How Progressive Hospitals Operationalize Their Quality Data

You’ve got your quality data. Now what?

Hospitals don’t lack for data on quality outcomes. The real question is what to do with it. Even after making sure the data is sound—by checking documentation, coding for accuracy, and verifying the integrity of data in the EHR, for example—people often wonder how to understand and use the information.

There aren’t easy answers. But, there are good answers and many, many good examples. A number of 3M customers are improving patient outcomes through deliberate and innovative uses of their quality data.
If you find yourself looking at a mass of quality measures, wondering what to do with your dashboard, you could look to what some hospitals have done and where they are going next with their data. Here is what I’ve learned from their experiences.

Choose meaningful metrics, not just statistics. The most useful quality measures can be tracked over time and linked to clinical practice. DRGs and similar risk-adjusted metrics provide a way to quantify patient outcomes, compare patient groups, and measure costs. Hospitals on the leading edge of quality improvement also measure health risk and avoidable hospital services—potentially preventable readmissions complications, ED visits, ancillary services, and initial hospitalizations.

Target “impactibility” in areas of high cost and high variation. High rates might only be a lot of smoke, whether for readmissions, complications, utilization, patient non-compliance, etc. The hot spots are in areas of high costs or high variation:

  • Facilities, departments, and service lines where actual rates are far different from what you would expect
  • Areas where changes in the delivery of care would improve efficiency and profitability

Set a clear mission and assign the right messenger to engage clinicians. There is a point where all quality improvement efforts require change in the way care is delivered. The best way to influence these changes is with executive level support from your medical director and a designated liaison to work diplomatically with nursing staff and physicians.

Risk-adjust data to reflect patient severity of illness. Otherwise physicians with sicker-than-average patients will reject the results. Stratify your patient population by risk level so that clinicians can define appropriate care for each level. For example, one organization used risk-adjusted data to stratify a large pediatric population into categories as healthy, chronic (one chronic condition), complex (two or more chronic conditions) and critical (high severity). Each category shared similar utilization patterns and clinical characteristics. The organization then recommended guidelines for cost-effective care: standardize care for health members, manage outpatient care for chronic members, reduce utilization of avoidable hospital services by complex members, and effectively coordinate care for critical patients.

Monitor how well providers comply with protocols, and compare the results with trends in quality outcomes. One 3M site, for example, tackled pneumonia, urinary tract infections, clostridium difficile colitis, and decubitus ulcers, conditions where actual rates were higher than expected. As the hospital became more vigilant in following best practices and documenting compliance, they saw a reduction in complication rates and length of stay.

Share data, and share stories. The data represents what is real and what is measurable. Stories convey what is personal and what can be changed. Call them what you will—best practices, lessons learned, success stories—good quality reporting combines data with an account of who tackled the problem and how they solve it. Stories come about from listening to what people across disciplines have to say, not just measuring their performance. For example, one large health system realized that to get the value out of the data in their EHR, they needed to do more than build a data warehouse and dashboards. They talked with clinicians, pharmacists, social workers, and others about what was working and listened to what people said they needed to succeed. Then they built an IT infrastructure that helps people get information and share experiences across disciplines.

Kristine Daynes is a marketing manager at 3M Health Information Systems.

 

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