Using clinical practice analysis to improve care.
BACKGROUND
Improving clinical outcomes requires that physicians examine and change their clinical practice. Sustaining outcome improvements requires a dedicated and dynamic program of analyzing and improving patient care. In 1992 North Mississippi Health Services (NMHS) implemented a program to improve physicians' clinical efficiency. CLINICAL PRACTICE ANALYSIS ( CPA): CPA uses evidenced-based guidelines and examines each physician's resource utilization, processes, and outcomes for a diagnosis or procedure. Clinical practice profiles are developed, and individual performance is compared to local and national benchmarks and presented to physicians. The CPA process is used on its own or as a component of more comprehensive performance improvements projects. Physicians have been engaged in outcome improvement by more than 55 CPA projects.


RESULTS
NHMS has progressively reduced its Medicare loss and its length of stay (LOS) to 4.9 days. Mortality  and readmission rates have been reduced in specific diagnoses. The community-acquired pneumonia project reduced the LOS from 7.7 to 5.1 days, decreaesed the mortality rate from 8.9% to 5.0%, and decreased the cost of care from $4,269 to $3,834. The ischemic stroke project reduced the aspiration pneumonia rate from 6.4% to 0% and mortality from 11.0% to 4.6%. Patients' average LOS decreased from 10.7 days to 6.5 days, and their cost of care was reduced by $1,100 per patient.


CONCLUSIONS
Providing individualized    data has engaged physicians in improving outcomes. The program has evolved from improving efficiency to managing outcomes and from simple CPA projects to integrated performance improvement projects; however, the CPA process remains the cornerstone of the current process.
Englert
J
J
North Mississippi Health Services, 830 South Gloster Street, Tupelo, MS 38801, USA. jenglert@nmhs.net
Davis
K M
KM
Koch
K E
KE
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019985:Benchmarking; D002983:Clinical Competence; D017714:Community-Acquired Infections / Q000191:economics / Q000401:mortality / Q000628:therapy; D003365:Costs and Cost Analysis; D003625:Data Collection; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000592:standards; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008922:Mississippi; D017063:Outcome Assessment, Health Care; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission; D010820:Physicians / Q000592:standards; D011014:Pneumonia / Q000191:economics / Q000401:mortality / Q000628:therapy; D011015:Pneumonia, Aspiration / Q000401:mortality / Q000628:therapy; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards*; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000592:standards
D000900:Anti-Bacterial Agents