Tech companies such as Google and Amazon often use randomized continuous quality improvement projects to evaluate processes, and while the technique isn't widespread in health care, NYU Langone Health recently adopted the practice to assess routine patient care processes, according to a report published Thursday in the New England Journal of Medicine (NEJM).

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Randomized continuous quality improvement methods evaluate the effectiveness of routine processes performed by staff on a daily basis and provide insight into how to improve them.

Lead study author Leora Horwitz, an associate professor in the departments of population health and medicine at NYU Langone and director of the Center for Healthcare Innovation and Delivery Science, and colleagues helped to implement these methods at NYU Langone. The methods were used throughout the hospital, including in inpatient units, outpatient offices, and the ED.

NYU Langone focused on methods to improve post-hospitalization care, increase reception of a recommended preventive screening, capture patient-reported outcomes, and increase smoking cessation counseling rates, among other things.

"This program is important because there are always better ways to do things, but unless we have some data to show us that what we're doing is not fully effective, we have no incentive or inclination to find a better way to do it," Horwitz said.

Positive results

Within one year, NYU Langone completed 10 randomized quality improvement projects and has leveraged the findings to better serve patients, Horwitz and colleagues write. 

For example, the hospital discovered that altering the text of a prompt to provide tobacco cessation counseling led to a significant increase in medication prescription rates. Similarly, changing a handful of sentences in telephone scripts for outreach led to increased annual visit appointments, the researchers found.

They also discovered that post-discharge phone calls to patients were mostly ineffective, and patients who received them were returning to the hospital at the same rate as those who did not get calls.

With these results, NYU Langone gained a better understanding of how to focus their resources, Horwitz said. For example, call scripts may need to be changed or staff may need to be instructed to only call high-risk patients as opposed to all patients.

In the NEJM report, the authors also noted that the project "already shown that it can pay for itself through increased adoption of preventive services."

However, while the program has yielded "short-term quantifiable return on investment," the report authors noted that  the program's value lies in the form of lessons learned. "By learning that many of the interventions we had regarded as routine are not working, we can iteratively test until they become effective, or, if appropriate, we can reassign staff to perform different interventions that are more effective," the researchers wrote.

Separately, Horwitz said, "I believe we have an ethical responsibility to rigorously assess whether our operational interventions are effective, even when they may seem trivial, such as scripts for calls or mailings that we send to people to get them to get their colonoscopy." She continued, "If we don't, we can't be sure we are doing the best by our patients" (NYU Langone release, 9/18; Horwitz et. al., New England Journal of Medicine, 9/19; Vaidya, Becker's Clinical Leadership & Infection Control, 9/19).