Transforming administrative data into real-time information in the Department of Surgery

Abstract

Background Cardiothoracic surgical programmes face increasingly more complex procedures performed on evermore challenging patients. Public and private stakeholders are demanding these programmes report process-level and clinical outcomes as a mechanism for enabling quality assurance and informed clinical decisionmaking. Increasingly these measures are being tied to reimbursement and institutional accreditation. The authors developed a system for linking administrative and clinical registries, in real-time, to track performance in satisfying the needs of the patients and stakeholders, as well as helping to drive continuous quality improvement. Methods A relational surgical database was developed to link prospectively collected clinical data to administrative data sources at Dartmouth-Hitchcock Medical Center. Institutional performance was displayed over time using process control charts, and compared with both internal and regional benchmarks. Results Quarterly reports have been generated and automated for five surgical cohorts. Data are displayed externally on our dedicated website, and internally in the cardiothoracic surgical office suites, operating room theatre and nursing units. Monthly discussions are held with the clinical staff and have resulted in the development of quality-improvement projects. Conclusions The delivery of clinical care in isolation of data and information is no longer prudent or acceptable. The present study suggests that an automated and realtime computer system may provide rich sources of data that may be used to drive improvements in the quality of care. Current and future work will be focused on identifying opportunities to integrate these data into the fabric of the delivery of care to drive process improvement.

Health outcomes measurement and organizational readiness support quality improvement: a systematic review

“…Table 1 presents the characteristics of the 21 included studies. The studies focused on registries for the following patient groups; patients with diabetes [24–31], children with chronic conditions [32], patients with lung cancer [33, 34], patients with cystic fibrosis [35–37], patients with cardiac anomalies [38], patients undergoing cardiac surgery [39–41], patients with acute myocardial infarction [42], and patients referred for home health services [43]. The majority of the registries presented voluntary participation [25–27, 29–31, 35, 36, 38, 40–43].…”

“…Three registries required mandatory participation [28, 33, 34]. Most of the presented registries had the purpose of achieving QI [24, 25, 28–34, 37, 39, 41–43]. The remaining studies have introduced their clinical registry for research and educational purposes [26, 27, 35, 36, 38, 40, 44].…”

“…The remaining studies did not show statistically significant improvements. All included studies presented outcome measures for their respective improvement work, five of which also measured additional process measures [27–33, 35, 41, 42, 44]. Table 2 presents outcomes measures used, QI methods applied and whether statistically significant improvement of outcome measures was achieved.…”

“…19 teams of 4 to 5 persons met at 4 (group A) or 2 (group B) training sessions during which education by QI experts was provided, using the Breakthrough Series curricula.Readmission rate+Bleeding complication+Jakobsen et al, (2009) [33]1-year survival+5BenchmarkingIndicators (staging, surgical procedures, complications and survival) have been registered in 5007 patients who underwent surgery. Each year the results have been audited locally, regionally and nationally and improvements have been proposed, implemented, monitored and evaluated by the audit-plenary.2-year survival+5-year survival030-day mortality0 a Kraynack et al, (2009) [35]FEV10 a 12Learning and Leadership CollaborativeA QI process is described from the initial team-building phase, through the assessment of care processes, standardization of care, and developing a culture of continuous improvement aiming to improve pulmonary function of the paediatric patients.MacLean et al, (2009) [25]Blood pressure010The Chronic Care ModelProviding decision support and patient decision support in diabetes care delivery.BMI0SF-12Physical0 a SF-12 MentalQuality of life0Exercise habit+Toh et al, (2009) [30]Poor HbA1c (9% and above)0 a 11IT application as feedback toolChronic disease management system with patient reminders based on registry data.Good LDL-control below 2.6 mmol/L0 a Baty et al, (2010) [29]% with HbA1c < 7%+10No clear QI methodImplementing a comprehensive system-based disease management process including a diabetes registry and quality reports.% with HbA1c < 9%+%with LDL < 100+Beaulieau et al, (2010) [41]Mortality0 a 7BenchmarkingIT application as feedback toolImplementing a method for linking administrative and registry data to track quality improvement initiatives through dashboards.Infusion rate0 a Bricker et al, (2010) […”

Evaluation of an electronic health record structured discharge summary to provide real time adverse event reporting in thoracic surgery

“…Once clinical data are structured within the electronic record, it supports immediate transfer to reporting dashboards. Timely reporting of metrics is thought to be important in quality improvement 6. Therefore, we developed an electronic real time data collection system (ERD), which consists of embedded data collection fields in an electronic health record discharge summary that automatically reports to a web-based dashboard system.…”