Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 120Disease Management Version 3.0Medical Management GuideORYX — http://www.jointcommission.org/AccreditationPrograms/Hospitals/ORYX/facts_oryx.htmORYX is a set of objective measures to assessthe clinical quality provided by inpatient facilities.Implementation of ORYX is a requirement forhospital accreditation with TJC. Under MHS ClinicalQuality Management (CQM — https://www.mhscqm.info/),ORYX data are abstracted from medicalrecords in all bedded (inpatient) MTFs. MTFs mustchoose a combination of applicable core and noncoremeasure sets. *The USAF may not exclusivelyuse TJC for MTF accreditation, but ORYX data arestill collected and reported.Core measure sets generally reflect inpatientprocesses and outcomes, and include the following:• Acute myocardial infarction• Heart failure• Pneumonia• Pregnancy and related conditions• Effectiveness of Care• Access/Availability of Care• Satisfaction with the Experience of Care• Use of Services• Cost of CareHEDIS ® Domains of Care• Health Plan Descriptive Information• Health Plan Stability• Informed Health Care ChoicesSource: http://www.ncqa.org/Portals/0/HEDISQM/HEDIS2009/2009_Measures.pdfFig. 29 – HEDIS ® Domains of Care• ADHD• Asthma• Cancer Screening• Chlamydia Screening• Cholesterol Management• COPDList of HEDIS ® Effectiveness ofCare Measure Topics• Diabetes• Geriatrics• Glaucoma Screening• Hypertension• Immunizations• Lead Screening• Low Back Pain• Medication Management• Mental Illness• Myocardial Infarction• Osteoporosis• Rheumatoid Arthritis• Smoking Cessation• Upper Respiratory Infections• Urinary Incontinence• Weight/Activity AssessmentsSource: http://www.ncqa.org/Portals/0/HEDISQM/HEDIS2009/2009_Measures.pdfFig. 30 – HEDIS ® Effectiveness of Care Measure Topics
Medical Management GuideVersion 3.0Disease ManagementPage 121• Hospital-based inpatient psychiatric services(DoD does not report this data to TJC)• Children's asthma care• Surgical Care Improvement Project (SCIP)• Hospital outpatient measuresNon-core measures are generally ambulatorycare measures and include diabetes, asthma, andhypertension. For more information, visit the MHSCQM website or contact a local QM representative.The MHS publishes MTF performance data forHEDIS ® and ORYX measures on publically availableportals, including the Hospital Compare and MHSCQM websites.goals. Every 10 years, the Department of Healthand Human Services (HHS) revises this documentto account for major risks to health and wellness,evolving public health priorities, and emergingtechnologies related to our nation's healthpreparedness and prevention. Healthy People2020 is anticipated to be published in early 2010.Additional information is available at the CDCwebsite at http://www.cdc.gov/.The MHS has recently focused on the 10 LeadingHealth Indicators identified by HP 2010 (Fig. 32),with an emphasis on tobacco use, alcohol abuse,Healthy People 2010 (HP 2010) — http://www.healthypeople.gov/Healthy People 2010 LeadingHealth IndicatorsThe Healthy People 2010 measure set wasdeveloped by the CDC to serve as a road mapfor improving the health of all people in theUnited States. HP 2010 consists of 28 focus areascontaining 467 objectives with measures to assessthe health of American communities. A limitedset of 10 objectives, the Leading Health Indicators(Fig. 31), reflects the major health concerns in theUnited States for the beginning of the 21st century.Indicators were selected based on their ability tomotivate action and their importance as publichealth issues, and on the availability of data tomeasure progress.HP 2010 provides measure definitions and currentbaseline data with epidemiologic stratifications,along with desired targets. The HP 2010 websiteprovides additional resources and helpful strategiesfor implementing programs to meet the HP 2010• Physical Activity• Overweight and Obesity• Tobacco Use• Substance Abuse• Responsible Sexual Behavior• Mental Health• Injury and Violence• Environmental Quality• Immunization• Access to Health CareFig. 31 – Healthy People 2010 (HP 2010)Leading Health Indicators
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