Choosing Reports Wisely: Considerations in Reporting for Clinical Improvement
technology adoption and diffusion, information technology, quality of care, ambulatory/outpatient care, clinical practice patterns/guidelines, engagement of stakeholders, clinical decision-making, health care costs/resource use, dissemination and implementation of innovations, quality improvement, pharmaceuticals
Background: Group Health has undertaken a number of clinical improvement initiatives arising from the ABIM Foundation Choosing Wisely® campaign. Currently, the particular focus is on reducing the use of antibiotics for upper respiratory infections. To support this effort, clear, timely, reliable reporting is required to understand the current state and motivate and recognize change.
Methods: Throughout the Choosing Wisely campaign, we have developed and refined our reporting methods, tools and dissemination strategies. We target reports to different audiences –– numerical summaries for grant funding, clinic-level charts for clinical leaders, and detailed provider-level reporting. A single data set of visit-level data is used for all reports and rolled up to the appropriate level. We have focused much of our effort on provider-level reporting. Goals include giving providers insights into their own practice patterns, highlighting improvements, and identifying peers who could be consulted for ideas on successfully changing practice. To this end, we have been working to develop reports that summarize rates, volume and temporal trends into a single easily interpreted graphic. Migrating to Tableau visualization software has been instrumental in this effort.
Results: For report consumers, we have developed reports that are regularly disseminated, clearly documented, visually appealing and easy to interpret. For report development, we have worked toward automation and adopted tools geared toward rapid data exploration. The rate of antibiotic prescription for upper respiratory infections has decreased sharply since reporting began. We have observed that providers appear engaged with the improvement process, and that leadership is enthusiastic about the potential for future developments in reporting to facilitate ongoing change. Long-term support from executive, clinical, information technology and research leadership has been critical to our work. We also benefit from provider feedback –– we share visit-level data on request, enabling providers to do chart audits and report potential data quality problems.
Conclusion: With sustained work over time, we have developed a suite of reports that effectively support important clinical improvement efforts. We plan to adapt this reporting scheme for use with other quality measures as well. We also look forward to migrating to an online interactive platform where leaders and providers can access reports directly.
Fuller S, Handley M, Sparks A, Wicklund K. Choosing reports wisely: considerations in reporting for clinical improvement. J Patient Cent Res Rev. 2017;4:153.