Baseline Assessment of Quality Improvement Activities in the California Department of Health Care Services: Methods and Results
DHCS works closely with health care providers, health plans, advocacy groups, and local government, among others, throughout California to ensure that health care services are available and accessible for low-income individuals and families and persons with disabilities. DHCS is placing renewed emphasis on achieving optimal clinical outcomes by eliminating overuse, ineffective services and avoidable complications, and by advancing safe, cost-effective care.
In the late spring of 2012, a team functioning under the direction of the Chief Prevention Officer conducted an inventory of the Department’s Quality Improvement (QI) activities. The inventory sought to: 1) establish a Department-wide baseline of QI activities in three areas: clinical care, health promotion and disease prevention, and administration; 2) identify quality metrics that were being collected by the Department but which were not specifically linked to QI activities; 3) identify gaps in the Department’s QI activities; and 4) obtain recommendations for additional QI efforts.
The assessment team developed and pilot tested a Quality Improvement Survey (QIS) instrument that was then administered to all the operational units within the Department. All units responded to the survey, with 18 Offices and Divisions providing detailed information and 20 other units reporting no activities.
A total of 20 clinical care, 4 health promotion and disease prevention, and 20 administrative QI activities were reported. Some examples included California’s Delivery System Reform Incentive Payments (DSRIP) Program; reducing all-cause readmissions and health care acquired infections; improving the proportion of Medi-Cal members who get help in quitting smoking; waivers to help frail seniors and persons with mid- to late-stage HIV/AIDS or developmental disabilities remain in their homes and communities as an alternative to being placed in health care facilities; and enhancing fraud detection and deterrence.
Thirty metrics, including 13 Healthcare Effectiveness Data and Information Set (HEDIS) measures, were being collected by DHCS but were not specifically linked to statewide QI activities. In addition, survey respondents noted both broad gaps in current QI practices (e.g., lack of consistent measurement and translation of data into QI efforts Department-wide) and specific programmatic gaps (e.g., the absence of a comprehensive tobacco treatment plan). Respondents offered many suggestions for new QI activities involving multiple programmatic areas within the Department, including dental care; obesity, tobacco, and alcohol and substance abuse prevention; data, measurement, and modeling; business processes; and QI training. Multiple cross-cutting QI activities were noted.
The findings of this report will help inform the development of a multi-year Department-wide Quality Improvement Plan.