Evidence Based Process Measures:

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Evidence Based Process Measures A Key to Success
Under Pay-for-Performance
Mark L. Braunstein, MD Chairman and CEO
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Institute of MedicineCrossing the Quality Chasm
In the absence of a national commitment and
financial support to build a national health
information infrastructure, the committee
believes that progress on quality improvement
will be painfully slow. -- March, 2001
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President BushState of the Union Address
By computerizing health records, we can avoid
dangerous medical mistakes, reduce costs, and
improve care. -- January, 2004
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IOMThe Diagnosis
The U.S. health care delivery system does not
provide consistent, high-quality medical care to
all people. Americans should be able to count on
receiving care that meets their needs and is
based on the best scientific knowledge -- yet
there is strong evidence that this frequently is
not the case.
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IOMThe Prescription
Provide an opportunity for providers to share in
the benefits of quality improvement. Rewards
should be located close to the level at which the
reengineering and process redesign needed to
improve quality are likely to take place.
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Congress should adopt pay-for-performance program
s for hospitals, home health agencies, and
physicians.
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These practices can be translated into measures
of the process of care.
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• Factors Under the Providers Control
• Encourage Evidence-based Practice
• Encourage Better Information Systems

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Assessing Care of Vulnerable Elders (ACOVE)
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ALL vulnerable elders should have documentation
that they were asked about or examined for the
presence of balance or gait disturbances at least
once.
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IF a CHF patient is newly diagnosed,
THEN education about disease management should be
provided and documented.
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Outcome vs Process Measures
An outcome measure looks at results while a
process measure looks at the intermediary actions
necessary to achieve those results.
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Outcome vs Process Measures
Outcome measures are inherently retrospective
process measures, at least in principle, can be
used prospectively.
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Process measures look at the flow of work between
and among people. A common example in physicians
is CPOE.
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• Communications breakdowns
• Things slipping between the cracks
• Manual work arounds

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Presuming that we have successfully isolated the
right queries or program logic used to identify a
business opportunity as part of our BI program,
it is worthwhile to attempt to automate that
logic to free analyst resources for exploring new
opportunities. For example, if our BI process has
exposed a sequence of events that take place
before a customer closes a bank account, it would
be worthwhile to imbed the knowledge of that
sequence in an operational framework that can
identify the sequence at an early stage and alert
the proper agent within that workflow to contact
the customer before the undesired event takes
place.
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The Right Care for Every Person Every Time.