Practical database approaches to improving healthcare performance

Against a background where healthcare is experiencing huge changes and is experiencing public scrutiny as never before, this student describes an approach to creating continuous quality improvement (CQI) projects that results in improved quality and reduced costs.;The central hypothesis of this dissertation is "Practical data-driven approaches will improve healthcare quality and costs?" This research describes six separate projects from cardiac surgery, pulmonary, and emergency medicine that test this hypothesis. Success will be measured by ranking each project from 1 to 7 in both improved quality and costs. Each project can theoretically receive scores that range from 2 up to 14. A score of 8 would indicate that no progress had been made in either the quality or cost area while a score of 14 would indicate that the maximum level of improvements had been made in both areas.;This student developed a program that features provider-driven CQI projects, applied biostatistics, cost-management, clinical and functional outcomes, projects that focus on important clinical questions, and risk-modeling. The concept of data-driven decision-making created several exciting CQI projects that resulted in projects that potentially affect how healthcare is delivered and bordering on economics and public policy aspects. The contributions of the student involve design and execution of these clinical projects.;The laboratory for this work was Eastern Maine Medical Center (EMMC) in Bangor, Maine.;Using the scorecard previously described to evaluate the 6 projects, 4 projects scored with improved quality, with 3 ranking near or at the top. Five of the six projects scored positive results in reducing costs, with 4 receiving top scores. Top honors went to the cardiac surgery low output failure project scored perfect scores in both categories, while the coronary artery bypass off-pump surgery project scored a 6 in quality and a 7 in cost outcomes. The average quality improvement was 5.5 while the average cost improvement was 6.3 for all six projects.;These results strongly support the hypothesis that data-driven CQI results in improved quality and cost reduction, that included mortality and severe morbidity.