Improving Quality Outcomes through Implementation of a Core Measure Nurse and the Electronic Medical Record

Purpose:
The Affordable Care Act mandates “Value-Based Purchasing” be tied to hospital performance on core measures and HCAHPS. The goal is to be 100% compliant on all quality measures set forth by the CMS to ensure full payment by Medicare.

Significance:
Reimbursement is currently tied to quality core measures and determined by improvement and achievement of scores. As of January 1, 2013, reimbursement changes will go into effect.

Strategy and Implementation:
The position of a “Core Measure Nurse”, dedicated to ensuring 100% compliance of all core measures, was integrated into the Quality Department of a community hospital to assist in ensuring compliance. This nurse collaborates daily with abstractors in a morning huddle using Electronic Medical Records (e-Medical Record). They review the patients needing attention to meet the measures looking at the Quality Measures Dashboard in the e-Medical Record. This nurse carries a beeper and is paged on every discharge. When paged, she checks on the global immunization measures (IMM),the Surgical Care Improvement Program(SCIP)criteria, Stroke, Pneumonia, AMI, and HF measures to ensure that all measures are met. In addition, many forms of communication, including emails, phone calls, etc, are made between the core measure nurses and the abstractors. The electronic medical record serves as a communication tool among all caregivers in identifying and determining the needs of each patient.

Evaluation:
Prior to implementation of this process, 26% of core measures reached the 100% goal. Following implementation, over 40% of core measures reached the 100% goal.

Implications for Practice:
Nursing and quality departments partnering with e-medical record demonstrated improved quality measures not met prior to this implementation. Using this combination of partnership strategies and technology continues to be our vision for the future in providing the highest quality of patient care.