Building the Infrastructure for Value at UCLA: Engaging Clinicians and Developing Patient-Centric Measurement.
OBJECTIVE
Evolving payer and patient expectations have challenged academic health centers (AHCs) to improve the value of clinical care. Traditional quality approaches may be unable to meet this challenge.


METHODS
One AHC, UCLA Health, has implemented a systematic approach to delivery system redesign that emphasizes clinician engagement, a patient-centric scope, and condition-specific, clinician-guided measurement. A physician champion serves as quality officer (QO) for each clinical department/division. Each QO, with support from a central measurement team, has developed customized analytics that use clinical data to define targeted populations and measure care across the full treatment episode.


RESULTS
From October 2012 through June 2015, the approach developed rapidly. Forty-three QOs are actively redesigning care delivery protocols within their specialties, and 95% of the departments/divisions have received a customized measure report for at least one patient population. As an example of how these analytics promote systematic redesign, the authors discuss how Department of Urology physicians have used these new measures, first, to better understand the relationship between clinical practice and outcomes for patients with benign prostatic hyperplasia and, then, to work toward reducing unwarranted variation. Physicians have received these efforts positively. Early outcome data are encouraging.


CONCLUSIONS
This infrastructure of engaged physicians and targeted measurement is being used to implement systematic care redesign that reliably achieves outcomes that are meaningful to patients and clinicians-incorporating both clinical and cost considerations. QOs are using an approach, for multiple newly launched projects, to identify, test, and implement value-oriented interventions tailored to specific patient populations.
R. Clarke is medical director for quality, University of California, Los Angeles (UCLA) Faculty Practice Group, and assistant clinical professor, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.A.S. Hackbarth is manager, Value Analytics Team, UCLA (University of California, Los Angeles) Health, Los Angeles, California.C. Saigal is vice chair, Department of Urology, and professor, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California.S.A. Skootsky is chief medical officer, University of California, Los Angeles (UCLA) Faculty Practice Group, and professor, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
Robin
R
Clarke
Andrew S
AS
Hackbarth
Christopher
C
Saigal
Samuel A
SA
Skootsky
D000046:Academic Medical Centers / Q000191:economics / Q000592:standards*; D002140:California; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care; D016730:Program Development; D015397:Program Evaluation; D011470:Prostatic Hyperplasia / Q000628:therapy*; D011787:Quality of Health Care; D014573:Urology Department, Hospital / Q000191:economics / Q000592:standards*