Quality Improvement Project Guide Essay.
Hospital systems across the country face a number of pressing problems: clinical variation, preventable medical errors, hospital acquired infections, delays in patient discharge, and dwindling cash flow. While health systems need to consistently innovate in order to tackle these problems, many quality improvement projects fail to deliver on ROI.Quality Improvement Project Guide Essay.
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While there are many different definitions of quality improvement, the Health Resources and Services Administration (HRSA) defines it as “systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.” In addition to a practical definition, health systems need a roadmap to help guide successful quality improvement projects forward.Quality Improvement Project Guide Essay.
Health Catalyst has focused on helping health systems identify, prioritize, and succeed in tackling quality improvement projects since 2008. With the right evidence, analytics, and methods, providers and improvement teams can transform healthcare, improving the quality of care delivered to the patients they serve and the bottom line. Health Catalyst offers a roadmap to use best practice, adoption, and analytics together to drive outcomes improvement. This article provides examples of quality improvement in healthcare that may help others in their journey.Quality Improvement Project Guide Essay.
Clinical Examples of Quality Improvement in Healthcare
Healthcare systems working to improve clinical quality face the difficult challenge of aligning changes across the organization. But health systems can learn from successful clinical quality improvement projects and implementing key principles of their success. Below are three successful clinical examples of quality improvement in healthcare covering a wide range of issues facing many health systems today.Quality Improvement Project Guide Essay.
1. Pharmacist-led Medication Therapy Management Reduces Total Cost of Care
The first example is a recent project to improve patient outcomes and reduce cost where Allina Health leveraged their analytics system to demonstrate the impact of their pharmacist-led medication therapy management (MTM) in reducing the total cost of care.Quality Improvement Project Guide Essay.
In order to reduce medication-related adverse events the health system initially considered expanding the involvement of pharmacists performing medication therapy management (MTM) to a group of Medicaid patients covered by a shared-risk contract. Before making this decision and developing a comprehensive business plan, the health system wanted to better demonstrate the unique impact pharmacists were making on patient outcomes. The health system leveraged its analytics platform and Health Catalyst professional services to perform a comprehensive analysis. The analysis showed the following results:Quality Improvement Project Guide Essay.
- $2,085 mean total cost of care reduction per patient in the six-month period after the first pharmacist MTM encounter; over $590,000 extrapolated out over 283 MTM patients.
- 12% reduction in hospital admissions per 1,000 members and a 10% reduction in emergency department visits per 1,000 members.
- Statistically significant decreases in average medication count.
The analysis demonstrated the unique, positive impact pharmacist medication therapy management program is making on patient outcomes in the six-month period following the pharmacist MTM. This program is effectively reducing the total cost of care.Quality Improvement Project Guide Essay.
2. Optimizing Sepsis Care Improves Early Recognition and Outcomes
The second example of a clinical quality improvement project deals with an issue well-known to hospital systems. Sepsis is a major driver of mortality in the U.S.–it’s estimated that up to half of all hospital deaths are linked to the infection. Identifying sepsis early can be challenging, as the patient’s physical response presents as a syndrome of non-specific symptoms, which delays recognition, diagnosis, and treatment–all of which increases mortality rates.Quality Improvement Project Guide Essay.
Mission Health, North Carolina’s sixth largest health system, had previously implemented evidence-based sepsis care bundles. However, their processes for identifying patients with sepsis and initiation of care was fragmented and varied widely across the system, negatively impacting outcomes. By using a comprehensive data-driven approach to facilitate early sepsis identification and standardize the treatment of sepsis, including the addition of evidence-based alerts, Mission Health gained insights into sepsis performance to drive improvements. Using this comprehensive approach for early recognition and treatment, they achieved substantial improvements in sepsis outcomes, including the following:Quality Improvement Project Guide Essay.
- 1% relative reduction in mortality for patients with severe sepsis and septic shock.
- 9% relative difference in mortality for patients that received the evidence-based protocols compared to those who did not—the evidence-based protocols substantially reduce mortality.
- 4% relative reduction in emergency department (ED) length of stay (LOS) for patients with severe sepsis and septic shock.
- Four percent relative reduction in ICU LOS for patients with severe sepsis and septic shock admitted from the ED.Quality Improvement Project Guide Essay.
The health system will continue to use this proven plan to improve sepsis outcomes and enhance care for patients with sepsis and they are laying the groundwork to move the early identification screening tools to the outpatient setting, including urgent care centers and physician offices.
3. Boosting Readiness and Change Competencies Key to Successfully Reducing Clinical Variation
This example of clinical quality improvement in healthcare comes from UnityPoint Health, a healthcare system serving Iowa, western Illinois, and southern Wisconsin. System leaders recognized the importance of reducing clinical variation and the need to have strong physician champions and robust analytics to effectively support improvement efforts. However, they also realized that without understanding organizational strengths and weaknesses related to adopting change and improving outcomes, they would struggle to successfully implement initiatives that delivered the desired benefits and sustained improvements over time.Quality Improvement Project Guide Essay.
