HS506f, Advanced Topics in Quality and Performance Measurement in Healthcare3/7/2016

THE HELLER SCHOOL FOR SOCIAL POLICY AND MANAGEMENT

BRANDEIS UNIVERSITY

HS506f, Advanced Topics in Quality and Performance Measurement in Healthcare

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HS506f, Advanced Topics in Quality and Performance Measurement in Healthcare3/7/2016

Spring 2016, Module 2

Deborah GarnickOffice hours: By appointment

781-736-3840 (Office)Class: Thursdays 2:00-4:50 pm

ocation: The Heller School – Room 163

Course Description: The purposes of this module are to provide students with the capacity to:

-Understand how performance measures are developed

-Marshall and critically assess the literature on a focused topic in quality and performance measurement

-Learn from classmates about a range of topics related to quality and performance measurement

-Gain experience in presenting your work

-Gain experience in offering constructive written feedback.

This module builds on the pre-requisite initial module which is focused on the centrality of quality of care issues in contemporary health services research, health care policy, and management of healthcare organizations. The first module, offered as an elective every year, introduces basic concepts and offers an overview of the field. This module is offered as an elective every other year.

The first several sessions focus on specific areas of research includingdevelopment and testing on measures, relationship of process/structure measures to outcomes, and composite measures. Based on students’ interest, additional topics may be substituted. The remaining sessions will be focused on in-depth exploration of the research literature on specific topics related to students’ interests, and tied together with common themes for the semester. Sometime during first module, the instructor will meet with students enrolled in the second module to select the themes and specific topics (see below for additional details).

Course Requirements:

20% Class participation The success of this class depends on full preparation by all students for each class, demonstrated by participation and contribution to class discussions and participation in short on-line surveys throughout the semester. The course will be run as a seminar and participation in presentations, critique, and discussions will be a key aspect of student participation. The goal is to demonstrate engagement and investment in the class and evidence of interest in the material under study.

Attendance is required and recorded at every class. Absences will be excused only for exceptional circumstances. If an absence is anticipated, please request it in writing by submitting an e-memo to the professor no later than 5:00 pm the day before the scheduled class. If an unanticipated need to be absent arises, please submit a written memo or email explaining the circumstances as soon as possible before the next class.

50% Paper: Papers are due on March 17th (With the understanding that students can post an updated version at least one week before their scheduled presentation).

Students are encouraged to tailor their paper topic to fit their interests (e.g. mental health performance measures, child health, home health care, healthcare for persons with disabilities). After each student in the module decides on a topic, the student presentations will be organized by theme. Some themes may overlap with topics introduced during the first module, but they will be addressed here in greater depth.

For some doctoral students who are considering whether quality of health care will be central to their dissertation topic, this module offers the opportunity to explore a topic in depth and to benefit from their classmates’ insights. There is no one set style of paper, because the goal of the class is to be most useful to each student’s goals. In the past, a few students have proposed new performance measures, others have investigated an approach to quality improvement (e.g., checklists), state policies and their impact – the choice is yours. However, here are a few examples of paper options.

  • Perspectives. One option is to write a short paper in thestyle of a “Perspective” article on a topic of your choice that is related to a quality issues that particularly interests you. A Perspective is a common article format in the health policy and medical literature that is used to disseminate important ideas. Under different names, these articles can be found in the New England Journal of Medicine, JAMA, Annals of Internal Medicine, JAMA Internal Medicine, and other journals. The Perspective: 1) identifies a relevant issue, problem, or challenge in health care quality; 2) Evaluates the key dimensions of the issue, often using data; 3) proposes potential solutions or improvements to health policy or care delivery to address the problem. The paper should be relatively brief, between 1,500 and 2,000 words. See the papers by Berwick (Measuring physicians’ quality and performance: Adrift on Lake Wobegon), Jain (Googling ourselves – What physicians can learn from online rating sites), and Ryan (Grade pending: lessons for quality reporting in health care from the New York City restaurant sanitation inspection program) in the reading list for examples.
  • Dissecting Scholarly Articles. Select several scholarly journal articles on a specific topic (e.g., a specific performance measure such as integration of behavioral and physical health, the relationship of process to outcomes for a particular condition) and get the instructor’s approval of the articles. Prepare a review which includes the following: 1) an introduction to the topic of the articles, the issue being discussed, and why you selected it, 2) the hypotheses being studied, 3) a description of the study samples (e.g., random/non-random, sample size), 4) the methods used, 5) major findings, and 6) conclusions. Then discuss the authors’ opinions, views, clarifications, or claims regarding the research. This approach is a “deep dive” into the process of analyzing and evaluating scholarly journal articles in the area of quality. This would be a more typical term paper – about 15 pages.
  • “Deeper Dive.” This approach would mean taking a deeper look at a single (or possibly set) of performance measures – or a quality improvement approach (e.g., checklists, state regulation) - tracing the evidence, history, current use, unintended consequences, scientific evidence etc. (answering many of the questions in the NQF measure submission forms). This would be a more typical term paper – about 15 pages.

