Comparative workflow modeling across sites: Results for nursing home prescribing

Abstract

Workflows associated with health care delivery vary between settings, and understanding similarities and dissimilarities can inform context-sensitive practice change. Clinical workflows are complex, dynamic, and context-dependent, and comparing workflow across multiple settings can support tailored implementation of practice-change interventions. We propose a methodology for comparative workflow modeling and evaluate its use through application to antibiotic prescribing in six nursing homes in two states in the United States. After collecting multi-site workflow data and developing a cross-site workflow model from nursing home field visits, we constructed a comparison matrix of workflow task occurrences and variations and used it to perform cross-site comparisons across all six NHs.