ABSTRACT
Real-time feedback is a growing trend in patient- and family experience (PFE) work as it allows for immediate service recovery, though it typically requires a significant investment of time and financial resources. We describe a partnership with our "edutainment" system to administer an automated daily experience question (the "Daily Pulse Measure [DPM]") that allowed targeted just-in-time responses to low scores with minimal administrative cost. Through a series of Plan-Do-Study-Act cycles guided by family feedback, the question was created and modified, and the use of the question spread to all hospital units. The response rate was 23%, similar to our Hospital Consumer Assessment of Healthcare Providers and Systems survey response rate of 24% during the study period. Though the DPM did not have a consistent impact on the results of the 2 PFE survey questions we evaluated, units with improved PFE scores after the DPM roll-out tended to have more robust service recovery than those with low scores.
ABSTRACT
The Complex Care Center at Cincinnati Children's Hospital Medical Center developed and implemented a set of evidence-based clinical process measures of immunization delivery, preventive and chronic condition laboratory screening, and behavioral health medication surveillance for use in the primary care setting. METHODS: Improvement activities focused on 4 measures across 4 domains mandated by the National Committee on Quality Assurance for patient-centered medical home recognition. Interventions were implemented in phases from January 2017 to October 2018. The goal was the improvement in immunizations, preventive lead screening, vitamin D testing in chronic conditions, and behavioral health medication surveillance. Preventative lipid screening in the entire population and thyroid-stimulating hormone levels in patients with Down syndrome were also measured. RESULTS: The offering and the completion of an immunization bundle increased from a mean of 61.0% to a mean of 83.7% of patients. Eligible patients with documented lead surveillance increased from 61.2% to 96.5%. Patients with documented 25-hydroxy vitamin D levels increased from 72.2% to 87.8%. The percentage of patients metabolically monitored while taking an atypical antipsychotic continued at 92.0%. CONCLUSIONS: Using quality improvement education, data measurement/feedback, electronic medical record optimization/decision support, and care gap identification with planned care, the Complex Care Center demonstrated improved reliability in needed immunization delivery and laboratory screenings for a heterogeneous primary care population of children with medical complexity. As the numbers of children with medical complexity rise, so does the importance of reliable processes and relevant measures for quality in their unique care delivery systems.
