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What's the Key to Evidence-Based Quality Improvement? It's in the Metrics.

You're the owner of a pizza joint and want to improve timely delivery of pizza. Before diving in, ask yourself: What are you trying to accomplish? How will you know a change is an improvement? What change can you make that will result in an improvement? These fundamentals of the Institute for Healthcare Improvement(IHI)'s Model for Improvement can be applied to any improvement initiative.

Every day, quality improvement consultants at the James M. Anderson Center for Health Systems Excellence (the Anderson Center) present these same questions to Cincinnati Children's Hospital Medical Center (Cincinnati Children's) clinical teams. Established in 2010, the Anderson Center aims to dramatically expand Cincinnati Children's work in quality improvement (QI). During the past six years, John Lynn Jefferies, MD, MPH, FAAP, FACC, Director of the Advanced Heart Failure and Cardiomyopathy Services at Cincinnati Children’s, has worked closely with the Anderson Center's James M. Brown, Senior Quality Improvement Consultant on a significant condition outcomes improvement (COI) project objective: Improve clinical outcomes of Cardiomyopathy Clinic pediatric patients within the Heart Institute at Cincinnati Children's.

Prior to 2010, no formal cardiomyopathy program existed at Cincinnati Children’s. Today, with over 5,000 pediatric and adult patients, the program is one of the largest in the country, receiving 10-15 new referrals every week. Utilizing IHI's Model for Healthcare Improvement, including Plan-Do-Study-Act, Dr. Jefferies and Brown have learned the following while striving to meet their project objective.

  • Plan: Determine how to be most effective. Before beginning a QI project, evaluate your scope of work and staffing. This will enable you to effectively implement direct interventions that can be sustained. These steps allowed Cincinnati Children's to facilitate care coordination through standardized processes, creating a registry, implementing a process for reliable data entry a point of care and developing quality improvement metrics reports.
  • Do: Make it easy to do the right thing. If it is not easy for Cincinnati Children's clinical staff to submit reliable data at point of care, valuable information is lost. Take the time to build processes and educate new hires. Adoption requires action and support, so lead by example.
  • Study: Expand care to the whole patient. Cincinnati Children's leverages patient-reported outcome data to expand care to the whole patient, not just treat cardiovascular disease. For example, because Cardiomyopathy Clinic pediatric patients complete pre-clinical and post clinical surveys on anxiety and depression, the hospital was able to measure a 67% improved depression score and 65% improved anxiety score. Use metrics to assess the status of your project objective, but also study data to determine all of your patients' needs.
  • Act: Never stop striving. Cincinnati Children's project execution allows the hospital to track patient metrics leading to evidence-based QI. However, there's always room to improve patient outcomes and clinical care. If you met your COI objective, push forward. Cincinnati Children's future goals include working as a team to determine what's important to patients based on registry data, providing individualized care and making care affordable by identifying inefficiencies and empowering patients and families in self care.

The Advanced Heart Failure Clinic within the Heart Institute at Cincinnati Children’s was the first to be accredited by the Battelle Healthcare Colloquium and has served as a benchmark for subsequent pediatric heart failure programs seeking accreditation. Dr. Jefferies serves as the Colloquium's Medical Advisor, supporting membership by providing clinical expertise in heart failure program improvement, hospital quality issues and other healthcare improvement initiatives as needed.

Are you a Colloquium member? Watch the CardioConnect webinar on this topic on the Member Portal.