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Targeting ambulatory care cases for risk management and quality management
1College of Nursing, Department of Family and Community Health, East Tennessee State University, Johnson City 37614-0676.
Summary
Identifying high-yield areas for ambulatory care quality review is crucial. This study presents untoward event screens using diagnosis and procedure codes to efficiently pinpoint areas needing attention, improving risk management.
Area of Science:
- Healthcare Management
- Quality Improvement
- Ambulatory Care
Background:
- Untargeted medical record reviews in ambulatory care are inefficient due to low yield and high costs.
- Effective quality review and risk management require identification of "highly productive" areas.
- Highly productive areas are defined by significant medical/economic impact, case volume, and potential for issues.
Purpose of the Study:
- To describe a method for identifying highly productive areas for quality review in ambulatory care.
- To develop and evaluate untoward event screens for efficient risk management.
- To improve the yield and cost-effectiveness of quality review processes.
Main Methods:
- Development of untoward event screens utilizing hospital discharge diagnosis and procedure codes.
- Inclusion of parameters such as length of stay and cancer staging in the screening process.
- Evaluation of the proposed approach across six ambulatory care organizations.
Main Results:
- The developed untoward event screens effectively identify areas with high potential for quality review.
- The approach demonstrated efficiency in pinpointing areas of concern within ambulatory care settings.
- Evaluation confirmed the effectiveness of the proposed screening method.
Conclusions:
- Untoward event screens provide an effective and efficient means to identify "highly productive" areas for ambulatory care quality review.
- This method offers a targeted approach, overcoming the limitations of untargeted reviews.
- The findings support the implementation of this strategy for enhanced risk management in ambulatory care.
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