Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : Improving Care for the End of Life : 10.0 Ways to Use Information Systems in Quality Improvement

If you don't know where you're going, you'll probably get lost.
- Yogi Berra

Beyond Number Crunching

Information management is critical to good patient care: Tracking clinical data, along with the administrative data for billing and staffing, is a key element for resource management. Groups aiming for breakthrough change should view the information system as a tool that can be quite efficient in measuring patient care and the effects of change on that care.

Measuring change is essential, but it must not overwhelm the team's work or become its central task. Groups do not want to devise elegant measures for a lack of improvement!

One way to be more efficient in improvement work is to use the management information systems (MIS) developed for service delivery, either patient care or program management, as a quality improvement tool. For example, an automated medical record can have a "pop-up" query asking if an ICU patient has an advance directive. This prompt is likely to get questions asked and responses documented. By having this query in every medical record, the system can put in place an automated record to tally advance care plans.

Hospital record-keeping systems routinely collect data that can be used to measure quality improvement. For example, staffing data can become a measure of continuity of care: How many nurses visited a hospice patient in one week? How many hospice patients saw more than three different home health aides in any given week? How many families called the after-hours answering services? (For more details, read chapter 7 to learn how Hope Hospice used this approach to improve continuity of care.) How many late-stage heart failure patients were admitted to the hospital emergency room? Financial data can show when cases are opened or closed (and, as a result, how long a patient was in a system) and the services billed for the patient (e.g., home infusion therapy, skilled nursing care, and so on).

Looking at administrative data from a different perspective can reveal much about where change is needed - and the effect of such change.

In This Chapter

Health care programs require systems to gather information to manage services and billings. In some organizations, these systems are also designed to monitor and support quality improvement. This chapter gives ideas for how to use the MIS for improvement and introduces some rather extraordinary systems developed specifically to support quality monitoring and improvement. The major ways teams have used MIS to improve end-of-life care include:

Innovators Need to Know

  • Tracking changes through data collection is essential to know whether a change is an improvement.
  • Go beyond information collected for clinical records and use other information systems to track quality improvement: Billings can track emergency room admissions for heart failure patients, for instance, and human resources can determine how many different providers visited a patient in any given month.
  • Paper medical records provide a starting point for finding patients to include in interventions and for periodically tallying specific changes.
  • Changing the information on existing forms to include new questions - e.g., "Do you have an advance directive in your medical record?" - can be its own innovation.

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].

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