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

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Unit 2: Improving Operations through Evidence-Based Medicine and Balanced Scorecards AHS 403
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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
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The cure to wide variation in clinical practice: the consistent application of EBM Major tool: the clinical guideline (also known as a protocol) Institute of Medicine definition: “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” National Guideline Clearinghouse http://www.guideline.gov 3
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Disagreement on the science underlying a guideline Challenge to professional autonomy “cookbook medicine” Lack of variation in treatment approaches decreases “natural” discoveries 4
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All clinical care is a mix of custom and standardized care processes High-quality organizations Master the art of custom care Optimize the science and consistent delivery of standard care 5
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6 Custom Custom and Standard Health Care Separate and Select Standard Sorting Re-sorting Examples: Laser eye surgery Minute clinic 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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7 Custom Separate and Accommodate Standard Sorting Re-sorting Example: Duke Cardiology Clinic Patients sorted by protocol Nurse practitioners provide standard care Cardiologists provide custom care Every fourth visit, standard patients are evaluated by the nurse practitioner and physician
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8 Custom Modularize Standard Sorting Re-sorting Example: Andrews AFB Clinic Physician serves as architect—care designer Physician performs evaluation and creates plan Standard care provided by other organizations and departments Hypertension modules: weight control, diet, drug therapy, stress modification, surveillance
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9 Custom Integrated Standard Sorting Re-sorting Example: Intermountain Healthcare Identified 62 standard processes—90 percent of inpatients Standard processes built into emergency medical record Physician encouraged to override standard care as needed Overrides are recorded, analyzed, and used to improve standard process
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Savings in the system can be achieved by consistent, high-quality ambulatory care, which prevents unneeded hospital admissions AHRQ has identified a set of ambulatory care sensitive conditions, which are measured with prevention quality indicators (PQIs) 10
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Public reporting Pay for performance Tiered systems of care 11
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12 What gets measured gets managed
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This note was uploaded on 08/21/2011 for the course AHS 403 taught by Professor Paustian during the Summer '11 term at University of Alabama at Birmingham.

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

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