DM certification available from JCAHO
Program assesses disease-specific care
As consumers and referral sources look for ways to assure that the performance of the health care entities they choose is up to par, it’s more important than ever for your disease management program to distinguish itself.
That’s why the Joint Commission on Accreditation of Health Care Organization (JCAHO) has begun offering its Disease Specific Care Certification to recognize high-quality programs that foster better outcomes for people with chronic conditions.
The Disease Specific Care Certification program recognizes the emergence of disease management and offers programs a way to differentiate their programs from the rest.
Certification can give a disease management program a competitive edge in the marketplace by making consumers, payers, and clinicians aware that the program has demonstrated compliance with national standards developed to address the needs of chronically ill patients, says Maureen Connors Potter, RN, MSN, executive director of JCAHO’s Disease Specific Care Certification program.
"The general public will be aware that the program has the gold seal of approval. For instance, if a family member or friend is looking for a program for someone recently diagnosed with diabetes, they can see a program of excellence and say that’s where they want their family member to go," she adds.
Certification differs from JCAHO accreditation in that it demonstrates commitment to providing a comprehensive chronic care or condition-specific service. Accreditation is a comprehensive evaluation of the organization’s overall services.
"Certification and accreditation can be viewed as separate, yet complimentary programs," Potter says. The Joint Commission is offering certification in any disease management program requested including common diseases such as asthma and diabetes as well as rarer conditions such as end-stage renal disease and multiple sclerosis, she says.
To meet the criteria for certification, a program must:
- Support a patient’s self-management activities.
- Utilize a standardized method of delivering integrated and coordinated care based on clinical guidelines or evidence-based practice.
- Tailor treatment and intervention to individual needs.
- Promote the flow of information across settings and providers while protecting participants’ rights and privacy.
- Analyze and use data to continually improve treatment plans.
- Evaluate ways to improve performance and clinical practices to improve patient care.
"We stress good communication among all care providers and with patients to ensure patients’ privacy, to identify trends and track variances and problems areas so clinical quality improvement activities can take place," Potter says.
Communication is an important part of the patient safety focus since chronically ill patients often take multiple medications prescribed by specialists as well as their primary care physicians. For instance, a specialist and a primary care physician may prescribe the same medication with different names and patients may not be aware of it, she says.
The standards require that the programs use disease management guidelines from the National Clearinghouse for Guidelines.
The guidelines may be updated or adapted for local implementation following a review by a multidisciplinary team.
At present, JCAHO does not specify any particular guidelines for the disease management program.
"Disease management is a fledgling industry in its first stages. Our certification is not prescriptive about guidelines nor about performance measures. Over time, as a consensus develops, we will participate in cooperation with other accrediting bodies and organizations such as the National Quality Forum and the American Medical Association to have the same measures. This will give us a national mechanism to compare apples to apples," Potter says.
When there is a consensus on guidelines, the Joint Commission will share them with certified organizations and those who request a review and require that they utilize those particular performance measures and report on them.
Currently, the guidelines allow the disease management organizations to select four areas for performance improvement, with the requirement that one performance measure is patient perception of care and another is a clinical measure, such as monitoring retinal eye examinations for diabetics.
The other two may be other clinical measures, a health status parameter, or an administrative measure, such as reduction in emergency room visits or hospitalizations due to complications from the disease. Certification is for up to two years. The first year, JCAHO conducts an on-site review. At the beginning of the second year, it conducts an external review, based on data submitted by the disease management organization and extends the certification for the second year.
"The second year’s review is off site unless there are significant changes in the data or some other indicator to warrant it. We have established a sentinel events line, and if we receive calls or complaints about a program, we may go back on site during the second year," Potter adds.
National disease management programs administered from a centralized location also are eligible for certification. The certification extends to all organizations that have purchased the services as long as the programs at each location are similar in such areas as comprehensiveness and documentation.
"We do certify disease-management programs in health plans as well as disease-management vendors who serve health plans, integrated delivery systems from hospitals, and physician groups. Certification can cross over all those settings," Potter says.
The certification program was pilot-tested in 10 locations, and several organizations have achieved certification since the first on-site review was conducted in February.
The standards were developed with input from chronic care management experts, employers, and consumers, Potter says. An advisory committee with representatives from 16 organizations and five at-large people with expertise in disease management will guide the program as it evolves.
JCAHO Disease Specific Care Certification Eligibility
- Organizations that provide clinical care directly to participations. Examples include hospitals, clinics, home care companies, long-term care facilities, rehabilitation centers, and physician groups.
- Organizations that provide clinical support and interact directly with participants by telephone, the Internet, or other electronic methods. Examples include disease management service companies and health plans with disease management services.
Material Required for JCAHO Accreditation
- Demographic information
- Identification of disease-specific services to be evaluated
- A summary of clinical guidelines used for each disease state and collateral documents
- An aggregated report of disease-specific outcomes measures
- A report describing participant’s perception of quality of care
- Performance improvement action plans, demonstrating how data have been used to improve practice
- Educational material provided to participants
- Mission statement, goals, and objectives
- Written code of ethical business and professional behavior
- Self-description of compliance with standards
- Marketing and other presentation materials
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