Implementation of a High-Value, Evidence-Based Care Program: Impact and Opportunities for Learning Organizations

Area of Science:

• Healthcare Management
• Quality Improvement
• Evidence-Based Medicine

Background:

• Value-based care focuses on outcomes and harms per dollar spent, integrating patient-centered delivery, consistent measurement, and enabling health IT.
• A systemwide initiative was designed to implement high-value, evidence-based practices across healthcare delivery.

Purpose of the Study:

• To implement and measure a systemwide high-value, evidence-based care initiative.
• To assess the impact of a program structured around five pillars of high-value practices.

Main Methods:

• A quasi-experimental study was conducted from September 2019 to August 2022 at the University of Texas Medical Branch.
• The program utilized five pillars: blood management, antimicrobial stewardship, laboratory, imaging, and opioid stewardship, with interdisciplinary teams.
• Targeted interventions aimed for a 10% improvement in goals each fiscal year, with monthly measurements recorded.

Main Results:

• Teams achieved 50% of goals in FY 2020, 50% in FY 2021, and 70% in FY 2022.
• Antimicrobial stewardship showed a decrease in meropenem days of therapy (DOT) from a baseline of 45 DOT/1,000 patient days to 26.9 DOT/1,000 patient days.
• Key interventions included provider engagement, educational conferences, and transparent data analysis.

Conclusions:

• A multidisciplinary approach, combining administrative leadership, providers, and trainees, leads to sustainable, measurable high-value healthcare.
• Structuring programs with pillars and defined metrics drives progressive improvement in value-based goals.
• Challenges can be leveraged as learning opportunities to refine technological and educational value-based interventions.