WLSACONVERGENCE SUMMIT

EMPOWERING CLINICIANS TO MAKE HIGH-QUALITY DECISIONS IN CHRONIC AND SERIOUS ILLNESS THROUGH MOBILE HEALTH TECHNOLOGIES

JON NICOLLA, PROJECT DIRECTOR, CENTER FOR LEARNING HEALTHCARE, DUKE UNIVERSITY

Jon Nicolla, MBAProject Director, Center for Learning Healthcare, Duke University

Empowering Clinicians to Make High-Quality Decisions in Chronic and Serious Illness

Through Mobile Health Technologies

What is the primary driver of suboptimal care in healthcare delivery?

• Inconsistency in delivery of care• Clinical

• Institutional

• Governmental

• Common vs. Special Cause Variation

How can we solve this problem?

• We need a platform that:• Can be utilized in multiple clinical settings

• Has been tested and validated for use in both academic and community settings

• Is translatable across multiple disciplines

• Contains a standard set of data elements based on clinically validated instruments

• Can longitudinally track and manage chronic and serious illness patients

Current Landscape

• Current technologies being developed to standardize care and clinical decision making are limited

Current Method Limitations

Paper Method Retrospective analysis; delayed feedback

Electronic Health Record Lack of real-time decision support; limited responsiveness to data usage

Decision Support System Untested in many clinical settings

No cross-site standardization across all solutions

Untested in community settings

Untested in chronic and serious illness management

Our Solution

How it started

• Who?• Carolinas Palliative Care Consortium

• How?• Systematic Review

• Paper-version

• Usability Testing

• Feasibility Testing

Features of QDACT

• Web-based Platform agnostic

• Longitudinal patient management

• Real-time clinical registry feed

• Robust reporting capabilities

• Clinician-validated branching logic

• Decision support capabilities

• Color-coded clinical decision alarms

• Site-level census management

• HIPAA compliant security features

Proof of Concept

• Test Case• Palliative Care

• Sites• Four Carolinas Consortium sites

• Methodology• Plan-Do-Study-Act

• Measures• Timely management of constipation (NQF# 1617)

• Timely management of dyspnea (NQF# 1639)

Cycle 1 (Nov-Dec)

Electronic, point-of-care quality data capture only

Cycle 2 (Dec-Jan)

Add weekly, personalized reports on conformance to measures

Cycle 3 (Jan-Feb)

Add weekly, comparative reports on conformance versus Consortium

PDSA Schedule

Weekly Provider Reports

Results

ConformancePaper-Based(March 2008-Oct 2011)

QDACT only(Nov 4-Dec 3 2012)

QDACT + personal reports (Dec 4-Jan 10, 2013)

QDACT + personal reports + comparisons (Jan 11 –Feb 11, 2013)

Timely Management of Dyspnea

6% 93.3% 94.1% 100%

Timely Management of Constipation

4% 92% 100% 100%

Conclusions

• Properly equipped mobile health solutions can be used to promote improved clinical decision making

• Varying degrees of clinician feedback can improve adherence to quality measures

• As medicine becomes faster, the implementation of flexible mobile health solutions, such as QDACT, will become imperative to the delivery of consistent quality patient care

Implications

• Establish standardized quality-based palliative care consult

• Solutions like QDACT:• Promote Rapid Learning Quality Improvement (RLQI)

• Promote usage of Data Triple Aim

• Allow easy multi-site analysis

• Develop validated care pathways

Next Steps

• Global Palliative Care Quality Alliance• Current RLQI

• QDACT (V2.1)

• Expansion• QDACT.PCRC

• QDACT.HOME

Thanks

• CLHC Team

• Carolinas Palliative Care Consortium

• Global Palliative Care Quality Alliance

Questions?

Jon Nicolla, MBA Project Director, Center for Learning Healthcare, Duke University

Jonathan.nicolla@duke.edu

www.qdact.org

WLSACONVERGENCE SUMMIT

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