ACA Correctional Health Care Standards - Looking Forward.
Health care delivery has experienced unprecedented change during the past decade Advances in medical technology, new generations of pharmaceuticals and a shift toward preventive measures and managed care are among several key areas of change that have "trickled down" to the correctional health care environment. During this same time period, the prevalence of serious diseases such as HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. and HCV HCV
hepatitis C virus
HCV 1 Hepatitis C virus, see there 2. Human coronavirus. See Coronavirus. (hepatitis C virus
The decisions being made by clinical and correctional decision-makers are more complex and difficult than ever before. Correctional health care has been described as a huge jigsaw-puzzle with many interconnecting and interdependent in·ter·de·pen·dent
Mutually dependent: "Today, the mission of one institution can be accomplished only by recognizing that it lives in an interdependent world with conflicts and overlapping interests" pieces. Access standards, disease management, quality improvement, security controls, staffing issues and legal requirements represent just a few of the critical issues in building a quality correctional health care system.
So, where does a correctional agency or correctional health care provider turn for guidance and assistance in putting all the pieces of the puzzle together? The answer is the American Correctional Association The American Correctional Association is an association of providers of services to prisons in the United States. It holds an annual trade show where products used in prisons are shown to prospective purchasers.
It was formerly known as the American Prison Association. (ACA ACA - Application Control Architecture ). Health care standards have been an integral part of ACA accreditation programs since their creation in the 1970s.
In 1989, ACA published its first health care-specific program -- Certification Standards for Health Care Programs. In addition to health care standards, this program included standards on safety and emergency procedures, sanitation sanitation: see plumbing; sanitary science. , security and control, training and staff development, and fiscal and personnel procedures. Several facilities continue to maintain certification in this program. Through various forums, ACA's membership has become more aware of correctional health care issues and the need to better evaluate the performance of correctional health care operations.
In 1999, ACA's senior leadership responded to the concerns of its membership and committed to a major revision of the Certification Standards for Health Care Programs. A health care task force was formed and charged with updating existing health care standards and developing a new health care program based on contemporary correctional health care practices. The health care task force is comprised of prominent health care and corrections professionals from a variety of clinical and correctional disciplines. Key members of the health care task force include three state medical directors, a correctional nurse, a clinical psychologist, the director of a large state correctional system, a correctional health services health services Managed care The benefits covered under a health contract administrator, a senior federal sector representative, a corrections consultant, an infectious disease Infectious disease
A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. specialist and the sheriff of a large metropolitan area. When completed, the new manual program will be titled Standards for Correctional Health Care Programs.
Another endeavor for the task force was for the new correctional health care program to be developed as a performance-based standards model. Performance-based standards are a growing trend in both the public and private sectors. The federal Government Performance and Results Act The Government Performance and Results Act (GPRA) is a US Law enacted in 1993. It is one of a series of laws designed to improve government project management. The GPRA requires agencies to engage in project management tasks such as setting goals, measuring results, and reporting was instrumental in setting an example and requires all federal agencies to develop a set of performance measures to evaluate whether they have achieved their missions and goals. Other organizations and businesses were encouraged to follow the government's lead and to embrace similar performance-based models. Performance-based standards are not unique to ACA accreditation programs and currently are being used in various formats by other accreditation organizations. However, they are relatively new to the health care setting.
ACA formally endorsed performance-based standards several years ago and already has revised Standards for Adult Community Residential Services to include performance-based standards. Both the performance-based standards model and the traditional process-oriented standards model require an evaluation of policy, procedures and practice. In addition, several of the elements in each model are essentially the same even though they have different names. The major difference between the two models is that performance-based standards require the analysis of outcome measures (essentially data elements), which are used to determine an organization's overall performance.
Outcome measures are distinct from program activities. For example, counting the number of tuberculin skin tests Tuberculin Skin Test Definition
Tuberculosis (TB) is an airborne infectious disease caused by the bacteria Mycobacterium tuberculosis. Besides culturing in the laboratory, the two most common types of tests to screen for exposure to this disease given to offenders is not an outcome measure (it is a process indicator), but measuring the incidence of positive readings or diagnosed TB in the offender offender n. an accused defendant in a criminal case or one convicted of a crime. (See: defendant, accused) population is an outcome measure. Similarly, counting the number of consultations or referrals ordered by a primary care provider is a process indicator, while measuring the number of consultations or referrals that actually occurred is an outcome measure. When trended, outcome measures can be used (over time) to help a facility determine how well it is meeting short- or long-term requirements and goals. Outcome measures are not intended to create facility or industrywide in·dus·try·wide
adv. & adj.
Throughout an entire industry: sales that have decreased industrywide; industrywide cooperation. benchmarks and, by design, they make no attempts to address the financial or human resource requirements The components of a system that are required by software or hardware. It refers to resources that have finite limits such as memory and disk. In a PC, it may also refer to the resources required to install a new peripheral device, namely IRQs, DMA channels, I/O addresses and memory of a facility. Outcome measures essentially are "report cards," that evaluate the overall impact and effectiveness of compliance with a particular standard or group of expec ted practices.
Outcome measures are a key element of performance-based standards and they deserve much discussion. However, another element of ACA's forthcoming Standards for Correctional Health Care Programs deserves equal attention. Approximately 100 expected practices were drafted by the health care task force after a detailed review of existing correctional health care-related standards. Many standards were revised, consolidated, deleted or added. Expected practices now reflect contemporary correctional health care practices and truly are the "core' of Standards for Correctional Health Care Programs. Expected practices are the "little pieces" of the big correctional health care puzzle. When connected (followed), they bring a correctional health care program together.
