Few healthcare provider organizations systematically track their healthcare equity, and fewer enable direct interaction with such data by their employees. From May to August 2019, we enhanced the data architecture and reporting functionality of our existing institutional quality scorecard to allow direct comparisons of quality measure performance by gender, age, race, ethnicity, language, zip code, and payor. The Equity Lens was made available to over 4000 staff in September 2019 for 82 institutional quality measures. During the first 11 months, 235 unique individuals used the tool; users were most commonly from the quality and equity departments. Two early use cases evaluated hypertension control and readmissions by race, identifying potential inequities. This is the first description of an interactive equity lens integrated into an institutional quality scorecard made available to healthcare system employees. Early evidence suggests the tool is used and can inform quality improvement initiatives.
Background:
The COVID-19 pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and data reporting. To help address these challenges, our institution leveraged electronic health record (EHR)-integrated Clinical Pathways (E-ICPs), easily-understood care algorithms accessible at the point-of-care.
Objective:
To describe the institution’s creation of E-ICPs to address the COVID-19 pandemic, and to assess the use and impact of these tools.
Setting:
Urban academic medical center with adult and pediatric hospitals, emergency departments, and ambulatory practices.
Methods:
Using the E-ICP processes and infrastructure established at our institution as a foundation, we developed a suite of COVID-19 specific E-ICPs along with a process for frequent re-assessment and updating. We examined the development and use of our COVID-19 specific pathways for a six-month period (March 1 to September 1, 2020), and describe their impact using case studies.
Results:
Forty-five COVID-19 specific pathways were developed, pertaining to triage, diagnosis, and management of COVID-19 in diverse patient settings. Orders available in E-ICPs included those for isolation precautions, testing, treatments, admissions and transfers. Pathways were accessed 86,400 times, with 99,081 individual orders placed. Case studies describe the impact of COVID-19 E-ICPs on stewardship of resources, testing optimization, and data reporting.
Conclusion:
E-ICPs provide a flexible and unified mechanism to meet the evolving demands of the COVID-19 pandemic, and continue to be a critical tool leveraged by clinicians and hospital administrators alike for the management of COVID-19. Lessons learned may be generalizable to other urgent and non-urgent clinical conditions.
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