Measuring quality often depends on one’s definitions, and it is quite appropriate to provide a glossary of terms to ensure a common understanding

Measuring quality often depends on one’s definitions, and it is quite appropriate to provide a glossary of terms to ensure a common understanding. Imagine that you are a clinical director at an organization with a contract for Medicaid Disease Management in a rural Midwestern state. You have oversight responsibility for eight registered nurses who serve in the capacity as health coaches in a telephone call center located in an office setting in the state’s capital. Your patients live in rural areas of the state, there are no urban settings, and there are few primary care providers who accept Medicaid. However, there are five primary hospitals spread throughout your state, a number of 25-bed “critical access” hospitals, and a few federally qualified health centers (FQHCs). Your DM program focuses on five disease conditions: CHF, COPD, asthma, diabetes, and CAD. Your program is guided by a very competent medical director, who is a physician, and you report to an executive director, who is also an APRN. You have sound information technology support, and the state sends claims data weekly with eligible patients who have already been identified with one or more of the various disease states for entry into your DM program. Consider your customer (the state in the Midwest) and the role of the telephone nurse and answer the following questions for discussion.

What are some examples of customers’ expectations that might emerge from this contract?

• How might the state in the Midwest define quality in measurable terms? At the end of the 3-year term? On an ongoing basis?

• What would represent the features of your program?

• What patient outcomes might be considered of value to your customer?

• What would constitute a deficiency?