The doctor side of primary care innovation
In the wake of health care reform, hospitals across the nation are challenged to deliver the highest quality of care in the most efficient manner. In order to accomplish this, medicine is borrowing a page from aviation by developing Evidence-based Order sets. Physicians, in collaboration with their peers, decide on a “best practice” checklist for a number of conditions seen in the hospital. Once agreed upon, these checklists are utilized for every patient with that condition, every time. These documented “best practices” ensure the highest quality of care, improved outcomes and increased patient safety and satisfaction.
At Saint Anthony Memorial, I am very proud to say that our physicians and staff have been leaders in implementing specific clinical support tools, including evidence-based order sets, plans of care, decision rules and practice guidelines into their everyday patient treatment procedures. As a model of success, we were asked to share some of our best practices with peers and other health care practitioners at the Zynx Health National User Conference, alongside Johns Hopkins University and the Iowa Health System.
These simple checklists have reduced errors and infections, and improved patient outcomes, safety and quality of care.
It is clear that evidenced-based health care is rapidly becoming the standard for leading hospitals and clinics throughout the nation. The fact that treatments can vary widely from region to region, along with the cost, is proof that best practices and standardization are needed. Electronic medical records (EMR) are another way for physicians to align what they are doing with what the best evidence suggests. More than just an electronic version of paper records, these new patient records offer decision support to physicians, reminding them when a test is needed, or flagging a disturbing trend in the health history or when test results become available. The EMR can also provide instant access to textbooks and journals, and warn physicians about risk factors and drug interactions. With a wealth of knowledge at their fingertips, this instant access serves as a co-pilot to physicians; a back-up system that ensures a level of safety and well being for patients that is unparalleled in the past.
At this point in time, most health care is designed to treat patients when they are sick. With the advent of Accountable Care Organizations (ACO), hospitals and health care professionals will receive incentives to keep patients healthy and out of the hospital. The Medicare Payment Advisory Commission recommended to Congress the ACO model for patient care to improve quality and lower costs, and the health reform bill also includes plans for a pilot program. (Source, Harvard Business Review, March 8, 2010) No matter what path health care reform takes, it seems logical that keeping patients healthy and offering incentives to physicians and hospitals for that purpose is a good use of resources.
For health care reform to succeed, hospitals will have to find more efficient and innovative ways to deliver quality care to patients. Saint Anthony Memorial has launched a Quality Rounding program, in which the quality team rounds on patients alongside physicians, fostering a teamwork approach to meet CMS standards compliance. Saint Anthony Memorial received the 2010 Anthem Successful Practice Award for the Quality Rounding program developed by our Quality team. The award recognized one hospital from Indiana, Ohio and Kentucky for successful implementation of outcomes-based, patient care-driven quality initiatives. Saint Anthony Memorial was the only hospital to win in the Core Measure Standards Quality Rounding category.
The goal of the Quality Rounding program is to elevate the quality and consistency of patient care delivery through improvement with compliance to the CMS Core Measure Standards. Working closely with physicians, the CMS data analyst and data abstractor round daily with physicians and staff to review patient records concurrently, and identify opportunities for CMS compliance, rather than waiting until after discharge to review the charts. Addressing these opportunities while the patient is still in the hospital fosters a sense of understanding and accountability among staff and physicians. This multidisciplinary approach, with continual education and feedback, ensures consistent, high quality care at Saint Anthony Memorial.
Anthem has requested permission to place the Quality Rounding program developed at Saint Anthony Memorial on the Anthem hospital website, so that other facilities can review the program and adopt this as a best practice. In order for hospitals to survive the challenges presented by health care reform, we must constantly review and improve the processes we have in place, and where appropriate, share the successes we have implemented. This is in the best interest of our patients, and in the best interest of the healthcare industry. The future of health care depends on a strong, efficient and caring network of healthcare providers. At Saint Anthony Memorial, we are proud to contribute in any way possible toward the quality of care and safety of all patients.