unit2 - Unit 2: Improving Operations through Evidence Based...

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1 Unit 2: ImprovingOperations through Evidence Ǧ Based Medicine and Balanced Scorecards AHS 403 ± Medical progress ± Laboratory experiments ± Clinical trials ± Translation to clinical practice ± However, translation to practice is poorly executed ± Structural, motivational, economic barriers ± Result widespread variation in practice and inconsistent quality 2 ± The cure to wide variation in clinical practice: the consistent application of EBM ± Major tool: the clinical guideline (also known as a protocol protocol) ± Institute of Medicine definition: ±systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances² ± National Guideline Clearinghouse ± http://www.guideline.gov 3 ± Disagreement on the science underlying a guideline ± Challenge to professional autonomy ±cookbook medicine² ± Lack of variation in treatment approaches decreases ±natural² discoveries 4 ± All clinical care is a mix of custom and standardized care processes ± High Ǧ quality organizations ± Master the art of custom care ± Optimize the science and consistent delivery of standard care 5 Custom and Standard Health Care Separate and Select Examples: •Laser eye surgery • Minute clinic 6 Custom Standard Sorting Re-sorting Patients self-select Source: Bohmer, Richard. 2005. Medicine’s Service Challenge: Blending Custom and Standard Care.” Healthcare Management Review Oct.–Dec.
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2 Separate and Accommodate Example: Duke Cardiology Clinic •Pa t ien ts sor ted by pro toco l •Nurse prac t i t ioners prov ide standard care •Card io log is cus tom care 7 Custom Standard Sorting Re-sorting •Every four th v i t , s tandard patients are evaluated by the nurse practitioner and physician Modularize Example: Andrews AFB Clinic •Phys ic ian serves as architect—care designer per forms eva lua t ion and creates plan •S care ided other organizations and 8 Custom Standard Sorting Re-sorting other organizations and departments •Hyper tens modu les : we igh t control, diet, drug therapy, stress modification, surveillance Integrated Example: Intermountain Healthcare •Iden t i f ied 62 s processes—90 percent of inpatients processes bu i l t in to emergency medical record •Physician encouraged to 9 Custom Standard Sorting Re-sorting override standard care as needed •Overr ides are recorded , analyzed, and used to improve standard process ± Savings in the system can be achieved by consistent, high Ǧ quality ambulatory care, which prevents unneeded hospita admission prevents unneeded hospital admissions ± AHRQ has identified a set of ambulatory care sensitive conditions, which are measured with prevention quality indicators (PQIs) 10 ± Public reporting ± Pay for performance ±
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unit2 - Unit 2: Improving Operations through Evidence Based...

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