Article type
Year
Abstract
Background: Many processes of health care could be improved. Adherence to evidence-based best practices, and reduction in unwanted variation in care and prevention should significantly improve population health and better manage care provided through health care systems.
Objectives: 1. To review the availability and quality of evidence that could support important process improvement (PI) efforts in clinical areas such as organ failure in sepsis, ventilator-acquired pneumonia, central line infections, acute coronary syndrome and stroke, and prevention of communicable disease, cancer, and cardiovascular disease. 2. To describe evidence and efforts to implement evidence-based practices consistently in a large health care delivery system.
Methods: We searched the Cochrane Library, major data bases, and guidelines for studies and systematic reviews on healthcare process improvement, preventive services, and PI implementation for preventive screening, immunizations, and care for sepsis, coronary disease, stroke, and pneumonia. We characterized the quality of the evidence and reviewed process improvement projects at Kaiser Permanente in these areas.
Results: Evidence is generally observational for clinical process improvement, immunizations and screening. There was good evidence for the testing and treatment portions of process improvement protocols, but less so for the entire integrated process. Nevertheless, positive results were demonstrated in most areas.
Conclusions: Trials are most often focused on specific treatments rather than processes of care. Processes occur over time, with a number of sequential or parallel components. The quality and availability of evidence to support health care processes varies significantly and can require chains of evidence, which are indirect by definition. Outcomes can include positive or adverse events, resource use, and operational efficiency as well as intermediate and final clinical states. Even when there is good evidence, how to have providers to do the right thing consistently remains an open question.
Objectives: 1. To review the availability and quality of evidence that could support important process improvement (PI) efforts in clinical areas such as organ failure in sepsis, ventilator-acquired pneumonia, central line infections, acute coronary syndrome and stroke, and prevention of communicable disease, cancer, and cardiovascular disease. 2. To describe evidence and efforts to implement evidence-based practices consistently in a large health care delivery system.
Methods: We searched the Cochrane Library, major data bases, and guidelines for studies and systematic reviews on healthcare process improvement, preventive services, and PI implementation for preventive screening, immunizations, and care for sepsis, coronary disease, stroke, and pneumonia. We characterized the quality of the evidence and reviewed process improvement projects at Kaiser Permanente in these areas.
Results: Evidence is generally observational for clinical process improvement, immunizations and screening. There was good evidence for the testing and treatment portions of process improvement protocols, but less so for the entire integrated process. Nevertheless, positive results were demonstrated in most areas.
Conclusions: Trials are most often focused on specific treatments rather than processes of care. Processes occur over time, with a number of sequential or parallel components. The quality and availability of evidence to support health care processes varies significantly and can require chains of evidence, which are indirect by definition. Outcomes can include positive or adverse events, resource use, and operational efficiency as well as intermediate and final clinical states. Even when there is good evidence, how to have providers to do the right thing consistently remains an open question.