Clinically Meaningful Quality Metrics Improve the Provider Experience

Nearly half (46 percent) of all physicians report that they suffer from burnout, citing too many bureaucratic tasks as one reason. Providers want to find meaning in their work, and improvement on many current quality metrics do not predict better patient outcomes or experience of care. They are looking for tools to reduce their workload and improve their ability to provide excellent care, including having metrics and registries that are meaningful and informative.

Faced with the challenge of making quality measures meaningful, Partners HealthCare worked to redefine measures to be more relevant, create point-of-care registries to manage an all-payer population, created teams of Population Health Coordinators to support front-line teams in managing the registries, and used its analytics platform to monitor change and explore provider variation in order to improve quality. This resulted in:

• 85 percent of clinicians surveyed felt that the new metrics helped them take better care of their patients.
• Quality improved at an unprecedented rate on an all-payer population 5 times bigger than the standard P4P population.
• Near real-time measurement using clinical data eliminated months-long delays, while run charts and provider and clinic-comparison views turbo charged quality improvement.
• 125 percent increase in user adoption of the analytic tool (99 unique users, 674 unique sessions, and rising).

Comprehensive Approach to CAUTI Prevention Leads to Dramatic Reduction in Infections

Despite being common, healthcare-associated infections are potentially deadly and carry a significant financial cost. Of healthcare associated infections, catheter-associated urinary tract infections (CAUTI) are one of the most common, despite most instances of CAUTI being preventable.

As CAUTI was determined to be one of the top five influential factors in the publicly report quality scores, Piedmont Healthcare looked to data for more visibility into factors that were contributing to CAUTI rate in an effort to permanently reduce the number of infections. By engaging staff for compliance with CAUTI prevention best practices, Piedmont has seen sustainable improvements.

Results:

• 50.2 percent relative reduction in CAUTI standardized infection ratio (SIR). This translates to 37 fewer patients with infections than expected.
• 6.7 percent relative improvement in insertion bundle compliance.
• Maintenance bundle compliance improved dramatically, with nearly a three-fold increase in the percentage of patients receiving the maintenance bundle.

Using Analytics and Technology to Improve the ED Patient Experience

Substantial evidence indicates a correlation between a patient’s experience in a healthcare setting and adherence to medical advice, appropriate use of healthcare services, and clinical outcomes. Many organizations evaluate patient experience using Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) survey scores.

Mission Health’s patient experience survey scores in the emergency department (ED) were significantly lower than desired. Extended wait times negatively impact patient experience and perceptions of quality of care.

To improve the wait-time experience, Mission changed to a quick registration process, implemented patient notifications via text messaging, and began notifying patients of anticipated delays due to volume surges, thus better managing expectations. Text messaging also improved patient privacy, as did remodeling the waiting room to create a private registration area.

In just over a year, Mission’s ED achieved the highest patient experience ratings it had ever received:

• Threefold improvement in patient ranking of:
  • Overall quality of care.
  • Provider communication.
• 29 percent relative reduction in time from discharge order to patient discharge.

Quick Registration Dramatically Reduces Delays in ED Patient Care

Patient registration is an essential step in the emergency department (ED) workflow—it is required to initiate EHR documentation and impacts patient safety. Correctly identifying patients during registration is critical, as caregivers use historical data in the EHR to make treatment decisions.

Mission Health, as part of its ongoing performance improvement work, discovered that its registration process was lengthy—patients were waiting in line for as long as 15 minutes to be checked into the ED to receive treatment.

To improve its registration process, Mission implemented a quick registration process (e.g., asking fewer questions upon patient presentation at the ED) based on frontline staff feedback that, in a little over one year, dramatically reduced delays in ED patient care:

• 70 percent relative reduction in the time to complete registration, with current performance under one minute.
• 33 percent relative improvement in time from patient arrival to triage start time.
• 24 percent relative reduction in median length of stay (LOS) for discharged patients, 15 percent relative reduction for admitted patients, and 42 percent relative reduction in median LOS for behavioral health patients.

Emergency Department Triage Redesign Dramatically Reduces Wait Times, LOS, and Left Without Being Seen Rates

Overcrowding in the emergency department (ED) has been associated with increased inpatient mortality, increased length of stay (LOS), and increased costs for admitted patients. ED wait times and left without being seen (LWBS) rates—patients who present to the ED but leave before receiving a medical evaluation—are indicators of overcrowding.

