The IQ Program: A Search for
New Ways to Improve Quality and
A new program at the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center is organizing data to improve physician and service performance, fostering innovative ways to measure quality and track long-term outcomes, and increasing infrastructure support to enable faculty to conduct a range of clinical trials and patient-centered research.
The Innovation and Quality (IQ) Program uses data to help physicians improve their compliance with proven, evidence-based guidelines, and create new measures that will lead to better care and improved patient outcomes.
“When providers receive detailed feedback about their performance, it helps them identify areas in which they can improve. The simple act of raising awareness can lead to rapid improvement,” says Dong H. Kim, M.D., director of the Mischer Neuroscience Institute and professor and chair of the Vivian L. Smith Department of Neurosurgery at UTHealth Medical School. “Physicians receive feedback about their performance using metrics they defined and data they validated. Because the data is credible to them, they respond to it quickly with ideas for improvement.”
One goal of the IQ Program is the creation of datasets for neurosurgical conditions that will be used to monitor overall physician performance. “For instance, in cases of traumatic brain injury we monitor our performance by adding our own metrics to specific measures recommended by the National Institute of Neurological Disorders and Stroke,” says Georgene Hergenroeder, M.H.A., RN, CCRC, assistant professor of neurosurgery and IQ Program director.
“Each of our patients will be assessed using standardized neurological outcomes measures at specified intervals so that we can determine how they are progressing compared to baseline and to group norms for their neurological condition. These metrics will also be incorporated into our clinical trials to determine if the study drug or device is having the desired impact. “We measure our performance by our patients – their outcomes and their satisfaction. By analyzing the combined metrics, we can determine where we can improve our performance,” Hergenroeder says.
“For instance, American Diabetes Association Guidelines for critically ill patients and American Heart Association/American Stroke Association Guidelines recommend that patients’ blood glucose levels be maintained to avoid extremes. We are monitoring blood glucose levels by disease type as well as by provider. Physicians are notified routinely of the percentage of their patients and patient days that fell either inside or outside of the acceptable range.”
Physicians and nurses at the Mischer Neuroscience Institute have successfully tracked standard quality metrics for the past few years, says Miriam Morales, director of strategic analytics. Now, they’re looking at physician performance and interventions in meaningful ways that tie these and other metrics directly to outcomes.
“Dr. Kim has assembled a team of more than 30 physicians, researchers, quality improvement and IT specialists, biostatisticians, department chairs, directors, research nurses, fellows and operations staff, and charged them with the creation of an infrastructure that will help us conduct innovative studies, promote our quality efforts and find innovative ways to improve quality,” Morales says. “By integrating all of our data, we can see in real time how patients are doing on neuro-critical lab values such as oxygen saturation, intracranial pressure and potassium management. This takes us beyond the information available in the electronic health record for a look at individual physician performance.
“We are constantly asking questions and modifying our IQ tools,” Morales says. “The infrastructure we’re creating will track a range of outcomes – pain, neurological worsening, functionality, cognition, quality of life and others – across various subsets of our patient population. We can track how well our doctors are adhering to a protocol. We can find better ways to track outcomes. Once we have the infrastructure in place, we’ll have access to a rich data source that includes long-term outcomes and enables us to identify the best interventions for a particular condition. We can then tie that data to decisions about future research, enabling us to positively impact patient outcomes throughout the timeline of patient care.”
Clinical research is crucial to optimizing care and providing patients with state-of-the-art treatment options. Physicians affiliated with the Mischer Neuroscience Institute are melding research and clinical practice. Patients are evaluated, and those who meet qualifying criteria are invited to participate in innovative research studies. In addition, neuroscience patients are offered the opportunity to participate in research by consenting to allow their tissue samples to be banked in the Neuroscience Research Repository (NRR) for current and future research.
As an example, Dr. Kim and Teresa Santiago-Sim, Ph.D., have used the NRR to collect samples and detailed genetic data on intracranial aneurysm patients and their family members. Through this important effort, a gene mutation present in a subset of patients who develop intracranial aneurysms has been identified.
The gene mutation was evaluated in animal models to confirm its contribution to the disease process. The finding is clinically useful and is a guide for close monitoring of patients with a family history of aneurysm who have the mutation. Future study of this gene is expected to uncover underlying genetic mechanisms. Clinical trials, which test novel treatments to advance cures, are only available at select centers for patients who meet very specific study criteria. Prior to offering a study to patients, the study design and the test treatment undergo rigorous testing as well as scientific and ethical reviews of risk and benefits.
“Through clinical trials patients collaborate with us to improve the care of future patients as well as their own care,” Dr. Kim says. “The IQ program relies on experienced researchers testing novel treatments in clinical trials and transitioning the results of that research to clinical practice. The IQ staff will help faculty by providing administrative and regulatory support, with a 24/7 on-call system of clinical nurses to monitor and enroll patients into trials, and a team to provide statistical analyses.”
For example, a trial currently under way is based on what researchers have learned about brain trauma from previous trials conducted at Memorial Hermann-Texas Medical Center, UTHealth Medical School and collaborating centers across the country. Clinician researchers cool patients with brain traumaassociated subdural hematoma prior to surgical evacuation of the blood clot. Preliminary studies indicated that cooled subdural hematoma patients had better cognitive function at six months after injury than patients treated with standard care at normal temperature.
The new trial, offered at Memorial Hermann-TMC and a few other centers, will definitively determine if cooling subdural hematoma patients prior to clot evacuation improves outcome. If the treatment results in superior outcomes, it will be incorporated into standard care. As the IQ program expands, researchers will design new trials to help neuroscience patients reach their desired functional potential.