Clinical Practice Guidelines Successful Implementation in LTC IT Environment

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Clinical Practice Guidelines Successful
Implementation in LTC IT Environment
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What are CPGs

• Systematic review of research pertaining to a
  clinical question
• Evaluation of the strength of evidence supporting
  clinical decisions
• Recommendations on management

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Quality

• Currently defined by adherence to guidelines
• Moving toward measuring outcomes
• Analytics depend on robust clinical database
• Appropriate observations
• Chronicled over time.
• Subjected to multivariate analysis
• Unequivocal outcomes

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Trust

• Providers will tend to adopt guidelines from peer
  groups, not government
• Scientific validity rarely questioned
• Motivation always questioned
• Best interest of individual patients will always
  be the driving force for most physicians
• Majority of doctors believe guidelines are
  simplistic and biased
• Physician autonomy is often challenged

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Changing Practice

• Providing guidelines improves adoption
• Written guidelines rarely improves care
• Paper forms unique to each condition or guideline
  is problematic
• Most successful CPG implementations are
  multi-factorial interventions

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CPGs 2007

• Still compliance driven
• Nearly no evidence for LTC and functionally
  impaired frail aging population
• Defining optimal outcomes remains elusive
• Dying is not the worst thing in the world
• Data is owned by multiple stakeholders
• Some may not be incented by quality

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Automated solutions at the point of care and
CPGs based on respected sources is working at
Erickson
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Are you ready for CPGs?

• Vision
• What is the goal for this initiative
• Are you solving a problem or trying to lead?
• Values and Commitment
• Resources speak louder than words
• Readiness
• Is your organization already electronic?
• Leadership
• Is your medical director bought in?
• Will the staff receive data well?

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• Resources and Scoping
• Define the available data
• Define the point of care
• Define the interdisciplinary team
• User perspective and buy in
• Study existing workflows
• Optimize the value proposition
• Roles and Responsibilities
• CPGs create new opportunities for non physician
  generated assessments to have impact
• Build infrastructure to support interdisciplinary
  process
• Development
• Based on above factors
• CPGs should be simple but not transparent

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Execution

• Implementation and Roll out
• Careful peer review on content
• Validate analytics
• Pilot site with best team and validated process
• Training
• Multimedia and on site
• Training is not just technology but the clinical
  model
• Metrics
• Adoption
• Assessment
• Audits
• Outcomes

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Automated clinical data management must improve
the quality of interdisciplinary discourse and
but it must not reduce its quantity.
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Examples
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Key points

• Incorporate providers at all levels of
  development and execution
• Build clinical content for use at the point of
  care
• Create simplicity for providers while enhancing
  their control over content
• Feedback on adoption and other key metrics