By consistently integrating information from a readiness assessment, an opportunity analysis, and expert resources, the health system was able to establish a prioritization and implementation approach to outcomes improvement that produced the following results:Quality Improvement Project Guide Essay.
- Variable costs were reduced by more than $1.75 million based on the deployment of interventions in sepsis alerts, order sets, and other clinical decision support tools.
- Reductions in length of stay have allowed patients to return home earlier and spend more than 1,000 additional nights in their homes.
- Millions of clicks have been reduced for clinicians based on deployment of new sepsis screening tools.
- 36% increase in sepsis screenings completed in the emergency department (ED).
- Sepsis order set utilization in the ED has increased by more than 185 percent.
The health system plans to continue identifying large improvement opportunities aligned with its strategic planning cycle and the priorities identified by clinical and operational leadership.Quality Improvement Project Guide Essay.
Financial and Operational Examples of Quality Improvement in Healthcare
Financial challenges are increasingly threatening the future of healthcare organizations. In order to thrive in an increasingly complex environment, financial and operational improvement projects are more important than ever. But, health systems need to tackle the right projects at the right time for their organization. Below are three excellent financial and operational examples of quality improvement in healthcare.Quality Improvement Project Guide Essay.
4. New Generation Activity-Based Costing Accelerates Timeliness of Decision Support
The first example comes from UPMC, an academic medical center affiliated with the University of Pittsburgh. Health system leaders recognized that the common denominator to addressing threats to sustainability is to fully understand and effectively manage costs. To address this, they implemented activity-based costing (ABC), facilitated by the Health Catalyst CORUS™ Suite, to deliver detailed and actionable cost data across the analytics environment, and support service line reporting, contract modeling, and clinical process improvement. They used this capability to effectively drive cost savings and improve clinical outcomes in many of its service lines, including Surgical Services, Women’s Health, Orthopedics, and Cardiovascular.Quality Improvement Project Guide Essay.
Through its analytics platform and best-of-breed, ABC models, UPMC is improving quality and safety, reducing costs, and increasing value across service lines. An efficient accounting closing process delivers timely and accurate information to guide decisions and operational adjustments. Taking these steps led to the following improvements:Quality Improvement Project Guide Essay.
- Three-day reduction in time to close.
- Monthly preliminary results are typically reviewed within one business day, affording more time for validation and analysis.
- Executives receive financial data up to three days sooner.
- Reduction of 3.5 FTEs needed to complete the monthly close.
- Reduced 60 human touchpoints and opportunity for error.
- Multiple months of data can now be run simultaneously.
- Provided support for new data-driven governance structure.
5. Systematic, Data-Driven Approach Lowers Length of Stay and Improves Care Coordination
The second example comes from Memorial Hospital at Gulfport. The hospital was faced with declining revenue due to changes in Medicare and Medicaid reimbursements. Hospital leaders knew additional methods of providing more efficient and cost-effective quality care were needed to maintain long-term success. Improving and reducing length of stay (LOS) improves financial, operational, and clinical outcomes by decreasing the costs of care for a patient. It can also improve outcomes by minimizing the risk of hospital-acquired conditions.Quality Improvement Project Guide Essay.
Hospital leaders embraced the challenge of reducing LOS to lower costs and lessen risk for its patients. By adopting a systematic, data-driven, and multi-pronged approach, Memorial has achieved significant results in one year, including:Quality Improvement Project Guide Essay.
- $2 million in cost savings, the result of decreased LOS and decreased utilization of supplies and medications.
- 47-day percentage point reduction in LOS.
- Improved care coordination and physician engagement have successfully reduced LOS.
- The 30-day readmission rate has remained stable.
- Three percent increase in the number of discharges occurring on the weekend.
6. Clinical and Financial Partnership Reduces Denials and Write-Offs by More than $3 Million
The last example of financial and operational quality improvement projects comes from The University of Kansas Health System. Despite previous initiatives, The University of Kansas Health System’s claim denial rate of 25% was higher than best practice (five percent). System leaders realized that, in order to provide its patients with world-class financial and clinical outcomes, it would need to engage differently with its clinical partners.Quality Improvement Project Guide Essay.
To effectively reduce revenue cycle and implement effective change, the health system needed to proactively identify issues that occurred early in the revenue cycle process. To rethink its denials process, it simultaneously increased organizational commitment, refined its improvement task force structure, developed new data capabilities to inform the work, and built collaborative partnerships between clinicians and the finance team. As a result of its renewed efforts, process re-design, stakeholder engagement, and improved analytics, The University of Kansas Health System achieved impressive savings in just eight months, including:Quality Improvement Project Guide Essay.
- $3 million in recurring benefit, the direct result of denials reduction.
