Ongoing studies cite clinical best practices
AAAHC IQI seeks to provide QI benchmarking
The Wilmette, IL-based Accreditation Association for Ambulatory Health Care Institute for Quality Improvement (AAAHC IQI) is seeking to provide quality improvement opportunities for health care professionals through a series of clinical performance studies, which began when the organization was established in 1999.
To date, 11 such studies have been performed, covering ambulatory care areas such as colonoscopy, knee arthroscopy, and cataract extraction; and disease management issues such as asthma.
These studies have a distinctive philosophical approach, explains Sam J.W. Romeo, MD, MBA, head of the association’s performance measurement initiative and a medical administration consultant in Turlock, CA.
"To survey or review the literature is an episode of confirmation, but it does not demonstrate an ongoing culture of commitment to quality," says Romeo.
"We need to do that on our own initiative. I’ve been appalled more often than not by the initiatives coming from payers, but if we as a profession don’t belly up to the bar and demonstrate what quality is, we have every right to be criticized," he adds.
The studies, he explains, "must be based both on what is known objectively and what we learn empirically."
Romeo’s goal was to put in place a mechanism to create an ongoing current and prospective way of measuring quality.
"Heretofore, almost all studies have been done on a retrospective basis; by the time they appeared, the horse was often out of the barn, and many errors’ would appear simply because the knowledge had changed," he observes.
When Romeo’s group decides to conduct a study, "We put together people in that field, review the literature to find the most appropriate care, then determine the data elements we can aggregate to make the process current and reasonable for people to do, and we do all this on a concurrent basis."
For benchmarking purposes, all those who participate in the study submit flowsheets that are subsequently analyzed and compared. "You know who you are, but nobody else does; your facility is just given a number," Romeo explains. Institutions can participate by contacting the association (www.aaahciqi.org). The fee is about $400.
"What’s most important is that this process is novel," he says. "Nobody else has demonstrable results of a concurrent and prospective study."
What has been learned
In the past three years, much of value has been learned about best practices, Romeo says. Here are a few examples:
• Knee arthroscopy.
"One thing we discovered was that the post-op recovery time can be reduced as much as 45 minutes if you use a local anesthetic and conscious sedation as opposed to a general. And if you use IV sedation and a local, you can save $150 a case."
• Colonoscopy.
Those patients who had effective analgesia during their procedures and reported less discomfort were much more likely to agree to come back on a 10-year basis, which is what is recommended. "If you hurt people too much, they just won’t think it’s worth it to come back," Romeo explains.
• Asthma disease management.
Those patients who had the opportunity to spend more time in education had fewer visits to the ED and had less serious attacks, demonstrating that patient education can reduce costs.
Some of the knowledge derived from studies in a specific area can transfer into other areas, Romeo notes.
"For example, the finding that using IV sedation and a local [as in knee arthroscopy] is now being applied in multispecialty cases," he reports.
Need More Information?For more information, contact:
- AAAHC IQI, 3201 Old Glenview Road, Suite 300, Wilmette, IL 60091-2992. Telephone: (847) 853-6060. Fax: (847) 853-9028. E-mail: [email protected].
- Sam J.W. Romeo, MD, MBA: 334 Sunday Drive, Turlock, CA 95382. Telephone: (209) 535-1693.
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