The Use of Decision Support Systems
in Continuous Quality Improvement
Janice Kaczmarek
Susan Lovejoy
Problem with CQI in Health Care

Many healthcare organizations have
implemented quality improvement measures
as a means to improve outcomes, but do not
have an information tracking system to:
– Analyze clinical data
– Monitor utilization and costs
– Track outcomes
Intermountain Health Care
“Given that ‘you manage what you measure,’
we have to extend our efforts beyond the
financial measures that have traditionally
driven healthcare delivery systems.”
Dr. Brent James, V.P.
Intermountain Health Care’s Medical Research
What is Driving the Need for CQI?
Provider accountability by insurers,
consumers, government
 Need to eliminate unnecessary treatment
and procedures
 Attempt to minimize the large variations in
practice patterns
 Control medical expenses
 Improve patient outcomes

What is CQI?

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Continuous Quality Improvement: strategies or
methods used to improve upon existing systems or
techniques in an effort to provide better quality
products and/or services to consumers.
CQI is not limited to health care, it has been used
throughout the centuries in all types of industries.
Other Names
– Total Quality Management (TQM)
– Quality Assurance (QA)
– Quality Improvement (QI)
Clinical QI at IHC
Clinical Project
Cost Structure Improvement
Fast track extubation in TICU
Long-term Ventilator management
HFOV (RDS in premature newborns
Shock Trauma Respiratory ICU
Antibiotic Assistant
Pediatric ICU
Infection prophylaxis in surgery
Adverse drug event prevention
Community-acquired pneumonia
Ventilator support for hypoxemia
Group B strep sepsis of newborn
$5.5
$4.7
$3.7
$2.5
$1.2
$.7
$.6
$.5
$.5
$.5
$.3
$20.7
Tools for Quality Improvement
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Plan-Do-Check-Act Cycle (PDCA)
Guidelines
Clinical/critical pathways
Computer-based clinical decision support systems
(CDSS)
–
–
–
–
–
Alerting Systems
Assisting Systems
Critiquing Systems
Diagnosing Systems
Reminding Systems
Outcomes-FYI
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Outcomes are states or conditions of individuals
and populations attributed to antecedent health
care.
Not a direct reflection of quality of care.
Relationship between process and outcome is a
probability and may be modified by factors other
than health care.
Large sample sizes required to obtain results that
are meaningful, which take a long time to collect.
Three Classes of Outcomes

Physical Outcomes
– Complications
– Changes in biological function
– Functional status measures

Service Outcomes
– Satisfaction surveys

Cost Outcomes
NovaMedica Application
Clinical Performance Improvement Package
 Developed in collaboration with
Intermountain Health Care.
 Designed to track clinical performance and
patient outcomes.
 Utilized by clinicians, managers other
members of Intermountain as outcomes,
educational, and marketing tool.

Example of NovaMedica
http://www.novamedica.com/
Gaps in Existing Approaches
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Lack of integration of current systems
Inability to generate useful information with
existing system
Lack of consensus on most meaningful outcomes
measures
Limited implementation of electronic medical
record
Resistance to utilize information systems for
outcomes purposes
Potential Solutions
Investment in information system
integration, including the electronic medical
record
 Consensus on a limited set of appropriate
outcome measures
 Increased education to provider community
on the benefits of electronic outcomes
tracking
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