Step | Description | Example |
Problem | All coalitions began with the same problem statement. | AMI mortality is too high. |
Objective | Coalitions then generated a mirroring objective that was meaningful and measurable within their operating context. | Reduce unadjusted 30-day AMI mortality for all payer classifications by 3% from Fiscal Year 2014 baseline (6.69%) by 31 December 2015. |
Root cause analysis | Coalitions used multiple sources of data to identify and prioritise root causes of AMI mortality in their context. | Lack of standardisation of care, complex patient population with multiple comorbidities, inconsistent transitions in care. |
Strategy development | Coalitions adapted evidence-based strategies and generated novel strategies, tailored to address their prioritised root causes. | Structured form for pharmacy rounding on patients and review discharge medications; introduction of real-time risk stratification using two tools; creation of an AMI follow-up clinic. |
Results | Coalitions created evaluation plans to match their strategies and evaluate progress towards their SMART objective. | Increase in number of pharmacist interventions; improved reliability of risk stratification; decrease in proportion of patients lost to follow-up; decrease in unadjusted mortality from 6.7% to 2.7%. |
AMI, acute myocardial infarction.