| Description of Safety Initiatives |
Goal or Expected Outcome |
Evaluation Tools |
| Practice guidelines |
Evaluate and improve quality care and provide an educational reference for physicians. |
Clinical guidelines are reviewed annually to ensure that the guideline is current and reflects evidence based medicine. |
| Hayes Guidelines for experimental and investigational treatments |
Care provided to members is state of the art and is based on nationally recommended evidence based guidelines |
Hayes Guidelines are updated biannually to ensure that the guidelines provide the most up to date evidence based information. |
| Physician prescription utilization profiling for pharmaceutical management. Reviews physician formulary adherence and average cost of prescription drugs. |
Promote better formulary adherence. Promotion of medication regimes that are consistent with best practices. |
Pharmaceutical reports on physician prescription utilization patterns are tracked and evaluated with recommendations for improvement over time. |
| Diabetes program assists members and their physicians to manage diabetes |
More members with diabetes receive appropriate tests and diabetic care for early detection of complications.
Decrease in rates for complications such as lower extremity amputation, ESRD, blindness ad hospitalization. |
HEDIS measures will be evaluated to look at health outcomes related to Diabetes and address opportunities for improvement |
| Breast cancer Initiative Program assists members with breast cancer detection |
Members will receive appropriate detection tests to detect breast cancer and will be educated on breast self-exam. |
HEDIS measures will be evaluated to look at health outcomes related to breast cancer and address opportunities for improvement. |
| Inpatient quality of care indicators - readmission rate |
Review and identify quality of care issues and /or service issues, identify the involved entity and request a corrective action plan. |
Readmission rates will be evaluated and opportunities to reduce readmission rates will be tracked and implemented. |
| Credentialing and Recredentialing of providers |
Prevent adverse outcomes by utilizing credentialed providers |
These findings are presented to the Quality Improvement Committee. Tracking and trending and opportunities for improvement will be addressed. |