Healthcare’s Quality Quest: Getting Closer, But Still Haven’t Arrived

By Dustyn Williams, MD, CEO, DoseDr
Twitter: @DustynWilliams
Twitter: @TheDoseDr

Healthcare’s quality movement has come a long way since the Institute of Medicine released its ground-breaking report, To Err is Human: Building a Safer Health System, which launched the industry into a period of soul searching. That’s what happens when a professional community recognizes the catastrophic impact of its own errors—in this case, a massive toll on human life.

Now, nearly two decades later, the evolution of the quality movement has moved from a mere minimum standard of care to a comprehensive, patient-centric approach. After decades spent steeped in fee-for-service models, the healthcare industry is redefining how quality and value are measured to support a higher plane of performance.

To overcome the limitations of traditional approaches to care, organizations are compelled to seek out care models and solutions from the persona of a positive deviant—defying the natural order to accept inefficiencies within a system and developing work-arounds for those inefficiencies. “Business as usual” no longer suffices to move the needle on outcomes performance. While utilization of health IT to deliver optimal care is now mainstream, industry stakeholders must do more than simply check off regulatory boxes to achieve sustainable performance improvement. They must have access to critical tools that power proactive, actionable clinical workflows to effectively and rapidly address health conditions and engage patients in their care.

Evolving Regulatory Front
Over the last two decades, the healthcare industry’s quality focus has evolved from widely-adopted “lean” principles to steps outlined by the Institute of Medicine, including standardized regulations to enhance patient safety performance standards, implementation of continuous patient safety monitoring and mandatory reporting systems.

Recent regulatory movements now mandate that healthcare organizations effectively measure and assess the success of implemented interventions, or lack thereof. Process measures, generally based upon evidence based best-practices, are often used to assess and standardize quality care. In theory, this approach should minimize variation, leading to improved outcomes.

Limitations of Current Approaches
The reality is that only a limited amount of evidence exists supporting the correlation between process measures and significantly improved process outcomes. Simply following these best-practice protocols does not necessarily equate to better outcomes. That’s why recent movements on the regulatory front point to greater focus on outcomes measures.

Although process measures have moved the industry a step closer to standardized best practices, they have limitations. For instance, process measures do not take into account the length of time required to yield results or patient accountability. For a system to thrive, patients with chronic health conditions must learn to manage their health and medical conditions on a daily basis.

The mammoth diabetes epidemic is a perfect example. Existing process measures do not consider the day-to-day challenge of diabetes management. To effectively manage the disease, patients with severe diabetes must continually monitor the condition and account for the various factors that alter insulin levels. Changes in required insulin doses include food intake, physical activity and time of day. Missing a dose or taking an incorrect one can lead to additional adverse health events, resulting in costly hospitalizations and ER visits. To further complicate matters, primary care physicians have limited resources, such as staff, time and meaningful tools to truly impact care.

Value-based care should yield impactful outcomes and enable the implementation and advancement of positive deviance in the form of innovations. However, the critical framework and tools necessary to achieve this have been missing from the equation. Although incentives are provided to improve adherence to best-practices, industry stakeholders must now leverage forward-thinking care models and tools that will support greater focus on outcomes performance. Positioning for the future of healthcare requires a new approach: one that engages patients in their own healthcare.

Next-Generation Care Delivery Models: A Path to Success
Today’s providers must embrace new innovations and care delivery models for sustainable change to occur. Technology provides the key to success through the provision of tools that enable improved patient-provider interaction and ongoing care monitoring. By empowering patients with access to these tools, patients gain both a comprehensive understanding of their health and the ability to effectively self-manage their conditions.

The use of telemedicine is on the rise, particularly with smartphone applications. These solutions deliver easily-understandable, actionable information to patients in real time. Monitoring capabilities combined with alert systems ensure potentially severe health concerns are rapidly addressed. This proactive, patient-centric approach to care management helps to improve adherence to care plans and medications while driving timely intervention to prevent adverse health effects that result in costly medical encounters.

Patients and providers are increasingly leveraging chronic care management telemedicine solutions that enable patients to self-enter data that is then aggregated and analyzed in real time. With instant feedback capabilities, healthcare organizations and providers are equipped with the functionalities to evaluate and improve processes.

For example, diabetes care management platforms, such as DoseDr, illustrate the success of telemedicine solutions in managing complex chronic conditions. Patients simply enter their blood sugar level into the application and are instantly provided with the correct dose of insulin. When needed, telemedicine physicians can make frequent, small titrations between clinic visits with primary care providers. Patients can also access documentation on their blood sugar levels and insulin intake at any time on the application. In just one month, this approach reduced A1c levels from an average of 9.4 to 6.3. Without such a platform, achievements of this magnitude may take up to seven years, if at all, to accomplish.

Providers and patients who embrace these forward-looking care models are essential in a system that provides quality care and outcomes for all populations. Ultimately, this kind of deviation is necessary for healthcare to reach the summit of its quality quest.