- $4 million annualized recurring benefit.
- Successfully partnered with clinical leadership to transition ongoing denial reduction efforts to operational leaders.
The Quality Improvement Journey
Healthcare systems working to improve care, reduce expenses, and improve the patient experience face many challenges, including the need to align changes across many levels of an organization. But the process of identifying, prioritizing, and implementing these changes can be improved with the right tools and, process, and people. Once these three things are in alignment, health systems can tackle clinical, financial, and operational quality improvement projects like the examples covered here and make incredible strides in the clinical, financial, and operational health of the organization.Quality Improvement Project Guide Essay.
Everyone involved in improvement projects from doctors and nurses, to data analysts and administrators are busy with other projects. Quality Improvement projects typically mean additional work everyone involved. However, health systems have the ability to improve care, patient experience, and save lives through quality improvement projects that reduce clinical variation, preventable medical errors, hospital acquired infections, delays in patient discharge, and improve the bottom line.Quality Improvement Project Guide Essay.
Would you like to learn more about this topic? Here are some articles we suggest:
- Is a Medical Writer the Missing Accelerant to Your Outcome Improvement Efforts?
- Unlocking the Power of Patient-Reported Outcome Measures (PROMs)
- How to Evaluate Emerging Healthcare Technology With Innovative Analytics
- Emergency Department Quality Improvement: Transforming the Delivery of Care
- Improving Quality Measures Can Lead to Better Outcomes
Is a Medical Writer the Missing Accelerant to Your Outcome Improvement Efforts?
As healthcare organizations pursue greater efficiency and shift focus from volume to value, quality improvement efforts are more important than ever. If improvement efforts are poorly managed or executed, projects can easily stall out and take up valuable time, money, and resources, while returning little in the way of results. To combat this, Health Catalyst recommends a Seven Guiding Questions Framework for Outcomes Improvement. This framework leverages the Three Systems: the systematic integration of analytics, best practices, and adoption functions to drive transformation in healthcare. However, even improvement efforts that have the right people, processes, and technology in place can struggle to make sufficient progress.Quality Improvement Project Guide Essay.
Cross-functional teams, while vitally important, take time to reach a shared understanding because of their varied backgrounds, frames of reference, and even vocabularies about why and how to tackle specific improvement projects. Improvement teams can struggle to identify and select manageable chunks of work to focus on. Momentum slows and enthusiasm evaporates. What is the improvement team missing that can help speed time to adoption and value? A medical writer with healthcare knowledge and strong information design skills may be the missing accelerant to outcomes improvement.Quality Improvement Project Guide Essay.
Functions a Medical Writer Can Fulfill—and Why They Matter
Medical writers with the right skills can fill an invaluable role on healthcare improvement teams. They can help teams investigate the problem, standardize processes to address and measure progress, and unite best practice, analytics, and adoption systems to drive improvement.Quality Improvement Project Guide Essay.
Mike Noke, Senior Vice President of Professional Services at Health Catalyst, said about working with writers in this setting, “When working in complex healthcare environments, relevant and clear communication and documentation is essential, but requires a skillset often not inherently found on clinical and technical teams. Medical writers combine healthcare domain awareness with effective communication skills that assist in articulating the intent, the methods, and value of improvement teams so that these may be more broadly understood and leveraged.”Quality Improvement Project Guide Essay.
So, what exactly can a medical writer in this setting do? Here are four skills that a writer with strong information design skills brings to an improvement team:
- Synthesizing and summarizing massive volumes of information. For example, many diabetes guidelines are long, complex documents with hundreds of recommended practices. In an effort to standardize processes for improvement, a writer can boil down and organize the material in a way that helps teams know where to start.
- Integrating different types of information in simple, often visual ways. This helps everyone get on the same page by showing the connections between technical, strategic, clinical, operational, and financial issues and concerns.
- Facilitating the discussions of an improvement team. Writers can help teams with rapid cycle drafts and reviews, a problem-solving model used for improving a process or carrying out change. Facilitating this process helps build engagement and buy-in and facilitates effective change management.
- Positioning the team for standardization and collaboration. Writers are often instrumental in developing “tools for transformation”—checklists, order sets, process flow posters—materials that encapsulate standard practices and make it easy for people to collaborate and adopt the newly designed way of working.Quality Improvement Project Guide Essay.
Examples of Output of Medical Writers in a Healthcare Setting
The unique skill set of medical writers/information designers in the healthcare domain is best illustrated with specific examples from their work on improvement teams.
Synthesizing and Integrating Information
Writers can create artifacts that helps answer questions such as, “What does a work process look like?” “What are the most important best practices?” and “For the greatest positive impact, where should we measure and manage?” An example of this is the CAUTI Prevention Care Process Improvement Map shown below in Figure 1.Quality Improvement Project Guide Essay.
