Standard Treatment Protocols Managing Quality & Cost

1. Standard Treatment ProtocolsManaging Quality & Cost Dr. Farouk Abdallah Pediatrician, Q.M. Consultant Esqua Founder & Board Member 1995 Nasser Institute Quality Unit Founder & Consultant 2001

2. بسم الله الرحمن الرحيم • Current Health Environment: • Avoid Overutilization. • Minimize Health Insurance Benefit Package. • Spending Caps on national basis. • Review Care Provided in order to reach high quality and law cost.

3. Using standard treatment protocol to manageQuality and cost in health care: • New standardized set of clinical Guide lines that reduce unnecessary Variation in care. • Elimination of redundant intervention. • Establish clear Line of Communication for all care givers. • Simultaneously reduce L.O.S in Hospitals, and bad Practice in O.P as Well.

4. Approach to Quality and Cost Control New Thinking: • Cost Reduction and Quality Improvement are Related Issues – no more Unrelated. • Quality by Inspection theory of bad apples (Donald Berwick) Harvard. To reach and eliminate bad Employee and practices.

5. Methodology: • Standardization: are best way to provide service & control cost. • Demonstrate effectiveness as a prerequisite for adopting the new processes. • Shared Responsibility by each person in health care for each process agreed upon.

6. Coals of S.T.P.s: • Raising Quality and Lowering cost by defining and standardizing best care for a typical patient in a diagnostic category. • To redesign care for patients within selected diagnoses in a Health care facility Meeting Minimum structure standards. • Eliminating Unnecessary tests procedures, intervention, Drugs, Standardize Quality and limit cost. • Integrating Management of Quality and cost to reach (charge / cost) models. • To establish a bench Mark that can be used to calculate actual cost – so contracting can be no more guess work – for a certain care given.

7. S.T.P.s DevelopmentSelection of Target Procedures and Diagnoses Criteria: • Volume. • High cost procedure. • High Risk procedure. • Multiple Specialties involved. • Multiple Nursing units work. • Niche program. • Political consideration.

8. Structure Involved: • Oversight committee. • Sub committees Concerned for specialties involved in those diagnoses. Participants: • Avoid resistant group (cook – Book vision). • Select Best Physicians who understand and adopt the current environment, besides Lab., Radiology, and Nursing groups. • Financial expertise: is critical and essential.

9. Monitoring: • Using Clinical Indicators which measures Both the desirable and undesirable occurrences. • Review clinical paths and essential steps in diagnoses and treatment of a condition or procedure Via appropriate Medical Record screening.

10. Summary Standard Treatment Protocols Managing Quality Cost • to familiarize all care givers with new best practices in order to adapt and tailor best care for a given Facility. • To Structure Committees for Concerned specialties, besides the over sight Committee. • To Identify and select Target procedures and interventions and Diagnoses for S.T.P.s.

11. Summary Standard Treatment Protocols Managing Quality Cost • To standardize S.T.P.s by the proper Committee, approved by the oversight committee within available Facilities structure and selected Drug Formulary. • Documentation of all steps for a given care for a certain category of patient Diagnoses, Using the approved and valid medical record. • To monitor the process by screening the desirable and the undesirable occurrences and indicators for continuous Evaluation using proper screening form (available).

12. Summary Standard Treatment Protocols Managing Quality Cost • Billing, for all components of care given for a certain Category of diagnoses or procedure using suitable form (available) Regularly for 6 months to reach standards and identify deviations in cost by Expertise Financial analyst. • Consequently contracting for a given care is no more a guess work but rather a valid value.