discharge medications should be noted clearly and accurately in the
chart and listed in the Discharge Instructions.
HEART FAILURE continued
Assessing LVEF
Left Ventricular Function Assessment
Evaluate LVS function prior to arrival (no time limit), during stay, or definitively plan
evaluation for after discharge. Otherwise, **document a reason for Not evaluating.
 Ejection Fraction must be assessed by
means of the following:



Echocardiogram
Nuclear testing
Cardiac catheterization with left
ventriculogram
 Must be assessed and documented
prior to arrival, during hospitalization,
or during planned follow-up.
EF < 40% or description of
moderate/severe needs to be recorded.
HEART FAILURE continued
ACEI Or ARB Prescribed For LVSD At Discharge
Discharge: Prescribe ACEI or ARB for LVEF <40%
Medication Profile
 Assess current medication profile
 If patient not on the following meds determine
why?
 Ace Inhibitor (CRI, cough, hyperkalemia)
 ARB
 Beta Blocker (failed BBL in past?)
 Aldactone (CRI, hyperkalemia)
 Assess whether there have been adjustments in
the following medications?
 Diuretics
 Ace-Inhibitors
 Beta Blockers
HEART FAILURE continued
Smoking cessation
 Definition:
 Smoking risks :
Smoking is any person who has
smoked in the past 12 months,
or is currently smoking.
 Developing Blood clots
 Heart disease
 Heart attack
 Heart failure
 Stroke
 Blood vessel thickening
Fat and plaque stick as a result of
smoking. This thickening causes blood to
become harder to flow through the
vessels. The reduced flow to the heart
can end in chest pain, hypertension, and
increased heart rate.
Follow Up after Discharge
24 Hrs post D/C
Home Health Visit
Feedback to HF clinician
If concerns discuss at f/u
appt
Patient
Discharged
with transition
plan
3-4 Days post D/C
•Visit with HF clinician for
med reconciliation
•Clinician to provide
summary for
cardiologist/PCP
•Feedback to Home Health
prn for f/u visits
Ongoing
1. Ongoing f/u with
Cardiologist as
scheduled
2. Ongoing Home
Health as indicated
Time Line
48-72 Hrs post D/C
•Case Management f/u phone call
5-7 Days post D/C
1. Reminder of HF appt
2. Ensure Cardiology and /or PCP
f/u appt is made
•2nd Home Health visit
1. Reinforce patient/family education
2. Medication reconciliation
3. Ensure follow up visits with
cardiologist/PCP
4. Report changes in
health/medications to HF clinician/
Cardiologist/PCP
Core Measure Set (CMS)
3. PNEUMONIA
Pneumococcal Vaccination
1) Screen pts 65 and older for vaccination status
2) Vaccinate pt prior to discharge if:
a) not previously vaccinated
b) no documented allergy
c) no bone marrow transplant w/in the past 12 months
d) no radiation/chemotherapy currently being received as a scheduled dose, received during this stay
or <2 weeks prior to this stay; or no *shingles (Zostavax) vaccination received w/in the past 4
weeks
e) patient does not refuse
Blood Cultures Performed within 24 Hours Prior To 24 Hours After Hospital
Arrival
Blood Cultures Performed:
1. Pts Transferred or Admitted w/in 24hrs of Hospital Arrival to ICU (due to PN or complications due
to PN) Collect blood culture anytime from the day prior to arrival up to 24hrs after hospital
arrival.
2. ED [Determined by clearly documented admit order]
*If blood culture is done, collect blood culture prior to initial antibiotic.
Adult Smoking Cessation Advice/Counseling Always inquire.
PNEUMONIA continued
Antibiotic Received Within 6 Hours Of Hospital Arrival
Administer initial dose w/in 6hrs of arrival. Counts pts who receive antibiotics w/in the 1st 24hrs of
hospital arrival only.
Must clearly document to reflect actual administration and include the following:
1) ABX Name
2) Date of Admin
3) Time of Admin
4) Route of ABX
Special Note: All patients with a diagnosis of PN should receive antibiotic treatment.
Allowance is given when documentation reflects pt has *another source of infection (w/in the 1st 24hrs of arrival), is
compromised, has healthcare associated PN, or has risk factors for drug resistant pneumococcus.
