ADULT HEALTH QUALITY MEASURES RELATED WITH ACA
ThesisStatement:Adultquality measures as designated by the “Health and Human Services”(HHS) as the basis of ACA conformity have explicitlyallocated intents, including promoting quality care for thebeneficiaries, which are important but are sometimes programmed forimmediate results, therefore, compromising the future of health care.
AdultHealth Quality Measures Related With ACA
Duringan engagement in activities, there are subjectiveexpectations in regards to the outcome of the projects. Commonly, theparticipants anticipate rewards from the projects as per theobjective of the set program such as a patient’s expectation ofgetting better after a periodwhile in therapy or on medication. The principle described hereapplies in all settings and can be expected to impact the progress aswell as enthusiasm in activity performance. Healthcare is an industrywhere performance is projectedto be consistent and of high quality such as to attract preferablerewards in the of success in the treatment of patients (Richards&Hemstreet, 2012). For this reason, objectives are set toascertain that there aresetmotivators or guidelines which guide the staff participating withinan environment towards comprehensivesuccess in their specific tasks.
Toevaluate the objective achievements,there are some mechanisms used to go about it such as evaluatingincrement in the life expectancy within a community after aparticularprogram has been started there (McGlynn et al., 2003). The describedmeasures are ideal for determining the effectiveness of the saidinterventions set up within certain targeted communities. However,health is a sensitive topic and quality is of optimal importance andshould thus be maintained within high and accepted standards. Forthis purpose, there have been designed some measurement criterionsused to assess the quality of the services offered to the targetedpersons.
Thedescribed assessments are quality measures and are used to determinethe quality of the services beingdisseminatedwithin individualprograms (Ramsaran-Fowdar, 2005). Therefore, paradigms are firstdecided and are used to evaluate the meritsof projects in question. It is thus important to notice the role ofoverall authorities that come together totake action on theseparadigms (Richards &Hemstreet, 2012). In this paper, Adultquality measures arestudied,and the intentions set out to beachievedare examined todiscover other unforeseen demerits that can beassociatedwith the measures set about. Notably, the study of this concept iswithin the Affordable Care Act (ACA) which is enforced by States orsubsequent federal regulators who take over from the States in thecase of compilation (Rosenbaum, 2011 Sommers et al., 2013).
Typesof Quality Measures
Throughquality measures, the HHS allows a mechanism of quantifying healthcare as a general concept offered through the ACA system. Throughthese tools, the healthcare system is fragmented into variouscomponents necessaryinthe efficient care provision and thus evaluates these componentsindividually (Sommers et al., 2013). The mechanism isof particular importancewhen auditing the system and there is a need to troubleshoot specificflaws in the system (Ramsaran-Fowdar, 2005). These tools evaluateoutcomes, processes, organizational structures, as well as thepatient perception of the care, received subject to their associationto quality goals or their influence on those components that arequality-oriented. Goals associated with this evaluation includeappropriatecare, efficiency, equitability, safety, effectiveness, andpatient-centeredness (Aiken et al., 2012).
Adulthealth can beevaluatedas a patient experience measurement.However,there are other criticalmeasurements tethered to this component and therefore ought to beassessedtoo (McGlynn et al., 2003 Gittell, 2008). It is thus important tonote the various forms of quality measures that are involved inspecific evaluations. These are outcome, process as well asstructural measures. It is crucial to trace the areas in the systemthat are involved and determine their measures of the quality subjectto the adult context, toevaluate a single component of health such as the context of adults,Structural measures are necessarilysubject to the institution or organization participatein providing the care.Therefore,this is a comprehensive measurement tool (Ramsaran-Fowdar, 2005). Theconcepts evaluated using these tools include organizational systemssuch as entry or record mechanism and systems, certification ofphysicians or provider/patient ratios. Evidently, this is applicablefor the subject matter as specified providers,or organizational adult handling can be evaluated under thesecircumstances (McGlynn et al., 2003). For instance, gynecologistsdespite being capable of treating persons from all age groups areparticularly important for the adults,and their provider/patient ratio can thus be appropriateindexes for adult quality measurements.
