Keys to Improving Your Clinical Program Effectiveness

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As a Registered Nurse, I’ve seen first-hand the difficulties associated with narrowing the focus of a clinical program improvement project. Healthcare is a complex business consisting of thousands of clinical improvement opportunities. The first important step is the desire to do a project – at least by one influential team member. The next step, to keep the process simple and prioritize your projects, is directly related to the complexity of healthcare. Following a structured process with representation from all stakeholders will help to ensure success.

Effective prioritization requires an enterprise data warehouse (EDW), healthcare analytics, a clinical integration hierarchy, and an organizational readiness assessment (which I explain further in another blog).

Prioritizing with Healthcare Analytics

The Health Catalyst Key Process Analysis (KPA) Application helps you focus your clinical quality improvement efforts in the areas with the greatest potential. The KPA Application sorts each patient encounter into a three-tiered clinical integration hierarchy:

  • Clinical Program (e.g. Cardiovascular)
  • Care Process family (e.g. Ischemic Heart Disease)
  • Care Process (e.g. Acute Myocardial Infarctions)

care process

The diagram above shows a sample of just four Care Processes: Hyperlipidemia Coronary Atherosclerosis, Acute Myocardial Infraction, Percutaneous Intervention (PCI), and Coronary Artery Bypass Graft (CABG). Care Processes can be grouped into Care Process Families, such as Ischemic Heart Disease. Multi-disciplinary professional team members specialize in the care of patients within a Care Process Family. From a clinical hierarchy perspective, Care Process Families integrate into a Clinical Program.

Narrowing to a Care Process

How does the clinical integration hierarchy help you narrow the focus of your project? Clinical program improvement initiatives include standardization of care at the Care Process level, as well as at the Care Process Family level. You decide on the level you will select based on the project Aim. If the Aim is based on an intervention improvement associated with a unique Care Process versus the Care Process Family, then the Care Process level is used. If the Aim is focused on a similar treatment, medications, or services common across a Care Process Family, then the family level hierarchy is most appropriate.

Clinical Program Improvement Examples

Here are two examples that demonstrate selection of the clinical hierarchy based on your project goal:

  • Care Process Improvement: A team of interventional cardiologists, cath lab nurses, and technologists organize to develop standardized strategies for the management of percutaneous interventions, such as coronary artery stent placement.
  • Care Process Family Improvement: An interdisciplinary team of interventional cardiologists, cardiac surgeons, emergency care physicians, and cardiac nurses participate in the development of criteria to triage patients with cardiac chest pain between PCI, CABG, and medical management.

How do you prioritize your clinical improvement programs? Can you share some examples of clinical program improvements you’ve done at the care process and/or care process family hierarchy level

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