The naysayers discourage pursuing evidence-based medicine because it takes too long and costs too much. They say independent physicians have no incentive to follow hospital-developed, clinically proven guidelines and that even if quality can be validated, no one will listen.
We've disproved the naysayers by having practiced evidence-based medicine for several years-producing extensive report cards, developing systemwide clinical guidelines and sharing outcomes data in a user-friendly form with our communities.
Memorial Health Services in Long Beach, Calif., is a 1,434-bed system with five hospitals operating in Los Angeles and Orange counties in California. The system includes Anaheim Memorial Medical Center, Long Beach Memorial Medical Center, Miller Children's in Long Beach, Orange Coast Memorial Medical Center in Fountain Valley and Saddleback Memorial Medical Center in Laguna Hills.
When we started, there were no universal performance standards. But we believed once we identified benchmarks, we could document quality through conformity to them. Our physicians and hospitals would increase market share because we could prove our clinical capabilities. So we made the development of benchmarks a high priority, assigned support staff to the task, and asked for volunteers among physicians and medical staff.
In 1993 we started looking worldwide for the most acceptable benchmarks in more than 200 clinical categories. We collected data on indicators covering most of our patients so we could measure and document our patients' outcomes, survival rates, functional independence, readmissions, complications, recovery, and dozens of clinical diagnoses and treatments.
We developed interdisciplinary care-line teams that focus on homogeneous patient populations with specific healthcare needs-for example, cancer, heart problems, OB/GYN, orthopedics, critical care, pediatrics and emergency care. Under physician direction, each team develops scores of clinical guidelines and tracking tools. These guidelines cover such areas as chest-pain evaluation, vaginal deliveries, and routine and symptomatic mammograms.
The teams work to improve quality and efficiency, examine service utilization and outcomes, review costs, develop disease prevention and management programs, and recommend diagnoses and treatments to attending physicians.
To help ensure clinical success, we standardize care across the continuum-in the hospital, physician offices, outpatient settings and in patients' homes.
Outcomes managers follow patients' progress to ensure they're getting necessary treatment.
Our quality approach is cost-effective. We think having every mammogram read by two radiologists, for example, is less expensive than one reading, because we have fewer errors.
Our physicians and healthcare professionals continually compare outcomes with the industry's most accepted standards.
In 1994 we began presenting quality information annually in comprehensive hospital-specific report cards, newsletters, brochures and advertisements directed at physicians and other referral sources, payers, employers and the public. Last year we added a systemwide report card to show our combined quality.
Through our information infrastructure, we collect and analyze outcomes and educate staff, physicians, patients and families on-line and through written reports. Workstations in hospitals, physician offices and outpatient settings are linked to allow access to clinical results and outcomes.
Employees, physicians and other volunteers share information about the program with the community, wear MemorialCare shirts to work every Friday and sport MemorialCare license-plate holders.
We believe MemorialCare will help our communities become measurably healthier and help evidence-based medicine become the market standard. Our goal is to change the focus from low cost to high quality and superior value.
