Quality Certification Process for Nurse-Managed Health Clinics

Transcription

1 Quality Certification Process for Nurse-Managed Health Clinics 1

2 Overview of Quality Certification Program The Quality Certification Program has been developed to recognize those nurse managed health clinics that meet the quality standards established by the Quality Task Force of the National Nursing Centers Consortium, the Institute for Nursing Centers, and the Nursing Centers Research Network. The certification process is voluntary. Nurse managed health clinics that apply for certification are demonstrating their commitment to measuring and improving quality of care and service. Participating in the certification process is intended to help centers self-identify their quality program s strengths and areas for improvement, and provides the opportunity to receive feedback from external quality review professionals. The certification application form includes three sections: description of the site; attestation that the site meets the established quality standards; and, provision of documentation (policies and procedures, forms, etc.) that supports the attestation. Completed applications will be reviewed by a quality review professional, and any requests for additional information or clarification will be relayed back to the applicant. The attestation section of the application will be reviewed along with the provided documentation. An advisory panel will review the external reviewer s findings. Once approved by this panel, a copy of the report will be provided to the applicant site. The report will include a certification determination into one of the following categories: Full certification attestation complete, and documentation supporting adherence to quality standards provided in full. Member is certified for two years. Provisional certification attestation complete, and documentation generally supports adherence to quality standards, with minor deficiencies noted. Site has three months to provide documentation showing that these deficiencies have been addressed. The provisional certification may then be continued, or converted to full certification for the remainder of two years from time of initial determination. Partial certification attestation complete, and documentation generally supports adherence to quality standards, but major deficiencies noted in one or more areas. Site has six months to submit documentation showing that these deficiencies have been addressed. The certification may then be upgraded to provisional or full, with full certification for the remainder of two years from time of initial determination. Non-certification -- the member s application demonstrates significant deficiencies, requiring a major modification and resubmission. The letter will include specific recommendations for addressing the deficiencies. In this case, the subsequent review will be considered a new application with another review fee charged. The report will include information on any standards found to not be fully met, with comments on how the site could address the deficiency. Once a member s application is reviewed and full certification achieved, a certificate will be issued documenting that the member s policies and procedures were found to comply with the quality standards. 2

3 To Apply: To apply for the Quality Certification, the following documents/items must be submitted: 1. A completed application (attached) 2. Required documentation that supports application as attachments 3. Payment for application. Payment: The cost to apply for the Quality Certification is $1,100. There will be an additional charge for multi-site organizations in which policies and practices differ across sites. Call to get an initial consultation and pricing quote. All payments can be made by check or credit card. Make checks payable to National Nursing Centers Consortium. Check Enclosed Credit Card Cardholder Name Type of Card Amount Approved Card Number Expiration Date Security Code Review Process: After a completed application and payment are submitted, applications will be reviewed by a quality review professional, and any requests for additional information or clarification will be relayed back to the applicant. An advisory panel will review the external reviewer s findings. Once approved by this panel, a copy of the report and a formal certification will be provided to the applicant site. Submit applications to: Amy Clark at aclark@nncc.us or 1500 Market Street, Centre Square East, Philadelphia, PA Any questions can be directed to Amy Clark at aclark@nncc.us or

4 Application for Site Certification Part 1: General Information 1. Site/Organization Name: 2. Name of Person Completing Application: 3. Title of Person Completing Application: 4. Contact Information of Person Completing Application: a) Phone: b) 5. Site Address(es): 6. Type of Site (please check best answer) Primary Care Comprehensive Primary Care (primary care plus other services) Health and Wellness Other (Please specify) 7. Year Established: 8. Is this NMHC Part of a Larger Network? YES NO a. If YES, Name of Network: b. If YES, Number of Clinics in Network: 4

5 Part 2: Site Demographics 9. Number of Unduplicated Patients Served Annually: (use whole numbers, no decimals, estimate if necessary) 10. Annual Number of Patient Visits (Encounters): 11. The following questions (#12 through #18) relate to the demographics of the population served by your clinic. All demographics should be based on the number of unduplicated PATIENTS. However, if you do not have data on patients, you may report based on number of VISITS. Please indicate whether you will be reporting on patients or visits: Patients (this is preferred) Visits 12. Indicate the percentage RACE breakdown of your clinic s patients (use whole numbers, no decimals, fill 0 in boxes that are N/A and estimate if necessary, if applicant does not have data please indicate DK for don t know ): African American/Black Caucasian Asian American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Other 13. Indicate the percentage of your patients that identify as Latino/Hispanic (use whole numbers, no decimals, fill 0 in boxes that are N/A and estimate if necessary, if applicant does not have data please indicate DK ): 14. Indicate the percentage of patients that belong to each age group (use whole numbers, no decimals, fill 0 in boxes that are N/A and estimate if necessary, if applicant does not have data please indicate DK ): Indicate the percentage GENDER breakdown of your clinic s patients (use whole numbers, no decimals, fill 0 in boxes that are N/A and estimate if necessary, if applicant does not have data please indicate DK ): Male Female Transgender/Other 5

