Dissemination and Implementation of Evidence Based Best Practice Across the High Value Healthcare Collaborative (HVHC) Using Sepsis as a Prototype - Rapidly Learning from Others

Abstract

The dissemination of evidence-based best practice through the entire health care system remains an elusive goal, despite public pressure and regulatory guidance. Many patients do not receive the same quality of care at different hospitals across the same health care system. We describe the role of a data driven learning collaborative, the High Value Healthcare Collaborative (HVHC), in the dissemination of best practice using adherence to the 3-hour-bundle for sepsis care. Compliance with and adoption of sepsis bundle care elements comparing sites with mature vs non-mature care delivery processes were measured during the improvement effort for a cohort of 20,758 patients. Non-mature sites increased their bundle compliance from 71.0 to 86.7 percent (p < 0.005). This compliance increase was primarily based on increased compliance with the fluid element of the bundle that improved for non-mature locations from 76.4 to 94.0 percent (p < 0.005).

Keywords: Comparative Effectiveness Research; Data Collection; Delivery of Health Care; Electronic Health Records; Quality Improvement.

Figure 1

3-hour-bundle (Bundle) and intravenous fluid bolus (Fluids) compliance for Mature and Non-Mature sites from quarter one 2015 through quarter four of 2016 in percent. Non-Mature sites rapidly improved to match Mature sites.

Figure 2

3-hour-bundle compliance and bundle elements over time for Non-Mature emergency departments demonstrating that the increase in fluid compliance was responsible for the improved 3-hour-bundle compliance.