For this assignment, you are to address either “Question A” or “Question B”. Select one or the other – do not compose a response to both.Submit your response as per the guidelines stated in the syllabus. Please submit your document as a “.doc” or “.docx” file using the “Assignments” tab of the web course. Do not submit your response in the “Discussions” section of the course.

Question A:

Select a healthcare condition that has recently been noted to be associated with increasing hospitalization rates within a healthcare organization (hospital) of your choice.

  • Determine the impact of these hospitalization rates on the community served by the hospital you have selected.
  • If you were the CEO of this hospital, how would you address the problem in your strategic planning process?


Question B:

Review the various patient safety indicators presented in the PowerPoint presentation for Module 4 and select an indicator of particular interest to you (excluding hospital-acquired infections). Address the following questions in a response of sufficient length to demonstrate a thorough understanding of the concepts discussed in this chapter.

  • What specific patient subpopulation, in terms of gender and age, appears to be at greatest risk for the hospital safety event that you selected?
  • What factors might predispose your subpopulation to the safety event that you selected?
  • As a healthcare manager, what strategy (or strategies) would you recommend an an organizational approach to reducing the incidence of the safety event you selected. 


ATTACHED ARE THE POWERPOINTS AND AN ARTICLE THAT SUPPORT THE DISCUSSION AS WELL -Agency of Healthcare Resrearch and Quality -Dartmouth Atlas of Health -Hospital Readmissions

Discussion Question Guidelines

• Your response to the discussion question must be of sufficient length to permit the instructor to assess your understanding of the subject matter. I would suggest a discussion posting of no less than 500 words. This assignment should include cited works as indicated with a list of references at the conclusion of the document.
• Please single-space your discussion. 
• Do not attach a cover sheet/title page with your posting.
• Please make sure your response relates to the relevant concepts explored in the question and that all components of the discussion question are addressed.

Quality Improvement in Neurology: Dementia Management
Quality Measures

Germaine Odenheimer, MD,a Soo Borson, MD,b Amy E. Sanders, MD, MS,c Rebecca J. Swain-Eng, MS,d

Helen H. Kyomen, MD, MS,e Samantha Tierney, MPH,f Laura Gitlin, PhD,g,h

Mary Ann Forciea, MD,i John Absher, MD,j Joseph Shega, MD,k and Jerry Johnson, MDi

Professional and advocacy organizations have long urged
that dementia should be recognized and properly diag-
nosed.1,2 With the passage of the National Alzheimer’s
Project Act3 in 2011, an Advisory Council for Alzheimer’s
Research, Care, and Services was convened to advise the
Department of Health and Human Services. In May 2012,
the Council produced the first National Plan to address
Alzheimer’s disease, and prominent in its recommendations
is a call for quality measures suitable for evaluating and
tracking dementia care in clinical settings.4 Although other
efforts have been made to set dementia care quality stan-
dards, such as those pioneered by RAND in its series
Assessing Care of Vulnerable Elders (ACOVE),5 practition-
ers, healthcare systems, and insurers have not widely
embraced implementation. This executive summary (full
manuscript available at reports on a
new measurement set for dementia management developed
by an interdisciplinary Dementia Measures Work Group
(DWG) representing the major national organizations and
advocacy organizations concerned with the care of individ-
uals with dementia. The American Academy of Neurology
(AAN), the American Geriatrics Society, the American
Medical Directors Association, the American Psychiatric

Association, and the American Medical Association–
convened Physician Consortium for Performance Improve-
ment led this effort. The ACOVE measures and the
measurement set described here apply to individuals whose
dementia has already been identified and properly diag-
nosed. Although similar in concept to ACOVE, the DWG
measurement set differs in several important ways; it
includes all stages of dementia in a single measure set, calls
for the use of functional staging in planning care, prompts
the use of validated instruments in patient and caregiver
assessment and intervention, highlights the relevance of
using palliative care concepts to guide care before the
advanced stages of illness, and provides evidence-based
support for its recommendations and guidance on the
selection of instruments useful in tracking patient-centered
outcomes. It also specifies annual reassessment and updat-
ing of interventions and care plans for dementia-related
problems that affect families and other caregivers as well
as individuals with dementia. Here, a brief synopsis of
why major reforms in healthcare design and delivery are
needed to achieve substantive improvements in the quality
of care is first provided, and then the final measures
approved for publication, dissemination, and implementa-
tion are listed

Quality of Care Measurement

“To assess the quality of medical care one must first unravel a mystery: the meaning of quality itself. It remains to be seen whether this can be done by patiently teasing out its several strands or whether one must, in despair, use a sword to cut the Gordian knot”.

Avedis Donabedian,1980

The Triple Aim

Proposed by Donald Berwick as the previous Administrator of the Centers for Medicare and Medicaid Services

An attempt to transform the American healthcare system in accord with the vision set forth in his 2008 “Triple Aim” Health Affairs article.

Consists of three overarching goals:

Better care for individuals (described by the six dimensions of health care performance listed in the Institute of Medicine’s 2001 report “Crossing the Quality Chasm”: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity).

Better health for populations (by addressing “the upstream causes of so much of our ill health,” such as poor nutrition, physical inactivity, and substance abuse).

Reduction in per capita healthcare costs

Hospital Quality: M&M cases
“Monday Mornings”

Morbidity and mortality (M&M) conferences: recurring conferences conducted by medical services at academic medical centers, most large private medical and surgical practices, and other medical centers

Usually peer reviews of mistakes occurring during the care of patients

Main objectives: to learn from complications and errors, to modify behavior and judgment based on previous experiences, and to prevent repetition of errors leading to complications.

Non-punitive and focus on the goal of improved patient care

Proceedings generally kept confidential by law, occur with regular frequency (often weekly, biweekly or monthly), highlight recent cases of concern, and identify areas of improvement for clinicians involved in the case.

Also important in identifying systems issues (e.g., outdated policies, changes in patient identification procedures, arithmetic errors, etc.) which affect patient care


Case: Right Regimen, Wrong Cancer

A 48-year-old man with a history of metastatic penile cancer was admitted to an inpatient internal medicine service for his fourth round of