How to Find the Best Interventions for Clinical Quality Improvement

Health systems rely on clinical quality improvement projects to drive better patient care, but meaningful changes can only come from an improvement team’s deliberate action. This action is called an intervention and addresses a clinical quality improvement process metric and higher-level outcome goal.

Selecting efficient, effective interventions can be a challenge without knowing where to start. In response, improvement teams can identify a process metric (a standard measurement used to evaluate a process) as a working template for clinical quality improvement projects. The process metric is written, measurable, and time-sensitive and ensures the clinical quality improvement team is on track to achieve its outcome goal (Figure 1).

Figure 1: The outcome goal development process.

Interventions: The Steps to Achieve Clinical Quality Improvements

Once a workgroup identifies a process metric, it does process mapping to identify the right intervention to implement and officially starts the clinical quality improvement process. Intervention types include a process intervention or an outcome measurement intervention.

A process intervention focuses on an activity or aspect of a care-delivery process, while an outcome measurement focuses on results and measures the effectiveness of the change in the care process. Not all process interventions will have a direct outcome. However, by focusing on care processes, improvement teams canmeasure the outcomeand identify areas with a direct impact on improvement.

当前的实践、临床医生的想法或输入，以及与工作流分析相一致的记录在案的最佳实践研究，都可以促进对干预措施的建议。在选择干预措施之前，改进团队应确定适当的数据集来衡量每次干预的成功(例如，针对2型糖尿病患者的干预措施降低了糖化血红蛋白水平)，并审查最新的文献，以确保团队遵循最新的最佳实践。

Data Highlights Process Inefficiencies and Care Gaps—A Critical Insight for Clinical Improvement

卫生系统通常以共同的结果目标(减少死亡率、住院时间、费用或再入院)作为临床改善项目的良好起点。For example, many health systems struggle to lowerhigh readmission rates对于心力衰竭患者，会给患者、卫生系统和支付人造成昂贵的医疗费用。

Before starting any clinical improvement project, a healthcare organization needs a comprehensive data platform (e.g., theHealth Catalyst® Data Operating System (DOS™)) that can aggregate data from multiple sources. Once the health system can access specific heart failure data, for example, the improvement team can identify areas for improvement and use that insight to create outcome goals and process metrics targeting these problem areas.

An example of an outcome goal for lowering high readmission rates for patients with heart failure could be: “To achieve and sustain a 30 percent reduction in the 30-day and a 15 percent reduction in the 90-day all-cause readmission rates for patients with heart failure in six months.” Associated process metrics would be to improve discharge bundle compliance from 45 to 70 percent within the next year or standardized diuresis protocol adherence from 55 to 75 percent in the next six months.

Process Metric Guides Interventions that Lead to Clinical Quality Improvement

After the health system has agreed on the process metric, the care team can create interventions that support the metric. The health system’s clinical leaders can develop evidence-based, heart failure-specific best practice readmission bundle interventions, such as the following:

• Schedule follow-up care before discharge: Before discharge, clinicians schedule follow-up care with patients. Patients with a high risk for readmission are scheduled within seven days when possible. All other patients are scheduled for follow-up care within 14 days.
• Reconcile medication:A physician reviews the patient’s medications within 48 hours of discharge and provides instructions on how to take them.
• Schedule follow-up phone calls:护理团队成员在患者出院后的特定时间内(基于患者再次入院的风险水平)打电话给患者，评估他们的情况，并询问他们对药物治疗是否有问题或担忧。

Data Measures an Intervention’s True Impact and Accounts for Downstream Implications

After the care teams decide on the best interventions (listed above), improvement teams can work with data experts to integrate intervention baselines and practices into theHeart Failure analytics accelerator, allowing clinicians and administrators to easily track and understand each intervention’s impact on readmissions. The analytic insight and the data visualization also allow teams to assess the interventions’ impact on costs and patient satisfaction.

Additionally, because the health system’s focus on reducing readmission rates could impact other areas, such as increased emergency department (ED) visits or decreasedpatient experiencescores, the teams could add balance measures to track ED encounters, observation stays, length of stay, and patient satisfaction rates. After six months, the care team can compare heart failure readmission data and see if the interventions have led to significant clinical improvements (e.g., a 10 percent reduction in 30-day heart failure readmission).

The Secret to Choosing a Successful Intervention: Data Visualization Dashboards

为临床改善目标和过程度量选择正确干预的秘密是选择提供收益(或改善)的东西，并提供维持这种收益的手段。例如，通过选择包括及时随访预约在内的心力衰竭干预措施，患者可以获得医疗监督和更好的护理。与此同时，医院通过在患者出院后不久对其进行监测，防止再次入院，同时也减少了与再次入院相关的经济处罚。

Many clinical improvement teams use custom dashboards to display the key metrics they want to monitor to track the intervention they have selected (Figure 2).

Figure 2: A heart failure patient follow-up dashboard.

这些仪表板帮助临床团队轻松地识别并维持收益。仪表板还允许团队成员监控关键指标，例如预定的后续预约的百分比以及与重新入学率的关系。通过提供团队目标的当前视图以及实现目标的实际可视化进展，临床团队避免陷入次优医疗实践。

Data, Dashboards, and Process Metrics Form a Triple Threat Approach to Clinical Improvement

为了使临床质量改进项目发挥作用——并保持工作团队成员必须创造一个促进成功的环境。首先，改进团队必须仔细选择最佳的过程度量，以影响项目和相关干预的更高层次的结果目标。然后，团队可以使用数据和数据可视化工具不断监测和衡量进展，以确保干预措施达到预期结果。通过持续的监控，改进团队可以立即识别出不期望的结果，减少浪费的时间和资源。通过遵循这一临床改进路线图，临床医生加强护理过程，使患者获得可用的最佳护理。

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. Using Improvement Science in Healthcare to Create True Change
2. Drive Better Outcomes with Four Data-Informed Patient Engagement Tactics
3. Six Steps Towards Meaningful, Ongoing Healthcare Performance Improvement
4. How Data Can Reduce Length of Stay and Keep the Revenue Stream Flowing
5. Improving Sepsis Care: Three Paths to Better Outcomes

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