Antibiotic Selection for immunocompetent Pts.
Influenza Vaccination
1.
2.
*Screen pts 50 and older during current flu season (when vaccine is available -March) for
vaccination status.
* Hospital is only responsible for collection during discharges Oct - March.
Vaccinate pt prior to discharge if:
a) not previously vaccinated this flu season
b) no documented allergy
c) no documented bone marrow transplant w/in the past 6 months
d) no documented Guillian-Barre syndrome w/in6 weeks after previous influenza
vaccination
e) patient does not refuse
Core Measure Set (CMS)
4. Surgical Care Improvement Project (SCIP)
Principal Procedures applied: CABG, Other Cardiac, Hip/Knee Arthroplasty, Colon,
Hysterectomy, Vascular and *Other Major Surgery
*Prophylactic Antibiotic Selection:
Appropriate Prophylaxis Antibiotic Selection *Must clearly document to reflect actual
administration and include the following:
1. ABX Name
2. Date of Admin
3. Time of Admin
4. Route of ABX. Document suspected/diagnosed infections clearly.
*Antibiotic Received within 1 Hour of Surgical Incision
*Antibiotics Stopped within 24 Hours of Surgery End time (48 hours for cardiac patients)*
[or
2hrs if rec’ving Vancomycin or a fluoroquinolone] prior to surgical incision.
*Appropriate Hair Removal (no razors)*
Either remove surgical site hair by clippers or depilatory OR do not perform
hair removal.
Clearly document actual hair removal or that hair removal was not done.
Surgical Care Improvement Project(SCIP) continued
*
Controlled Postoperative Serum Glucose (< 200mg/dL) among Major
Cardiac Surgery Patients*
Control pt’s 6AM blood glucose to 200 m/dL on Postop Day 1 (POD1) and
Postop Day 2 (POD2).
Suggestion: Maintain and document blood glucose levels throughout the entire postop period.
Excludes: Burn patients, transplant patients and patients with preop infections
Surgery patients with active warming during surgery or temperature > 96.8O
F/ 36O C 30 minutes prior to 15 min after anesthesia end time**
Document:
*Active Warming intraoperatively to maintain normothermia AND/OR at
least 1 body temp 96.8F/36C
30 min prior to or 15 min after anesthesia end time;
or
Document:
**Intentional/Maintained Hypothermia perioperatively. Documentation must
reflect use during the periop period.
Surgical Care Improvement Project (SCIP)
*Urinary catheter removed Post-op day 1 or 2**
Urinary Catheter Removed: (Awareness of and monitoring need to continue urinary cath is
crucial.)
Remove indwelling urethral catheter on *POD0 through POD2 or document reason on POD1 or
POD2 for continuing cath. (Only applies to caths placed perioperatively and still in place at time of
discharge from recovery/PACU.)
Reasons:
1. Pt in ICU and receiving : diuretics
2. Phys/APN/PA reason documented for continuing cath postoperatively
Do Not Count: Physician orders alone; pt refusal; high risk of falls
[Periop: From hospital arrival through discharge from recovery/PACU (Or max of 6hrs after arrival
to a recovery area other than PACU, i.e., ICU)]
[Postop: Within 24hrs after anesthesia end time]
*POD 0 = Anesthesia End Date. POD 2 ends at midnight. Day of surgery is day zero.
Excludes: Urological/gynecological/ perineal procedures.
