Decision Analysis for Metric Selection on a Clinical Quality Scorecard.

Clinical quality scorecards are used by health care institutions to monitor clinical performance and drive quality improvement. Because of the rapid proliferation of quality metrics in health care, BJC HealthCare found it increasingly difficult to select the most impactful scorecard metrics while still monitoring metrics for regulatory purposes. A 7-step measure selection process was implemented incorporating Kepner-Tregoe Decision Analysis, which is a systematic process that considers key criteria that must be satisfied in order to make the best decision.

Clinical validation of the AHRQ postoperative venous thromboembolism patient safety indicator.

Background: The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) screen for potentially preventable complications in hospitalized patients using hospital administrative data. The PSI for postoperative venous thromboembolism (VTE) relies on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for deep vein thrombosis (DVT) or pulmonary embolism (PE) in secondary diagnoses fields. In a clinical validation study of the PSI for postoperative VTE, natural language processing (NLP), supplemented by pharmacy and billing data, was used to identify VTE events missed by medical records coders.

Automated clinical data collection for national quality measurement reporting.

Collecting data for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ORYX Core Measurement Reporting can be automated using an object-oriented, client-developed program that extracts data from a clinical data repository and utilizes an MHA vendor upload process. The process eliminated 39% of the manual data collection efforts.

Using business intelligence to monitor clinical quality metrics.

BJC HealthCare (BJC) uses a number of industry standard indicators to monitor the quality of services provided by each of its hospitals. By establishing an enterprise data warehouse as a central repository of clinical quality information, BJC is able to monitor clinical quality performance in a timely manner and improve clinical outcomes.

Identification of patients with coronary heart disease: meeting regulatory standards vs. improving overall care.

Acute myocardial infarction (AMI) patients can be identified prospectively by troponin-I (TnI) result monitoring and retrospectively by ICD-9 diagnosis coding. Prospective identification is needed for interventions, while retrospective identification is required for regulatory reporting. Prospective approaches can identify patients with a reasonable degree of accuracy, but they cannot always predict ICD-9 coding for that condition.