The Nationwide Children's Hospital Blood and Marrow Transplant Index: A Quality Improvement Approach to Assess the Performance of a Pediatric Blood and Marrow Transplant Program.

Abstract

Introduction: To design and test a metric that reflects the overall quality and safety performance of our blood and marrow transplant program (BMT) and use this metric to enhance the quality of care provided to patients.

Methods: The BMT index (BMTI) aggregates safety events and missed opportunities for best practices into a composite score that reflects the overall clinical performance of the BMT program, irrespective of the type of transplant or patient outcome. We selected 13 domains and divided them based on the time in the transplant continuum. The BMT journey has 3 general spheres: (1) the pretransplant, (2) the transplant admission, and (3) the posttransplant follow-up and long-term care. The BMTI represents the total count of adverse safety events or missed opportunities to deliver quality care within a given period within these domains. In this regard, lower aggregate BMTI scores reflect higher quality care and improved overall systems performance.

Results: The BMTI was easy to calculate and monitor. The annual BMTI aggregate score progressively decreased from a baseline of 133 in year 1 to 35 in year 3 (73.68% reduction), leading to a follow-up version of the BMTI that addressed new domain measures and achieved sustained mode.

Conclusions: The BMTI is a valuable metric for monitoring the efficiency of the BMT service quality improvement initiatives. This concept applies to other programs. Specifically, the index documented the ability to improve the quality of patient care and provide consistent, evidence-based care.