Harmonised care: The key to reducing variability in care

By Denise Basow, CEO, Clinical Effectiveness, Wolters Kluwer, Health
In every patient encounter, clinical decisions represent the finely balanced combination of patient preferences, evidence, and clinician experience. Tho...

In every patient encounter, clinical decisions represent the finely balanced combination of patient preferences, evidence, and clinician experience. Those individual decisions can contribute to care variability in a region, among a population, or for a particular condition. Clinical decision support (CDS) solutions can play a key role in harmonising clinical decisions across care teams, thus addressing care variability and improving clinical effectiveness.

CDS Can Help Align Care Team Decisions

As care teams have expanded, clinical decisions are being made across several roles, introducing the risk of misaligned decisions. But care teams who use an evidence-based CDS solution are more likely to make consistent decisions, thus standardizing care and improving outcomes. CDS resources provide clinicians with the right information right when they need it, whether at the point of care or in between patient appointments.

CDS resources not only save time with quick access to answers, but also empower care teams with the knowledge and confidence they need for clinical decision-making in familiar and unfamiliar scenarios.

From a healthcare management perspective, CDS resources can also help promote a culture of collaboration amongst care team members.

Targeting Errors: New Research on CDS

A recent study found that clinicians using a CDS resource have notably lower rates of diagnostic errors when compared to a control group of doctors without CDS.  The study, “Effectiveness of a clinical knowledge support system for reducing diagnostic errors in outpatient care in Japan: A retrospective study,” was published in the January 2018 issue of International Journal of Medical Informatics. Researchers evaluated how computer-based systems might help to prevent and reduce diagnostic errors. To use a well-established and far-reaching CDS resource, the study selected UpToDate from Wolters Kluwer.

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The study identified 100 patients from an outpatient department in a community-based hospital in Tokyo, Japan over a one-year period. The exposure group of fifty patients received care by doctors with access to UpToDate, while a control group of fifty patients were seen by doctors without it.

Researchers found the diagnostic error rate was significantly lower in the group using UpToDate compared with a control group without access to UpToDate (2% versus 24%). If that reduction was extrapolated out across a healthcare organisation, think about the substantial impact on patient safety and cost-savings that could be achieved.

How to Achieve Harmonised Care?

CDS is playing a critical role not only in reducing errors, but in reducing variability in care. This can be achieved by empowering nurses, doctors, pharmacists, and the entire care team to harmonise their care decisions, resulting in better patient care and improved clinical effectiveness.

Viewing over 480mn topics a year, clinicians depend on UpToDate around the world at thousands of healthcare organisations, from individual practices to national ministries of health. Feedback from CMOs and CMIOs at large health systems validates the strategic need to reduce unwanted care variability, not only because it optimises patient care, but also because it reduces costs and waste. 

To address variability, some organisations are building guidelines for standardised care authored by multidisciplinary clinical committees. However, it quickly becomes challenging to keep these guidelines updated and to promote adoption at the point of care. CDS resources like UpToDate, when used by care teams on a large scale, can be a more effective approach for harmonising care and reducing care variability

The Future of CDS

Reducing variability in care at a population level is not simple and requires that we align the decisions made by care teams and their patients. Today’s CDS capabilities already demonstrate the ability to substantially reduce diagnostic errors and improve patient outcomes. As we look ahead, with capabilities to leverage SMART on FHIR, AI, and more closely aligned  care  teams, CDS moves closer towards closing the gaps in care so patients can have a more consistent and effective healthcare experience


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