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QUALITY DATA FOCUSED REVIEW

QUALITY DATA FOCUSED REVIEW. RICHARD GRZYB . Abstraction The Good The Bad The Confusing. IT ALL RESTS ON THE ABSTRACTOR!!. One Small Abstraction Error Could Result in Large Consequences!!!. “For want of a nail the shoe was lost” “For want of a shoe the horse was lost”

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QUALITY DATA FOCUSED REVIEW

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  1. QUALITY DATAFOCUSED REVIEW RICHARD GRZYB

  2. AbstractionThe Good The Bad The Confusing

  3. IT ALL RESTS ON THE ABSTRACTOR!!

  4. One Small Abstraction Error Could Result in Large Consequences!!! • “For want of a nail the shoe was lost” • “For want of a shoe the horse was lost” • “For want of a horse the rider was lost” • “For want of a rider the battle was lost” • “For want of the battle the kingdom was lost”

  5. Sample VBP Worksheet

  6. HOW ONE FAILURE CAN AFFECT THE BOTTOM LINE

  7. PLAY BY THE RULES! • Follow the Specifications Manual Rules • Do Not ASSUME Anything • Don’t be Swayed by a Clinician Stating that “It is Assumed”…. • Validators Do Not Make any Assumptions

  8. THE RULES CAN CHANGE • Understand the rules • Check yearly updates to see if abstracting rules have changes!!!!! • The Strange Case of Avascular Necrosis • For years it was a Pre-Op Infection • Now it is not! • NEVER ASSUME

  9. QUEST IT • WHEN IN DOUBT QUEST IT – • KEEP THE QUESTION SIMPLE! FRAME IT SO THAT THEY UNDERSTAND • KEEP A LOG OF ALL ANSWERS • KEEP NOTES ON YOUR ABSTRACTION FORMS • DISCUSS WITH OTHER ABSTRACTORS

  10. FREQUENTLY ASKED ABSTRACTION QUESTIONSOCTOBER 2013

  11. Outpatient Abstraction Updates and Common Errors From CDAC and CMS Educational Reviews

  12. Hospital Outpatient Quality ReportingProgram Educational ReviewsPain Management Review entire ED record for documentation of pain meds received prior to arrival Age 17 and under are eligible to get either Oral Parenteral (IM,IV, etc) if it is the first administration of pain med

  13. Hospital Outpatient Quality ReportingProgram Educational ReviewsStroke Last known well- need specific date and time Can use time range if it documented as specific number of hours

  14. Hospital Outpatient Quality ReportingProgram Educational ReviewsSurgery All antibiotic elements must be collected from a single source Clinical trial – must be relevant to measure abstracted to answer yes

  15. Hospital Outpatient Quality ReportingProgram Educational ReviewsChest Pain Cardiac vs. atypical chest pain An exclusion overrides an inclusion

  16. Hospital Outpatient Quality ReportingProgram Educational ReviewsAcute Myocardial Infarction Follow the rules for determining STEMI Take your time, find the first EKG, review line by line.

  17. Hospital Outpatient Quality ReportingProgram Educational Reviews Provider time needs to be clearly documented May have to change ED form to comply

  18. 2014 UPDATES/CHANGES OUTPATIENT • Pain-Intranasal is Now Allowed(age 2-17) • Suspended OP 19-ED Transition Record • Suspended OP 24-Cardiac Rehab • OP 27-Flu Vaccines • OP 29-Colonoscopy Follow Up • OP 30-Colonoscopy with Polyps • OP 31-Cataract-Improvement in Vision • OP 16-Troponin Removed

  19. 2014 UPDATES/CHANGES INPATIENT CMS ELIMINATING MEASURES HOWEVER, THE JOINT COMMISSION ISKEEPING MOST MEASURES AS THEY ARE REFERRED TO NOW AS, ACCOUNTABILITY MEASURES

  20. 2014 UPDATES/CHANGES INPATIENT • RETIRED MEASURES • HF-1 DISCHARGE INSTRUCTIONS • PN-3b- BLOOD CULTURES IN THE ED • SCIP- 10 PERIOP TEMP MANAGEMENT • IMM-1 – PNEUMOCOCCAL IMMUNIZATION (ON HOLD)

  21. 2014 UPDATES/CHANGES INPATIENT PNA- Compromised and HCAP Merging into New Data Element: Reason for Alternative Empiric Antibiotic Therapy Based on 2 concepts: 1. Patient has condition that could cause an impaired immune system 2. Patient has condition that justifies an alternative antibiotic regimen

  22. 2014 UPDATES/CHANGES INPATIENT SCIP 4- Blood Sugar Post-Op for Cardiac Surgery • New Timeframe: 18-24 Hours • Glucose level now less than 180

  23. 2014 UPDATES/CHANGES INPATIENT SCIP VTE- Aspirin added for Elective Ortho -Total Hip -Total Knee -Fractured Hip Surgery

  24. 2014 UPDATES/CHANGES INPATIENT • ED- Observation Strata Folded into Reporting Measure • VTE- Oral Factor Xa is a reason for: • No VTE Prophylaxis • No Overlap Therapy • Discontinuation of Parenteral Therapy

  25. ABSTRACTION ISSUES • MI- Follow Step by Step to Determine if the First EKG Shows a STEMI • CMO • PNA • Look at Final Diagnosis • If MD just Re-stating X-ray Report that Patient has PNA this would NOT count as PNA in the ED

  26. TAKE HOME POINTS • Core Measures Abstraction is Important • “In God we Trust”- for the Rest Quest! • View and Listen to all the Webinars/Updates and Make Notations on Abstraction Forms

  27. QUESTIONS

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