Best practices: Interpreting measurement data for quality improvement: standards, means, norms, and benchmarks.

Abstract

and improving care. We use a narrow definition of a best practice, adapted from Donabedian’s framework of structures, processes, and outcomes of health care (3). In this construct, a “practice” is a process—the means by which a delivery system interacts with and influences patients. A “best practice” is a process that has been demonstrated to produce superior results, such as better patient outcomes. To illustrate a challenge confronting clinicians and managers in the course of quality-improvement work, we describe a common situation: A community mental health center named CMHC, Inc., decides to adopt a report card of performance measures to assess quality of care. The center selects measures that reflect the needs of its patient population and staff concerns about where care might fall short. One concern is that many of the patients may not be completing prescribed courses of antidepressants. Thus CMHC’s report card includes a measure to assess adherence after initiation of medication treatment for depression. The measure assesses the proportion of patients with major depressive disorder who complete a 12-week acute phase of antidepressant treatment. Data from CMHC are collected and analyzed, and clinicians and managers meet to review the results. They learn that 55 percent of patients initiating a new course of antidepressant