Texas Children's Hospital Reduces Clinical Quality Improvement Project Time by 85%

My job involves working with a broad spectrum of healthcare organizations from community hospitals to children’s hospitals to large teaching and academic centers on clinical quality improvement projects. My clients, like all healthcare organizations, are focused on the Triple AIM (IHI, 2013): improving the delivery of high quality patient care, reducing costs and improving healthcare outcomes.

Clinical Quality Improvement projects follow a standard process: articulate the problem statement; define the population; identify data gaps; collect the data; and, implement evidence based practice interventions to deliver measurable and sustainable improvement. If you’ve led or been a part of these projects, you know the kick-off process of articulating the problem and defining the population can take six or more months.

Read Texas Children’s Kick-Start Secret>>

Evidence-Based Practice

The evidence-based movement is over a decade old, and its beginnings are tied to evidence-based practice in medicine. The first appearance of the term evidence-based medicine occurred in the fall of 1990 in a document describing the residency program at Canada’s McMaster University (Guyatt, & Drummond, 2002).  The goal is to be aware of the evidence on which one’s practice is based, the soundness of the evidence, and the strength of inference the evidence permits. Some of the key concepts in this description are evidence and critical appraisal.

One of my clients, Texas Children’s Hospital (TCH), has established a formal entity, the Evidence Based Outcomes Center (EBOC) to spearhead its effort to make clinical practice consistent with the best medical science throughout its facilities. The EBOC is tasked with:

  • Identifying areas for quality improvement
  • Assembling the right team to address guidelines for the targeted patient population
  • Rigorously examining the latest clinical evidence
  • Systematically creating guidelines with embedded recommendations and soliciting feedback from its community of clinical care users
  • Teaming with clinical departments to roll out evidence-based guidelines to the broader clinician population

The Evidence-Based Outcome Center’s Time to Value Problem

Texas Children’s had implemented an electronic health record (EHR), which contained a wealth of data. But hospital leaders found that the data didn’t meet clinicians’ expectations for usefulness. It was the EBOC’s task to mobilize the usefulness of the Epic implementation as it related to guidelines driven care—to analyze the data, create and support evidence-based guidelines and deliver actionable information to clinicians.

Despite a clear mission, an enterprise-wide EHR implementation and solid organizational support, efforts to use the data were slow and inefficient. Even for improvement projects with a very limited scope, it would take the EBOC as many as six months to develop and kick off clinical program improvement projects—and even more time to determine whether the initiative was yielding positive results.

Texas Children’s needed technologies and methodologies that would enable them to integrate data management, science and evidence—and then to effectively incorporate the evidence base into everyday clinical practice. These resources would enable them to unlock the potential of their data, provide transparency to providers and mobilize clinicians to embrace quality-improvement initiatives.

Texas Children’s first step in creating an analytic framework to increase the usefulness of their data was implementing Health Catalyst’s Late-Binding ™ EDW platform. The EDW integrates data from source applications—clinical, financial, patient satisfaction and more—and makes it available for reporting and analysis. Designed specifically for healthcare, the EDW incorporates a late-binding data model—an agile approach that assembles data from source applications just in time to address new analytic use cases.

With the data aggregated for analytics purposes, EBOC no longer had to cobble reports or manually analyze data. The team was able to efficiently identify areas with the most potential for quality improvement. Rather than needing six months to develop a clinical improvement initiative, EBOC could define patient cohorts, analyze baseline data, address data quality issues and define targeted improvement goals in 90 days.

But this 50 percent improvement in process time was just the beginning. By subsequently implementing the Population Explorer application to run on the EDW, Texas Children’s was able to outperform even that distinct improvement. The application equipped the EBOC team with tools for exploring a variety of analytical measurements across the registries they chose to focus on.

Rapid-cycle Process Improvement

Texas Children’s EBOC has reduced the time required to develop clinical program improvement projects by 85 percent.

Before implementing the Health Catalyst solution, EBOC teams needed six months to develop a new, evidence-based initiative for a targeted clinical program. Today, they are able to define cohorts, analyze and validate baseline data; and in collaboration with a care process team, draft concrete quality-improvement targets in a matter of a few weeks. The solution also helps them identify upfront the best individuals to participate on the quality-improvement team for a specific initiative.

Read the entire story, Texas Children’s Hospital: Bundled Population Registries Kick-Start Rapid-cycle Clinical Process Improvement

Sample Population Explorer Visualization

reduce time to develop clinical program improvement

Population Explorer and Other Customer Successes

Read more analytics success stories in healthcare.

If you are interested in learning more about the Health Catalyst Population Explorer or reading other customer stories check out these resources:

How long does it take you from start to finish to kick-start and deliver results on a clinical improvement project? What solutions are you using to integrate evidence-based guidelines into your clinical programs? Please add your comments below.

Guyatt, G. & Drummond R. (2002). User’s Guides to the Medical Literature: A Manual for Evidence-Based Practice. Chicago: American Medical Association, p. xiv
Institute for Healthcare Improvement (2013). The IHI Triple Aim. Retrieved from http://www.ihi.org/offerings/Initiatives/TripleAim/Pages/default.aspx