From Data to Decision: An Implementation Model for the Use of Evidence-based Medicine, Data Analytics, and Education in Transfusion Medicine Practice

Abstract

Healthcare in the United States is underperforming despite record increases in spending. The causes are as myriad and complex as the suggested solutions. It is increasingly important to carefully assess the appropriateness and cost-effectiveness of treatments especially the most resource-consuming clinical interventions. Healthcare reimbursement models are evolving from fee-for-service to outcome-based payment. The Patient Protection and Affordable Care Act has added new incentives to address some of the cost, quality, and access issues related to healthcare, making the use of healthcare data and evidence-based decision-making essential strategies. However, despite the great promise of these strategies, the transition to data-driven, evidence-based medical practice is complex and faces many challenges. This study aims to bridge the gaps that exist between data, knowledge, and practice in a healthcare setting through the use of a comprehensive framework to address the administrative, cultural, clinical, and technical issues that make the implementation and sustainability of an evidence-based program and utilization of healthcare data so challenging. The study focuses on promoting evidence-based medical practice by leveraging a performance management system, targeted education, and data analytics to improve outcomes and control costs. The framework was implemented and validated in transfusion medicine practice. Transfusion is one of the top ten coded hospital procedures in the United States. Unfortunately, the costs of transfusion are underestimated and the benefits to patients are overestimated. The particular aim of this study was to reduce practice inconsistencies in red blood cell transfusion among hospitalists in a large urban hospital using evidence-based guidelines, a performance management system, recurrent reporting of practice-specific information, focused education, and data analytics in a continuous feedback mechanism to drive appropriate decision-making prior to the decision to transfuse and prior to issuing the blood component. The research in this dissertation provides the foundation for implementation of an integrated framework that proved to be effective in encouraging evidence-based best practices among hospitalists to improve quality and lower costs of care. What follows is a discussion of the essential components of the framework, the results that were achieved and observations relative to next steps a learning healthcare organization would consider.