Quality Management (QM)
The Community Clinics Health Network (CCHN) offers the following Quality Management (QM) Services:
- Access Audit
- Patient Satisfaction Survey
- Peer Review
- Continuous Quality Improvement (CQI) Studies/Audits
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The services are provided in accordance with the CCHN Policies and Procedures, the QM Plan and the QM Schedule approved annually by the Physician Council, composed of Medical Directors from participating community clinics and health centers. The four QM services are outlined below.
ACCESS AUDIT
The Telephone Access Audit monitors access and service availability, while incorporating the unique needs and preferences of the diverse clinic patient population in arranging appointments and facilitating access to care. Individual clinic data is provided to participating health centers to monitor trends. Data is also aggregated across clinics and compared to benchmarks.
The purpose of measuring access is to assess and insure the availability of appropriate primary and specialty care providers and clinic services to the patient population served and identify and correct any areas or issues that may impede access to care.
CCHN has been conducting semi-annual access audits since October 2000. CCHN currently conducts access audits at approximately 30 clinic sites. The Access Audit Tool was designed to capture all information required by the health plans and by the National Committee for Quality Assurance (NCQA), and monitors access, service availability, and the unique needs and preferences of the diverse clinic patient population in arranging appointments and facilitating access to care. Five areas are measured against the standards set forth by the California Coalition of Managed Care Plans for health care access.
PATIENT SATISFACTION SURVEY
The Patient Satisfaction Survey monitors eight areas including ease of getting care (access); wait time; provider care; nurse/medical assistant care; all other employee care; payment; facility (maintenance/accessibility); and confidentiality. The survey also provides an opportunity for patients to comment on likes, dislikes, and suggestions for improvement. Individual clinic data is provided to participating health centers to monitor trends. Data is also aggregated across clinics and compared to benchmarks.
The purpose of measuring patient satisfaction is to assess and improve the quality of health care services by focusing on the needs and expectations of community health center patients. By conducting a patient satisfaction survey, CCHN is able to collect and review survey data from patients to be aware of patient-perceived concerns and to incorporate specific trends of problems into other review processes that are part of the Quality Management Plan.
CCHN staff has been conducting patient satisfaction surveys since 2000, and increased the efficacy of this strategy in 2003 with an automated process. CCHN currently conducts quarterly patient satisfaction surveys at more than 40 community health center locations. The survey is a standardized tool developed by the Bureau of Primary Health Care and allows CCHN to benchmark results to clinics nationwide. The patient satisfaction tool measures eight items: ease of getting care (access); wait time; provider care; nurse/medical assistant care; all other employee care; payment; facility (maintenance/accessibility); and confidentiality.
PEER REVIEW
The Peer Review process monitors the provision of medical care, utilization, continuity of care, documentation in medical records and adherence to health maintenance guidelines. Individual clinic data is provided to participating health centers to monitor trends. Data is also aggregated across clinics and compared to benchmarks.
The purpose of the peer review process is to assess and identify areas for improvement in the provision of medical care, utilization and documentation by clinic staff; to establish inter-provider consistency and adherence to baseline uniform standards in the care of patients and in the documentation of medical records; to document the quality of care that patients receive; to improve or change protocols or standards of care; and to ultimately improve the quality of care provided in the clinic.
The peer review process was initiated in 2000 and has proven successful in evaluating clinical compliance and medical record documentation. By the end of 2004, the CCHN had completed more than 540 peer reviews at over 30 clinic sites. Currently CCHN peer review measures medical records documentation and compliance with national clinical guidelines for prevention by evaluating six items: general care, utilization, continuity of care, medical records, health maintenance, and further review.
CONTINUOUS QUALITY IMPROVEMENT (CQI) STUDIES/AUDITS
The CQI audit process monitors specific clinical indicators and standards of care through medical record review and other data capture systems. Individual clinic data is provided to participating health centers to monitor trends. Data is also aggregated across clinics and compared to benchmarks.
The purpose of conducting Continuous Quality Improvement (CQI) audits is to assess and assure the quality of health care for all users of community health centers by measuring key indicators of care. By conducting CQI audits at the clinic level, specific care management techniques are assessed. Clinics with customized CQI activities are able to identify indicators of care management specific to their patient population, and improve their internal health center communication and care processes. CQI activities are a critical aspect of quality and disease management, and provide baseline data to measure success at improving quality of care. CQI audits are a major component of the CCHN Quality Management Program.
As of the end of 2004, the CCHN community health centers and staff have completed eight CQI projects with chart audits and action plans as needed. The CQI audit process includes identifying and evaluating specific clinical or service issues, collecting data, and using standardized indicators and benchmarks to develop and implement the quality improvement plan as needed. CCHN staff analyzes the data and compares the results to Health Plan Employer Data and Information Set (HEDIS) measures designed by the National Committee on Quality Assurance (NCQA) to gauge the effectiveness of health care providers.