27 Apr Dashboard Metrics Improve Physician Compliance With Guidelines

MedicalResearch.com Interview with:
Henry J. Michtalik MD, MPH, MHS
Department of Medicine, Johns Hopkins University
Armstrong Institute for Patient Safety and Quality
Baltimore, Maryland

Medical Research: What is the background for this study? What are the main findings?

Dr. Michtalik: Current healthcare reform emphasizes providing high-value, evidence-based care.  Compliance with practice guidelines and best-practices remains a challenge in the ever-changing healthcare environment.  Multiple methods are typically used to enhance compliance with these guidelines, including physician education, computerized order entry systems with clinical decision support, provider feedback, and payment incentives.  These strategies are used for many conditions, including heart failure and venous thromboembolism (VTE), blood clots.

The purpose of this study was to examine the impact of an individualized physician dashboard and pay-for-performance program on improving VTE prophylaxis rates amongst hospitalists.  We performed a retrospective analysis of over 3000 inpatient admissions to a hospitalist service.  We examined the impact of a web-based hospitalist dashboard which provided VTE prophylaxis feedback, both alone and in combination with a pay-for performance program which provided a small financial payment for achieving compliance rates greater than 80%.

We found that compliance significantly increased from 86% during baseline to 90% during the dashboard alone phase.  Addition of the pay-for-performance program further increased compliance to 94%.  The fastest improvement occurred during the dashboard only phase.  Annual physician payments ranged from $53 to $1244, with 17 of the 19 payments under $1000.

Medical Research: What should clinicians and patients take away from your report?

Dr. Michtalik: Feedback is critical for improving provider compliance with guidelines and can be done by using real-time dashboards.  Payment incentives served primarily as a method to engage providers and the fastest improvement occurred during the dashboard only phase, emphasizing the importance of directed feedback.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Michtalik: Physician dashboards can be tailored to the specific priorities of a hospital, such as readmissions and length of stay.  Similarly, financial incentives can be adjusted based on institutional priorities and resources.  Both dashboards and pay-for-performance can be used to enhance compliance with practice guidelines and achievement of quality metrics.

Citation:

Michtalik, H. J., Carolan, H. T., Haut, E. R., Lau, B. D., Streiff, M. B., Finkelstein, J., Pronovost, P. J., Durkin, N. and Brotman, D. J. (2015), Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis. J. Hosp. Med., 10: 172–178. doi: 10.1002/jhm.2303

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MedicalResearch.com Interview with: Henry J. Michtalik MD, MPH, MHS (2015). Dashboard Metrics Improve Physician Compliance With Guidelines 

Last Updated on April 27, 2015 by Marie Benz MD FAAD