Abstract
BackgroundUsing outcome measures to advance healthcare continues to be of widespread interest. The goal is to summarize the results of studies which use outcome measures from clinical registries to implement and monitor QI initiatives. The second objective is to identify a) facilitators and/or barriers that contribute to the realization of QI efforts, and b) how outcomes are being used as a catalyst to change outcomes over time.MethodsWe searched the PubMed, EMBASE and Cochrane databases for relevant articles published between January 1995 and March 2017. We used a standardized data abstraction form. Studies were included when the following three criteria were fulfilled: 1) they relied on structural data collection, 2) when a structural and comprehensive QI intervention had been implemented and evaluated, and 3) impact on improving clinical and/or patient-reported outcomes was described. Data on QI strategies, QI initiatives and the impact on outcomes was extracted using standardized assessment tools.ResultsWe included 21 articles, of which eight showed statistically significant improvements on outcomes using data from clinical registries. Out of these eight studies, the Chronic Care Model, IT application as feedback, benchmarking and the Collaborative Care Model were used as QI methods. Encouraging trends in realizing improved outcomes through QI initiatives were observed, ranging from improving teamwork, implementation of clinical guidelines, implementation of physician alerts and development of a decision support system. Facilitators for implementing QI initiatives included a high quality database, audits, frequent reporting and feedback, patient involvement, communication, standardization, engagement, and leadership.ConclusionThis review suggests that outcomes collected in clinical registries are supportive to realize QI initiatives. Organizational readiness and an active approach are key in achieving improved outcomes.
Highlights
Using outcome measures to advance healthcare continues to be of widespread interest
The studies focused on registries for the following patient groups; patients with diabetes [24,25,26,27,28,29,30,31], children with chronic conditions [32], patients with lung cancer [33, 34], patients with cystic fibrosis [35,36,37], patients with cardiac anomalies [38], patients undergoing cardiac surgery [39,40,41], patients with acute myocardial infarction [42], and patients referred for home health services [43]
Eight out of the 21 included studies reported statistically significant improvements in outcomes including longterm survival, mortality, readmission rate, bleeding complications, systolic blood pressure, Glycated Hemoglobin (HbA1C), Low-density lipoprotein (LDL), exercise habits (FEV1), depression improved in the acute phase (PHQ-9 score) and hospitalization with ambulatory care-sensitive conditions resulting from the implementation of quality improvement (QI) initiatives
Summary
Using outcome measures to advance healthcare continues to be of widespread interest. The goal is to summarize the results of studies which use outcome measures from clinical registries to implement and monitor QI initiatives. The current body of literature lacks insights into the extent to which the use of outcome measures from clinical registries, either when identifying, selecting or monitoring QI initiatives, can impact health outcomes. Value-based health care aims at achieving higher value for patients while ensuring sustainability of the healthcare system by an efficient and effective delivery of care [14]. This goal is assumed to be achieved by measuring and using outcomes per medical condition for the identification of improvement potential across the full cycle of care [12]. Higher value for patients by measuring outcomes is one of the potential methods for improving quality of healthcare relative to the costs spent. For the purposes of this review, we only focused on outcome measures and not on the respective costs
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