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Standardising hospitalist practice in sepsis and COPD care
  1. Steven Bergmann1,
  2. Mary Tran2,
  3. Kathryn Robison1,
  4. Christine Fanning1,
  5. Simran Sedani1,
  6. Janet Ready1,
  7. Kelly Conklin3,
  8. Diana Tamondong-Lachica2,
  9. David Paculdo2,
  10. John Peabody2,4
  1. 1Penn Medicine Princeton Health, Plainsboro, New Jersey, USA
  2. 2QURE Healthcare, San Francisco, California, USA
  3. 3Premier, Charlotte, North Carolina, USA
  4. 4School of Medicine, University of California, San Francisco, California, USA
  1. Correspondence to Dr John Peabody, University of California, San Francisco, CA 95817, USA; jpeabody{at}qurehealthcare.com

Abstract

Background Hospitalist medicine was predicated on the belief that providers dedicated to inpatient care would deliver higher quality and more cost-effective care to acutely hospitalised patients. The literature shows mixed results and has identified care variation as a culprit for suboptimal quality and cost outcomes. Using a scientifically validated engagement and measurement approach such as Clinical Performance and Value (CPV), simulated patient vignettes may provide the impetus to change provider behaviour, improve system cohesion, and improve quality and cost efficiency for hospitalists.

Methods We engaged 33 hospitalists from four disparate hospitalist groups practising at Penn Medicine Princeton Health. Over 16 months and four engagement rounds, participants cared for two patients per round (with a diagnosis of chronic obstructive pulmonary disease [COPD] and sepsis), then received feedback, followed by a group discussion. At project end, we evaluated both simulated and real-world data to measure changes in clinical practice and patient outcomes.

Results Participants significantly improved their evidence-based practice (+13.7% points, p<0.001) while simultaneously reducing their variation (−1.4% points, p=0.018), as measured by the overall CPV score. Correct primary diagnosis increased significantly for both sepsis (+19.1% points, p=0.004) and COPD (+22.7% points, p=0.001), as did adherence to the sepsis 3-hour bundle (+33.7% points, p=0.010) and correct admission levels for COPD (+26.0% points, p=0.042). These CPV changes coincided with real-world improvements in length of stay and mortality, along with a calculated $5 million in system-wide savings for both disease conditions.

Conclusion This study shows that an engagement system—using simulated patients, benchmarking and feedback to drive provider behavioural change and group cohesion, using parallel tracking of hospital data—can lead to significant improvements in patient outcomes and health system savings for hospitalists.

  • evidence-based medicine
  • quality improvement
  • hospital medicine
  • implementation science

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Footnotes

  • Funding This study was funded by Premier.

  • Competing interests QURE, whose intellectual property was used to prepare the cases and collect the data, was contracted by Penn Medicine Princeton Health (formerly Princeton HealthCare System).

  • Patient consent for publication Not required.

  • Ethics approval The CPV data gathered were obtained as part of clinical quality and safety. The data were not collected for research purposes and contained no patient information. Accordingly, per the Office of Research Integrity of the US Department of Health and Human Services under the US Code of Federal Regulation, 45 CFR 46, the study was exempt from Institutional Review Board review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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