- A successful initiative at the Cincinnati Children’s Medical Center found quality improvement methods — including the development of EHR registries and tools — improves clinical, functional, and patient-reported outcomes for children with chronic or complex conditions.
From 2012 to 2015, a team of researchers led by Jennifer Lail, MD, FAAP, developed the Condition Quality Outcomes Initiative to assist condition teams in applying parts of the Chronic Care Model to improve outpatient care delivery for chronically-ill children.
Heading into the initiative, Cincinnati Children’s anticipated improving outcomes by a margin of 20 percent.
Clinicians employed several improvement activities throughout the three-year initiative focusing on a range of objectives from coordinated care to pre-visit planning.
Developing an EHR registry and system tools offered clinicians several awareness and monitoring benefits. Clinicians used the EHR technology to keep tabs on which patients were being seen for care, which were missing care, and how their patients were progressing.
To ensure EHR technology and patient care were tailored specifically to patient needs, each team of clinicians defined their patient populations and developed criteria for inclusion in patient registries built into the EHR system.
Clinicians benefitted from electronic medical assistance tools such as risk-stratification tools and self-management assessments — all developed in the hospital’s EHR system. Cincinnati Children’s also developed data infrastructure and reporting systems during the initiative for measure development, analytics, and enhanced care gap reports using the data available from EHR technology.
Care coordination was also instrumental in improving patient outcomes during the initiative.
“Teams examined the flow of ambulatory patients through a clinic visit and the tasks performed by each team member in order to streamline processes, eliminate duplicative work, and reallocate work to the most appropriate team member,” noted Lail et al. in the report published in The Joint Commission Journal on Quality and Patient Safety.
Care coordination allowed for more efficient, less redundant, and better-managed patient care.
In total, 13,601 of the 27,221 active patients at Cincinnati Children’s — about 50 percent — reflected improvements in the state of their condition by the end of the initiative, smashing the projected 20 percent improvement rate researchers anticipated from the outset.
The overwhelmingly positive results of the initiative suggest to clinicians that employing the Chronic Care Model across diverse populations in need of care for chronic or complex conditions improves patient outcomes.
Of the 18 chronic condition teams involved in the initiative, 11 achieved the hospital’s goal of reaching a 20-percent improvement in clinical outcomes.
“With collaborative support for population management, outcome measurement, and implementation of components of the Chronic Care Model guided by QI methodologies and data analytics, clinical teams can improve outcomes for their pediatric patients with chronic conditions,” Lail et al. concluded.
The advantages of EHR technology for population health management support the industry’s move toward entirely electronically-accessible medical histories and EHR systems capable of streamlining care coordination.
EHR technology has also proved potentially valuable in improving patient care for warfarin patients during transitions of care from in-hospital to post-hospital warfarin management. A study by the University of Missouri Health Center published in January of this year found a modified EHR workflow can help physicians develop flexible warfarin management plans to monitor patients and their dosages more closely during transitions of care. The technology allowed clinicians to mitigate adverse drug reactions and improve anticoagulation therapy.
As policy shifts toward a value-based care system focusing more on patient outcomes than amount of services, optimizing patient care and delivering the most efficient treatment possible will become an incentivized priority.
While Cincinnati Children’s Condition Quality Outcomes Initiative proved successful in fulfilling the objectives clinicians set forth, the hospital stated in its report it will continue its work to improve clinical outcomes for children with chronic conditions.