One-Stop Quality Improvement, Within Keystrokes
Daniela Levi, MD
Fragmentation of information in the U.S. healthcare system, low compliance with quality improvement guidelines, and patients’ widely varying levels of disease awareness are critical issues in patient safety. Dr. Daniela Levi, Assistant Professor and Director of Quality, Safety, and Development in the Division of Critical Care Medicine at Albert Einstein College of Medicine/Montefiore Medical Center, seeks to bridge the gap in healthcare reporting, increase transparency and performance improvement, and empower patients to make informed decisions through a new web-based software program called Power to Patient (P2P).
Clarifying and Publicizing Best Practices
“Working in critical care has opened my eyes to the difference in practices from institution to institution and from physician to physician,” Dr. Levi said. “I have noticed that some treatments that have been shown to be proven are not widely used, while treatments shown not to be helpful are still in use.”
Many websites currently report hospital outcomes, but the complexity of the information renders navigation difficult and time-consuming. Additionally, these reporting systems while is invaluable, yet virtually incomprehensible to the lay person. Extensive research into usability of healthcare websites has informed the design of P2P, which will present information from providers’ reporting systems in a well-organized, synthesized fashion, with a layering effect to allow for increasing detail while reducing information overload. Consistent table layouts, information “chunking,” and integration of symbols are some of the techniques that will enhance the user experience.
Dr. Levi anticipates that P2P will particularly benefit private practices and nursing homes in remote areas. The program is designed to support these facilities by disseminating treatment guidelines and tools for diseases commonly seen in the practice (particularly those such as diabetes and hypertension), and comparing that practice’s guidelines and outcomes with those of other practices in the region as well as larger centers across the nation.
Capitalizing on Competitive Nature
P2P’s success will depend on the competitive nature of physicians and healthcare practices. In contrast to current quality improvement methods such as P4P (pay for performance), which reward providers financially for meeting pre-established treatment measures, P2P relies on physicians to voluntarily report their own outcomes. By creating what she considers to be a more subtle, culturally sensitive motivator, Dr. Levi believes that she can appeal to physicians’ inner character and drive. “Collecting our own data and posting it to share with our colleagues has great value,” she said. “Showing each other what we can do, and how we can improve, is the biggest incentive for improvement.”
Helping Patients Heal Themselves, Beginning in the Bronx
P2P’s end users include patients, physicians, and institutions, and the complexity level is customizable, but according to Dr. Levi the system will be designed primarily for patients. A diabetic patient using P2P, for example, would first see what it means to have the disease; how to control it; options for medication; and treatment alternatives such as exercise, diet, and herbal therapies. Using the tool, the patient could search for nearby diabetes treatment centers with the best outcomes, and find local resource networks such as support groups.
Dr. Levi anticipates that Bronx healthcare providers will be the first to benefit from this program, which she plans to pilot to the Bronx RHIO, a regional healthcare-information-sharing collaborative of hospitals (including Montefiore Medical Center), doctors' offices, clinics, and nursing homes throughout the Bronx. “Every day, I see patients who are very informed about their diseases, as well as those who have no information at all,” said Dr. Levi. “In the Bronx, where our patient population is so diverse, P2P will provide them with highly comprehensible, easily accessible information, with options for more detail and complexity.”