Core Measure Set (CMS)
5. Venous Thromboembolism (VTE )
•
Recommended Venous Thromboembolism Prophylaxis Ordered admission to 24 hrs after surgery*
•
Appropriate Venous Thromboembolism Prophylaxis given Within 24 hours prior to Surgical
Incision Time to 24 hours after Surgery End Time*
Surgery
Recommended Prophylaxis
Elective Total Hip Replacement
Any of the following started within 24hrs of surgery:
• Low molecular weight heparin (LMWH)
• Factor Xa Inhibitor (fondaparinux)
• Warfarin
Elective Total Knee Replacement
• Same as for Elective Hip Replacement including :
 Intermittent pneumatic compression devices (IPC)
Venous foot pump (VFP)
General Surgery
Any of the following:
• Low-dose unfractionated heparin (LDUH)
• Low molecular weight heparin (LMWH)
• Factor Xa Inhibitor (fondaparinux)
• LDUH or LMWH or Factor Xa Inhibitor (fondaparinux) combined with IPC or GCS
Intracranial Neurosurgery
Any of the following:
• Intermittent pneumatic compression devices (IPC) with or without graduated
compression stockings (GCS)
• Low-dose unfractionated heparin (LDUH)
• Low molecular weight heparin (LMWH)†
• LDUH or LMWH† combined with IPC or GCS
† Current guidelines recommend postoperative low
molecular weight heparin for Intracranial Neurosurgery
Gynecologic Surgery/ Urologic Surgery
Any of the following:
•Same as for General Surgery including:
Intermittent pneumatic compression devices(IPC)
Urologic add: • Graduated compression stockings (GCS)
CORE MEASURES
ALL ABOUT THE DATA
A major part of the quality improvement agenda in the hospital is centered on the
“core measures,” a set of national quality performance measures.
Hospitals began to address a subset of the current core measures as part of
hospital accreditation by the Joint Commission.
Since then, the core measures have been aligned with CMS quality measurement
for the Medicare program and adopted by the National Quality Forum consensus
process.
Core Measures are used as a benchmark for hospital clinical performance and spur
improvement.
In many states, they represent some portion of hospital reporting to regulatory
authorities.
Core measure results are also posted on public Web sites such as
HospitalCompare1 to facilitate comparison shopping by consumers,
and increasingly linked to reimbursement as part of the Centers for Medicare &
Medicaid Services (CMS) Value-Based Purchasing and the pay-for-performance
programs of many other payers.
© 2011 Computer Sciences Corporation
Authors: Jane Metzger and Donna Schmidt, RN
CORE MEASURES
ALL ABOUT THE DATA
 These measures were a result of The National Voluntary Hospital
Reporting Initiative, which was a joint effort led by the AHA, the
Federation of American Hospitals, and the Association of American
Medical Colleges to:
 Provide useful and valid data about hospital quality to the public
 Provide hospitals a sense of predictability about public reporting
 To standardize data and data collection mechanisms
 To foster hospital quality improvement
 These measures were to be collected on inpatient records only, and for
a defined population which was determined by algorithms specific to
each measure.
CORE MEASURES
ALL ABOUT THE DATA
•
•
•
•
Hospitals may choose their core measure sets from those currently
available.
No specific measure sets are currently mandated by the Joint
Commission for data collection in 2009.
Participation is “voluntary” and hospitals are not required to
participate. However, those who choose NOT to participate will
receive a reduction of 2.0 percent in their Medicare Annual Payment
Update for the fiscal year.
To qualify for full market basket payment, hospitals must submit
complete data for each (CMS) required quality measure by the
posted submission deadlines. (Inpatient and Outpatient)
CORE MEASURES
ALL ABOUT THE DATA
•
Each measure’s specific data can be collected either retrospectively or
concurrently.
•
Data is then submitted to JCAHO and CMS and used for quality improvement
and public reporting.
•
•
•
Data is submitted to CMS/JCAHO on a quarterly basis
Validated by CDAC, CMS’s re-abstraction center.
Validation must be passed by at least 75% accuracy or information publicly posted
will have a “not validated” notation by it.
Facilities may correct abstraction errors and resubmit to CMS.
Data is then publicly reported on CMS website: Hospital Compare.
•
•
CORE MEASURES
ALL ABOUT THE DATA
 Data is submitted to CMS/JCAHO on a quarterly basis
 Validated by CDAC, CMS’s re-abstraction center.
 Validation must be passed by at least 75% accuracy or information
publicly posted will have a “not validated” notation by it.
 Facilities may correct abstraction errors and resubmit to CMS.
 Data is then publicly reported on CMS website: Hospital Compare.
CORE MEASURES
ALL ABOUT THE DATA
Conclusion
Whichever way you choose to collect, abstract and submit
your data, it is reported publicly. People, organizations,
insurance companies and anyone who wants it—it’s out there
for everyone to see.
Core Measures is here to stay. It is only going to expand and
have more impact. It is important to work together to
collect, report and improve your data where you can.
