The Power of Clinical Practice Improvement Methodology

THE POWER OF
CLINICAL PRACTICE IMPROVEMENT
METHODOLOGY

Detailed Overview of Clinical Practice Improvement

What can a Clinical Practice Improvement study database do?

A Clinical Practice Improvement (CPI) study database allows clinicians to ask and answer questions about associations among patient, process, and outcome variables. For example, is a difference in patient outcomes due to differences in treatments or to differences in patient characteristics, such as their severity of disease? Or, does one treatment result in better outcomes than another for a specific group of patients?

A Clinical Practice Improvement study database helps clinicians determine how and where to improve clinical decision-making in order to achieve better patient outcomes. The focus is on determining better clinical processes, not on identifying bad performers.

In addition, Clinical Practice Improvement study databases are often used to answer questions about medical treatments and practices not even conceived of when the original study was designed. Because of their rich level of detail, these databases are a fertile source of associations that clinicians can use to evaluate objectively the effects of the treatments they give to similarly ill patients. As a consequence, they can make direct, practical changes in their clinical practice that benefit patients.

What data are used?

All relevant patients qualify for studies, and therefore are included in the database.

Comprehensive data describing the entire care process are captured: patient characteristics, actual treatments, and patient outcomes. All data needed to identify best practices can be captured by the Comprehensive Severity Index (CSI^®) software.
Patient data are measured at a level of detail that can be used by clinicians in complex, clinical decision-making processes.

These include:

Severity measurements that capture all relevant disease-specific physiologic signs and symptoms
Actual timing, amount, and frequency of treatments
Measures of health status, clinical, and cost outcomes

What results are derived from a CPI study?

A Clinical Practice Improvement study can provide several important results:

Patient care processes are almost always improved, and patients get better faster.
As patients get better faster, costs are decreased.
The extensive data collected are available to answer new questions not conceived of at the time the initial Clinical Practice Improvement study was designed.

How does CPI differ from other approaches?

Brian Ely, M.D., a physician at Sutter Health, wrote recently:

"The validity of a particular scientific methodology is highly dependent upon its ability to eliminate or neutralize confounding influences. In some manner, the specific interactions being studied must be isolated. Randomized control led trials (RCTs) typically accomplish this by eliminating individuals subject to real or potential comorbidities and through close control of protocol administration. With that approach, control of systematic variation is primarily through physician measures, and statistical analysis plays a limited role.

In contrast, CPI depends heavily on statistical analysis. Given reasonable control of data quality, the power of large numbers combined with sophisticated statistical analysis methodologies can produce information of validity equal to or greater than that resulting from classical RCT approaches."

The highly specific manner in which the quality and quantity of data are handled in a Clinical Practice Improvement study make it a very appropriate and effective method to determine what works best in the care of patients.

Detailed Overview of Clinical Practice Improvement