Explain the role of quality assessment in the utilization management process.
HS460M3-3: Explain the role of quality assessment in the utilization management process.
Hospital Cesarean Section Review
Scenario:
The hospital’s Utilization Management Committee discovers that the rate of cesarean section births at the hospital is higher than the rate at other hospitals in the region, meaning a higher percentage of women at other hospitals are having vaginal deliveries.
The Utilization Management Committee wants to evaluate the medical necessity of cesarean section births at the hospital using clinical practice guidelines available on this topic.
Address the following issues and questions:
1. How would you organize a project team or project improvement team to review this information?
What steps are involved?
Who are possible members of the review or project?
What are their individual roles and responsibilities as members of the project?
2. What kind of data should be reviewed?
Where would you find comparative or benchmarking data?
Provide examples of possible data resources and examples of benchmarking information for cesarean section rates.
3. What are the resources available for practice guidelines?
Provide examples of sources for practice guidelines.
What kind of indicators (measurements) should be developed or be utilized?
4. What performance improvement tools or processes would you utilize to accomplish steps 1–3 and project goals?
5. Provide a summary of the performance improvement project per the accomplished steps as outlined above.
Minimum Submission Requirements
This Assessment should be a Microsoft Word (2-3 pages) document, in addition to the title and reference pages.
Respond to the questions in a thorough manner, providing specific examples of concepts, topics, definitions, and other elements asked for in the questions. Your submission should be highly organized, logical, and focused.
Your submission must be written in Standard English and demonstrate exceptional content, organization, style, and grammar and mechanics.
Your submission should provide a clearly established and sustained viewpoint and purpose.
Your writing should be well ordered, logical and unified, as well as original and insightful.
A separate page at the end of your submission should contain a list of references, in APA format. Use your textbook, the Library, and the internet for research.
Be sure to cite both in-text and reference list citations where appropriate and reference all sources. Your sources and content should follow proper APA citation style. Review the writing resources for APA formatting and citation found in Academic Tools. Additional writing resources can be found within the Academic Success Center.
Your submission should:
include a cover sheet;
be double-spaced;
be typed in Times New Roman, 12 -point font;
include correct citations
be written in Standard English with no spelling or punctuation errors; and
include correct references at the bottom of the last page.
Answer preview to explain the role of quality assessment in the utilization management process.
APA
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