Your facilities future may depend on it!
Karen Allen, RHIT September 26, 2009
www.inhima.org/files/Core_Measures.INHIMA.ppt · PPT file
St Elizabeth Core Measure Data
NATIONAL QUALITY INITIATIVES (JC/CMS PUBLICLY REPORTED DATA) DASHBOARD
(Publicly reported databases)
Indicator
Edgewood/Covington
Profile: Core Pneumonia
Adult smoking cessation
Pneumococcal screening/vaccination
Blood cultures, if ordered prior to 1st antib
Influenza vaccination (seasonal)
Antibiotic selection
Blood cultures, 24 hrs ICU adm
Antibiotic given within 6 hours
Profile: Core Acute Myocardial Infarction
Aspirin at arrival
Aspirin prescribed at discharge
ACEI/ARB for LVSD
Beta blocker prescribed at d/c
Adult smoking cessation
PCI w/I 90 minutes
Statin prescribed at d/c
Profile: Core Heart Failure
ACEI/ARB for LVSD
Discharge instructions
Adult smoking cessation
Evaluation of Left Ventricular Systolic function
Profile: Surgical Infection Prevention
Prophylactic antibiotic W/I 1 hr incision
Prophylactic antibiotics d/c w/I 24 hr OR
Antibiotic selection
Cardiac pts 6am postop serum glucose < 200
Appropriate hair removal
Venous Thromboembolism Prophylaxis
Venous Thromboembolism Prophylaxis
Timing
Beta Blocker prior to adm & preop
Urinary cath removed by end of POD2
Perioperative temp management
3RD
11
11
11
2011 Goal
CMS
CMS
Top 10th National Avg
Percentile
97
100
92
100
95
100
91
100
91
99
ND
ND
95
100
2nd
09
3rd
09
4th
09
1st
10
2nd
10
100
97.1
100
96.1
96
100
97.1
100
100
95.7
NA
100
83.3
100
100
100
100
NA
95.2
100
97.4
100
100
100
96.6
85.7
100
100
100
100
100
100
96.4
100
100
100
97
100
ND
100
100
100
100
100
100
ND
100
ND
91.3
100
100
100
ND
100
66.7
100
100
96.9
100
85.7
95.2
100
100
100
97.4
100
98.1
93.8
50
100
100
100
100
NA
100
90.9
97.1
100
88.9
100
NA
100
100
100
100
100
100
100
100
100
ND
100
100
100
100
100
91.7
ND
100
100
100
100
100
100
ND
100
100
100
100
100
100
ND
100
100
100
100
100
100
ND
100
100
100
100
100
85.7
ND
100
100
100
100
100
88.9
ND
100
100
100
100
100
100
ND
100
100
100
100
100
92.3
100
98.8
100
100
100
100
100
100
100
100
100
100
100
100
98.6
100
100
100
100
100
100
100
100
100
100
100
100
100
ND
98
98
96
98
99
89
ND
100
100
100
100
91.4
100
100
97.4
100
100
95.5
100
100
92.2
100
100
95.4
100
100
98
100
100
94.7
100
100
94.7
100
100
95
100
100
98.1
100
100
100
100
100
100
100
94
87
98
100
100
100
100
100
100
100
100
100
100
100
100
100
98
97.7
93.5
97.7
97.7
99.5
100
97.4
96.4
99.1
85.7
100
100
98.4
97.4
100
97.6
99.5
97.1
98.4
98.4
96.9
95
100
97.4
99.2
97.5
97.5
86.1
100
94.2
98.3
97.1
97.4
89.5
100
100
98.6
89.6
97.1
100
100
90
100
97.5
97.7
91.7
100
93.3
98.3
98.2
98.3
97.2
100
98
97.4
97.3
96.7
100
100
98.1
96.5
96.4
99.1
77.8
100
98
100
77.8
100
100
100
100
100
100
100
99
100
100
96
94
97
93
99
94
100
100
ND
ND
97.7
95.3
ND
ND
94.3
96.5
ND
ND
94.9
98.4
79.1
99.2
94.2
96.4
81.5
100
95
98.1
88.2
100
86.7
100
88
98.9
93.3
96.2
94.4
100
98
96.4
84.7
100
98.1
94.5
94.5
100
98
100
96.9
99.3
100
100
81.8
100
100
100
100
ND
92
92
89
ND
2011 Goal - Score in top 10th percentile in 75% of core measure scores
4TH
10
2ND
1st
09
Prliminary Column(s) indicates reviews not complete. Data is subject to change.