6 16. Indicate the percentage of patients that identify as LBGT (use whole numbers, no decimals, fill 0 in boxes that are N/A and estimate if necessary, if applicant does not have data please indicate DK for don t know ): 17. Indicate the percentage of HIV positive individuals your clinic serves (use whole numbers, no decimals, fill 0 in boxes that are N/A and estimate if necessary, if applicant does not have data please indicate DK for don t know ): 18. What percentage of patients in your clinic have the following types of insurance (use whole numbers, no decimals, fill 0 in boxes that are N/A and estimate if necessary, if applicant does not have data please indicate DK for don t know ): Medicare (including Medicare MCOs) Medicaid (including Medicaid MCOs) Private Insurance Veteran Insurance No Insurance/Self-pay Others 19. Indicate the percentage of VISITS (encounters) by type (use whole numbers, no decimals, fill 0 in boxes that are N/A and estimate if necessary, if applicant does not have data please indicate DK for don t know ): Health Maintenance/Wellness Acute Health Problems Chronic Disease Management Case Management Mental Health Patient Education Other (Please specify) 20. Indicate the current staffing of your clinic, by recording the number of full-time equivalent (FTE) staff of each type: Certified Registered Nurse Practitioners Other Nurse Practitioners Other Nurses Other Clinical Staff (indicate types: ) Administrative Staff 6

7 Part 3: Self-Assessment of compliance with NNCC Quality Standards For each of the 46 NNCC Quality Standards, in the table below, indicate the extent to which your site meets that standard, using the following scale: FULL = PART = UNMET = N/A = Fully meet the standards Partially meet the standard Does not presently meet the standard Standard is not applicable to the site For any applicable standard that is not fully met (Part, Unmet, N/A), please provide a detailed explanation in the NOTES section at the end of the table. Please write the standard number before the note. At least 65% of all applicable items must be fully met, and at least 80% of all applicable items must be partially or fully met, in order to obtain certification. The threshold for certification may be raised in future years. # Standard FULL PART UNMET N/A 1 The stated mission of the NMHC reflects a commitment to increasing access to quality care 2 The stated mission of the NMHC reflects a commitment to elimination of health disparities. 3 Care is patient centered, i.e. the needs of the patient are central to all practice decisions, and includes integration of self-management support strategies. 4 Primary, secondary, and tertiary prevention services are provided by the practice and the practice facilitates access to services not directly provided. 5 Services provided are community oriented and based on the identified needs of the community. 6 Partnerships with community agencies are formally established and are sufficient to assist with patient selfmanagement support and meeting patients basic human needs (e.g. food, clothing, shelter, and safety). 7 Patient education and case/care management services are core services provided by the nursing clinic. 8 The nursing clinic supports health professional education by encouraging all health profession students to have clinical experiences at the clinic. 9 A formal on-going quality improvement program is in place. 7

8 10 Quality outcomes are benchmarked against national standards of care and measured regularly. 11 The clinic has all appropriate emergency plans in place. 12 The clinic meets national standards and legal requirements of state and federal regulators. 13 When evidence exists, practice interventions, including practice management strategies, patient education, and case management services, as well as direct patient care, are evidence-based. 14 Patient satisfaction is monitored on a regular basis and reflects criteria integral to the mission and vision of the practice. 15 Recognizing the complex determinants of health, the nursing clinics provide or facilitate access to health care services. 16 Solutions to patient health problems are addressed at multiple levels, i.e. individual, family and community interventions. 17 The nursing clinic demonstrates the value of interprofessional collaboration to deliver quality care through partnerships with a variety of members of the health care team. 18 The environment, staff, and services provided are respectful to all patients and are culturally and linguistically appropriate. 19 The clinic addresses the needs of the whole patient to include bio-psycho-social-spiritual concerns as the and their impact on the patient s health and well-being. 20 Behavioral and mental health issues are addressed as part of the management of all health problems. 21 The nursing clinic increases access to quality health care services across the continuum of care, including facilitating access to specialty services. 22 The clinic increases access to people who are risk for health disparities through assuring that the practice is culturally and linguistically appropriate and that services are affordable. 23 Services are available at times and in locations that meet the needs of the patient community being served. 24 As a part of determination of patient satisfaction, the nursing clinic documents that services provided are rated highly by the acceptable to patients being served. 25 Services are affordable to patients being served or mechanisms are in place to assist patients with the cost of care. 26 An annual budget is sufficient to support the activities of the nursing clinic. 8

