Creating a center of excellence.

Being able to identify your facility as a Center of Excellence characterized by quality of patient care and services, outcomes and financial performance-sets your hospital apart from others. St. Luke's Episcopal Hospital in Houston developed a three-pronged approach to quality improvement which has helped the hospital establish and maintain its position as such a Center. Other institutions can modify this approach for their own use. Service line management is the hospital's first avenue of approach, a means of aligning and coordinating staff efforts and services for a particular patient population, to achieve a better integrated service delivery system. St. Luke's also uses a case management model, a system of planning, coordinating, monitoring and delivery care on a case-by-case basis, to provide the best care at the lowest possible cost. A third strategy is outcomes management, which uses outcomes assessment information to track the experience of an aggregate patient population. A collaborative practice team oversees the research, data evaluation and determination of changes to be implemented. It also establishes the desired outcome for the patient population. St. Luke's has used these initiatives to improve care, particularly among cardiovascular patients. Ultimately, the hospital changed its methods of care as a result of this assessment. Change took time to gain favor with hospital physicians. In 1991, St. Luke's applied to HCFA's Bypass Demonstration project, in which Medicare distributes a lump sum to cover surgeons, cardiologists and other disciplines for Medicare-eligible DRG 106 and 107 patients. St. Luke's joined the project in 1993. As a result of participation in the project, Medicare allows selected sites to call themselves a Medicare Participating Center of Excellence.