changing landscape of quality – implications for pediatric specialties and data systems ramesh...
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Changing Landscape of Quality – Implications for Pediatric Specialties and Data Systems
Ramesh Sachdeva, MD, PhD, JD, FAAP, FCCMChief Scientific Officer, VPS
Professor of Pediatrics, Critical CareMEDICAL COLLEGE OF WISCONSIN
Associate Executive Director
Medical Director, Quality InitiativesDirector, Department of Subspecialty Pediatrics
AMERICAN ACADEMY OF PEDIATRICS
Achieving Change to Improve Quality and Enhance OutcomesEight Steps of Change
Increase Urgency
Build the Guiding Team
Get the Right Vision
Communicate for Buy-In
Empower Action
Create Short-term Wins
Don’t Let Up
Make it StickCreating a climate for change
Engaging and enabling the whole
organization
Implementing and sustaining
change
Kotter, John P. and Cohen, Dan S. The Heart of Change. Boston: Harvard Business School Press, 2002.
The DNA of Continuous Learning for QIKnowledge Management
Level 1:Standardized
Infrastructure for Knowledge Sharing
Level 3:Top-Down Retention
Measurement
Level 5:Organizational
Knowledgebase
Level 7:Continual Process
Improvement
Level 2:Top-down Quality-Assured Information Flow
Level 4:Organizational Learning
Level 6:Process-Driven Knowledge Sharing
Level 8:Organizational Self-Actualization
In: http://wisdomsource.com/k3m_overview.html
Role of the Intensivist
Improving care for the child in the PICU
Role of the Intensivist
Leadership at the hospital and system level
Role of the Intensivist
Impacting child health outcomes
Contemporary View for Data Systems
DATA
Quality Improvement
INFORMATION
ACTION
Clinical Usability
Reliability
EHR – Best Practices
Validity
Risk Adjustment
*(Sachdeva et al., Pediatrics 1999 – HRQOL)
Long Term Outcomes*
Whole System Measures
Emerging View for Data System Integration
PICU
30% of kids <2Y admitted to PICU for respiratory diseases
were preemies(Gunville et al., J Peds
2010)
NICU
Prenatal – weight adjusted survival
PICU – risk adjusted survival
Community
6 Months – significant morbidity (Jones et al.,
Pediatrics 2006)
VPS
STS/NSQIP
VON
PHIS
Future Direction for Data Systems- BIG Data
MARCH 16, 2015 BY LAURA LANDRON
Pediatric ICU Quality Measures
• Children's Health Insurance Program Reauthorization Act (CHIPRA) – Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Measures Program (PQMP)
• Project Management Center of Excellence (PMCoE) – Pediatric Intensive Care Unit (PICU) Quality Measures
• WAVE 1 Measures – (1) Incidence of Pressure Ulcer-standalone, (2) Risk Assessment for Pressure Ulcer, (3) Screening for Nutritional Status, (4) Red Cell Transfusion
• WAVE 2 Measures – (1) Composite Measure on Preventable Harm, (2) Incidence of Pressure Ulcer-component, (3) Composite Measure on Patient Comfort, (4) & (5) Pain Management-2components, (6) & (7) Sedation Management-2components, (8) & (9) Iatrogenic Withdrawal Mananagement-2 components
Learning from Specialty NetworksResearch – Knowledge Management - Practice
Primary Care
Pediatricians
Pediatric
Subspecialists
Practice
Transformation
Technology
Payment Reform
Team Based
Care
Surgery
NSQIP
Oncology
POND4Kids
NICU
VON
GI-IBD
ImproveCareNow
CCMVPS
If not us, then who?If not now, then when?
Dr. M artin Luther King, Jr.
Discussion Questions • What changes are needed in the VPS to meet the current needs of
hospitals and health systems?
• SOI models – next generation?
• Subspecialty modules – PICU?
• How can quality measures be embedded into VPS to effectively inform public reporting and payment policies?
• What are solutions to technical barriers to specialty data system integration?
• Should the VPS become a registry?
• Role of VPS in informing strategies for integrated delivery systems and ACOs to improve child health population outcomes?