9 27 The budget reflects and supports the mission and strategic plan of the practice. 28 The clinic makes an effort to limit its negative impact on the environment. 29 The parent organization supports the nursing model and provides institutional support for the practice. 30 The clinic supports all employees, staff and clinicians, to practice at the full scope of their education and competency. 31 The clinic leadership supports the nursing model. 32 The clinic has strategic and business plans in place that serve as the basis of major decisions and are updated annually. 33 Policies and procedures are in place to assure that clinic operations are standardized and that all employees know proper clinic operations. 34 The clinic has an advisory board that includes consumers/patients and staff as well as practice leadership. 35 The clinic regularly evaluates the satisfaction of all employees with the work environment. 36 There is evidence that the work environment is considered by employees to be safe, supportive of their professional development, that their voices are heard and respected as members of the clinic team, that work expectations are clearly described and that they are provided with sufficient resources to do their work. 37 A health record, preferably electronic, is in place to collect data that support a patient registry function as well as a patient health record and practice management functions. 38 Data are collected that reflect care process, e.g. blood pressure checks or self-management goals. 39 Data are collected that reflect clinical outcomes, e.g. A1c or patient utilization of health resources. 40 Data are collected that balances productivity with quality that reflect balancing outcomes, i.e. processes that support the infrastructure, e.g. cost effectiveness or patient satisfaction. 41 Data are collected that reflect the impact of the nursing clinic on the elimination of health disparities. 42 Data are collected that reflect the impact of the nursing clinic on the increasing access to health care. 43 When appropriate, data collection processes are IRB approved. 44 The clinic meets ADA standards for accessibility. 45 The clinic meets OSHA standards for employee and patient safety. 46 Policies and procedures are in place to handle hazardous waste and to protect hazardous drugs and materials. 9

10 NOTES (Indicate Standard # and write explanatory note. Attach additional pages if needed) 10

11 Part 4: Required Documentation To support your responses to the self-assessment in Part 2, please attach the following documentation to this application. Indicate if the document is attached (Y), not attached (N), or not applicable (N/A) for each requested item. If attached (Y), make sure to put the attachment number on each attachment, corresponding to the attachment numbers in the table. Att # Attachment Description Y N N/A 1 Mission statement for the applicant organization (standards 1 and 2) 2 Policies and procedures and/or other documentation showing the details of the quality measurement and improvement process used by the organization (standards 9, 12, 13, and 38 to 42) including at least one specific baseline measurement and performance improvement plan resulting from that measurement 3 Data findings from the program s quality program or studies (standard 10) 4 Policy/procedure for handling emergencies (standard 11) 5 Results of patient satisfaction assessment (standard 14), including demonstrating that services would be recommended to others are deemed acceptable to patients (standard 24) 6 List of services available at the clinic (standards 4, 16 7 List of referral sources and/or partners for additional services (standard 6, 7, 15) 8 Advisory board members list, and copy of most recent meeting minutes (standard 34) 10 Policies and procedures and/or other documentation showing how the clinic ensures that services are culturally and linguistically appropriate (standards 18 and 22) 11 Policies and procedures and/or other documentation showing how the clinic assesses and manages behavioral health needs (standard 20) 12 Schedule of office hours during which services are available (standard 23) 13 A copy of the clinic s budget for the most recent operational year (standards 26 and 27) 14 A copy of the most recent annual report and/or business or strategic plan for the clinic (standard 32) 15 Policies and procedures addressing clinical operations and staff training (standards 33 as well as standards for nursing model and health services sections of standards), staff evaluation of workplace, satisfaction with worksite 16 Copy of the health record template or sample screen shots for electronic record (standard 37) 17 Provide URL for clinic website (if applicable) 18 Copy of general marketing material (brochure, flyer, etc.) that is publicly available to inform on clinic hours, mission, services, etc. 11

12 Part 5: Attestation I certify that the information contained in this application is true and accurately reflects the current mission and operations of the applicant organization as identified on page 1 of this application. Signature Name Title / / Date of Application 12