Duke Clinical Research Institute[精品].ppt

Reducing Errors of Omission:What have we learned? Standardized orders Right drugs, right dose, if not why not Earlier cardiology consult +/- Transfer Systems approach Patient discharge flight plan (1 page) “Here’s what you’re on” And, “why” “Quality Feedback” Emphasis on sharing results back w/ clinicians Academic Detailing Working directly with sites’ issues Reducing Errors of CommissionWhat have we learned? Education of physicians on pharmacokinetics of ACS drugs in selected populations (elderly) Pharmacist on the healthcare team Point of care technology Computerized physician order entry Decision support tools Safety drills: “Can this happen at my center?” Are We Improving? CRUSADE Acute ( 24 hrs) Medication UseQuarter 1, 2002 vs. Quarter 4, 2003 CRUSADE Discharge Medication UseQuarter 1, 2002 vs. Quarter 4, 2003 Where to Go from Here?Ideas for Collaboration Standardize Data Elements ACC QI Registry Standards Meeting VA-CRUSADE efforts Link Data Entry GWTG/CRUSADE/NRMI Standardize Re-Think and QI indicators Based on evidence and health policy implications Collaborative QI Efforts/Experts Oklahoma (QIO-ACC partnership) Creating a “Tipping Point” for Care The Key Movers “Mavens” Inspirational leaders selling with evidence “Connectors” cross-talk b/t clinicians, QI personnel + administrators + regulators The Stickiness Factor National movement Local action / plans involvement Ongoing challenge: single hit not enough The Context Needs to be Right Time...but the time is now “The Tipping Point: How little things can make a big difference” Malcolm Gladwell 2000 It’s easy to get good players. Casey Stengel Getting ’em to play together … That’s the hard part. * * Presented at Millennium/Schering Symposium at 2002 AHA * * Continuous Quality Improvement (CQI)Ending Business as Usual in ACS  Eric D. Peterson, MD, MPH Associate Professor of Medicine Director of CV Outcomes Research and Quality Duke Clinical Research Institute  Challenges To Healthca