Standards for Correctional Health Care Programs will soon be available to correctional agencies that desire a stand-alone accreditation of their health care programs or a specialized accreditation to complement ACA's facilitywide accreditation award. When part of a combined audit, Standards for Correctional Health Care Programs will supercede Verb 1. supercede - take the place or move into the position of; "Smith replaced Miller as CEO after Miller left"; "the computer has supplanted the slide rule"; "Mary replaced Susan as the team's captain and the highest-ranked player in the school" the health care standards in other program manuals. It is anticipated that at least two health care professionals will spend at least three days auditing the new program, regardless of whether it is a combined or stand-alone health care audit. For very large health care operations, such as medical or mental health centers, additional auditors may be used. Approximately 100 health care auditors already have been chosen to perform these specialized audits. They represent a variety of health care disciplines and include representation from physicians, nurses, mental health practitioners, health services administrators and dentists Dentists can refer to one of the following:
Keith Midberry is a former regional manager for ACA's Standards and Accreditation Department.
Elements of process-oriented standards from Adult Correctional Institutions Noun 1. correctional institution - a penal institution maintained by the government
detention camp, detention home, detention house, house of detention - an institution where juvenile offenders can be held temporarily (usually under the supervision of a juvenile , Third Edition:
Standard: a required condition, a specific number, a requirement that a process or policy and procedure be in place.
Example: written policy, procedure and practice designate des·ig·nate
tr.v. des·ig·nat·ed, des·ig·nat·ing, des·ig·nates
1. To indicate or specify; point out.
2. To give a name or title to; characterize.
3. the conditions for periodic health examinations of inmates.
Primary Documentation: the written guidelines guidelines,
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. specifying what will be accomplished and how it will be done.
Example: written policy and procedures; physical exam forms.
Secondary documentation: the backup materials that demonstrate that written policies and procedures Policies and Procedures are a set of documents that describe an organization's policies for operation and the procedures necessary to fulfill the policies. They are often initiated because of some external requirement, such as environmental compliance or other governmental are being implemented; the "tracks" or "footprints."
Example: completed physical exam forms.
Elements of performance-based standards from Standards for Correctional Health Care Programs:
Performance standard: what is to occur; defines essential condition to be achieved; represents a state of being, not an activity.
* Offenders have unimpeded unimpeded
not stopped or disrupted by anything
Adj. 1. unimpeded - not slowed or prevented; "a time of unimpeded growth"; "an unimpeded sweep of meadows and hills afforded a peaceful setting" access to a continuum of health care services.
* Health care services are evaluated and continually improved.
* Offenders are treated fairly and their rights are not violated vi·o·late
tr.v. vi·o·lat·ed, vi·o·lat·ing, vi·o·lates
1. To break or disregard (a law or promise, for example).
2. To assault (a person) sexually.
Outcome measures (data): effectiveness; measurable evidence compared over time; indicates improvement or sends up red flag; collected continuously, analyzed an·a·lyze
tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es
1. To examine methodically by separating into parts and studying their interrelations.
2. Chemistry To make a chemical analysis of.
3. periodically; expressed as ratios, rates or percentages.
* Number of offender specialty consultations completed during a 12-month period; number of specialty consultations ordered by primary health care providers during a 12-month period.
* Number of problems identified by internal review that were corrected during a 12-month period; number of problems identified by internal review during a 12-month period.
* Number of offender grievances related to unfair treatment or rights violations found in favor of the offender during a 12-month period; number of offender grievances related to unfair treatment or rights violations during a 12:month period.
Expected practices: how to accomplish the standard (the means to an end): actions that produce the desired outcome, what we think is necessary to gain compliance (not necessarily the only way to do so); best thinking of the field (previously called standards).
* Offenders who need health care beyond the resources available in the facility, as determined by the responsible physician, are transferred under appropriate security provisions to a facility where such care is available. There is a written list of referral sources for emergency and routine care that is reviewed and updated annually.
* Monthly statistical reports are prepared and include, at a minimum, the utilization of health care services by category, referrals to specialists, prescriptions written, laboratory/X-ray tests completed, infirmary infirmary /in·fir·ma·ry/ (-ah-re) a hospital or place where the sick or infirm are maintained or treated.
n. admissions (If applicable). off-site hospital admissions, serious illnesses/injuries, deaths and off-site transports.
* There is a system for resolving offender grievances relating to relating to relate prep → concernant
relating to relate prep → bezüglich +gen, mit Bezug auf +acc health care disputes.
Protocols: a written framework or instructions that guide implementation. i.e., policies and procedures, post orders, training curriculum, formats for logs and forms, handbooks, facility diagrams. etc. (previously called primary documentation).
* Written policy and procedures; referral/consultation forms.
* Written policy and procedures; statistical report forms.
* Written policy and procedures; grievance griev·ance
a. An actual or supposed circumstance regarded as just cause for complaint.
b. A complaint or protestation based on such a circumstance. See Synonyms at injustice.
2. report forms.
Process Indicators: evidence that practices are actually (and properly) being implemented and documentation that can be periodically and continuously analyzed; tracks or footprints that allow management to monitor ongoing operations. i.e., logs, records, measurements, observation, interviews (previously called secondary documentation).
* Health record; completed referral/consultation forms; transportation log; interviews.
* Documentation of monthly statistical reports.
* Grievance records; interviews.