Figure 1: A CAUTI Care Process Improvement Map is a good example of how information designers synthesize information.
The care map above draws on multiple source documents—clinical guidelines, systematic reviews and meta-analyses, cohort and cross-sectional studies—to help orient team members to the scope of a care process, the major outcomes it affects, and the application metrics that support work in this area of care. Overlaying analytics, improvement opportunities, and clinical practice in a single, simple visual, the map communicates across disciplines—helping data experts, administrators, and clinicians get on the same page. This accelerates quality improvement around the care process.Quality Improvement Project Guide Essay.
As writers document the improvement teams’ work and plans through iterative drafts and reviews, they can use plain language to help people focus (and re-focus) on what matters most. Does the team understand the problem? Do they know what to change? Are the changes resulting in improvement? Writers can also absorb and reflect the concerns of the multidisciplinary team members to create materials that support change. What do stakeholders need to know in order to act? Figure 2 below shows a page from the handbook Implementing Governance for Outcomes Improvement.Quality Improvement Project Guide Essay.
Figure 2: This page from the handbook “Implementing Governance for Outcomes Improvement” suggests how medical writers can help teams manage complex ideas.
To develop the handbook on governance, writers worked with subject matter experts (SMEs) from a range of backgrounds. They organized the copious amount of input from SMEs, including anecdotes, research, and recommendations, and, in an iterative process, developed a set of actionable steps applicable to any organization.
Just as in client organizations that work with writers, the Health Catalyst team found that the shared development work powerfully engaged team members and helped them become more knowledgeable and empowered—and ultimately led them to become effective champions of our organization’s approach to governance.Quality Improvement Project Guide Essay.
Positioning the Team for Standardization and Collaboration
Writers can devise presentation modes that help teams negotiate a common tension in improvement work: “How can we drive standardization and improve reliability while allowing for warranted variation and pragmatic innovation?” The blueprint shown in Figure 3 is a good example of writers’ information design abilities to do this.Quality Improvement Project Guide Essay.
Figure 3: A blueprint created by writers that helped set the table for future improvement work.
This blueprint records an organization’s experience with digital innovation, centered on its key activities and including lessons learned along the way. The complete blueprint covers several dimensions and levels of detail of the organization’s transformation and provides supporting artifacts that give project details, examples, and tools. Ultimately, all the information in a blueprint will be searchable and filterable by different users.Quality Improvement Project Guide Essay.
The blueprint has a narrative structure that is broken into phases and discrete steps. The goal being to demonstrate the value of new technology and make it easier, quicker, and cheaper to replicate the innovation while avoiding the “one-size-fits-all” prescriptiveness that would likely generate resistance. The writers who worked on this project found that the story structure was engaging and allowed the client to instruct, inspire, and empower, while at the same time balancing the ideal and the actual, the theoretical and the practical, and the site-specific advice.Quality Improvement Project Guide Essay.
What Skills Does a Medical Writer Need in a Healthcare Environment?
Writers may not have the same clinical or technical expertise as domain experts, but they possess many soft skills, like the ones described in Liz Wiseman’s book, “Rookie Smarts: Why Learning Beats Knowing in the New Game of Work.” One of the major tenets of the book is that experience can sometimes be a hindrance when it comes to collaborative thinking about complex problems. “Someone operating with rookie smarts provides much-needed orchestration, reframing the issues, posing the question, searching for truth, and then bringing the newfound intelligence back to bear on the problem.” It’s this precise ability that writers bring to the table for improvement teams.Quality Improvement Project Guide Essay.
Other important skills for writers in this space include:
- Writing – especially a talent for synthesizing and summarizing.
- Research – an ability to understand the subject matter and spot trends.
- Interpersonal skills.
- Visual thinking – Although writers don’t need to be graphic designers, effective information design requires the ability to visually represent, summarize, and clarify information.
- Curiosity – “Rookie smarts” such as curiosity and the ability to ask questions that simplify and clarify problems are extremely valuable.
- Commitment to the cause – a belief in the work of outcomes improvement via data-driven analysis, standardization, and measurement is a necessary trait for someone to truly have an impact.
Finding This Unique Skill Set in the Organization
Where does an organization find someone with this skill set? While a medical writer may have past experience in medical or technical writing or communications, the right person for this role could already be part of the organization. Look for the skills above, especially the soft skills described in Wiseman’s book. To be successful in this niche area, a writer must possess a unique skill set not often found on clinical or technical teams.Quality Improvement Project Guide Essay.
A Missing Piece of the Puzzle
The skill set writers/information designers bring to the table can help speed the work of improvement teams, as shown in the examples above, by helping teams identify manageable tasks to focus on, articulating the process, and creating visual artifacts to help improve and clarify communication. Additionally, they can help communicate the value of improvement teams to a larger audience and speed future improvement projects by creating tools for transformation that can be used again.Quality Improvement Project Guide Essay.
