From indicators to best practices

Opal Reinbold, chief quality officer for Palomar Pomerado Health in San Diego, has used the data generated by her system's participation in the Premiere Health/CMS demonstration project to move beyond measuring compliance with CMS measures to improving best practices.

"In the past year, I recognized that we were doing well with [CMS] indicators, but not with implementing best practices," she recalls. "We were chasing the data down, but we were we so engaged that not every single patient was getting best care every single time."

At the end of 2005, she pulled together a steering committee comprised of physician champions, quality improvement, nursing staff, pharmacy, case managers, and ancillary departments. "We looked at our data and established best practice work teams headed by nursing, physician champions, case managers, quality managers, pharmacy, and so forth," she reports. "Our goal is to get to 100% for every indicator and to hard-wire best practices." These groups put together PI teams, and all have action plans in place.

"We're also breaking the data down by physician and unit," she adds. "This is not punitive; it is to help them understand and build systems solutions so we can't fail. The order sets we are using are automatically put on, flagged, and everyone on the team is reminding the physician."

The teams also are conducting concurrent reviews on an ongoing basis as the patient goes through the care process. "We look at the chart and make sure the patient receives best practice care every time," says Reinbold.

So far, she says, "We've done very well." One of the groups that presented last week had 100% for every indicator. "That's our goal," she says.