Advanced Nursing Field Experience Term Paper

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Quality Improvement Activity (QIA) Form Instructions

When to Use the QIA Form

This document is a guide for completing NCQA's Quality Improvement Activity (QIA) form. This form can be used for the QIA required NCQA accreditation and certification programs, as applicable. It must be used to meet the Quality Improvement Projects required for Medicare Advantage Deeming.

You are not required to use the QIA form; however, you must provide the data it requests in order for NCQA to review your QIAs completely and accurately. Submit a QIA for each activity you present by attaching it to the applicable element in the Survey Tool using the Attach Document feature in the Survey Tool.

Detailed instructions on attaching documents to the Survey Tool are found in the Survey Tool Instructions under Help on the Main Menu bar.

The purpose of the QIA form is to summarize the clinical and service quality activities that you are using to demonstrate meaningful improvement in the applicable element.

You should not complete the QIA forms for service or clinical activities that you use to demonstrate compliance with other standards that require data collection and analysis such as member/enrollee satisfaction, availability and access and satisfaction with UM. Document compliance with these standards as you would document any other standard.

All data points must be final when your organization submits the Survey Tool.

NCQA does not recommend using this form to report on activities that have only one data point (e.g., baseline only).

Consult the appropriate Explanation for the meaningful improvement standard for the accreditation or certification program for which you apply.

Remember that you cannot achieve a score of 100% with only one data point.

The activity will not be considered.

Achieving Meaningful Improvement

Submit enough data

To receive "credit" for meaningful improvement, you must submit enough data to allow an evaluation of any seasonal variations that could affect the results. On the service side, open-enrollment seasons can affect such activities as ensuring access to primary care and reduction in referral time frames. In most cases you must present:

annual measurement occurring during the same season (e.g., comparing the first quarter of one year to the first quarter of the following years) for areas that show seasonal differences, such as provision of enrollment cards five quarters of data fifteen months of data.

Note: If you do not have adequate data to satisfy the above conditions or if you believe that the results are not biased by seasonal issues, provide an explanation as it relates to QI 12 and QI 13 under Other Pertinent Methodology Features, in Section I.

The improvement must meet the time period covered in the survey

To receive "credit" for meaningful improvement, the improvement must have occurred in the three-year period covered in the survey. For example, if you have annual data on member satisfaction since 1996, but the date of the survey for which this QIA is being prepared is January 2008, only data beginning in 2005 should be shown.

In other words, the improvement must have started at some point during the three years immediately prior to the survey and have been subsequently sustained.

For Renewal Surveys, you may need to present measurements for the year prior to the current survey period if these data were not available for your previous survey.

The QIA Form

The form's five sections

The QIA form is divided into five sections:

Section I Activity Selection and Methodology

Section II Data/Results Table

Section III Analysis Cycle

Section IV Interventions Table

Section V Chart or Graph

Activity name and activity examples

The form first asks you to supply an activity name. The activity name should succinctly encompass the purpose of the activity and begin with an action word that accurately states what the activity is designed to do (e.g., "improving," "increasing," "decreasing," "monitoring"). Examples are listed below.

decreasing the risk of congestive heart failure improving claims turn-around time to practitioners increasing the rate of diabetic foot exams improving access to behavioral health services decreasing practitioner complaints with the referral process.

QIA Instructions and Form 15

2 QIA Instructions and Form

QIA Instructions and Form 1

Effective July 1, 2007

Effective July 1, 2007

Section I:

Activity Selection and Methodology

This section asks you to provide the rationale for choosing this QI activity for your organization. Explain why the clinical or service activity affects your members or practitioners.

NCQA requires you to choose service improvements based on their impact on members.

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NCQA also accepts improvements in practitioner satisfaction that relate to utilization management (UM) processes or effects (e.g., issues identified in UM 11) for one service QIA.

Examples are listed below:

improvements in turnaround time for prior-authorization requests decrease the time that members wait to receive care requiring authorization and/or increase productivity for practitioners improvements in UM decision making turn-around-time ensure more satisfied members and/or practitioners improvements in referral to specialist turnaround time reduce the number of complaints and appeals regarding referrals.

Rationale

Define the rationale for selecting the activity

This section asks you to define your rationale for selecting this activity for improvement.

Why was it chosen over others?

Why is it important to your members or practitioners?

Why is it worth the resources your organization is spending on it?

Using objective information provide as much information that is specific to your organization as possible.

You do not have to provide generic defenses for most clinical or service issues. For example, do not include explanatory phrases such as "member services departments serve many important functions," or "neuropathy of the foot is a serious condition that affects thousands of diabetics nationwide."

Nor is it necessary to provide literature source cites on the importance of a clinical or service issue to members unless it is an unusual topic. Focus on the importance of the activity to your organization.

Importance of activity

Include pertinent organization data or community demographic data that reflect the importance of the activity to your organization's membership. Describe the magnitude of the issue related to the activity in quantifiable terms.

Activity examples

Examples are listed below.

Between 2004 and 2005, hospitalization due to diabetic foot neuropathy rose 9%. This was the largest increase in any diabetes related hospitalization. Research has shown that periodic foot screening of diabetics and self screening by diabetics can decrease rates of foot neuropathy.

Practitioner dissatisfaction turnaround time with UM decisions increased from 5 to 15% between 2004 and 2005. This was the largest increase in practitioner dissatisfaction the organization has received for four years. In addition, this 15% dissatisfaction rate was the highest dissatisfaction rate on the practitioner survey.

Quantifiable Measures

Quantifiable measures clearly and accurately measure the activity

This section asks you to list all quantifiable measures you use in this activity, including those added over time. Quantifiable measures should clearly and accurately measure the activity being evaluated. List your baseline benchmarks and goals and if you modify them over time, list the updated benchmark or goal in the table in Section II.

Multiple measures

You may use one or more measures for each activity. For some activities, multiple measures are useful. For example, practitioner complaints and actual turn-around-time for UM decisions would be two measures that are closely linked to the timeliness of UM decisions.

In other cases, multiple measures may not be useful. For example, you may display multiple measures associated with a CHF disease management (DM) program, only one of which shows improvement. Unless the intervention is clearly focused to address that measure, NCQA may not consider the improvement meaningful.

Denominator

Describe here the event being assessed or the members who are eligible for the service or care. Indicate whether all events or eligible members are included, or whether the denominator is a sample. Examples of responses are listed below:

all physician complaints

members 35 years of age and older during the measurement year who were hospitalized and discharged alive from January 1 -- December 24 of the measurement year with a diagnosis of congestive heart failure all survey respondents

14 QIA Instructions and Form

Numerator

Describe here the criteria being assessed for the service or care:

all physician complaints concerning UM decision turn-around-time members meeting the criteria for inclusion in the denominator who received an ambulatory prescription for ace inhibitors within 90 days of discharge survey respondents who do or do not like the event in the denominator

First measurement period

State here the time period covered by the initial assessment.

For clinical issues, this is typically an entire calendar year (e.g., January 1, 2008 -- December 31, 2008).

For service issues, the measurement period is often monthly or quarterly (e.g., January 2008 or 1Q 2008). Measurement periods may vary by measure. For example, the first measurement period for UM decision timeliness may be the first quarter of 2008, but the measure addressing timeliness may not have started until the third quarter of 2008.

Baseline benchmark

Include.....

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