THE CLINICAL-PRACTICE IMPROVEMENT (CPI) MODEL AND HOW IT IS USED TO EXAMINE THE AVAILABILITY OF PHARMACEUTICALS AND THE UTILIZATION OF AMBULATORY HEALTH-CARE SERVICES IN HMOS - RESULTS FROM THE MANAGED CARE OUTCOMES PROJECT (MCOP)

Many American healthcare facilities have come to understand that quali ty controls cost. Clinical practice improvement (CPI) is a methodology that creates a clinical laboratory, built into the everyday practice setting, to find and test best practices. A CPI study is an analysis o f the content and timing of individual steps in a medical care process aimed at producing better clinical outcomes for the least necessary c ost over the continuum of a patient's care. Statistical regression ana lyses are used to determine whether and how much a particular step act ually improves medical outcomes. Systematic determination of individua l process steps that improve medical outcomes is the best way to devel op demonstrably better care and practice. Combining CPI methodology an d a data monitor creates a dynamic environment ill which all patient e ncounters potentially contribute to improving the process of care. We describe a recent multisite study: the Managed Care Outcomes Project ( MCOP). The MCOP study design permits us to compare the effects of vari ous pharmaceutical treatments on resource utilisation in actual practi ce in managed-care organisations. The MCOP database is an important re source for developing information required to design systems-based dis ease management programmes.