Improving Patient Outcomes: 5 Best Practices

The federal government regularly implements new ways to transform the healthcare industry. One ongoing priority is improving patient outcomes on a national scale by outlining standards of care. To achieve this mission, several health organizations, particularly the Centers for Medicare and Medicaid Services (CMS), enforce requirements that tie quality measures to payment incentives and penalties. With an increasing emphasis on value-based care, improving outcomes at the facility-level requires more comprehensive strategies.

Leaders of healthcare facilities are undoubtedly facing tough challenges in providing high-quality care to patients with limited resources. In this article, we’ll review measures the government uses to evaluate clinical outcomes and discuss five practical ways to improve them at your facility:

1. Utilize Quality Measures as a Predictive Tool
2. Incorporate Shared Decision-Making
3. Educate Nurses
4. Create Nurse Champions
5. Increase Nurse Retention

Outcomes and Quality Measures, Explained

In healthcare, “outcomes” are defined as the impact a facility’s services and interventions have on the health status and quality of life of patients. As this impact can be difficult to conceptualize, CMS utilizes a set of “quality measures” to assess outcomes and quantify a facility’s ability to provide high-quality care.

Essentially, CMS obtains data from insurance claims and standardized reports that are used for tracking and improving patient outcomes across various types of health systems. Quality measures not only inform patient care standards, but they can also impact a facility’s ability to attract business and earn revenue through certain CMS programming criteria. A few examples include:

• Five-Star Quality Rating System: This system provides public-facing ratings of nursing homes that prospective residents and families can use to select care.
• Value-Based Purchasing Program: This program adjusts Medicare incentive payments based on a facility’s performance.
• Hospital Outpatient Quality Reporting Program: This program deducts payments from outpatient facilities that fail to report on required quality measures.

Example of How Quality Measures Indicate Outcomes

The specific outcomes and quality measures your facility reports to CMS or decides to monitor will depend on your patient population. To illustrate an example of how measures can be used for capturing patient outcomes, we can take a look at how CMS examines resident length of stay in nursing homes. The language of these quality measures are outlined in the table below.

By defining standardized measures that determine short versus long length of stay, CMS can better track and compare this outcome within and among various facilities. This also serves as a helpful tool for facilities that are seeking ways to track their own performance.

Improving Patient Outcomes at Your Facility

Now that we’ve gone over what outcomes are and how they’re measured, here are five ways you can improve them at your facility.

1. Utilize Quality Measures as a Predictive Tool

CMS develops a variety of evidence-based quality measures that go into evaluating and improving patient outcomes. These measures provide extensive insight into the patient’s state of health and serve as a foundation for individualizing care. If your facility is required to report to CMS on certain quality measures, you can also use this information to implement strategies that mitigate problems for at-risk patients.

Beyond reporting requirements, many facilities also create their own quality measures to track patient reported outcomes and other factors that aren’t captured by CMS-developed measures, such as access to care. This is a recommended way to tailor data collection to meet the needs of your facility.

Here are some helpful tips on using quality measures to predict outcomes while developing a plan with your nursing management team.

• Utilize the CMS inventory to find existing quality measures, or inform the creation of measures that are tailored to your facility.
• Identify the most important outcomes to your facility that will have the most significant patient impact.
• Determine the desired outcome for each clinical measure.
• Define the metrics for patient and quality outcome success or failure.
• Establish what the consequences are for not meeting the outcomes.
• Formulate how to improve the quality of care for patients already struggling with their health and functional abilities.

Example: An elderly female prone to UTIs can be placed on an automatic toileting schedule upon admission to reduce long voiding intervals and decrease infection risk.

2. Incorporate Shared Decision-Making

Shared decision-making is the process of including a patient and their family as active participants in the healthcare team. Nurses assist patients by providing education and information about their health and medical conditions. This, in turn, empowers patients to become more invested in their health and make informed decisions regarding their treatment plans.

Patient-centered care is a fundamental concept in healthcare that’s even centered in global strategies outlined by the World Health Organization. According to the Agency for Healthcare Research and Quality (AHRQ), by placing patients at the center of their own care, your facility can achieve:

• Improvements in patient health outcomes.
• Enhancements in patient satisfaction.
• Reduced medical mistakes and increased patient safety.
• Lower costs for facilities and patients.
• Eligibility to become recognized as a patient-centered medical home (PCMH) or accountable care organization (ACO).

Example: After the nurse explains to the patient and their family the importance of preventing UTI to their overall health, they can engage the patient to develop a toileting routine that works around the patient’s schedule and needs.

3. Educate Nurses

Through providing nursing education, facilities can remain current on evidence based practice standards and improve outcomes. Education is an ongoing process that includes yearly reviews, competencies, and periodic in-services focusing on prevention, early identification, and nursing management for conditions commonly affecting patients. It can also include training regarding patients’ rights when receiving care.

Example: Your facility can offer annual training on the cause and prevention of UTIs, perform annual competency on sterile technique with catheter insertion, and provide quarterly in-services on early identification of infections.

4. Create Nurse Champions

In addition, you can create a staff committee dedicated to improving healthcare measures specific to your patients’ needs. Enlist a nurse from each unit to become their quality champion, the subject matter expert who provides updates, answers questions, offers guidance, and gathers outcome data. By engaging nursing staff through education and inviting them to be a part of the solution, your facility is leveraging your best asset for improving patient outcomes.

Example: Your nursing champion for infection prevention can consult with the nursing staff caring for patients to review early UTI signs and symptoms. Additionally, they can provide important education points to reinforce when providing care.

5. Increase Nurse Retention

The federal government oversees a number of initiatives aimed at increasing and retaining nursing staff and, subsequently, improving patient outcomes. For instance, CMS mandates the reporting of turnover rates for all direct-care nursing professionals and nurse administrators. This information is then used to calculate quality ratings.

Adequate nurse staffing is associated with fewer pressure ulcers and urinary tract infections, decreased risk of hospitalizations, reduced mortality, and improved quality measures, including falls and pain management in nursing residents. If you’re wondering how to improve patient outcomes through staffing, take heart in knowing that there are effective ways to reduce nurse turnover and support your nursing leadership to create a positive work environment.

Example: Patients receive more consistent care by having the same nursing staff attend to their needs. This allows subtle changes signaling a UTI to be promptly identified and incorporated into an action plan.

Need Help Improving Patient Outcomes?

Assembling a top-notch nursing team is essential to providing excellent patient care. Need a hand raising the bar at your facility? Learn more about improving care, retaining staff, and other important aspects of staffing a healthcare facility through IntelyCare’s free newsletter.

IntelyCare writer Katherine Zheng, PhD, BSN contributed to the writing and research for this article.