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Groups often want to start projects by creating a list of "all patients with ________ (a particular condition)." Usually, one way to accomplish this is to review medical records. If a team wants to track the rate of severe pain on the hospital's third floor, the denominator has to be the patients on that floor over a specified time. If a team wants to track and improve continuity of care by making opioid drugs available after hospital discharge among patients who have trouble paying for medication, the registry might be a list of all patients who are receiving opioids in their last two days of hospitalization. That list might be readily made from pharmacy or billing records, even if the hospital does not have an automated clinical record.
Sometimes the MIS-generated list needs to be reviewed and revised. For example, one team uses its MIS to generate a monthly list of all patients (and their diagnoses) seen by each particular physician in a primary care clinic. The physician then reviews the list for people who are "sick enough that death in the next few months would not be a surprise." The team uses the resulting patient list to target counseling, symptom management, advance planning, and family support.
One institution aimed to improve decisions about resuscitation. One very efficient monitor was the simple rate of CPRs at death divided by total deaths.
In short, information systems are useful in creating lists of patients with whom to target interventions or monitor events.
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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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