The Nationwide Children's Hospital Blood and Marrow Transplant Index: A Quality Improvement Approach to Assess the...

Area of Science:

• Hematology
• Transplant Medicine
• Quality Improvement Science

Background:

• Assessing the quality and safety of Blood and Marrow Transplant (BMT) programs is crucial for patient outcomes.
• Existing metrics may not comprehensively capture the multifaceted nature of BMT care.
• A standardized, integrated metric is needed to evaluate and enhance BMT program performance.

Purpose of the Study:

• To design and validate a novel metric, the BMT Index (BMTI), for assessing overall quality and safety in BMT programs.
• To utilize the BMTI to drive improvements in patient care and program efficiency.
• To establish a benchmark for monitoring continuous quality improvement in BMT services.

Main Methods:

• The BMT Index (BMTI) was developed by aggregating safety events and missed best practices across 13 domains.
• These domains were categorized into three phases of the transplant continuum: pre-transplant, transplant admission, and post-transplant care.
• The BMTI score represents the total count of adverse events or quality care deficits within these domains; lower scores indicate better performance.

Main Results:

• The BMTI proved to be easily calculable and monitorable.
• The aggregate BMTI score demonstrated a substantial reduction, decreasing by 73.68% from a baseline of 133 in year 1 to 35 in year 3.
• A subsequent version of the BMTI was developed to incorporate new measures, achieving sustained improvements.

Conclusions:

• The BMTI serves as a valuable tool for monitoring the effectiveness of quality improvement initiatives in BMT services.
• The index successfully documented improvements in patient care quality and the delivery of consistent, evidence-based care.
• The BMTI framework is adaptable and applicable to other clinical programs seeking to enhance quality and safety performance.