wh2014 session: empowering clinicians to make high-quality decisions in chronic and
DESCRIPTION
Wireless Health 2014 Conference Technical Session 1 featuring speaker Jonathan Nicolla.TRANSCRIPT
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WLSACONVERGENCE SUMMIT
EMPOWERING CLINICIANS TO MAKE HIGH-QUALITY DECISIONS IN CHRONIC AND SERIOUS ILLNESS THROUGH MOBILE HEALTH TECHNOLOGIES
JON NICOLLA, PROJECT DIRECTOR, CENTER FOR LEARNING HEALTHCARE, DUKE UNIVERSITY
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Jon Nicolla, MBAProject Director, Center for Learning Healthcare, Duke University
Empowering Clinicians to Make High-Quality Decisions in Chronic and Serious Illness
Through Mobile Health Technologies
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What is the primary driver of suboptimal care in healthcare delivery?
• Inconsistency in delivery of care• Clinical
• Institutional
• Governmental
• Common vs. Special Cause Variation
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How can we solve this problem?
• We need a platform that:• Can be utilized in multiple clinical settings
• Has been tested and validated for use in both academic and community settings
• Is translatable across multiple disciplines
• Contains a standard set of data elements based on clinically validated instruments
• Can longitudinally track and manage chronic and serious illness patients
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Current Landscape
• Current technologies being developed to standardize care and clinical decision making are limited
Current Method Limitations
Paper Method Retrospective analysis; delayed feedback
Electronic Health Record Lack of real-time decision support; limited responsiveness to data usage
Decision Support System Untested in many clinical settings
No cross-site standardization across all solutions
Untested in community settings
Untested in chronic and serious illness management
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Our Solution
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How it started
• Who?• Carolinas Palliative Care Consortium
• How?• Systematic Review
• Paper-version
• Usability Testing
• Feasibility Testing
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Features of QDACT
• Web-based Platform agnostic
• Longitudinal patient management
• Real-time clinical registry feed
• Robust reporting capabilities
• Clinician-validated branching logic
• Decision support capabilities
• Color-coded clinical decision alarms
• Site-level census management
• HIPAA compliant security features
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Proof of Concept
• Test Case• Palliative Care
• Sites• Four Carolinas Consortium sites
• Methodology• Plan-Do-Study-Act
• Measures• Timely management of constipation (NQF# 1617)
• Timely management of dyspnea (NQF# 1639)
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Cycle 1 (Nov-Dec)
Electronic, point-of-care quality data capture only
Cycle 2 (Dec-Jan)
Add weekly, personalized reports on conformance to measures
Cycle 3 (Jan-Feb)
Add weekly, comparative reports on conformance versus Consortium
PDSA Schedule
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Weekly Provider Reports
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Results
ConformancePaper-Based(March 2008-Oct 2011)
QDACT only(Nov 4-Dec 3 2012)
QDACT + personal reports (Dec 4-Jan 10, 2013)
QDACT + personal reports + comparisons (Jan 11 –Feb 11, 2013)
Timely Management of Dyspnea
6% 93.3% 94.1% 100%
Timely Management of Constipation
4% 92% 100% 100%
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Conclusions
• Properly equipped mobile health solutions can be used to promote improved clinical decision making
• Varying degrees of clinician feedback can improve adherence to quality measures
• As medicine becomes faster, the implementation of flexible mobile health solutions, such as QDACT, will become imperative to the delivery of consistent quality patient care
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Implications
• Establish standardized quality-based palliative care consult
• Solutions like QDACT:• Promote Rapid Learning Quality Improvement (RLQI)
• Promote usage of Data Triple Aim
• Allow easy multi-site analysis
• Develop validated care pathways
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Next Steps
• Global Palliative Care Quality Alliance• Current RLQI
• QDACT (V2.1)
• Expansion• QDACT.PCRC
• QDACT.HOME
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Thanks
• CLHC Team
• Carolinas Palliative Care Consortium
• Global Palliative Care Quality Alliance
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Questions?
Jon Nicolla, MBA Project Director, Center for Learning Healthcare, Duke University
www.qdact.org
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WLSACONVERGENCE SUMMIT
www.wirelesshealth2014.org