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Part III Standards for Compliance

stakeholders to improve the quality of health and health care for all Americans. Implemen-tation of the National Quality Strategy involves identifying and pri- oritizing quality improvement efforts, sharing lessons learned, and measuring the collective success of Federal, State, and private sector health care stakehold- ers across the country” (8). Published in March 2011, the initial National Quality Strategy “established 3 aims—Better Care, Healthy People/Healthy Communities, and Affordable Care and 6 priorities for quality improvement. The National Quality Strategy’s first annual progress report to Congress, published in April 2012, elabo- rated on these 6 priorities and established long-term goals and national tracking measures to monitor quality improvement progress. The 2012 report also identified 3 strategic opportunities for improvement, which cut across all 6 priority areas. This second annual report provides updates on public and private payers’ collaborative efforts to align quality mea- sures, progress against national tracking measures (where possible) and establishment of aspirational targets (as needed), private-sector successes in each of the 6 priority areas, and progress on each of the 3 strategic opportunities” (8).

“Driving quality improvement is a core function of Centers for Medicare & Medicaid Services (CMS). This commitment is particularly evident as CMS enhances its partnerships with a delivery system in which providers are supported in achieving better out- comes in health and healthcare, at lower cost, for the beneficiaries and communities they serve. The vision for the CMS Quality Strategy is to optimize health out- comes by leading clinical quality improvement and health system transformation. The CMS Quality Strat- egy is built on the foundation of the CMS Strategy, and the HHS National Quality Strategy (NQS). Like the NQS, the CMS Quality Strategy was developed through a participatory, transparent, and collaborative process that included the input of a wide array of stake- holders. For more than a year, a group of leaders from across CMS met and developed the strategy. This group also sought out advice and input from other HHS agencies, the community, and CMS beneficiaries to inform their efforts” (9).

“CMS is working to support the delivery of con- sistent high-quality care, promote efficient outcomes in the healthcare system, and ensure that health insurance remains affordable for the millions of Americans who seek coverage. The 3 CMS quality strategy aims are better care, access to coverage, and improved health. The CMS strategy is based on 4 main goals. CMS is using all policy levers and program authorities to achieve the goals. This includes rewarding innovation

in the delivery of services, implementing initiatives to reduce burden, and employing state-of-the-art technol- ogies to assure program integrity across our healthcare coverage programs” (10).

CMS created this strategy “in accordance with legislation in the Patient Protection and Affordable Care Act (ACA) of 2010 [Section 3011, National Strategy amended the Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) by adding Part S— Health Care Quality Programs, Subpart I—National Strategy for Quality Improvement in Health Care, SEC. 399HH, National Strategy for Quality Improvement in Health Care (11)] which requires that each agency within the Department of Health and Human Services (HHS) report on its progress and development of a Quality Strategy” (10).

PERFORMANCE IMPROVEMENT AND MEASUREMENT

Performance improvement focuses on individual per- formance to correct errors when safety thresholds are crossed. Performance improvement studies processes to prevent or decrease the likelihood of problems. It identifies areas of opportunity and tests new approaches to fix underlying causes. Organization leaders have the responsibility for performance improvement. As a quality leader, the RDN is encour- aged to utilize the Academy of Nutrition and Dietetics Standards of Excellence (12). This tool is designed for RDNs to measure and evaluate an organization’s pro- grams, services, and initiatives that identify and distin- guish the RDN brand as the professional expert in food and nutrition.

All four Standards of Excellence—Quality of Leadership, Quality of Organization, Quality of Practice, and Quality of Outcomes—criteria apply to all practice segments of nutrition and dietetics: health care including acute care and long-term care; education and research, business and industry; and community nutrition and public health. In the standard Quality of Outcomes, the criterion considers whether the organi- zation promotes the RDN’s contribution to quality care by defining, measuring, and collecting nutrition-sensi- tive client/patient/resident/customer outcomes. As shown in Figure 23.1, this standard reviews if the orga- nization has a system in place to measure, evaluate, improve, and disseminate information related to nutri- tion and dietetics quality practice outcomes (12). The organization measures nutrition-sensitive quality related to resident, patient, client, product out- comes, process outcomes, or organization and structure outcomes. Figure 23.1 illustrates Systemic Methods for Performance Improvement: Plan-Do-Check Act