Bringing Consistency to the 9-Month Episode of Care
Even with its history of integration and consistency of care, when the Geisinger team started the exercise it found "unnecessary variation" in how care was delivered across its 25 clinic locations in the region. The leadership team made certain to communicate that the goal of the program was not to restrict physicians but to give them a defined framework, Cassagnol says.
"One of the biggest misconceptions is that whenever we actually go through the process of delivering the best practice measures, people tend to think we are restricting providers from practicing a certain way," he says. "The goal is to provide overall guidance of what's the expected level of care in a particular situation. There's always going to be deviation from the guidelines. We just want to make sure people are thinking about the guidelines and what should be done within the best practice measure. If there's a good reason to deviate from that, we just want to make sure there's an active thought process behind
Any set of best practices has to be fluid to embody the latest evidence. One example is when growing evidence from the American College of Obstetricians and Gynecologists suggested that women who delivered via elective cesarean prior to 39 weeks saw an elevated risk of complications.
John Nash, MD, chairman of the department of obstetrics and gynecology at Geisinger Health System, says the physician team quickly moved to adopt procedures to avoid elective cesareans prior to 39 weeks.
"All we had to do as a group was say, 'This is now what [ACOG] says is the standard. It is the best practice.' How can we justify putting babies and moms at risk?" Nash says. "That risk is fairly small, but why put them at any risk? How could we defend ourselves if we got a bad outcome? So our Geisinger docs got together and said, 'We are not going to accept anybody that schedules a C-section prior to 39 weeks.' "
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