AORN Journal
Volume 88, Issue 3 , Pages 351-353, September 2008

Measuring Ambulatory Care Quality

Article Outline

 

Measuring and reporting quality data is an integral part of health care. Its significance is not underestimated by anyone undergoing a survey by the Joint Commission. Not only is an institution's accreditation dependent on documenting quality data, but reimbursement by private and public payers also is closely tied to quality outcomes.

Hospitals providing care to inpatients report standardized measures typified by the Joint Commission's standards and patient safety goals, as well as measures required by the Centers for Medicare & Medicaid Services (CMS). Until recently, individual ambulatory surgery centers (ASCs) collected quality data, but a set of reportable national quality standards has not been available nor required. Part of the difficulty in developing a national set of quality standards for ASCs has been an absence of agreed upon ambulatory patient-specific measures.1 Inpatient criteria do not necessarily reflect outpatient care needs.

Why should ASCs agree on, and report, national standards for ambulatory patient care? Because ASC quality measures are necessary to

•enable public scrutiny of ambulatory quality—consumers are demanding information on the outcomes achieved by health care providers,

•provide information related to pay-for-performance—the CMS has been mandated by the US Congress to develop a system for reporting quality measures or risk financial penalties,

•respond to state data collection requirements—state agencies are increasingly requiring that quality metrics be reported,

•collaborate with payers and consumer representatives—payer contracts are commonly based on performance measures, and

•facilitate quality improvement initiatives of individual ASCs—systematic data collection facilitates benchmarking an ASC's quality program.2, 3

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ASC Quality Collaboration 

In 2006, the ASC Quality Collaboration was formed by leaders from ASCs; associations that focus on health care quality and safety; and professional organizations, including AORN.1 Recognizing the need for a standardized set of quality measures, an expert panel composed of clinical and administrative leaders, health policy makers, members of accrediting agencies, and representatives from state and federal regulatory agencies such as the CMS convened to identify measures that were not only reflective of currently accepted measures of surgical quality but also were pertinent to the ambulatory population.2

Five quality measures were developed by the members of the ASC Quality Collaboration:

1.Patient Burn;

2.Prophylactic IV Antibiotic Timing;

3.Patient Fall in the ASC;

4.Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant; and

5.Hospital Transfer/Admission.3

These five quality measures have been endorsed by the National Quality Forum and are under review by the CMS.4 The efforts of members within the ASC Quality Collaboration to work with payers, regulators, and accrediting agencies to achieve a meaningful set of standards provides a public and private template for collaboration and cooperation in achieving quality goals and ensuring adequate reimbursement schedules.

Clinicians and managers in ASCs play a critical role in the successful implementation of this initiative. Cost considerations related to developing a systematic documentation strategy that is efficient and effective require cooperation and collaboration within individual ASCs. The cost of instituting an electronic health record that could capture much basic quality data is a financial barrier for some ambulatory center physicians, but the potential health benefits and associated reimbursement considerations related to complying with regulatory mandates support the eventual reality of an electronic record.5

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Perioperative Nursing Resources 

What resources—financial, published, experiential, collegial—are available for perioperative nurses working in ambulatory settings to aid them in achieving a process to document care? One valuable resource is the ASC Quality Collaboration's Implementation Guide.3 This guide discusses each of the five measures, provides answers to frequently asked questions, explains the rationale for each measure, and includes other relevant information.

Perioperative nurses can use the Perioperative Nursing Data Set6 to specify interventions that will enhance the achievement of the outcomes identified in the measures. The legislative and political experience of perioperative nurses is another resource. The CMS policy makers and nurses' elected representatives are also stakeholders in this initiative. Nurses, whether for inpatients or outpatients, have a role in educating decision makers about patient needs within their sphere of practice and how caregivers ensure that patient needs are met competently, cost-effectively, and safely. Additional AORN ambulatory resources include the expertise of elected AORN representatives, members of AORN's Government Affairs Department, colleagues within AORN's Ambulatory Specialty Assembly, and articles in AORN Connections and AORN Management Connections7 related to various aspects of ambulatory quality initiatives.

Perioperative inpatient nurse colleagues also can be a resource. Although ambulatory patients have unique needs, many patient needs are similar, regardless of the setting. The similarities related to protecting patients from falls or burns provide a foundation for collaboration among all perioperative nurses. The differences between inpatients and outpatients enable perioperative nursing colleagues to identify and select the best approach to individual needs. Collaborative activities include sharing data collection expertise as well as identifying, measuring, and tracking quality indicators. With more than 50% of surgical patients undergoing ambulatory procedures,8 the need to establish a set of quality measures is imperative. The ASC Quality Collaboration has made an important contribution toward that goal.

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References 

  1. Group forms to promote standard quality measurement in ambulatory surgery centers [news release]. ASC Quality Collaboration; September 5, 2006 . http://www.ascquality.org/documents/ASC%20Quality%20Collaboration%20%20Press%20FINAL%20(9.5.06).pdf Accessed July 22, 2008.
  2. About Us: Ambulatory Surgery Centers Quality Collaboration Initiative. ASC Quality Collaboration . http://www.ascquality.org/about.html Accessed July 22, 2008.
  3. ASC Quality Measures: Implementation Guide. Version 1.0. ASC Quality Collaboration . http://www.ascquality.org/documents/ASCQualityCollaborationImplementationGuide.pdf Accessed July 22, 2008.
  4. Quality measures for ambulatory surgery receive approval [news release]. ASC Quality Collaboration; April 7, 2008 . http://www.ascquality.org/documents/ASCQCPR0408.doc Accessed July 22, 2008.
  5. DesRoches CM , Campbell EG , Rao SR , et al.   Electronic health records in ambulatory care—a national survey of physicians . New Engl J Med . 2008;359(1):50–60 Epub June 18, 2008.
  6. In:  Peterson C editors. Perioperative Nursing Data Set . Rev 2nd ed.. Denver, CO: AORN, Inc; 2007;
  7. Stanton C . New tools to promote ASC quality. AORN Management Connections. AORN, Inc . http://www.aorn.org/Managers/April2008Issue/NewToolstoPromoteASCQuality Accessed July 22, 2008.
  8. Cullen KA . Results from the National Survey of Ambulatory Surgery (NSAS) [slide presentation]. Ambulatory Surgery Center Association . http://www.ascassociation.org/slides2008/Cullen%20National%20Survey%20On%20ASCs.ppt#330,30 Accessed July 29, 2008.

PII: S0001-2092(08)00525-5

doi:10.1016/j.aorn.2008.08.004

AORN Journal
Volume 88, Issue 3 , Pages 351-353, September 2008

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