Closing the Loop by Operationalizing Systems Engineering and Design (CLOSED)
Motivation:
Specific Aims :
Aim 1:​Use systems engineering and patient engagement to design, develop, and refine a highly reliable “closed loop” system for diagnostic tests and referrals that ensures diagnostic orders and follow-up occur reliably within clinically- and patient-important time-frames.
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Aim 2: Use systems engineering and patient engagement to design, develop, and refine a highly reliable “closed loop” system for symptoms that ensures clinicians receive and act on feedback about evolving symptoms and physical findings of concern to patients or clinicians.
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Aim 3: Design for generalizability across health systems more broadly so that the processes created in Aims 1 and 2 are effective in (1) a practice in an underserved community, (2) a large tele-medicine system, and (3) a representative range of simulated other health system settings and populations.
Partners:
Sunday, June 2, 2019
Sunday, June 2, 2019
Approach:
Sunday, June 2, 2019
Results to Date:
Analysis and Reduction of Practice Variation
About
Unnecessary tests, treatments, and procedures account for a substantial proportion of national healthcare spending and have a wide range of negative effects at both patient and provider levels. Wasteful services provide no additional benefits or information, can cause unnecessary discomfort or even patient harm, and may limit service accessibility for other patients in need. Over utilization, as well as the opposite problem of underutilization, is part of the wider challenge of practice and outcome variation.
As part of the national "Choosing Wisely" campaign, a large number of clinical societies have released consensus recommendations on the appropriate use of tests and procedures routinely performed in their specialization fields. Our work examines practice variation in several such high-volume services, specifically pre-operative blood panels, x-ray imaging, and cardiovascular testing for low-risk surgical procedures. This project aims to reduce practice and outcome variation.
Project Team
Results
It was found that applications in two of the participating health systems were focusing on unnecessary preoperative tests for low-risk surgical procedures. Currently providing support on interventions and subsequent monitoring of outcome measures in one health system (two highest-volume hospitals).
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Lauren Gunderson
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Lindsey Baldo
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Rebecca Choi
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Susan Haas