Emerging Technologies

Quality Improvement Models for Better Care and Lowered Costs

Care team using quality improvement models

Jonathan French, CPHIMS, SHIMSSMany organizations are in the early stages of using clinical quality data as a tool to change standard practice and workflow. Organizations that successfully leverage this data to identify gaps in care, review workflows and interventions, and then pivot as the data suggests, have the opportunity to provide better care while lowering costs.

Two Davies Award recipients made significant changes to enhance care outcomes and in turn became more cost efficient. Sparrow Health System and University of North Carolina Health embraced the benefits of leveraging data to drive rapid-cycle quality improvement in healthcare and resilient workflow and information technology redesign to improve patient quality.

Changing Course to Battle CAUTI

Sparrow Health System had no formal program in place to address catheter-associated urinary tract infections (CAUTIs) when they implemented their enterprise-wide EHR. Sparrow looked to other programs for guidance on designing an IT-enabled CAUTI reduction program to standardize processes and documentation, paired with analytics to monitor performance. Sparrow modeled their program after Davies-recognized Texas Health Resources CAUTI program.

Unfortunately, CAUTI rates didn’t improve. Sparrow worked with a resilient clinical team using a comprehensive unit-based safety program model to reevaluate the process, people and technology needed to revamp this clinical program for success.

The team identified that their clinical decision support for documentation and tasks related to CAUTI was targeted toward Sparrow’s physicians, while most of the tasks related to CAUTI prevention were conducted by Sparrow’s nurses, like catheter management and timely removal. The clinical team worked with IT to redesign the CAUTI best practice alerts to face the nurses, and then added a mandatory nursing action to the Foley catheter order set. Model practices were established in policies, reinforced with professional reviews and outcomes-focused quality improvement measures, and made it easier for nurses to deliver the right care with alerts and standard orders.

As a result, Sparrow cut the number of CAUTIs from 52 to 20 or fewer with cost avoidance of over $1 million.

Modifying Prescribing Behavior with Analytics

A critical component to driving value-based care and quality improvement is changing prescribing behavior, particularly when a less expensive and equally clinically effective medication option exists. Physicians will often prescribe out of habit, even if the medication isn’t more effective and is more costly. UNC Health System decided to use analytics to change practice rather than utilize disruptive clinical decision support.

Two kinds of blood thinners used to treat patients receiving a percutaneous coronary intervention (PCI). One costs about 310 times as much as the other for each administration. UNC Health wanted to determine if the more cost effective medication was a feasible option.

The UNC Health interventional cardiologists piloted the more cost-effective option for patients undergoing a PCI to identify if there was a way of reducing costs without impacting care quality. Despite the pilot demonstrating that the less costly alternative is safe in most cases, adoption was slow, primarily because UNC did not incorporate any kind of data visualization to share with providers and promote accountability.

In response, UNC Health created a centralized PCI reporting dashboard. The dashboard includes quality improvement measures and outcomes benchmarking, clinical data from disparate systems, and cost data for supplies and medications from purchasing and inventory management systems.

Initial rollout of the dashboard created shared accountability for providers across the enterprise. However, when drilling down to individual physician data, it was clear that some providers had not changed their practice and continued to use the more expensive medication. UNC Health’s physician champions and cath lab leadership presented their findings to the non-compliant physicians and demonstrated that the alternative medication was clinically appropriate for the vast majority of the patients.

By leveraging the data to demonstrate quality improvement model practices for PCI patients, UNC Health reinforced their analytics dashboard as a reliable source of truth. This shift resulted in a cost savings of more than $400,000 in one year. By leveraging data and making changes through education, UNC Health added significant value for their patients.

HIMSS Davies Awards

The HIMSS Davies Award recognizes the thoughtful application of health information and technology to substantially improve clinical care delivery, patient outcomes and population health.

Begin Your Path to a Davies Award

Updated September 17, 2019