[Clinical practice improvement--clinical practice quality improvement of local health care processes]

Clinical Practice Improvement (CPI) is a methodological approach to develop analytically-based protocols to achieve desirable outcomes at the lowest essential cost over the continuum of local care processes. Several elements of the CPI approach make it attractive to clinicians: First, it is a scientific bottom-up approach that places accountability for practice improvement and outcomes with local clinicians. Clinicians are not told to blindly follow a guideline or protocol developed by others, but instead collect data on outcomes, on treatments, and on patient signs and symptoms that support practice change. CPI supports caregivers in making their own decisions about optimal care on the basis of objective statistical evidence gathered in the routine, everyday practice of medicine. Second, CPI measurement encompasses a comprehensive view of the care management process: patient characteristics, process steps, and outcomes. All three classes of data are considered simultaneously. This comprehensive measurement framework provides a basis for meaningful analyses of significant associations, as well as relationships between process and outcome. Third, the CPI methodology focuses on deployment and application. There is a continual emphasis on factors that can be implemented to improve outcomes and the process to achieve these results. This focus on implementation guides who is involved in the design, what data are collected, what questions are answered during analyses, and who designs the protocols or improvements in practice.