Two Quest Teams worked on ways to improve the quality of care in the region by agreeing on what constitutes best care and how it's defined. Evidence-Based Care Standards Team I worked in 2007 to identify a set of clinical practice guidelines to benefit central Illinois. Dr. Jim Graumlich, chair of the Department of Medicine at the University of Illinois College of Medicine at Peoria, served as the physician team leader and Tom Thomas was the black belt. The continuing work of this team was picked up by Team II in 2008, led by Dr. Jim Bauer and Tom Thomas.

Selecting Guidelines for Central Illinois

The first team's objective was to review many sets of clinical practice guidelines and agree upon a set that was a good fit for central Illinois. Twenty healthcare leaders came together to work on the project.

Why are guidelines important? As Dr. Jim Graumlich explains it, "There's usually more than one way to do something. If you asked three physicians how to treat a case of diabetes, you'd probably get three different answers. If you want to make a system for improvement, there needs to be a set of standards."

"Future projects will require a set of guidelines on how to treat diseases," Dr. Graumlich explained. "Our team had to find an organization that acts as a 'wholesaler,' distributing the guidelines to us, the 'retailers,' so that we can distribute the guidelines to teams of nurses and physicians."

"There were over a hundred different sets of guidelines," he continued. "We looked for ones that would fit the needs of central Illinois. If it was focused on just one disease, versus a range of relevant diseases, it was ruled out. If it only looked at in- or out-patient care and not both, then it was ruled out. We came to three sets of guidelines that accounted for a broad range of diseases."

The top three guideline sets were from the Institute for Clinical Systems Improvement (ICSI), Michigan Quality Improvement Consortium, and Zynx.

"We met for several weeks to a refine a scoring system," he said. "This system accounted for costs, updates, if the guidelines were accessible online, if it applied to outpatient care, and other factors. The set of guidelines that scored the highest was from ICSI."

Team member Tom Thomas pointed out, "The thoroughness of the evaluation process was important because as we roll this out to physicians, we can explain how we selected these guidelines. We have evidence to show how we came to that decision."

"Getting healthcare personnel to agree is like herding cats. But, the scoring system served as a set of rules that told us how to play the game. By following the rules, we were able to come up with a winning solution," concluded Dr. Graumlich.

Guideline Adoption and Implementation

The second Evidence-Based Care Team built on the work of the first team to garner support for the guidelines in central Illinois.

"The goal of this team was to ask questions of the physicians in the community, hear their voice, learn what will be helpful to them, and then develop a system that will make it easy for them to use the guidelines. It's really a redesign of how we deliver healthcare," said Thomas.

Dr. Jim Bauer, team leader for the project and a primary care physician for 34 years, believes the work of his team was important to the region.

"Right now, care is fragmented. Using agreed-upon guidelines allows everyone to improve and become more efficient in their delivery," he said. "The positive outcome is that providers, physicians and ancillary health personnel agree on the same definition of 'best care' and can use the ICSI guidelines as a benchmark and an opportunity to improve care for their patients."

Evidence-Based Care Standards Team I

Team Lead: Dr. Jim Graumlich
Black Belt: Tom Thomas

Team Members:
Douglas Allan
Dr. Don Baker
Dr. Jim Bauer
Dr. Andy Chiou
Dr. Barry Clemson
Dr. Mike Cruz
Dr. Tom Cusack
Dr. Steve Hippler
Dr. Michael Johnson
Dr. Elizabeth Kramer
Dr. Kathryn Kramer
Dr. Rick Luetkemeyer
Dr. Tim Miller
Dr. Sara Rusch
Dr. Tony Sauder
Sue Wozniak, RN
Sandy Brooks, RN
Michelle Klein

Evidence-Based Care Standards Team II

Team Lead: Dr. Jim Bauer
Black Belt: Tom Thomas

Team Members:
Dr. Rick Anderson
Dr. Matt Gorman
Julie Gray
Dr. John Houser
Dr. Rick Luetkemeyer
Kathy Pavkov, RN
Harita Shah
Cally Vinz