Dr. David Burton, former senior vice president of Intermountain Healthcare and founding CEO of Intermountain’s managed care plan, SelectHealth, is a big proponent of having medical writers on improvement teams. He said, “Writers are a catalyst to help clinicians, administrators, financial and technical experts digest into words and visual images the process by which healthcare is made available and provided to members and patients of healthcare systems. They are an extremely important catalyst to process improvement.” Ultimately, adding the role of a medical writer and information designer to an improvement team will help keep teams focused and engaged in order to speed improvement work.Quality Improvement Project Guide Essay.
Would you like to learn more about this topic? Here are some articles we suggest:
- Healthcare Project Management Techniques: A Pragmatic Approach to Outcomes Improvement
- How to Achieve Your Clinical Data Analytics Goals
- The Top Seven Healthcare Outcome Measures and Three Measurement Essentials
- Healthcare Data Management: Three Principles of Using Data to Its Full Potential
- How to Run Your Healthcare Analytics Operation Like a Business
Would you like to use or share these concepts? Download the presentation highlighting the key main points.
Click Here to Download the Slides
Unlocking the Power of Patient-Reported Outcome Measures (PROMs)
How do patients choose their doctors? This is the million-dollar question asked and explored by health systems’ executive teams and communication departments across the country. And, the answer might be different depending on who is being asked. Do patients use publicly available quality metrics, shop websites and articles, use their own personal healthcare network or PCP, ask friends and family, or use their insurance provider’s list? While these are the main choices available to consumers, each of these avenues is flawed in its own way.Quality Improvement Project Guide Essay.
One example is the personal vignette of a woman who was diagnosed with an aggressive form of breast cancer. Her friend, a cancer surgeon in a different state, vetted her available options with his oncology network. The surgeon recommended a physician with excellent outcomes, but the woman hated the physician’s bedside manner and ended up choosing a different doctor with much lower surgical outcomes than the recommended physician. If even surgeons can’t get patients–including friends and family–to the right providers, how can patients be expected to find the right provider and care for their needs? Patient-reported outcomes are the missing link in empowering patients and helping to define good outcomes.Quality Improvement Project Guide Essay.
Patient-Related Outcomes as the Outcome Metric of Relevance
Patient-Reported Outcomes (PROs) are defined by the National Quality Forum as “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.” Most healthcare organizations consistently measure things like mortality rates, length of stay (LOS), readmissions, lab values, or other process measures. As clinicians and health systems seek to provide better care, they will only succeed if they can accurately define what qualifies as a good outcome.Quality Improvement Project Guide Essay.
Health systems attempt to measure an ever-increasing amount of clinical measures, these often miss the mark of what matters to patients. Not many physicians have been asked by a patient what their 30-day mortality rate is, for instance. What’s often overlooked are issues that impact a patient’s quality of life. Patients care about things like, “If I have my prostate removed, am I going to be incontinent?” or “Can I pick up my grandchild?” Patients care about symptoms, daily activities, functional status, and mental health. All these things are difficult for health systems to measure, which is where patient-reported outcome measures (PROMs) come in. PROMs provide the missing link in defining a good outcome by capturing quality of life issues that patients care about and which often cause them to seek out care in the first place.
A great example that highlights the importance of patient-reported outcome measures is extracted from a Michael Porter Harvard Business School Case Review looking at urology surgery outcomes. When comparing two hospitals, one thought to be average, one considered to be one of the best in the country, there’s very little difference in mortality, particularly with prostate cancer. Looking at the five-year mortality outcomes in Figure 1, the results are nearly identical between the two institutions. However, the second two measures show rates of incontinence and impotence, and there’s a marked difference between the two.Quality Improvement Project Guide Essay.
As a patient, of primary importance is “Am I going to live,” but the second question is, “What is my life going to be like?” This is where some outcome measures are much more important to a patient’s quality of life. If a patient knows there is a 50 percent chance of becoming incontinent or a 75 percent chance of impotence when undergoing surgery for prostate cancer, this will affect his decision-making process. Even though both institutions can keep patients alive, it’s the best center that employed techniques that have helped patients maintain a high quality of life and retain dignity and relationships. Even though these measures aren’t reported in traditional healthcare metrics, they are sometimes the ones that matter most to patients.
Figure 1: Prostate Cancer Outcomes. Source: Harvard Business School Study.
Rather than using variation by provider or mortality to discover value, health systems can use patient-reported outcomes like incontinence after prostatectomy as a metric for quality improvement. An important thing to keep in mind about variation, especially in surgery is to be very thoughtful about case mix and know that each patient is not necessarily comparable to another. Physicians and surgeons should not be penalized for taking care of patients with greater comorbidities or with lower pre-op scores. When a health system plots and compares outcomes of faculty, looking for the lowest incontinence scores, they should consider the case mix, surgical technique, and any other extenuating factors to help manage and position the data with care. The goal is to identify best practices and drive system-wide quality improvement.Quality Improvement Project Guide Essay.
