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Quality Improvement & Data Systems for Performance
ExcellenceBoard and Executive Learning Series
June 2, 2012
Lucy A. Savitz, Ph.D., MBADirector of Research and
Education
Institute for Health Care Delivery Research
The Quality Challenge“the difference between the care we deliver and the care
we could deliver”
The Right Care
For The Right Person
At The Right Time
Care Delivery Falls Short of Potential
• Well-documented, massive variation in practices
• High rates of inappropriate care
• Unacceptable rates of preventable care-associated patient injury & death
• A striking inability to do what we know works
• Huge amounts of waste (>44%), spiraling prices, and limited access
Need for a Healthcare System that Learns
We require a sustainable system
• That gets the right care to the right person at the right time
and then
• Captures the results for making improvements.
Mission Critical Support for Performance Excellence
Training Clinical Integration
Foundation for Robust QI &
Delivery Science Research
Data Systems
Driving Change
• We combined our QUE “research” experience with Deming’s quality theory to create a series of training programs.
ATP Training, 1992-present
• 500+ Intermountain Staff
• 1,800+ External Participants
Training used to drive culture change.
Brent James, MD, M.Stat. , Chief Quality OfficerDirector and Founder; Institute for Health Care Delivery Research
Clinical Integration
• Clinical work process-based organizational structure
• A fundamental idea of QI theory is to identify key work processes then organize around them.
• A limited number of these key processes make up the majority of services you provide to patients.
Integrated Reporting and Analysis
EDWEDWFinancial
Data
FinancialData
Clinical Data
Clinical Data
Claims&Eligibility
Claims&Eligibility
Data Systems
HELP
Pharmacy Pharmacy
Radiology Radiology
Data Entry(CW)
& Results Review
EventMonitor
Billing &Financial
MedicalLogic
Modules
Medical Dictionaries
Database
Research& Analysis
(EDW)Patient Care
Database(CDR)
DatabaseInterface
LaboratoryLaboratory
2
InsurancePlans
Case for Continuous Improvement
Incorporating
• Innovation
• Disciplined QI
• Research & Evaluation
Critical to finding new designs/solutions for optimizing:
• Patient experience
• Health of the population
• Controlling cost/reducing waste.
The Problem
Reducing variation in compliance with evidence-based guidelines.
• Care Process Models (CPMs) are narrative documents that aim at representing state-of-the-art medical knowledge.
• Clinical Decision Support Tools can include all ways in which health care knowledge is represented in health information systems.
Key steps in our approach…
• Identify problem• Establish evidence base• Develop, test, & implement using QI
concepts and tools (define, measure, analyze, improve, control)
Institute for Health Care Delivery Research: Staffing
Leadership: 3.0 FTEs
Brent James, MD, M.Stat.; Executive Director
Lucy Savitz, Ph.D., MBA; Director, Research & Education
Todd Allen, MD; Assistant Quality Officer
Support Staff:
• Clinical Program Analysts: 13.25 FTEs
• Education Program Staff: 4.25 FTEs
• Program Support Staff: 4.5 FTEs
• Interns/Fellows: 3.0 FTEs
Core Functions of the Institute—supporting a Learning Commons
1. QI Training
2. Clinical Program Support, data examination to create the learning organization
3. Delivery System Transformation Support
4. Operationally Meaningful Research
5. Collaborations
6. Dissemination & Shared Learning
Scientific Approach to QIIOM: Selker, H et al., 10/11.
• Clear, measurable process & outcomes goals
• Basis in evidence
• Iterative testing
• Appropriate analytic methods
• Documented results
QI: Role in Driving Evidence Base
QI
ImplementationScience
ProgramEvaluation
Qausi-experimental
InterventionStudies(Trials)
Clinical Effectiveness
Outcomes
Driving the science of change/innovation…
Selected References
• Wallace, J, LA Savitz: Estimating Waste in Frontline Health Care Workers, Journal of Evaluation in Clinical Practice, 14:178-180, 2008.
• Clark, DD, LA Savitz, SB Pingree: “Cost Cutting in Health Systems Without Compromising Quality,” Frontiers of Health Services Management, 27(2):19-30, 2010.
• James, BC & LA Savitz: “How Intermountain Trimmed Health Care Costs Through Robust Quality Improvement Efforts,” Health Affairs, 30(6), 2011.
• Selker, H, C Grossman, A Adams, D Goldman, C Dexii, G Meyer, V Roger, L Savitz, R Platt: “The Common Rule and Continuous Improvement in health Care, A Learning System Perspective, IOM, October, 2011.
• Luther, K & LA Savitz: “Leaders Challenged to Reduce Cost, Deliver More,” Healthcare Executive, Jan/Feb, 2012.
Thank you.
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