Reducing Waste in Asthma Healthcare: The Impact of Data
Texas Children’s Hospital has always looked for ways to improve the quality and efficiency of its patient care. Texas Children’s is moving to a form of value-based payment under which hospitals that improve efficiency can keep the savings. To succeed under the new payment system, Texas Children’s leaders needed the ability to analyze and better manage specific populations of patients, especially those with costly, chronic conditions like asthma.
Why Clinical Quality Improvement Matters
I have treated numerous children in my career as an emergency department (ED) nurse and worked with Texas Children’s Hospital on their asthma clinical quality improvement project. Like my client, Dr. Charles Macias, I have countless stories about patients who made repeat visits to my ED for exacerbation of chronic conditions.
Here is Dr. Macias’ story in an abbreviated form…
Dr. Macias was working as an ED physician at Texas Children’s in 2004 when he met Jenny Jones, at the time a 5-year-old girl with asthma. Over the previous six months, Jenny had made three ED visits at two hospitals, in addition to a primary care physician (PCP) visit. Jenny’s multiple visits and uncontrolled asthma were directly affected by the six different asthma action plans with conflicting discharge instructions that her mother had received from six different physicians. Dr. Macias was appalled. Jenny Jones represented a broken system that suffered from a lack of integration. Poor patient experiences like hers contributed to the decision of Texas Children’s leadership to enhance its quality improvement program. Dr. Macias helped to ensure that asthma treatment was the first clinical area of focus for the new program.
The EHR: A Necessary First Step (But Not Enough)
Texas Children’s leaders were convinced technology could play a key role in improving the quality and coordination of care among its patient population. Their electronic health record system (EHR) has proved tremendously valuable as the means of digitizing care across the hospital. But, in reality, the newly digitized EHR data was hard to extract and combine with other data sources in a timely fashion.
Texas Children’s found that it took between three and six months for analysts to deliver clear answers to key clinical and operational questions using EHR data. As a result, executives and clinicians were not able to effectively leverage the data to make data-driven, financially sustainable improvements in care for either individuals or specific populations.
Texas Children’s learned that while implementing an EHR is clearly a necessary step toward data-driven delivery of care, the EHR alone is not enough without an EDW that enables an enterprise-wide, consistent view of data from many sources.
Key Clinical Quality Improvement Results
Using a healthcare enterprise data warehouse (EDW), healthcare analytics and a cross-functional team approach-Texas Children’s was able to drive significant adoption and 6 measureable results:
- Drove significant, measurable adoption of evidence-based order sets
- Decreased inpatient length of stay (LOS) for asthma patients by 11 hours
- Achieved and sustained a 49 percent decrease in unnecessary chest X-ray orders
- Sustained 67% increase in order set utilization
- Increased use of an EHR-based asthma action plan to 90 percent of physicians
- Established an effective, permanent clinical improvement team that continues to identify areas for care improvement and build evidence-based practices into the care delivery workflow.
What solutions are you using to drive and sustain your healthcare clinical improvement projects? What results are you seeing?
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