Clinical Decision Support-enabled Quality Improvement Worksheet (Essential Version)

Essential CDS/QI Worksheet from Jerome A. Osheroff, MD, TMIT Consulting, LLC

This worksheet is a key component of the Guide to Improving Care Processes and Outcomes in Health Centers, developed by TMIT Consulting, LLC and the HITEQ Center.

A helpful QI adage is that “systems are perfectly designed to produce the results they deliver.” This truism highlights the importance of understanding current care processes that are driving sub-optimal performance on the targeted measure (e.g., diabetes control, preventive care, use of expensive tests) so they can be refined to deliver better results. The CDS/QI worksheet supports this analysis through a structured, broadly applicable framework for documenting, analyzing, sharing and improving target-focused care activities.

• A tutorial on using this worksheet can be found here.
• A sample worksheet with a hypertension control case study is here.
• The CDC/Million Hearts Hypertension Control Change Package is an example of evidence-based tools and guidance for supporting target-focused QI efforts, helpful for identifying potential enhancements.

Instructions for using this worksheet

• Step 1: Document the improvement target and current performance (page 2).
• Step 2: Think about pertinent information flows and workflows driving performance (page 2) in light of pertinent evidence-based QI and care strategies for the target.
• Step 3:  After discussion with pertinent stakeholders, document current state information flows and workflows for the target (pages 4-6). Brainstorm potential enhancements to the current state with the QI team, and document these in the pertinent boxes beneath the current state.
• Step 4: Review all entries (pages 4-6), and summarize them in the overview table (page 3).
• Step 5: Use this completed worksheet with the QI team to help prioritize and implement high-yield enhancements to current workflows and information flows; consider beginning with those that will yield the greatest benefits with the least effort and resources.