The Use of Decision Support Systems in Continuous Quality Improvement

1
The Use of Decision Support Systems in Continuous
Quality Improvement

• Janice Kaczmarek
• Susan Lovejoy

2
Problem with CQI in Health Care

• Many healthcare organizations have implemented
  quality improvement measures as a means to
  improve outcomes, but do not have an information
  tracking system to
• Analyze clinical data
• Monitor utilization and costs
• Track outcomes

3
Intermountain Health Care

• Given that you manage what you measure, we
  have to extend our efforts beyond the financial
  measures that have traditionally driven
  healthcare delivery systems.
• Dr. Brent James, V.P.
• Intermountain Health Cares Medical
  Research

4
What is Driving the Need for CQI?

• Provider accountability by insurers, consumers,
  government
• Need to eliminate unnecessary treatment and
  procedures
• Attempt to minimize the large variations in
  practice patterns
• Control medical expenses
• Improve patient outcomes

5
What is CQI?

• Continuous Quality Improvement strategies or
  methods used to improve upon existing systems or
  techniques in an effort to provide better quality
  products and/or services to consumers.
• CQI is not limited to health care, it has been
  used throughout the centuries in all types of
  industries.
• Other Names
• Total Quality Management (TQM)
• Quality Assurance (QA)
• Quality Improvement (QI)

6
Clinical QI at IHC

• Clinical Project
• Fast track extubation in TICU
• Long-term Ventilator management
• HFOV (RDS in premature newborns
• Shock Trauma Respiratory ICU
• Antibiotic Assistant
• Pediatric ICU
• Infection prophylaxis in surgery
• Adverse drug event prevention
• Community-acquired pneumonia
• Ventilator support for hypoxemia
• Group B strep sepsis of newborn

• Cost Structure Improvement
• 5.5
• 4.7
• 3.7
• 2.5
• 1.2
• .7
• .6
• .5
• .5
• .5
• .3
• 20.7

7
Tools for Quality Improvement

• Plan-Do-Check-Act Cycle (PDCA)
• Guidelines
• Clinical/critical pathways
• Computer-based clinical decision support systems
  (CDSS)
• Alerting Systems
• Assisting Systems
• Critiquing Systems
• Diagnosing Systems
• Reminding Systems

8
Outcomes-FYI

• Outcomes are states or conditions of individuals
  and populations attributed to antecedent health
  care.
• Not a direct reflection of quality of care.
• Relationship between process and outcome is a
  probability and may be modified by factors other
  than health care.
• Large sample sizes required to obtain results
  that are meaningful, which take a long time to
  collect.

9
Three Classes of Outcomes

• Physical Outcomes
• Complications
• Changes in biological function
• Functional status measures
• Service Outcomes
• Satisfaction surveys
• Cost Outcomes

10
NovaMedica Application

• Clinical Performance Improvement Package
• Developed in collaboration with Intermountain
  Health Care.
• Designed to track clinical performance and
  patient outcomes.
• Utilized by clinicians, managers other members of
  Intermountain as outcomes, educational, and
  marketing tool.

11
Example of NovaMedica http//www.novamedica.com/
12
Gaps in Existing Approaches

• Lack of integration of current systems
• Inability to generate useful information with
  existing system
• Lack of consensus on most meaningful outcomes
  measures
• Limited implementation of electronic medical
  record
• Resistance to utilize information systems for
  outcomes purposes

13
Potential Solutions

• Investment in information system integration,
  including the electronic medical record
• Consensus on a limited set of appropriate outcome
  measures
• Increased education to provider community on the
  benefits of electronic outcomes tracking