McNair Peter D, Fang Jade, Schwarzwaelder Stephan, Jackson Terri
Palo Alto Medical Foundation Research Institute.
Nagra Kudelski Group.
EGEMS (Wash DC). 2015 Jan 8;3(1):1066. doi: 10.13063/2327-9214.1066. eCollection 2015.
Hospital-based clinicians have little information about the outcomes of their care, much less how those outcomes compare with those of their peers. A variety of care quality indicators have been developed, but comparisons tend to be hospitalwide, and often irrelevant to the practice and patient group of many hospital clinicians. Moreover, information is not enough to transform clinical practice, as the human response to such comparisons is, "I'm doing the best I know how." What is needed is granular, clinically specific feedback with peer-mediated advice about how "positive deviants" achieve better results.
This case study reports on the development and implementation of a web-accessible comparative outcomes tool, ExPLORE Clinical Practice, for hospitals and clinicians in California.
We use iterative development and refinement of web tools to report comparative outcomes; incremental development of suites of procedure-patient outcome pairs specific to particular medical specialty groups; testing and refinement of response time metrics to reduce delays in report generation; and introduction of a comments section for each measure that assists with interpretation and ties results to strategies found to lead to better clinical outcomes.
To date, 76 reports, each with 115 to 251 statistically evaluated outcomes, are available electronically to compare individual hospitals in California to statewide outcomes.
ExPLORE Clinical Practice is one of a number of emerging systems that attempt to lever available data to improve patient outcomes. The ExPLORE Clinical Practice system combines a clinical focus on highly specific outcome measures with attention to technical issues such as crafting an intuitive user interface and graphic presentation. This case study illustrates the important advances made in using data to support clinicians to improve care for patients. We see this information as a way to start local conversations about quality improvement, and as a means of generating peer advice for improving patient outcomes.
以医院为基础的临床医生对其治疗结果了解甚少，更不清楚这些结果与同行相比如何。虽然已经制定了各种护理质量指标，但比较往往是全院范围的，而且通常与许多医院临床医生的实践和患者群体无关。此外，这些信息不足以改变临床实践，因为人们对这种比较的反应是“我已经尽我所能了”。我们需要的是具体的、针对临床的反馈，并由同行提供建议，说明“正向偏差者”是如何取得更好结果的。
本案例研究报告了一种可通过网络访问的比较结果工具“探索临床实践”（ExPLORE Clinical Practice）的开发与实施情况，该工具面向加利福尼亚州的医院和临床医生。
我们采用网络工具的迭代开发和优化来报告比较结果；针对特定医学专科群体逐步开发一系列特定手术与患者结果的配对；测试和优化响应时间指标以减少报告生成延迟；并为每个指标引入评论区，以协助解读并将结果与被发现能带来更好临床结果的策略联系起来。
截至目前，已有76份报告可供电子查阅，每份报告包含115至251个经过统计学评估的结果，用于将加利福尼亚州的各医院与全州结果进行比较。
“探索临床实践”是众多试图利用现有数据改善患者结果的新兴系统之一。“探索临床实践”系统将对高度特定结果指标的临床关注与对技术问题的关注相结合，如设计直观的用户界面和图形展示。本案例研究说明了在利用数据支持临床医生改善患者护理方面取得的重要进展。我们认为这些信息是启动关于质量改进的本地对话的一种方式，也是为改善患者结果生成同行建议的一种手段。
