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Tracking Outcomes in Community Practices:

Mischer Neuroscience Associates Extends Accountability for Quality Across the City

CAR Community PracticesMost people would agree that it’s one thing to say you’re the best, but something entirely different to prove it. That’s exactly what leadership at the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center has being doing for the past five years by monitoring patient care, tracking outcomes and holding affiliated physicians and nurses accountable for the care they provide. At the same time, the Institute’s arm in the community, Mischer Neuroscience Associates (MNA), is creating an innovative roadmap for tracking quality in its physician practices across the city.

“After many years of looking at quality metrics for our programs and physicians at the Texas Medical Center, we decided it was time to extend our performance improvement initiatives across the Memorial Hermann Health System,” says Amanda Spielman, chief operating officer for neurosciences. “During that time we also built a neurology network to partner with our neurosurgeons in the community. Once we had a high-performance team with the full range of neuroscience providers in place, we wanted to know if we were looking at the right benchmarks for quality, safety and performance improvement based on the types of cases done in the community. We asked ourselves, how do you take a successful quality effort and move it from an academic medical center into the community? There’s no roadmap in existence for an effort like that, so we set out to create one.”

“Our goal was to apply the same standards we use at the Texas Medical Center to our community practices. Today, we’re tracking mortality, surgical site infections, length of stay, patient satisfaction and other data as a group, and using it to modify our clinical practice to ensure that we deliver best-practices care.”

— Paul D. Boone, M.D.

MNA neurosurgeon Paul D. Boone, M.D., practices at Memorial Hermann Memorial City Medical Center and has been very involved in the initiative to track quality outcomes in the community. “MNA is a collaborative effort between neurosurgeons, neurologists and pain management specialists who have made a commitment to excellence,” says Dr. Boone, who served on the faculty at Vanderbilt University Medical Center for eight years before relocating to Houston and joining Mischer Neuroscience Associates. “As part of that commitment, we needed to have a surveillance program in place that would allow us to look at quality data and track our outcomes. Our goal was to apply the same standards we use at the Texas Medical Center to our community practices. Today, we’re tracking mortality, surgical site infections, length of stay, patient satisfaction and other data as a group, and using it to modify our clinical practice to ensure that we deliver best-practices care.”

Traditionally, community practices have been more focused on the business of medicine than academic medical centers – scheduling patients, filing insurance forms, reviewing test results and following up. “It’s very unusual for community practices to engage in this kind of self-assessment,” Dr. Boone says. “Physicians in the community run busy practices and in general don’t track their quality metrics. With healthcare reform, government agencies and others are collecting data and making it available on the Internet. What we’re trying to do is put more focus on the quality of medicine we deliver, not just the business. We all believe we’re providing superior care, but if we rely on our own self-assessments, there may be surprises when we see the actual data. By proactively looking at our own data and continuously improving our practice, we stay ahead of the curve.” MNA practices are now holding regular Morbidity and Mortality (M&M) Conferences in which cases with complications or unexpected outcomes are reviewed. “This is just one example of moving initiatives typically done at academic medical centers to the community,” he says. “M&M Conferences allow us to sit down as partners and have cases presented to us. If an outcome was unexpected, we look at it analytically and discuss what could have been done differently. In this way we identify small problems before they become larger and implement practices to prevent future occurrences.”

As healthcare reform moves the focus of medicine toward keeping patients healthy, Dr. Boone expects the MNA quality and accountability effort to expand. “As demographics change and new technology emerges, health care is transforming before our eyes,” he says. “As a group we’re working hard to make sure we’re not only prepared for those changes, but leading them.”