Eliminating Health Care Disparities With Mandatory Clinical Decision Support

Lau, Brandyn; Haider, Adil H.; Streiff, Michael B.; Lehmann, Christoph U.; Kraus, Peggy S.; Hobson, Deborah B.; Kraenzlin, Franca; Zeidan, Amer M.; Pronovost, Peter J.; Haut, Elliott R.

doi:10.1097/mlr.0000000000000251

Cited by 106 publications

(75 citation statements)

References 48 publications

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“…No doubt, clinician and patient behaviors are strongly influenced by factors at the level of the organization, the health care environment, and the macro environment. In one study, organizational policy, i.e., mandatory clinical decision support, eliminated racial disparities in VTE prophylaxis (89). In another study, the elimination of copayments for cardiovascular therapy substantially reduced racial and ethnic disparities in patient adherence and cardiovascular outcomes (30).…”

Section: Principle 7 There Is a Continuum Of The Relative Proximal Imentioning

confidence: 99%

Racial and Ethnic Disparities in the Quality of Health Care

Fiscella

Sanders

2016

Annu. Rev. Public Health

385

232

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The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

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Section: Principle 7 There Is a Continuum Of The Relative Proximal Imentioning

confidence: 99%

Racial and Ethnic Disparities in the Quality of Health Care

Fiscella

Sanders

2016

Annu. Rev. Public Health

385

232

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“…Our prior studies demonstrated that order sets significantly improve performance, from a baseline compliance of risk‐appropriate VTE prophylaxis of 66% to 84% . In the current study, compliance was relatively flat during the BASE period, which included these order sets.…”

Section: Discussionmentioning

confidence: 51%

Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis

et al. 2014

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Background Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance, and payment incentives through programs to pay-for-performance. Objective To sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates amongst hospitalists. Design Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions. Setting 1060-bed tertiary care medical center. Participants 38 part- and full-time academic hospitalists. Interventions A Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80-100%. Measurements Prescription of American College of Chest Physicians guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments. Results Monthly VTE prophylaxis compliance rates were 86% (95% CI: 85, 88), 90% (95% CI: 88, 93), and 94% (95% CI: 93, 96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (p=0.01) and addition of the pay-for-performance program (p=0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; p=0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; SD ±350). Conclusions Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks.

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“…Assim, postula-se a necessidade do uso de ferramentas nas práticas de saúde que promovam um cuidado de qualidade e igualitário para os usuários, contribuindo para a redução das disparidades em saúde (25) .…”

Section: Discussionunclassified

Avaliação De Procedimentos Operacionais Padrão Implantados Em Um Serviço De Saúde

Pereira¹,

Carvalho²,

Santos³

et al. 2017

ACS

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Avaliação de procedimentos operacionais padrão implantados em um serviço de saúde Evaluation of standard operating procedures implemented in a health service Conflito de interesses:Não Contribuição dos autores: LRP concepção e planejamento do projeto de pesquisa, e obtenção dos dados. MFC concepção e planejamento do projeto de pesquisa, e obtenção dos dados. JSS análise/interpretação dos dados, redação e revisão crítica. GABM redação e revisão crítica. MACM redação e revisão crítica. RDA concepção e planejamento do projeto de pesquisa, e análise/interpretação dos dados. Contato para correspondência: Raquel Dully Andrade

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Eliminating Health Care Disparities With Mandatory Clinical Decision Support

Cited by 106 publications

References 48 publications

Racial and Ethnic Disparities in the Quality of Health Care

Racial and Ethnic Disparities in the Quality of Health Care

Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis

Avaliação De Procedimentos Operacionais Padrão Implantados Em Um Serviço De Saúde

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