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Clinical microsystems, Part 4. Building innovative population-specific mesosystems.
Karen E McKinley1, Scott A Berry, Leslie A Laam
1Division of Clinical Effectiveness, Geisinger Health System, Danville, Pennsylvania, USA. kmckinley@geisinger.edu
Joint Commission Journal on Quality and Patient Safety
|November 26, 2008
Summary
Geisinger Health System created an innovative mesosystem to integrate care delivery for improved patient outcomes. This model ensures reliable, evidence-based practices for specific patient groups, demonstrating adaptability for broader use.
Area of Science:
- Healthcare quality improvement
- Systems engineering in medicine
- Provider-driven healthcare innovation
Background:
- Geisinger Health System developed ProvenCare in 2005, initially for coronary artery bypass graft (CABG) surgery.
- ProvenCare utilizes a mesosystem approach to integrate care delivery across microsystems, enhancing evidence-based practices.
- The ProvenCare model has been successfully extended to other patient populations, including percutaneous coronary intervention (PCI).
Purpose of the Study:
- To apply clinical microsystem thinking to percutaneous coronary intervention (PCI) care delivery.
- To redesign PCI processes by engaging frontline professionals and establishing a dedicated mesosystem team.
- To ensure timely and accurate delivery of evidence-based care for PCI patients.
Main Methods:
- Utilized clinical microsystem principles to analyze and redesign PCI processes.
- Assembled frontline professionals to collaboratively improve care pathways.
- Implemented a beta-test phase to measure process changes and refine the mesosystem.
- Established clear role definitions, comprehensive plans, and guiding principles for program implementation.
Main Results:
- As of July 2008, 55% of patients in the PCI mesosystem pathway received 100% of the 40 measurable process elements.
- The beta-test phase allowed for iterative adjustments to optimize the care process.
- The mesosystem approach demonstrated progress in embedding evidence-based practices.
Conclusions:
- Geisinger Health System successfully integrated microsystems into an innovative mesosystem for reliable, evidence-based care.
- This adaptable model enhances care delivery for patient subpopulations.
- The ProvenCare mesosystem approach offers a scalable framework for improving routine healthcare.
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