Delfini
Evidence- and Value-based Model for Clinical Quality Improvement
=
Net Gain + (Net Loss)
Unite and
apply together evidence, QI and value
Consider
the plusses and minuses of —
— Healthcare Outcomes +
— Patient Perspective +
— Satisfaction +
— Savings/Cost +
— Other Considerations +
|
| Efficiency
and Effectiveness
|
What
is Quality In Healthcare?
We, like many
others, believe that quality in healthcare is the degree to which
health care services for individuals and populations increase
the likelihood of desired health outcomes and are consistent with
the best available scientific evidence.
According
to the Institute of Medicine (IOM), a quality system is one that
is effective, patient-centered, safe, timely, efficient and equitable.
Achieving
quality requires a systematic approach to—
- Identify
and utilize valid, useful and usable information
- Bring together
important health care system components to improve health care
and health outcomes with a focus on value
Before you decide
to change practice, you need to evaluate interventions for appropriateness.
And appropriateness has a number of components.
We evaluate appropriateness
by following a set of steps in a specific order.
The first thing to do is an evaluation for effectiveness and benefit.
If an intervention is effective the next step is to perform a
cost analysis. The last step is to “triangulate” other
areas such as coverage, politics, etc., using the best data you
have. This requires judgment. |
| Predictability
of Outcomes
Predictability
is a critically important concept in learning the best model for
achieving QI. |
If
you are going to implement change, you need to be as sure as you
can that the change will result in improved care. Typically variations
in practice are not sufficient to establish
a baseline for quality improvement. What is required to better understand
optimal practice is a “round-up” of medical evidence
which has been subjected to rigorous critical appraisal and synthesis. |
| Quality
Medical Evidence
We
have effective training methods and tools to make this easy
for staff. |
A
centerpiece of our QI framework is critical appraisal
of the medical literature, which we use to inform all
our steps, from seeking the right thing to do, to doing the right
thing right. We approach quality improvement first by asking what
valid and useful evidence is currently available in the literature
to assist leaders, clinicians and patients improve outcomes.
|
| Impacts
of Change &
Economic Analysis
|
Before
you make change, it is important to predict what’s going to
happen. Before implementing a QI initiative, the team should project
the impact of change. This can range from an analysis of
economic impacts as well as more subjective outcomes. All too often,
this ends up being a neglected step or one that is made impossibly
difficult and mysterious by those with “black box” approaches.
|
| Implementation
& Measurement
Strong
evidence of clinical improvement
facilitates implementation because people understand what to expect.
Even
when there is little or no published evidence,
QI teams become more confident about decisions when
they know what is (and what isn’t) in the medical literature.
|
We
have considerable experience in the area of implementation
and measurement—we can tell you what the
evidence says on these topics, and we can share our vast experience
(successes and failures) to help your staff prepare to make change.
We have a set of implementation tools and measurement tips that
are easy to understand and can jump start implementation planning.
You also need information
aids and decision-support for your staff
and your patients. We have considerable skills in creating highly
useful tools. We can provide people with clear advice and strategies
for content and presentation along with dissemination tips.
We have developed
simple, effective methods and the tools to successfully
“do” quality clinical improvements, based on the "value"
equation — quality, cost and satisfaction.
- Teaching leaders
& staff in your organization the value of evidence
in determining appropriateness
- Successful, functional
committees and work groups —
structures, processes, tools and tips
- Selecting good
projects for success
- Searching for
the best evidence regarding efficacy and effectiveness
- Critically
appraising the evidence for validity
- Assessing benefits
- Performing economic
analysis
- Assessing non-economic
impacts of practice change
- Summarizing
assessments
- Handling other
considerations — trials, tribulations, politics
and triangulations
- Preparing for
measuring change
- Developing information
and decision-aid tools
- Successful implementation
and maintenance strategies
|
Delfini
SERVICES
We offer a wide range
of supportive services
with the ultimate goal of increasing health care organizations’
and clinicians’ abilities to provide high quality, evidence-based
care and to improve medical decision-making
for organizations, leaders, teams, clinicians and patients.
• Creating
the EBM Organization • Creating the Evidence-based Practitioner
Help for organizations to position for evidence-based care and health
care quality; help for healthcare leaders and for individuals
• Evidence-based
Healthcare Educational Opportunities
Medical education and continuing medical education resources to
provide evidence-based practice (EBP) training in evidence-based
medicine (EBM), evidence-based nursing & other disciplines —
we provide training in, and facilitation of, all aspects of evidence-based
health care such as in critical appraisal to help you with medical
literature review of scientific research studies and in performing
all aspects of healthcare quality improvement activities
• Evidence
Assessment Training
How to perform a scientific review such as a systematic review and
evidence synthesis and how to create a clinical review, clinical
recommendation, clinical practice guideline, drug monograph, medical
technology assessment, scientific research paper, performance measure,
medical decision-making support such as communication aid and shared
decision-making aid, patient safety advisory or other evidence-based
clinical information
•
Evidence Reviews & Clinical Content
We can be engaged to perform scientific literature reviews to create
systematic reviews, including comparative effectiveness research (CER),
and can supply any kind of clinical content or clinical information
item you wish such as those listed including clinical guidelines,
drug monographs, decision support and more
• Committee
Help
Help for committee work such as pharmacy and therapeutics committee
(P & T committee) or medical technology assessment by providing
evidence-based guidelines and process steps including tips for all
aspects of committee work from committee management, structures,
processes and to clinical pharmacist education to inform all aspect
of staff work such as conducting evidence-based reviews, development
of drug monographs, meeting presentations and more such as formulary
management advice
•
Quality Improvement Teams
Help for quality improvement teams by providing facilitation of facilitation
of steps in systematic literature review, clinical practice guidelines
development and clinical improvement projects, including project selection
for success, cost analysis, implementation strategies and measuring
performance for quality improvement in health care
• Healthcare
Leadership Help
If you are a healthcare leader, especially a medical leader or pharmacy
leader, we have special help for you through our services and through
our other website, medicalleaders.org
—
we can provide a variety of services including strategies for effectiveness
in quality management in healthcare, how to identify good clinical
practice guidelines, patient-centered care strategies including
doctor patient communication training, performance measurement training
and development of effective performance measures, tips for meeting
management and more in your efforts for improving healthcare quality
in your organization to provide true evidence-based health care
• More
to achieve quality in healthcare...
Delfini
SERVICES
We offer a wide
range of supportive
services with the ultimate goal of increasing health
care organizations’ and clinicians’ abilities to provide
high quality, evidence-based care and to
improve medical decision-making for organizations, leaders,
teams, clinicians and patients.
Delfini
About Our Work 
Resources at
—
|
Resources:
Evidence-based Health
Care Quality Improvement Model
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