For all papers, when submitting your paper, please answer the following questions as a separate (last) page.

1. In one sentence, what is the main point you are trying to convey?

2. If you had additional time to work on this paper, would you want to change it? Explain.

3. What do you like most about your paper?

4. What do you like least?

5. Please ask one question that you would like me to address in my comments.

For all papers, references should be in standard style such as the American Psychological (for tips, see numbered references ( or another standard style. I very strongly encourage use of Endnote, which is available from Brandeis LTS site license (

In addition, a key reference for the class to read is also due on when you turn in your paper.

Students should have met at least once with the instructor during the first module to discuss their paper topic. Early in the second module, students should meet with the instructor again to discuss their progress.

Following their presentation, each student should turn in a revised paper within two weeks (or by the end of the semester for those presenting in the last weeks of the Module).

20% Paper Presentation. Each student will have about 70 minutes of class time for their paper presentation. This should be structured as a 20 minute PowerPoint presentation which clearly makes the arguments in your paper, followed by the student, instructor and guest faculty critique of your paper, and discussion. Students making presentations will be expected to tell what type of paper (see above) they are writing, address the key question/argument they are addressing, rationale for importance of their topic, a summary of relevant literature (with a focus on critical assessment of several selected articles), and assessment of additional needed research. They also will be expected to moderate the discussion of their presentation.

Each student should meet with the instructor to review their presentation during the week prior to the presentation.

Depending on the topic, other faculty and staff at The Heller School may be invited to sit in for specific presentations. The final set of themes, dates, paper topics, and reviewer assignments will be made available to the entire class during the first session.

20% Critique of Others’ papers.For two classmates’ papers, students are assigned to read and provide summary written critiques, present their critique in class and provide specific comments (Word track changes preferred) for two of their colleague’s term papers. The critiques should focus on the rubric posted in LATTE.There is a strong emphasis on gaining experience in providing feedback in a constructive manner.

In addition, during class each student will have a response sheet on which to record suggestions on

  • Overall organization
  • Knowledge of the history, developments and issues in the substantive aspect of the topic
  • Capacity to marshal and critically assess the literature
  • Overall quality of the writing

5% Reflective essays: At the beginning of the Module, each student will write a short essay (no longer than two double spaced pages) to address the following:

1)Why did you elect to take this Advanced Module?

2)What do you hope to get out of this module (e.g., preparation for dissertation, insights for implementing quality improvement projects, etc.)

This essay is due Wednesday March 9th at 5:00 pm. There are no wrong answers here, but rather the goal is for you to consider thoughts as the second Module starts.

Near the end of the semester, each student will write a second essay on:

1)What have you learned from the experience of presenting to the class and reacting to critiques?

2)What have you learned from the experience of critiquing your classmates’ work?

3)What are your suggestions (also an opportunity anonymously on the course evaluations) about improving this Module?

This essay is due Monday April 18th at 5:00 pm. Each of these essays will be graded as pass if turned in on time and show a thoughtful effort

Prerequisites: This module is intended mainly for doctoral students (masters students may enroll with instructor’s permission). HS505f, Quality and Performance Measurement in Healthcare, the module that introduces quality and performance measurement in is a pre-requisite (although not necessarily in the same semester). The conceptual basis for quality measurement as well as the methods of continuous quality improvement in healthcare can be broadly applicable to international settings. Thus, this module may be of interest to students whose focus is either domestic or international quality issues. To meet the broad needs of doctoral students across concentrations, and to broaden the intellectual focus of the class, examples of research and use of quality and performance measurement outside of healthcare also will be introduced during this course.

Provisions for Feedback: Regular and timely feedback will be provided to students, in the form of written comments on the term papers and class presentations. Ph.D. students will be evaluated on a pass/fail basis while master’s students will be evaluated with letter grades. Please feel free to meet with me individually by appointment to discuss class content, make suggestions, or raise any questions or concerns.

Academic Integrity: Violations of University policies on academic integrity, described in Section 3 of Rights and Responsibilities, may result in failure of the course or on the assignment, and could end in suspension from the University. If you are in doubt about the instructions for any assignment in this course, you must ask for clarification.

Notice: If you have a documented disability and require any accommodations, please bring them to my attention prior to the second meeting of the class. If you have any questions about learning or other disabilities, contact Mary Brooks, disability coordinator for The Heller School, at x62816, room 106, or at .

Course Schedule

Session 1 – Thursday, March 10th

Introduction to Advanced Topics – Class participation and expectations. During this session, we will discuss students’ interests and expectations for the course. We also will discuss requirements for students’ papers and presentations.

