Going Beyond Diagnosis: Continuous Quality Improvement
Measurement is a critical piece of continuous quality improvement and requires the collection of relevant data. These data are then used to create information to continuously improve organizational processes, including facilitating semi-structured decisions such as admissions, level of care, re-certifications, and discharge. Whether you're evaluating structure, process, outcomes, or patient/caregiver satisfaction, a standard language is essential when describing the health status of your patient population. That's where the International Classification of Functioning, Disability and Health (ICF) can help.
Health care organizations often evaluate the quality of their services by performing utilization review audits. These audits typically focus on high volume/high risk tasks that are critical to the organizational strategic plan. The evaluation often involves the selection of process and/or outcome measures.
The selection of the most relevant process or outcome measures may be limited by incomplete clinical documentation. Palmetto GBA's Going Beyond Diagnosis® educational initiative is focused on helping health care organizations identify, document, and communicate the unique health care needs of their patients - making it more likely that relevant pieces of data are available to support their quality initiatives.
To this end, Palmetto GBA's Medical Review Department has developed a Medical Review form based on the concepts of the ICF. The form contains fields for the identification of relevant ICF components/categories, a description of how they manifest clinically, clinical interventions implemented to address the identified categories, and relevant outcomes. The form, titled Going Beyond Diagnosis®: Using ICF Guidelines Worksheet is attached to this article.
To view this worksheet, select the PDF file icon below.
Palmetto GBA medical reviewers use the Going Beyond Diagnosis®: Using ICF Guidelines Worksheet to adjudicate claims for complex clinical scenarios. This systematic process helps Palmetto GBA ensure that relevant pieces of information in the health record are identified and considered during the medical review process. Please share this article, and the Going Beyond Diagnosis®: Using ICF Guidelines Worksheet, with those members of your organization engaged in continuous quality improvement.