Blue lettering denotes indicator selected for Value Based Purchasing [Pay For Performance]
Green indicates goal met
Red indicates goal not met
2010 Goal - Score meets or exceeds CMS top 10th percentile,
JUL/AUG SEPT
10
10
Prelimi
nary
1ST
3 National Quality Forum. Health Information Technology Expert Panel Report: Recommended Common Data Types and
Prioritized Performance Measures for Electronic Healthcare Information Systems. 2008.
4 Specifications Manual (Discharges 10/1/2008 to 03/31/2009). Alphabetical Data Dictionary. http://www.qualitynet.org/
dcs/ContentServer?cid=1203781887871&pagename=QnetPublic%2FPage%2FQnetTier4&c=Page.
http://www.qualityforum.org/projects/ongoing/HITEP/comments/
5 HIMSS Analytics. 2008 Annual Report of the U.S. Hospital IT Market. HIMSS. 2008.
6 Scalese, D. “Quality paper work is never done.” Hospitals & Health Networks. January, 2007.
http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/01JAN2007/0701HHN_DEP
T_StoryBoard&domain=HHNMAG.
7 Niemi, K, Geary, S, Quinn, B, et al. “Implementation and evaluation of electronic clinical decision support for compliance
with pneumonia and heart failure quality indicators.” Am J Health-Sys Pharm 66:389-397. 2009.
American Heart Association =
Webites
http://www.heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRisk
ofHeartAttack/Understand-Your-Risk-of-Heart-Attack_UCM_002040_Article.jsp
Learn about smoking and cardiovascular disease
Visit our Quitting Smoking area for plans, tips and tools to help you quit
Visit our Cholesterol website
Get your free personalized cholesterol treatment options report from the Heart
Profilers
Visit our High Blood Pressure website
Take our Blood Pressure Risk Assessment
Get your free personalized high blood pressure treatment options report from
the Heart Profilers
Visit our Physical Activity and Fitness website
Start! a walking program
Visit our Weight Management website
Visit our Heart of Diabetes website
References
Jane Metzger is Principal Researcher in CSC’s Emerging Practices, the applied research department of
CSC’s Global Healthcare Sector. Donna Schmidt, RN, is Partner, CSC’s Global Healthcare Sector.
References
1. http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp?version=default&browser=IE%7C7%7CWinXP&la
nguage=English&defaultstatus=O&pagelist=Home Accessed
March 24, 2009.
2. Specifications Manual (Discharges 10/1/2008 to 03/31/2009). Sections 2.1-2.4.
http://www.qualitynet.org/dcs/ContentServer?cid=1203781887871&pagename=QnetPublic%2FPage%2FQnetTier4&c=
Page.
3. National Quality Forum. Health Information Technology Expert Panel Report: Recommended Common Data Types and
Prioritized Performance Measures for Electronic Healthcare Information Systems. 2008.
4. Specifications Manual (Discharges 10/1/2008 to 03/31/2009). Alphabetical Data Dictionary. http://www.qualitynet.org/
dcs/ContentServer?cid=1203781887871&pagename=QnetPublic%2FPage%2FQnetTier4&c=Page.
http://www.qualityforum.org/projects/ongoing/HITEP/comments/
5. HIMSS Analytics. 2008 Annual Report of the U.S. Hospital IT Market. HIMSS. 2008.
6. Scalese, D. “Quality paper work is never done.” Hospitals & Health Networks. January, 2007.
http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/01JAN2007/0701HHN_D
EP T_StoryBoard&domain=HHNMAG.
7. Niemi, K, Geary, S, Quinn, B, et al. “Implementation and evaluation of electronic clinical decision support for
compliance with pneumonia and heart failure quality indicators.” Am J Health-Sys Pharm 66:389-397. 2009.
Core Measures
Karen Allen, RHIT September 26, 2009 www.inhima.org/files/Core_Measures.INHIMA.ppt ·
PPT file