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Sometimes, the existing MIS contains the numerator and the denominator for a study. A team that aims to reduce exacerbations of heart failure can tally emergency room visits and/or hospitalizations for a patient population defined as ever having been hospitalized for heart failure. If the team knows that virtually all exacerbations will be treated in its facility, it can track improvement entirely from billing data. In general, existing administrative data can be used to track most aims that center on utilization rates.
Other items commonly found in administrative data are prescription drugs, orders against resuscitation, and treatments for specific problems, such as skin breakdown. Since there is virtually no justified use for meperidine in chronic pain, a simple declining rate of its use helps to document improvement in prescribing practices.
Even if a team needs to measure some other aspects of care to be sure of improvement, having some core measure that is so easy to obtain (and thus never has missing values) is a real boost to enthusiasm. Most team members love clinical care and evidence of improvement - but they only tolerate data collection. It is easier to stay involved if data collection and measurement are easy.
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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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