Acommon type of these measurements is the process measure whichcomprises tools utilized in the evaluation of important activities inthe medical systems in consideration. In this context, these toolsare usedto highlight practices accepted in the industry such as servicesoffered to the patients (adults). For instance, HHS prescribe Opioidusage for cancer-freeadults CMCS Informational Bulleting in 2015 December 11th.Implementation of these standards in ACA institutions is thus easy asthere are clear guidelines as to the expectations desired by theoversight authorities (Rosenbaum, 2011). Outcome measures to qualityare perhaps the most straightforward indexes of evaluation as theyevaluate the effectiveness of individualprograms and care. Therefore, such tools like indicators are used todescribe the outcomes of the care provided for adults and thereforemaking it possible to categorize the status of care provided (McGlynnet al., 2003). Quality measures in this category are similar to theobjective achievement assessment as they describe overall successbased on some criterion decided on by the HHS. Due to the progressivenature of the healthcare provision, it is accurate to notice thatnumerousfactors influence factors are considered.These factors can beaccountedfor through application of mechanisms like the risk-adjustmentmechanisms.
Finally,the patient-oriented measures can be used to determine the quality ofthe care beingprovidedto them by aparticularsystem. In this regard, adults can be offered questionnaires,interviewed or subjected to surveys that can determine the quality ofACA care in the various involved institutions (McGlynn et al., 2003).The experience is considered primarily and is used to rate quality.Thereforethe patient’s feedback is treated as absolute,and each one is considered (Hasin et al., 2001 Gittell, 2008). Forinstance, patients might beaskedif providers they are entrusted to explain treatment options duringthe process of therapy.
Afterthe description of the quality measure, it is appropriate to describesome sample measurement used in the adult quality standardwithin the context of the ACA legislature (Rosenbaum, 2011). Theseare as prescribed by the Secretaryof HHS whose mandates are to formulate, modify as well as publicizethe data. Various measurements have beenenactedchangedand introduced from 2010 to refine the tools and ensure that the bestareusedin this vitalsector. Notably, the measures aredesignatedto various factions where they areclassifiedaccording to their purpose. The major factions include
• BehavioralHealth and Substance Use
• Careof Acute and Chronic Conditions
• PreventiveCare Experience of Care
Theabove-described classification categories individually house somemeasures that are useful in the comprehensive evaluation process. Forinstance, Medical Assistance with Smoking and Tobacco Use Cessation(MSC) and Initiation and Engagement of Alcohol and Other DrugDependence Treatment (IET) arehousedunder the first faction. It is thus notable that there are numeroustools designed for the purpose of adult quality. Preventive care isan important category in the ACA program as well as a measure ofthe quality of these services. Notably, screening and vaccination areessential in this category and the rulesdescribe the subjection of these services to adults toprevent the occurrence of diseases and conditions that couldotherwise beavoided.
Basedon the categorized factions of the adult quality measures, it ispossible to describe their intended purposes in the ACA context aftertheir implementation or initiation (Rosenbaum, 2011). Therefore, thissection isaimedat explainingsome intentions of the samples measures as noted in the essay.
PreventiveCare– Evidently, preventing occurrences of illness is much easier thanthe actual treatment of diseases associated with the progression ofthe screened ailments. In some instances, early detection isimportant in controlling as well as preventing medical complicationsthis is the case for heart diseases as well as cancer. It appliesin particularfor diseases that are chronic and their occurrence in the body ispioneered by somesymptoms. For instance, diabetes can beabatedthrough the intervention of obese persons who can easily benotedthrough proposed Adult Body Mass Index Assessment (ABA). Therefore,the ideal concept intended in the introduction of preventive care isto prevent the occurrence of medical complications in the form ofdisease acquisition of deterioration that cannot becontrolled.
BehavioralHealth and Substance Use– While describing these intentions it is appropriate to noticeuniversal ideas beingenactedthrough the quality measures. These are the fundamentalideas that are targeted by measures despite the existence of internalhurdles in the system such as the concepts of eligibility to receivethese services. The noted division in quality standardsis concerned with the rectification of behaviors societalcompatibilitytheseinclude reduction and control of substance abuse. Notably, medicalcare afforded to these efforts isthus consideredin accordance to the impact they have in the futuremodification of behavior. Mental health isintegratedinto this division and measures such as Antidepressant MedicationManagement (AMM) or Medical Assistance with Smoking and Tobacco UseCessation (MSC) are considered. Therefore, care here isfocusedon mental status in individuals which eventually affects theirbehavioral traits as well as substance abuse.