Patient-Reported Outcome Measures as a Guide for Appropriateness and Efficiency
PROs can also help surface and guide appropriateness and efficiency efforts. Many different techniques used in the OR and they’re all attributed to very different costs. When looking at a measurement like physical function after different types of reconstruction, the data shows that the three main ways of reconstructing a hip are associated with very different costs. The most expensive surgery actually had the lowest PROMIS physical function scores, so keep in mind that the most expensive treatment isn’t necessarily the best one.Quality Improvement Project Guide Essay.
Patient-Reported Outcome Measures Leads to Better Shared Decision-Making
When it comes to cancer surgery, sometimes the options available to patients are incredibly morbid and they’re faced with terrible choices where they trade off mortality versus morbidity. Patient-reported outcome measures can serve as a valuable tool by telling patients the experience of those who have gone before them.Quality Improvement Project Guide Essay.
Another great example is a laminectomy. Data shows that whatever level of leg pain patients present with is going to be cut in half. If a patient wants to know how he’s going to recover from his laminectomy, he can look at the PROMs data and see that immediately after surgery, most patients have almost no leg pain, but around the three-month mark, some of that pain starts to creep back in. Now the patient has that expectation and doesn’t need to call the physician’s office wondering what happened. This is a key factor in appropriately setting patient expectations and guiding decision-making in terms of whether or not the patient feels the benefit is high enough to justify the surgery.Quality Improvement Project Guide Essay.
Effect of Patient-Reported Outcome Measures on Providers
PROMs can even be helpful from the standpoint of office flow and mitigating phone calls about patient concerns that perhaps something went wrong with their surgery. This is important to note when thinking about getting already-overwhelmed providers to do “one more thing.”
As health systems progress toward improving care, reducing costs, and empowering patients, it can be difficult to know how to push past the landscape of “I can’t do one more thing” when it comes to clinician buy-in. Providers are being asked to do more and more with less and less. There are more regulations, a lot of which don’t make sense from a clinical perspective, and many providers are frustrated.Quality Improvement Project Guide Essay.
Even though patient-reported outcome measures can seem like a hurdle, the additional data can save health systems and providers time and enable deeper understanding and more personalized care. For example, providers can see the last two pain scores in the patient’s medical record since they came under the provider’s care, shown using an example patient in Figure 2.Quality Improvement Project Guide Essay.
Figure 2: Having patient-reported outcome measures (PROMs) data can enable more personalized care.
Using the example patient above in Figure 2, scores highlighted in yellow are out of range and abnormal. When this patient was initially seen, she had multiple domains that were concerning, including pain, physical function, pain interference with her day-to-day life, and global health (meaning how she was doing every day). Within this 2-month timeframe, the patient moved to within the normal range in every parameter. In a time when many providers feel like they receive a lot of negative feedback and it can be hard to quantify how well they’re doing, this type of feedback from PROs can be very rewarding for both providers and patients.Quality Improvement Project Guide Essay.
Patient-Reported Outcome Measures for Value Demonstration and Transparency
Perhaps one of the key benefits of PROs is to demonstrate value and transparency to patients. Partners Healthcare has created a forward-facing website called Care Decisions, that makes PROs data publicly available. The website shares data about heart disease, knee pain/arthritis, spinal stenosis, and prostate care that can help guide patient decisions.Quality Improvement Project Guide Essay.
Implementing Patient-Reported Outcome Measures
As healthcare organizations begin to explore the power of PROMs, they start seeing the value in many areas, including improving personalized care, shared-decision making, quality improvement, appropriateness and efficiency, and transparency. The next question is how to actually implement PROMs. Effective implementation requires a series of specific steps to ensure success:Quality Improvement Project Guide Essay.
- Leadership buy-in. It can be helpful to use other systems’ examples to help sell the idea to executives and departmental leaders.
- Form team functions charged with implementation, technology, data, and advanced analytics.
- Choose a technology platform.
- Decide on collection modalities and get IT working well.
- Pick an initial target.
- Implementation and data analysis. Which one comes first?
Whether to start implementation versus analysis first is a classic “chicken or egg” question. For data to show relevance, health systems need to implement PROMs. To implement PROMs, clinicians often want data about why it’s important. One thing to keep in mind is that a complete stop to the program can occur when physicians aren’t given the data from PROMs, especially as it’s looking at variation amongst providers. The key is to start small with someone who has faith in the program and then reward that faith by feeding their data back to that person in a timely fashion.Quality Improvement Project Guide Essay.
The other key to implementation is agreeing on which patient-reported outcomes to measure. With very rare exceptions, when asked more than 30 questions, patients stop participating. Other tips for successful implementation include:
- Agree on which PROs to measure and set clear criteria. For example, Criteria: Short, relevant to clinical care, validated, industry-standard, covered by PROMIS domain.
