involve delivery of services to the people (Newhouse & Pettit, 2006). The goal
of CQI is to improve service. CQI measures can be generic indicators or can
be narrowed into disease-specific outcomes.
Mandated Reports
Multiple publicly reported nursing indicators can be used to measure out-
comes of EBP protocols. Hospitals and other healthcare agencies are required
to gather data about specific disease entities and to report their findings to
public agencies. Outcome data, available on State Boards of Health and the
CMS websites, are published to make comparisons among healthcare facili-
ties. Organizations use these data to gain a picture of how they compare to
similar facilities. This is known as benchmarking. Clinical practice guidelines
or standards of care recommended by professional organizations can also
drive outcome selection.
There is often overlap among the various organizations that mandate
reporting. For example, consider health care related to the use of aspirin for
patients with cardiac disease. The American College of Cardiology (ACC) and
American Heart Association (AHA) have issued guidelines delineating the
performance measures for patients experiencing an ST-elevation or non-ST-
elevation acute myocardial infarction (AMI) (AHA, 2008). These performance
measures require that healthcare providers instruct patients to continue on an
aspirin regimen after discharge (AHA, 2008). The Joint Commission requires
hospitals to report on eight core measure sets, one of which is AMI (Joint Com-
mission, 2017a). One of the 33 CMS ACO outcomes includes use of aspirin or
other antithrombotics in patients with ischemic vascular disease that includes
those with a discharge diagnosis of MI (CMS, 2015). Achieving an acceptable
score on this outcome requires a multidisciplinary effort by physicians, nurses,
and pharmacists.
In addition to reporting mandatory CMS and Joint Commission data, many
healthcare facilities are members of not-for-profit organizations to benchmark
indicators. For example, hospitals can subscribe to databases maintained by the
ACC and the Society of Thoracic Surgeons. The ACC (2014) has eight databases
that include acute myocardial infarction treatment, outpatient cardiovascular
care, and diabetes and cardiometabolic treatments among others. The Society
KEY TERM
benchmarking:
Comparison of
organizational
outcome data to
other organizations
or national
databasesYour nurse manager selects you to represent the unit on a team monitoring patient safety. What
outcomes would you suggest the team monitor?CRITICAL THINKING EXERCISE 18-2
18.2 Choosing Outcomes 477