A quality improvement study to improve inpatient problem list use

Area of Science:

• Healthcare Quality Improvement
• Health Informatics
• Patient Data Management

Background:

• The problem list is a key component of meaningful use in healthcare, with a target of over 80% of patients having at least one problem documented as structured data.
• Current problem list utilization rates often fall short of this critical benchmark.

Purpose of the Study:

• To implement and evaluate a series of interventions aimed at increasing inpatient problem list usage to over 80% for both medical and psychiatric patients.
• To ensure at least one hospital problem is documented in the problem list at the time of patient discharge.

Main Methods:

• A quasi-experimental time series quality improvement trial was conducted.
• Interventions included increasing awareness, providing focused education, and delivering timely performance feedback via email.
• Control charts (p charts) with revised three-sigma control limits were used to monitor the primary outcome: the percentage of patients with a problem list entry at discharge.

Main Results:

• Medical inpatient problem list use increased from 31% to a sustained rate above 80%, peaking at 97%.
• Psychiatric inpatient problem list use rose from an initial 2% to an average of 72% following the interventions.

Conclusions:

• The study successfully demonstrated significant improvements in inpatient problem list adoption by both medical and psychiatric teams.
• The interventions effectively met the meaningful use objective of achieving over 80% of inpatients having a problem documented at discharge.