From the 2019 HVPAA National Conference
Ms. Lauren Hall (University of Chicago Medicine), Dr. Allison Bartlett (University of Chicago Medicine)
High Reliability, an FY19 enterprise objective addressing the value of care provided at UChicago Medicine, is a system-wide approach for translating evidence into everyday practice by empowering provider decision making at the point of care. The development and successful implementation of clinical care pathways is a key strategy to reduce unwarranted clinical variation and provide perfect care for every patient every time. UChicago has developed processes to identify clinical pathway priorities using benchmarking data from sources such as Vizient’s CDB-RM, quickly engage clinical teams in translating evidence into local practices, and deploy clinical decision support tools that make adherence easy.
1. Identify the core components of pathway development and opportunities to augment existing infrastructure for successful implementation
2. Discover processes that support the translation of paper-based guidelines into clinical decision support tools to maximize existing efforts to standardize care and scale guideline use across the organization
Supported by expert resources, clinical care teams work together to define perfect care. The work begins with a clinical champion who synthesizes the evidence for a specific condition or procedure and builds the case for change with the support of the High Reliability team. Through informal discussions with colleagues about the opportunities to improve patient care, the clinical champion sets the stage that becomes a burning platform for change. After gaining initial support from colleagues to engage in a care standardization project, the subject matter experts draft a clinical pathway translating evidence-based practice into a workflow that represents the local standard of care and addresses current barriers in care delivery. After key physician stakeholders come to consensus, a multidisciplinary team representative of each of the care team members involved in caring for the patient is convened to finalize the pathway and identify supporting processes that may be needed for implementation. During the multidisciplinary team review, clinical informatics consults on the optimal decision support solution and guides the information technology (IT) resources that will execute on electronic health record (EHR) design/modification.
From October 2018, 25 pathways have been deployed using this model, including those addressing heart failure, acute coronary syndrome, hip fracture, and pediatric community acquired pneumonia, among others. To support the implementation of clinical pathways, a governance process ensures that developed pathways are useful, used, and evidence-based. A governed self-service model supported by quality improvement, clinical leaders, IT and clinical informatics, allows subject matter experts to translate paper-based pathways into electronic pathways integrated within the EHR (AgileMD, SanFrancisco, CA, USA).
In summary, requirements for successful development and implementation of clinical pathways include the following: engagement of clinical leaders and stakeholders across the system, alignment with IT and clinical informatics resources, ability to implement appropriate CDS after establishing consensus, and the ability make small enhancements rapidly post go-live . We continue to work on assessing pathway utilization to inform the optimization of technology to support clinical decision making and analyzing the impact of clinical pathways on clinical practices, patient outcomes and cost.