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    Healthcare Plan Information

    The Health Plan of the Upper Ohio Valley Patient Safety Initiatives

    Improving the Quality of Healthcare by Reducing Medical Errors and Increasing Patient Safety Federal Employee Group Response 2005

    The Health Plan recognizes that patient safety is an important factor in healthcare. We strive to educate members and providers to participate in endeavors to maintain and to improve in this area of patient care. The Quality Improvement Department (QID) has continued in its efforts to identify patient safety issues to ensure better medical outcomes for our members. In 2004, the following safety initiatives were monitored and reported in the 2004 Quality Management Program Evaluation. Members may view the results of the studies on The Health Plan internet site @ www.healthplan.org.

    • Inpatient Quality of Care Indicators:
      Readmissions to the hospital within three (3) and thirty (30) days of an inpatient admission and any other identified potential quality of care concerns during an inpatient stay are reviewed concurrently utilizing the medical record(s). The goal of the review is to identify any quality of care and/or service issues, identify the person(s) responsible, and request a response for a corrective action plan.

    • Member Complaints:
      Members are encouraged to file a complaint for dissatisfaction with care or service. If consent is given to retrieve appropriate medical information and notify the provider of the complaint, the QID staff performs an investigation. The goal of the review is to identify any quality of care or service issues, identify the involved entity and request a response for a corrective action plan.

    • Continuity and Coordination of Care:
      Annually, continuity and coordination of care between providers of care is performed utilizing encounter data to identify the population and reviewing the medical record. The goal of the review is to identify appropriate written communication between physicians and facilities providing care for the member. Medical records are reviewed at the primary care physician office for evidence of communication. Data is analyzed for outliers and corrective action plans are requested when appropriate.

    • Drug Safety through Pharmacy Benefits Manager (PBM):
      Quarterly reports are submitted by the PBM identifying potential drug safety issues such as duplication of medications, excessive daily dose, drug interaction, inappropriate and inaccurate dosage, under utilization, refill too soon, and allergy. Appropriate actions are taken by the pharmacist.

    Improving the Quality of Healthcare by Reducing Medical Errors and Increasing Patient Safety Federal Employee Group Response 2005

    • Member Education:
      The 2004 Member Newsletter is utilized to educate members on patient safety study results as well as articles pertaining to safety measures. The goal of this intervention is two-fold in notifying the member how THP intervenes to ensure that members are receiving quality care and service and to educate its members on their responsibility in becoming knowledgeable in their own health care needs.

    • Disease Management Programs:
      The Health Plan offers diabetes, chronic heart failure, and chronic obstructive pulmonary disease management programs for members with these chronic conditions. We also offer a prenatal care program with outreach to all pregnant members and identification of high risk pregnancies that are monitored by a dedicated registered nurse. Smoking cessation programs are offered telephonically and in group sessions.

      Members can expect to receive educational mailings and based on severity of illness, individual telephone contact with a dedicated registered nurse. The individual contact monitors the members and provides education to enhance the member's self-management skills.

    • Evidence-based guidelines:
      The Health Plan uses evidence-based guidelines from nationally recognized organizations in the development and adoption of local guidelines for our physicians and members. Examples of Health Plan evidence-based guidelines include chronic heart failure, diabetes, hypertension, cholesterol management, community acquired pneumonia, management of depression, and preventive health. All guidelines are updated regularly and distributed to physicians.

    • Drug and Disease Profiles:
      Individual patient prescription drug profiles are shared with physicians upon request, or when concerns about dosage or drug interactions are identified. Patient disease profiles are shared with physicians for diabetes, chronic heart failure, and chronic obstructive pulmonary disease. In addition, childhood immunization status as well as members needing mammography and Pap testing are also shared annually with physicians.

    • Patient safety information to the physician:
      Patient safety information is included in the provider newsletter and the pharmacy newsletter. Issues related to pharmacotherapy and safety are addressed.

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