Tuesday, August 12, 2014

Quality Improvement Ver. 2.0?

Throughout its medical career, it's safe to say that the Population Health Blog has been quality-improvement ("QI") averse. While the PHB "got" the need for measurable outcomes, the jargon ("barrier analysis"), expertise (careerism) and culture (heavy on "administration") made it treat QI like an EHR alert: something to be tolerated, not embraced.   

After reading this on-line AHRQ manuscript on primary care QI, however, the PHB is reconsidering the topic.

Naturally, for all the wrong reasons.
The PHB explains.

According to the brief:

1) QI can be defined as continuously assessing performance over time to make ongoing adjustments in care processes  Like it or not, QI is being increasingly linked to licensing, accreditation, public reporting, media scrutiny, payor involvement and growing patient consumerism. It's true for hospitals, and it's just a matter of time until that extends to the outpatient arena.

2) Unfortunately, QI needs the three things that are in short supply in most outpatient settings: staffing, resources and commitment. Two other challenges include the never-ending work of patient care and the lack of any direct or indirect financial benefit. 

3) As a result, if primary care practices are going to meaningfully "do" QI, they'll need external support.  That means personnel/consultants who can train, provide technical assistance, find resources or suggest best practices. Large health systems may be able to adapt this from their hospital QI programs.  Smaller or independent clinics may have to turn to the overlapping regional alphabet soup of AHECs, RECs, QIOs, PBRNs, payer, employer and professional initiatives paid for by the Feds, states, insurers and foundations.  The chances of success will be greater if there are financial incentives (such as a piece of any shared savings) and networked learning involving other like-minded clinics.

The PHB's knows the AHRQ authors mean well, but wonders if it isn't time to start thinking about QI Ver. 2.0.  It would involve some of the following elements:

Turn key: easy to import with absolute minimum fuss, time to implementation, workflow disruptions and reliance on human guidance.

A contracted entity can remotely tap computerized billing, insurance claims or electronic record systems in a matter of days, letting the docs continue to focus on patient care.  If patient surveys are necessary, use text messaging or interactive voice response.

High tech: Cloud-based data collection, storage and reporting.  All the better if it's automated and scalable.

Once the data are collected, computers can calculate trends, means, standard deviations and statistical significance.  The process can be standardized and auditable.

Decision support: Link any insights to the artificial intelligence that guides patient care.

As point-of-care guidance on diagnosis or therapy grows more sophisticated, it can use the clinic's QI data to change processes and improve outcomes.

By the way, the PHB suggests one entity that is best able to champion this are the population-health care management programs.  They understand the need, possess much of the technology and could use QI to further their value proposition.

Image from Wikipedia

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