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Service Focus Areas
Quality & Mortality Review
Quality and mortality reviews focus on quality of care by reviewing care against service specific body of clinical knowledge. Reviews focus on thousands of clinical guidelines and standards of care. Customers can select the health service to further align focus review to service specific care requirements. Mortality reviews
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Reviews answer quality of care questions such as, Were acceptable procedures performed appropriate for the patient's indications? Providing clinical teams with the details behind the answer.
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In preparation for Root Cause Analysis for adverse events, customers can perform reviews and prompt reviews to focus on specfic areas of concern.
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Reviews the four requirements for medical malpractice, Duty, Breach of Duty, Causation and Injury from negligence.
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Quality review methodologies were built on academic medical center processes for medical care evaluation. ​​​​​​​
Peer Review
OPPE/FPPE
The Joint Commission's OPPE and FPPE standards establishes clear expectations for continuous evaluation of the professional practice of medical staff.
Programs should have a clear design structure, goals, review process that includes frequency, data collection, interpretation/assessment and standard of care evaluation.
At the core of any OPPE and FPPE program is how organizations perform evaluations.
The Eva SaaS takes the hassle out of the review process using Agentic AI-technology. The software is a HIPAA compliant, secure, encrypted platform accessible to medical staff office teams, health care service leaders and credentialing leaders.
EvaluCare's healthcare quality professionals help redesigned OPPE/FPPE programs at hospitals and have designed an intuitive user interface that allows customers to upload multiple patient records and perform and analysis against clinical guidelines and standards of the healthcare service, while allow customers to direct the review toward specific areas of concern.
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General Peer Review Focus Areas
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Care Delivered/Procedures Performed
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Documentation Requirements - Quality and Accuracy
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Appropriateness of Tests Ordered
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Appropriateness of Procedures Performed
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Clinical guidelines and Standards to be Met
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Transition of Care and Discharge Planning
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Plus: Customer Directed Concerns
Utilization Review
Utilization reviews are where care meets operations. Where clinical documentation and coding and billing lead to appropriate reimbursement for care delivery. And where patient severity of illness is properly reflected to impact quality performance..
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​The Eva SaaS reviews 15 established categories of care impacting interpretations of medical necessity, severity of illness variables, quality and reimbursement. Additionally customer may choose to respond to insurance denials with thorough and robust defense of clinical decision making.
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The EvaluCare healthcare quality experts have led improvement initiatives to improve utilization review processes at hospitals and health systems that have led to millions in reimbursement benefits by decrease claim denials for customers. ​​​​​​
Patient Tracers
Patient tracers are essential for evaluating care quality. Tracers are the patient's journey or "road map" to assess processes from admission to discharge. They can review system vulnerabilities and promote a culture of continuous, patient-and-family-centered improvement that go beyond mere compliance.
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The Eva SaaS patient tracers answer over 112 questions to help identify opportunities for improvement.
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Patient tracers help inform quality programming efforts by performing a system analysis of the entire patient encounter not just isolated tasks. It identifies weaknesses in systems and their interfaces.
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This supports an "ever-readiness" approach to proactively prevent harm and reduce risk.
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Categorized results support effective adjudication and response planning.