Using data to improve medical practice by measuring processes and outcomes of care.
BACKGROUND
The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not Mandatory)" and "Create the Guiding Coalition. (A Small, Devoted Group of People Can Change the World)."


CONCLUSIONS
Over the long term, we must transform thousands of local practice cultures so that useful data are used every day in countless ways to assist clinicians, support staff, patients, families, and communities.
Nelson
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Dartmouth Medical School, USA. eugene.c.nelson@hitchcock.org
Splaine
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ME
Godfrey
M M
MM
Kahn
V
V
Hess
A
A
Batalden
P
P
Plume
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SK
D015510:Clinical Medicine / Q000458:organization & administration / Q000592:standards*; D003625:Data Collection; D003627:Data Interpretation, Statistical; D006123:Group Practice / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D017146:Models, Organizational; D009513:New Hampshire; D019982:Organizational Case Studies; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D013597:Systems Analysis; D017749:Total Quality Management / Q000379:methods*; D014481:United States; D014589:Utah