Transcript The Second Revolution in Healthcare

Track IC: Pediatric Quality and Safety
• Human Factors in Surgical Care: Ethnographic and
Empirical Evidence
• Fundamental Issues in Rewarding Performance in
Pediatric Healthcare
• Enhancing the Medical Home for Children with
Special Needs: A Quantitative Approach
• The Role of Barcodes in Reducing Pediatric Drug
Adverse Events
If The Horse Dies, Get Off: A New
Revolution in Healthcare
The Quality Colloquium
Boston, MA
August 20, 2008
Paul V. Miles MD
Senior Vice President Quality and Maintenance of Certification
American Board of Pediatrics
No conflicts of interest to report
Three New Activities in Physician Quality
and Safety You May Not Be Aware Of
• Competency in quality improvement is now required
for all physicians to maintain board certification
• Knowledge about patient safety is now required for all
physicians to maintain board certification: ABMS
Patient Safety Improvement Program www.ABMS.org
• National collaborative to reduce pediatric catheter
associated blood stream infections in PICUs
Physician Quality
From “trust me, I am a physician” to “show me the
data”
Physicians have a professional obligation to measure
and continually improve the quality of the care they
and their care team deliver
And, they have a professional obligation to assess
and continually improve their professional
development
What do we mean by :
“Best Quality?”
• Quality = Best science + Context
Context: (what the patient wants and needs),
(provider variables), (micro system), (macro system)
IOM six dimensions of quality: safe, timely, effective,
efficient, equitable, patient centered
Maintenance of Certification
Six Core Physician Competencies
• Patient care
• Medical knowledge
• Interpersonal and communication skills
• Professionalism
• Assess and improve quality of care
• Systems-based practice
(Adopted by the ACGME and all twenty four ABMS specialty boards)
5 year survival rate
Acute Lymphoid Leukemia
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1960-63
70-73
74-76
Simone J., Lyons, J: J Clin Oncology 1998 Sep;16(9):2904-5
77-79
80-82
83-90
Bill Nugent
NACHRI Eliminating Bloodstream
Infections
In the first 6 months,
29 children’s hospitals
reduced infection rates
in the PICU by nearly
70 percent by adhering to
a rigid set of evidencebased practices shown
to prevent infections
in children.
Monthly Aggregate PICU CA-BSI Rate
BSI Collaborative
Began Oct 2006
8
7
BSI Rate per 1,000 Line Days
6
5
4
3
2
1
Notes:
1) Prior to October 2006, the aggregate monthly collaborative rate is the average of the rates
from all PICUs due to unavailability of line days data. Beginning in October 2006 the
aggregate rate is calculated by dividing the total number of infections for the entire
collaborative by the total number of line days.
2) Begining November 2006 control limits have been recalculated to illustrate the apparent
change in the process of care. The new control limits are variable, taking into account the
number of line days for each month (u-chart) while the previous control limits were constant,
only taking into account the change in average BSI rate from month to month (XmR chart)
03/07 n=28
Control Limits
70% improvement: 15 lives saved, 80 infections prevented,
$6.4 million not spent in the first 6 months
04/07 n=28
01/07 n=28
02/07 n=28
11/06 n=29
12/06 n=29
09/06 n=22
10/06 n=29
07/06 n=23
08/06 n=22
05/06 n=27
06/06 n=27
03/06 n=29
04/06 n=27
01/06 n=29
02/06 n=29
11/05 n=28
Center Line
12/05 n=28
09/05 n=28
10/05 n=28
07/05 n=28
08/05 n=28
05/05 n=28
06/05 n=28
03/05 n=28
04/05 n=28
01/05 n=27
02/05 n=27
11/04 n=26
12/04 n=26
09/04 n=27
Monthly BSI Rate
10/04 n=27
07/04 n=27
08/04 n=27
05/04 n=23
06/04 n=25
03/04 n=23
04/04 n=25
01/04 n=23
02/04 n=23
0
Cystic Fibrosis Care
Median FEV1
CF Patients 6-12 yrs
100
60
100
90
Percent Predicted
Percent Predicted
80
40
80
70
60
50
20
40
2000
2001
Ten Highest Centers
0
All Care Centers
Your Center
CFF National Patient Registry, 2004
*Wang & Hankinson equations
2002
2003
2004
University of Cincinnati
National Average
Cumulative % of Asthma Population with "Perfect Care":
Network and Select Practices
100%
Long Term Goal = 95%
90%
Performance
Feedback
Reports
|
q
80%
70%
60%
50%
Improvement
Collaborative on
Reliability
|
q
P4P
Program
|
q
Project
Inception
|
q
40%
p
P4P
Deadline
30%
20%
z
Self Management
Collaborative
Initiated
p
Web-based
Registry
Launched
p
"Perfect Care"
Including
Flu Shot
10%
O
ct
03
N
ov
0
D 3
ec
0
Ja 3
n
0
Fe 4
b
0
M 4
ar
04
A
pr
0
M 4
ay
0
Ju 4
n
04
Ju
l0
4
A
ug
04
S
ep
0
O 4
ct
04
N
ov
0
D 4
ec
0
Ja 4
n
0
Fe 5
b
0
M 5
ar
05
A
pr
0
M 5
ay
0
Ju 5
n
05
Ju
l0
5
A
ug
05
S
ep
0
O 5
ct
05
N
ov
05
0%
OVPCA Network
Practice 1
Practice 2
Practice 3
Practice 4
Practice 5
Practice 6
“Perfect Care”: composite measure of severity classified, identified management plan, and controller
medications for patients with persistent asthma
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