Bundling - Evidence-based practices
Introduction to evidence-based practices and bundling
Evidence-based medicine describes a diverse array of healthcare initiatives that seek to ensure that medical care received by patients is grounded in the best scientific knowledge and is appropriate for a given individual. Central to the ability to deliver safe, effective, and patient-centered care is a need for better and timelier evidence to guide clinical decisions about which medical interventions are best, for whom, and under what circumstances.
There has been dramatic success in improving the quality of patient care by focusing on the implementation of an entire group or bundle of evidenced-based practices to achieve a better outcome than when implemented individually. This new process is referred to as "bundling" of evidence-based practices. The science behind each element of the bundle is so well established that its implementation is considered a generally accepted practice. Separate elements of a bundle can be easily measured as completed or not completed. The entire bundle – all of the elements taken together – can be similarly measured as a whole. The effect of all the right processes occurring together should have a positive impact on the disease process and improve patient outcomes; the outcome being measured may be reported using a variety of rates. Unprecedented reductions in rates of ventilator-associated pneumonia and central line-associated bloodstream infections, for example, have been reported by hospitals participating in local, regional, state and national bundling initiatives. How to measure performance and the use of bundling have received increased attention as evidenced in a recent commentary, "All-or-None Measurement Raises the Bar on Performance" (.pdf) (64 KB) by Thomas Nolan and Donald Berwick in the March 8, 2006, issue of the Journal of the American Medical Association (JAMA).
Recent data from the Premier-CMS Hospital Quality Incentive Demonstration (HQID) Project has shown that the greater the compliance with all the widely accepted care measures for pneumonia and coronary artery bypass graft surgery, the greater the reduction in mortality, length of stay, readmissions, complications and cost. For more information, visit Premier's Web site. (http://www.premierinc.com/p4p/press/)
This Web site is intended to review a few of the successful regional, state, and national initiatives and provide access their tools and strategies for success. These include initiatives for eliminating:
- Central Line-associated bloodstream infections (CLA-BSI), and
- Ventilator-associated pneumonia (VAP)
Share your success
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Success story from Greater New York Healthcare Association (GNYHC)
Download (pdf)(415KB) GNYHC success in preventing bloodstream infections
The Premier Safety Institute welcomes any additional success stories or tools that healthcare organizations have found to be useful and are willing to share on this Web site. Please send an e-mail to safety_institute@premierinc.com or call us at 704.733.5865.