Careof Acute and Chronic Conditions– The quality measures in this division specifically focus on theadult’s dangerousconditions as well as those considered as chronic. Citing that therulesare intended for the entire ACA system, they areaimedat findinghow the quality of care matches up to the set standards (Rosenbaum,2011). Thus, factors such as Heart Failure Admission Rate (PQI08) areconsideredwhere the index’s rise or fall can beinterpretedregardingthe quality of services. Other measures in the division are about theprovision of appropriate care for the purpose of management ofchronic diseases such as the Controlling High Blood Pressure (CBP)quality measure.
Maternaland Perinatal Health– These measures arefeaturedin the context of childbirth or that of caring for the expectantwomen or those who have recently delivered. The care iscomprehensive,and services providedto these consumers areconsideredin the evaluation of the services’ quality. These arecapturedin Elective Delivery (PC01), Prenatal & Postpartum Care:Postpartum Care Rate (PPC) and PC-03: Antenatal Steroids (PC03).
CareCoordination– This concept is an example of a comprehensive quality measure suchas is described for the outcome quality measures. Commonly,timeliness isconsideredas an important paradigm with which the quality of the services canbemeasured.Timely Transmission of Transition Record (CTR) isa major componentof the divisions iscommonly usedas the sole determinant of the given quality stipulated for thedivision.
Theexperience of Care– An efficientmechanism forevaluating the consumer’s expectations in regards to the healthcare services while at the same time assessing quality. The measureis important as it is commonly unbiased as the subjects are theprimary consumers and therefore have experiencethrough the system (Hasin et al., 2001).
Evidently,the implementation of specific mechanics for the purpose of valuationisdrivenby extrinsic as well as extrinsic motivations these are theintentions. As described, the various divisions of quality measureshave cleargoals or plansas programmed by the administrations, HHS’ secretary. The centralidea concept beingaddressedin the context of the ACA is health care and given the legislaturesidealsitis accurate to notice that the quality measures are intended forupholding the health of the adults (consumers) (Aiken et al., 2012).Therefore, the concepts beingaddressedare related to health,and other concepts areinstalledin these measures are made done so as complimentary to this function(Pagán&Pauly, 2005).
Notably,the tools are used to evaluate the quality of the services for theadult consumers of the ACA as offered in various legible intuitions.As tools for measurement, they also act as ‘golden standards’ forthe medical industry as applicable for ACA (Rosenbaum, 2011). Herein,the providers have specified targets that they aim at achieving sothat they can consort to the standards set in the industry. Boththese functions are complimented by the tools function to identifyopportunities for intervention (Pagán&Pauly, 2005). As noted inthe introductory sections, the tools can identify specific partsin the ACA system that requires modification or change. The functionisespecially intertwinedwith the Care Coordination division of adult quality measures as thefeedback is not tethered to standards set about in the industry.Therefore, consumers can independently identify areas in the entiresystem where they were not satisfied and how their experience wasthus affected (Hasin, Seeluangsawat&Shareef, 2001).
Despitethe intentions of the quality measure tools, it is important tonotice that there might be some unanticipated consequences. Suchresultsarenotably citedin later stages after installation of these stepsin a system. Therefore, the intentions in the initial stages mightnot be applicable later on as the totality of the project might benegative (Aiken et al., 2012). An important example is the use ofcare coordination provisions as the basis forevaluating the quality of attentionbeing disseminated to the consumers (Hasin et al., 2001). Notably,different persons have varied opinions of what quality is and how itisdelivered.Therefore, the data collected from the tool, despite its legibilityis distorted and can hardly be used in situations where careimprovement is intended (Aiken et al., 2012). The describedinconvenience as a result of these tools uniquely affects the use ofconsumer feedback as a mechanism for gathering information regardingquality provision (Gittell, 2008). Another important factor toconsider when evaluating negativity of these tools is the impact theyhave on the providers. Notably, pressure on the providers to reach acertain standard makes working stressful and might lead tounder-performance. Further, the providers might result to forging adocument to avoid reprimands that aresometimes associatedwith non-conformity to the standards set through the tools.
Asdescribed in the literature presented in this article, there arenumerous functionsrelated to theuse of quality tools. These can further be understood individually asper the set divisions that they arelocatedwhich makes learningtheir dutieseasier. However, as hypothesized, some consequences with negativeimpacts on the provision of quality might arise in the long run.These have beenoutlinedas subject to the manner of information collection as well as thefinalstandards set for the providers. These attributes prove that futureunintended consequences are evident in the use of quality measurementtools in adult care as seen in ACA.
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