Composite Measures – Please read the article and report very carefully as they will form the basis of an in-depth discussion. Please pay particular attention to the topics of conceptualizing types of composite measures and to weighting, and be prepared to talk about the proc and cons of various approaches.

Swartz, M., Restuccia, J. and Rosen, A.K. (2015). Composite measures of health care provider performance: A description of approaches. Milbank Quarterly, 93(4): 788-825.

National Quality Forum Report -- Composite Performance Measure Evaluation Guidance, April 8, 2013

Session 2 – Thursday March 17thProcess/Structural Measures and Outcome Measures – How Do They Relate? During this session we will focus on the measurement of the association between process or structure measures and outcome measures.

Reading:

Garnick, D.W., Horgan, C.M., Acevedo, A., Lee, M. T., Panas, L., Ritter, G. A.,. & Huber, A. (2014). Criminal justice outcomes after engagement in outpatient substance abuse treatment. Journal of Substance Abuse Treatment, 46(3): 295-305.

Aiken, L. H., J. P. Cimiotti, et al. (2011). Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care, 49(12): 1047-1053.

Finney, J. W., K. Humphreys, et al. (2011). Why health care process performance measures can have different relationships to outcomes for patients and hospitals: Understanding the ecological fallacy. American Journal of Public Health,101(9): 1635-1642.

Session 2 -- Institute for Healthcare Improvement (IHI) 27th Annual National Forum - Keynote 4: Donald Berwick, MD - "Turtles" (55 minute video and discussion)

Table 1. Second Module 2016 Topics

Evans, Brooke / Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Primary Care Settings for Quality Improvement: The Role of Performance Measurement
This paper/presentation will investigate SBIRT implementation as a quality improvement strategy in primary care settings. The SBIRT implementation process will be explored, including the role of performance measurement. Policy implications and recommendations will be discussed.
Henry, Brandy / Proposing a Quality Measure for Clinical Screening of Substance Abuse in Drug Court
This paper will review current best practice guidelines for Drug Courts, as these are the closest existing quality measures. Screening guidelines from these standards will then be utilized to create a proposed NQF style quality measure for clinical screening of substance abuse in drug court.
Khatibzadeh, Shahab / heart failure quality measures
Lindahl, Elizabeth / Integration/care coordination measures
Ma, Siyu / 30-day Risk-Adjusted Mortality Rate as Health Care Quality Outcome Measure
This paper will introduce the 30 day mortality rates as a healthcare quality outcome measure, its history, specification, advantage and disadvantage, and application.
Raede, Frances / An Examination of Quality Measures used in the Emergency Department
This paper will dive into the rational and meaning behind quality measures used in the ED such as wait time and time to discharge/admission. It will also examine how/where these measures are reported, how they are used in academic/policy research and how they impact performance.
Zhang, Ye / schizophrenia measures -- analyze and summarize the current measures of schizophrenia care; compare schizophrenia measure with other serious mental illness
Zhou, Xiaofei / Does Public Reporting Work? Evidences from Consumer Choices
This paper will systematically review the journal articles in the effect of public reporting on consumer choice, especially focusing on the use of quality information. Theoretically, public reporting aims to change consumers’ choice in order to penalize provider with low quality. This is an indirect casual pathway to improve quality of care. This paper will try to dig out the reasons of success and failure of public reporting on changing consumer choices from past studies.

Table 2. Quality Module 2, 2016 Schedule

Date / Presenter / Topic / Discussants / Suggested Potential Guests
Thursday March 10th / Presentation expectations
Composite measures
Thursday March 17th / Process/Structural Measures and Outcome Measures – How Do They Relate?
Thursday March 24th 2:00-3:20 / Brooke Evans / Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Primary Care Settings for Quality Improvement: The Role of Performance Measurement / Connie Horgan, Mary Brolin, Marianne Pugatch
Thursday March 24th 3:35-4:50 / Siyu Ma / 30-day Risk-Adjusted Mortality Rate as Health Care Quality Outcome Measure
Thursday March 31st 2:00-3:20 / Xiaofei Zhou / Does Public Reporting Work? Evidences from Consumer Choices
Thursday March 31st 3:35-4:50 / Shabab Khatibzadeh / Heart Failure Measures
Thursday April 7th 2:00-3:20 / Frannie Raede / An Examination of Quality Measures used in the Emergency Department / Jon Chilingerian
Thursday April 7th 3:35-4:50 / Ye Zhang !st choice / schizophrenia measures / Request Brooke
Thursday April 14st 2:00-3:20 / Brandy Henry / Proposing a Quality Measure for Clinical Screening of Substance Abuse in Drug Court / Mary Brolin
Thursday April 14st 3:35-4:50 / Beth Lindahl / Integration/Care Coordination measures
Note – Thursday April 21st is a FRIDAY schedule
Thursday April 28th No class -- break

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