Improving Quality of Care in Federally Qualified Health Centers Through Ambulatory Care Accreditation.

HRSA supported health centers have a long history of participating in ambulatory care accreditation; however, there is a dearth of information on the relationship between accreditation and quality of care. We conducted a cross-sectional study of 1,202 health centers, using multivariate regression to estimate the association between accreditation and 14 clinical quality measures, controlling for patient and organizational characteristics. We also predicted national estimates of accreditation-related improvement in quality. Adjusted analyses show that accredited health centers achieved higher performance on adult weight screening and follow-up (coef = 0.037, p < .05), tobacco cessation intervention (coef = 0.042, p < .05), and use of lipid-lowering therapy (coef = 0.028, p < .05). Study results show that universal accreditation could result in additional 552,087 adult patients receiving weight screening and follow-up, 157,434 receiving tobacco cessation intervention and 25,289 receiving lipid-lowering therapy. This is the first national study to examine the impact of accreditation on health center quality of care. Findings suggest that HRSA support for accreditation has the potential to improve quality of care and as a result, reduce health disparities in underserved communities across the United States. Further research is necessary to identify specific elements of accreditation that have the greatest impact on quality of care.

Measuring efficiency among US federal hospitals.

This study evaluates the efficiency of federal hospitals, specifically those hospitals administered by the US Department of Veterans Affairs and the US Department of Defense. Hospital executives, health care policymakers, taxpayers, and federal hospital beneficiaries benefit from studies that improve hospital efficiency. This study uses data envelopment analysis to evaluate a panel of 165 federal hospitals in 2007 and 157 of the same hospitals again in 2011. Results indicate that overall efficiency in federal hospitals improved from 81% in 2007 to 86% in 2011. The number of federal hospitals operating on the efficiency frontier decreased slightly from 25 in 2007 to 21 in 2011. The higher efficiency score clearly documents that federal hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the health care industry. This research examines benchmarking strategies to improve the efficiency of hospital services to federal beneficiaries. Through the use of strategies such as integrated information systems, consolidation of services, transaction-cost economics, and focusing on preventative health care, these organizations have been able to provide quality service while maintaining fiscal responsibility. In addition, the research documented the characteristics of those federal hospitals that were found to be on the Efficiency Frontier. These hospitals serve as benchmarks for less efficient federal hospitals as they develop strategies for improvement.

A journey to become a federally qualified health center.

PURPOSE: Since 1998, Integrated Health Care (IHC), an academic nurse-managed center of the University of Illinois at Chicago College of Nursing, has delivered primary and mental health care to people with serious and persistent mental illness who are enrolled in psychosocial rehabilitation. DATA SOURCES: Federal guidelines and experiences of the steering group. This article reports our journey of transformation to a achieve the status of a Federally Qualified Health Center (FQHC). CONCLUSIONS: Nurse-managed clinics (NMCs) have become important in the U.S. healthcare system with well documented positive impact. However, financial issues have placed may NMCs at risk for closure. Achieving FQHC status is seen as a viable option to increase revenue and therefore financial stability. IMPLICATIONS FOR PRACTICE: This discussion of the benefits of FQHC status, an overview of some common compliance issues with FQHC requirements, and the report of lessons learned along the way in meeting FQHC standards that we encountered can provide support and guidance for other NMCs in similar situations.

Nutrition assessment outcomes: a protocol for Native American hospitals.

The incorporation of visceral protein testing into nutrition assessment protocols can help all hospitals rapidly and accurately identify patients in need of restorative nutrition therapy. Reilly showed that a 3- to 5-day delay in identifying malnutrition has a direct variable cost of $1,500 per case. Studies by Brugler, Mears, and Reilly have demonstrated longer lengths of stay and increased care costs because of nosocomial complications (i.e., infections, pressure ulcers, wound dehiscence, dyspnea, system failures) related to malnutrition. Brugler showed that functionality--a measure of a patient's independence and ability to perform daily activities--both at admission and discharge, the number of care interventions, the occurrence of complications, the level of nutrition treatment needed, and the patient's discharge disposition were strongly associated with their admission albumin value. Conversely, nutrition restoration leads to improved patient outcomes, reduced costs, maximization of care reimbursement, and fulfillment of regulatory requirements. Adoption of this protocol by other hospitals should allow them to demonstrate comparable results, thereby justifying the incorporation of visceral protein testing into their nutrition assessment methods.

Auditing. A method for evaluating quality of care.

The nursing process is accepted as a major framework for practice; but its integration in the quality assurance process, in a format where the phases of the nursing process are examined in a sequential manner has not been reported. The authors have developed a nursing process audit tool that provides an organized approach for evaluating independent nursing functions based on the nursing process. Each step in the nursing process can be evaluated individually and as a whole. The tool can be used concurrently and/or retrospectively. This tool provides nursing administrators with pertinent data that can be used to improve nursing practice.