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A Quality Improvement Bundle Including Pay for Performance for the Standardization of Order Set Use in Moderate
Insights
A quality improvement bundle successfully standardized computerized asthma order set use in moderately ill children. This initiative, including financial incentives, led to sustained high adherence rates among healthcare providers.
Area of Science:
- Pediatric Emergency Medicine
- Quality Improvement Science
- Health Informatics
Background:
- Standardizing care for moderately ill children with asthma is crucial.
- A computerized asthma order set, based on clinical guidelines, was developed to improve care.
- Adherence to standardized order sets can be challenging in busy clinical settings.
Purpose of the Study:
- To standardize the use of a computerized asthma order set for moderately ill children.
- To implement a quality improvement bundle with a pay-for-performance component.
- To evaluate the impact of this bundle on order set utilization.
Main Methods:
- A quality improvement bundle was developed for pediatric emergency and urgent care faculty.
- A run-in period included education and order set refinement.
- A 10-month evaluation period incorporated a pay-for-performance incentive (0.1% salary bonus for ≥90% adherence).
Main Results:
- Baseline computerized asthma order set use was 60.5%.
- Use increased significantly during the evaluation period, averaging 91.6%.
- Faculty earned bonuses in 8 out of 10 months, and high adherence persisted post-evaluation.
Conclusions:
- A quality improvement bundle, incorporating financial incentives, effectively increased and sustained the use of a computerized asthma order set.
- This approach demonstrated success in standardizing care for moderately ill pediatric asthma patients.
- The pay-for-performance component was associated with sustained adherence to the asthma order set.
Objective:
In order to standardize use of our hospital's computerized asthma order set, which was developed based on an asthma clinical practice guideline, for moderately ill children presenting for care of asthma, we developed a quality improvement bundle, including a time-limited pay-for-performance component, for pediatric emergency department and pediatric urgent care faculty members.
Methods:
Following baseline measurement, we used a run-in period for education, feedback, and improvement of the asthma order set. Then, faculty members earned 0.1% of salary during each of 10 successive months (evaluation period) in which the asthma order set was used in managing 90% or more of eligible patients.
Results:
At baseline, the asthma order set was used in managing 60.5% of eligible patients. Order set use rose sharply during the run-in period. During the 10-month evaluation period, use of the asthma order set was significantly above baseline, with a mean of 91.6%; faculty earned pay-for-performance bonuses during 8 of 10 possible months. Following completion of the evaluation period, asthma order set use remained high.
Conclusions:
A quality improvement bundle, including a time-limited pay-for-performance component, was associated with a sustained increase in the use of a computerized asthma order set for managing moderately ill asthmatic children.
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