- Technology platform must work seamlessly, including patient portal, Wi-Fi, tablets, security, data integration, real-time processing.
- Beware of common ongoing challenges such as: risk stratification, data for non-surgical treatment, patient-facing reports, and sharing data with clinicians.Quality Improvement Project Guide Essay.
Why Patient-Reported Outcomes Are the Missing Link
PROs are the outcome metric of relevance for many conditions treated. They are the missing link in defining a good outcome by capturing quality-of-life issues that are often the reason patients seek treatment. The results often vary considerably among treatment options, providers, and facilities, providing patients with more decision-making power geared toward the things they care about most. Making patient-reported outcomes a focus of care also gives providers power to improve patient care and the health of populations. Quality Improvement Project Guide Essay.
- The Secret to Patient Compliance: An Application of The Four Tendencies Framework
- Unleashing Patient’s Power in Improving Health and Care
- Quality Data Is Essential for Doctors Concerned with Patient Engagement
- Health Equity: Why it Matters and How to Achieve it
- How Care Management Done Right Improves Patient Satisfaction and ROI
How to Evaluate Emerging Healthcare Technology With Innovative Analytics
This report is based on a 2018 Healthcare Analytics Summit presentation entitled, “Innovative Analytics: Using Analytics to Evaluate Emerging Technologies.”
U.S. healthcare spending alone is larger than the gross domestic product of most nations. Total health spending in the U.S. was $3.5 trillion in 2017 and is projected to grow by an average of 5.5 percent annually from 2017 to 2026. If all U.S. healthcare spending was separated into its own sovereign nation, it would constitute the fifth largest economy in the world. Much of those healthcare dollars is spent on the costs of cardiovascular disease, which surpassed both Alzheimer’s disease and diabetes with a cost of $318 billion in 2015. That number is projected to more than double to $749 billion in 2035. Additionally, consumers and providers are not experiencing a great return on investment in healthcare dollars. In fact, life expectancy in the U.S. does not compare favorably to other countries which spend less per capita on healthcare.Quality Improvement Project Guide Essay.
These skyrocketing costs have a big impact on consumers, with premiums increasing by 74 percent from 2007 to 2017. During that same period, employer contributions increased by an average of 48 percent. The impacts are also being felt by hospitals and providers. In 2016, 30 percent of all Medicare fee-for-service patients were part of alternative payment models; that number rose to 50 percent in 2018. As healthcare systems are squeezed in all directions, they need to determine how to cut costs and still provide high-quality care. To do so, they will need to look across the care continuum for answers, eliminate silos, reduce variation in care, and look to emerging technologies.
Importance of Identifying Variation in Innovation
There are two types of variation in healthcare: necessary and unnecessary. Necessary variation is deviation from standardized care based on individual patient characteristics resulting in improved outcomes. Unnecessary variation does not result in a benefit to the patient and instead increases cost. Variation in practice patterns has been studied in multiple conditions and the conclusion is that higher cost regions are not associated with improved quality or outcomes. While health systems have to look at variation in care in order to reduce unwanted variation, they can look within their own four walls to gain insights from data in order to reduce costs and improve care.Quality Improvement Project Guide Essay.
How to Improve Outcomes and Decrease Costs
Health systems have struggled to answer the question of how to improve outcomes and decrease costs. New solutions are needed to answer an old problem. Healthcare systems can focus on these four pillars of healthcare improvement:Quality Improvement Project Guide Essay.
- Population Health Management – Improve the health of the population through adherence to clinical guidelines across the continuum.
- Quantify the population needs and measure adherence to clinical guidelines.
- Develop strategies and tools to improve care access and efficiency.
- Reduce Clinical Variation – Transform care delivery through the reduction of clinical variation.
- Reduce unnecessary variation in clinical care.
- Standardize care pathways and protocols.
- Increase value.
- Test New Processes of Care and Payment Models – Transform care delivery by piloting new and creative processes and payment models.
- Build on existing best practice programs and protocols to improve quality and efficiency in care delivery.
- Develop and test new payment models.
- Leverage Cutting Emerging Healthcare Technology – Explore new ways to efficiently care for patients.
- Implantable monitors.
- Complex procedures and surgeries.
As emerging healthcare technology comes into greater focus, it’s important for healthcare systems to evaluate the safety and effectiveness in order to effectively harness new technology for better care and reduced costs.Quality Improvement Project Guide Essay.
Optimizing Care Across the Cardiovascular Continuum
Additionally, in looking for the highest impact projects to tackle, health systems can look to optimize care across the cardiovascular continuum:
- Primary Care – providers can emphasize a healthy lifestyle, use routine treatment protocols, and follow referral protocols.
- Outpatient Cardiology – provide timely access to specialists, use guideline driven testing and treatment, and employ comprehensive diagnostic testing.
