Article type
Year
Abstract
Background: Healthcare systems are struggling with rising costs and uneven quality. Systems that make the shift from focusing on the volume of services provided to the outcomes patients achieve are most likely to succeed. The core of this new approach is maximizing value. Oregon Health & Science University (OHSU) formed partnerships with community hospitals with the goal of transforming members into a value-based healthcare system. Key to this transformation, is ensuring care is consistently delivered based on best evidence. OHSU created the Office of Clinical Integration and Evidence-Based Practice (EBP) whose focus is developing evidence-based clinical guidelines for the OHSU health system.
Methods: Guidelines are developed in partnership with multidisciplinary content expert teams with representatives from each hospital, and patient advocates. The Office of Clinical Integration and EBP uses the GRADE methodology to appraise and summarize research evidence. Content expert teams bring their clinical expertise to interpret the evidence to develop practice recommendations and consensus statements. Clinical decision support tools are created to support the guideline’s implementation and quality metrics for each guideline are identified.
Multidisciplinary, clinical implementation teams implement each guideline formally, and use metrics to drive for continuous improvement.
Results: To date, the Office has developed five clinical guidelines: Adult CF pain management, Supplemental feeding in neonates, Adult safe opioid prescribing for chronic pain, Colorectal cancer screening, and Acute low back pain, engaging more than 100 clinicians from across the health system. Post-implementation data from the CF guideline have shown improvements in patient-important outcomes, such as reductions in length of stay and opioid use.
Conclusions: The delivery of coordinated, consistent care is key to clinical integration within a health system. Engaging providers across the health system in designing clinical pathways has made implementation of guidelines more achievable, and has allowed for OHSU to make meaningful strides in transforming the health system into one that is integrated and focused on value.
Patient involvement: The OHSU Health System guideline recommendations are made based on evidence, clinical expertise and patient values and preference.
Methods: Guidelines are developed in partnership with multidisciplinary content expert teams with representatives from each hospital, and patient advocates. The Office of Clinical Integration and EBP uses the GRADE methodology to appraise and summarize research evidence. Content expert teams bring their clinical expertise to interpret the evidence to develop practice recommendations and consensus statements. Clinical decision support tools are created to support the guideline’s implementation and quality metrics for each guideline are identified.
Multidisciplinary, clinical implementation teams implement each guideline formally, and use metrics to drive for continuous improvement.
Results: To date, the Office has developed five clinical guidelines: Adult CF pain management, Supplemental feeding in neonates, Adult safe opioid prescribing for chronic pain, Colorectal cancer screening, and Acute low back pain, engaging more than 100 clinicians from across the health system. Post-implementation data from the CF guideline have shown improvements in patient-important outcomes, such as reductions in length of stay and opioid use.
Conclusions: The delivery of coordinated, consistent care is key to clinical integration within a health system. Engaging providers across the health system in designing clinical pathways has made implementation of guidelines more achievable, and has allowed for OHSU to make meaningful strides in transforming the health system into one that is integrated and focused on value.
Patient involvement: The OHSU Health System guideline recommendations are made based on evidence, clinical expertise and patient values and preference.