Development and Implementation of ExPLORE Clinical Practice, a Web-accessible Comparative Outcomes Tool for California Hospitals and Physicians

BACKGROUND: Hospital-based clinicians have little information about the outcomes of their care, much less how those outcomes compare with those of their peers. A variety of care quality indicators have been developed, but comparisons tend to be hospitalwide, and often irrelevant to the practice and patient group of many hospital clinicians. Moreover, information is not enough to transform clinical practice, as the human response to such comparisons is, “I’m doing the best I know how.” What is needed is granular, clinically specific feedback with peer-mediated advice about how “positive deviants” achieve better results. OBJECTIVE: This case study reports on the development and implementation of a web-accessible comparative outcomes tool, ExPLORE Clinical Practice, for hospitals and clinicians in California. METHODS: We use iterative development and refinement of web tools to report comparative outcomes; incremental development of suites of procedure-patient outcome pairs specific to particular medical specialty groups; testing and refinement of response time metrics to reduce delays in report generation; and introduction of a comments section for each measure that assists with interpretation and ties results to strategies found to lead to better clinical outcomes. RESULTS: To date, 76 reports, each with 115 to 251 statistically evaluated outcomes, are available electronically to compare individual hospitals in California to statewide outcomes. DISCUSSION AND CONCLUSIONS: ExPLORE Clinical Practice is one of a number of emerging systems that attempt to lever available data to improve patient outcomes. The ExPLORE Clinical Practice system combines a clinical focus on highly specific outcome measures with attention to technical issues such as crafting an intuitive user interface and graphic presentation. This case study illustrates the important advances made in using data to support clinicians to improve care for patients. We see this information as a way to start local conversations about quality improvement, and as a means of generating peer advice for improving patient outcomes.