- Sub-Specialty Care and Emergency Services – Standardize emergency care and protocols for complex patients requiring further evaluation and treatment.
- Advanced Therapies – Look at whether the right patients are receiving right complex procedures.Quality Improvement Project Guide Essay.
The Value of An Analytics Platform
To do all of these things effectively, healthcare systems need a robust analytics platform. In order to gain deep insights about the organization, its patients, and areas to maximize improvement, healthcare systems need a powerful analytics platform that brings data from many sources into a single source of truth. This allows an improvement team to evaluate the care that’s being provided, the impact on outcomes, and the impact on the cost of care. Once all the data is gathered, the next step is to decide what information to focus on.Quality Improvement Project Guide Essay.
Reliable Information that Produces Sparks
Once health systems have all the data they need brought together in an analytics platform, they need to decide what information to focus on. Assembling an improvement team is necessary to evaluate and assess ideas for improvement work. There are many great sources of information that spark ideas and excitement once improvement teams begin their work. These could include:Quality Improvement Project Guide Essay.
- Financial variance analysis.
- Payer contract data.
- Operational variance analysis.
- Data analysis.
- National benchmark data.
- Patient survey results.
- Patient complaint reports.
- Individual ideas.
Sparks for improvement ideas can also come from looking at processes, such as ideation sessions with subject matter experts, process mapping, or operational analysis. The more improvement teams begin to identify gaps in care, unintended variation, and other high-impact improvements that can be made, the more clinicians, frontline leaders, and staff begin to engage in the process and put forth new and higher quality ideas. As the permeation of quality increases, so do the quality and quantity of new sparks.Quality Improvement Project Guide Essay.
Identifying and Evaluating Emerging Healthcare Technology
In particular, health systems should identify ideas related to emerging healthcare technology. So, how or where can a health system identify these sparks? While ideas are everywhere, some great places to identify potential ideas related to new technology might include supply chain or operations, cost analyses, or physician and staff questions.
Knowing What Data to Use
Improvement teams need to begin by asking, “What data should be used?” The roadmap of an improvement journey begins there and then might take the following path by answering each of the questions or following the steps below:Quality Improvement Project Guide Essay.
- They must first create an initial hypothesis and then look at what data is needed.
- Where is the information documented: EMR, billing, other systems?
- Is it discrete?
- Is it consistently documented?
- Is it in the analytics platform?
- Can it be matched at the appropriate level (procedure v. encounter)?
- Run the analysis.
- Do the results match the hypothesis?
- What other filters need to be applied?
- Rerun the analysis.
- Present to stakeholders for feedback.
- Add additional filters as needed.
At this point in the data journey, the improvement team may take these results back to the subject matter experts and find out if the results make sense, if there are obvious gaps, etc. The goal is to then have data that is valuable in terms of analytical output and valuable to providers in informing clinical decision-making.Quality Improvement Project Guide Essay.
The Difference Between Efficacy and Effectiveness in Evaluation of Emerging Healthcare Technology
Technological improvements in healthcare have saved many lives and improved the quality of life for even more. Technology changed experiences for patients and families and impacted medical processes and the practices of healthcare professionals. However, there are so many new medical devices and other technologies entering the healthcare space that health systems and providers need to exercise caution and thoroughly evaluate the safety and effectiveness of new technologies before implementation. It’s important to strike the right balance between efficacy and effectiveness in the evaluation of emerging healthcare technology. The graph below shows the drastic increase in FDA Pre-Market Approvals of medical devices and reinforces the need for evaluation.Quality Improvement Project Guide Essay.
Figure 1: FDA Pre-Market Approvals of medical devices continue to rise almost every year.
It can be difficult to strike this balance as many medical professionals are looking for the next shiny, new thing. Health systems have to be able to differentiate between case studies in specific segmented populations versus the real-world implementation of new technologies. In practice, most patient populations are heterogenous and differ greatly from the homogeneous patient population where testing of new technology occurs. The overarching problem in moving from efficacy to effectiveness is understanding what new therapies or devices will truly support the mission of providing better quality care, better outcomes and lower costs. Oftentimes, new technologies, when placed into real-world settings, will end up being very costly and may not provide any additional benefits for patients.Quality Improvement Project Guide Essay.
Learning Key Lessons
Improvement teams can learn the following valuable lessons for evaluating emerging healthcare technology:
- Engage stakeholders throughout project.
- Clinical expertise, operational expertise, and data analytical expertise are critical for success.
- It’s important to be transparent about the motivation for the project.
- Health systems must have robust data and analytics to evaluate effectiveness in the practice setting.
While healthcare technology continues to advance rapidly, sound assessment with non-homogenous patient populations lags significantly behind. Ultimately, health systems need to be able to make their own decisions regarding implementation of emerging healthcare technology and other high-impact projects. Doing so requires a robust analytics platform.Quality Improvement Project Guide Essay.