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Bringing Consistency to the 9-Month Episode of Care

Jim Molpus, for HealthLeaders Media, August 26, 2013

In prenatal care, the best practices can sometimes be lab work, education, family history, social history, or radiology studies, Mateer says. What matters is that "all of those best practices are offered at the appropriate time for each and every individual, and that people don't fall through the cracks because you think somebody else did it and you don't have a good way of documenting and making sure it was done."

So how does a clinical team make certain it gets done? Hans P. Cassagnol, MD, associate chief quality officer of Geisinger Health System and director of obstetrics and gynecology for Geisinger-Northeast, says implementation is built around two primary tools.

"We actually used evidence-based medicine and the electronic medical record to come up with a set of best practice measures that we were going to hold all providers to," Cassagnol says. "What we have done over the past several years is use those two components with different ways of actually guiding the providers into delivering the evidence-based medicine at every single opportunity."

The first speed bump that many health systems may face is to create the initial set of best practices. Geisinger began with a set of 103 distinct best practices for perinatal care. "Some of those best practices can be as easy as something like taking vital signs," Cassagnol says, "recognizing that a blood pressure has to be taken at each and every visit. And some of those best practices are things that may just have to be offered once but at a specific time during the pregnancy. So in those 103 best practices, there are usually between about 240 to 300 times when those particular best practices need to be validated during a normal pregnancy."

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