Mission Health needed to address overcrowding in its ED. The community hospital system confirmed overcrowding when it determined that approximately 4,000 patients were leaving its ED each year without being seen.

Mission implemented an improvement process to address ED overcrowding. The hospital leveraged its analytics platform to develop an ED analytics application that provided actionable, timely ED performance data to focus improvement efforts on four areas: staffing patterns, registration, triage assessment by the registered nurse (RN), and early access to a qualified medical provider.

Mission achieved significant ED performance improvements:

• 89 percent relative reduction in LWBS rate, with current performance at 0.4 percent.
• 85 percent relative reduction in percentage of patients who left before treatment complete, with current performance at 0.58 percent.
• 75 percent relative reduction in median door to assessment by a qualified provider, with current performance under 15 minutes.

A Data-Driven Systems Approach to Improving Emergency Care

Health systems can directly impact the quality of emergency department (ED) care by reducing the time patients wait between arrival and seeing a qualified medical professional. Long ED wait times can reduce patient satisfaction and put patients at risk.

Mission Health determined that patients in its ED often waited more than 50 minutes to receive qualified medical care. To decrease this wait time, the hospital system sought to improve its ED patient flow. Using data-driven insights provided by use of its analytics platform, Mission could visualize each portion of the ED patient flow, enabling the improvement team to identify and respond to opportunities for process improvement.

Using this strategy, Mission achieved the following:

• 89 percent relative reduction in the rate of patients who left without being seen (LWBS), resulting in the current performance of 0.4 percent.
• 29 percent relative reduction in the time from discharge order to ED departure time.
• 24 percent relative reduction in the median length of stay (LOS) for patients who are discharged.

Readiness Assessment Crucial First Step in Building an Outcomes Improvement Focused Organization

Healthcare organizations need to be cognizant of their readiness for change, enabling them to create a plan that will enhance the organization’s ability to successfully drive change. While many studies have been completed on the importance of organizational readiness in non-healthcare organizations, there is little research and relatively few,  measurement tools focused specifically on healthcare organizations.

To cement the Pulse Heart Institute (Pulse Heart) as a destination for adult heart health, and ensure its long-term success, Pulse Heart required a better understanding of its readiness to drive and sustain outcomes improvements—which it found through an onsite assessment that leveraged the Health Catalyst^® Outcomes Improvement Readiness Assessment (OIRA) framework. Using the assessment findings and subsequent recommendations, Pulse Heart successfully developed, and continues to develop, the findings to guide workplans to improve competencies and enable the organization for long-term outcomes improvements success.

Based on the results of the onsite readiness assessment they have identified and implemented interventions to improve readiness for change in each of the five major OIRA Tool categories:

• Leadership, culture, and governance
• Analytics
• Best practices
• Adoption
• Financial Alignment

Labor and Delivery Transformations Lower Costs and Improve Care

One in three women delivers via cesarean in the U.S., and more than 90 percent of them have repeat operations in subsequent deliveries. Despite numerous evidence-based guidelines and established best practices for labor and delivery, clinical care varies widely for many practices. Labor and delivery care varied at Thibodaux Regional Medical Center, causing the organization to look for ways to standardize care.

To better understand variations in care, and opportunities to reduce its cost, the labor and delivery care transformation team at Thibodaux Regional used the Health Catalyst Labor and Delivery Advanced Application as well as the Financial Management Explorer application, which integrates data from billing and costing, and creates snapshots of current financial metrics.

Informing and educating providers with provider-specific data in conjunction with redesigned workflow, standardized supplies, and new, standardized protocols enabled the labor and delivery care transformation team at Thibodaux Regional to experience cost savings and improved outcomes, including:

• 24.4 percent relative reduction in the cost of care for uncomplicated vaginal delivery. Projected annual cost savings of $266,067.
• 22 percent relative reduction in the cost of care for cesarean deliveries. Projected annual cost savings of $346,856.

Standardized Best Practices Improve Elective Colon Surgery Outcomes

Nationally, readmission within 90 days after colorectal surgery occurs in about one in four patients, at a cost of approximately $9,000 per readmission. Committed to improving its clinical and financial outcomes, MultiCare, an integrated healthcare delivery system in the Pacific Northwest, decided to focus an improvement effort on elective colorectal surgery when it recognized that patient population had a high opportunity for improvement in both clinical outcomes and cost.

Effectively using its existing quality improvement methodology and Collaborative structure, MultiCare leveraged the work of the Enhanced Recovery After Surgery (ERAS) Society and identified and implemented standardized best practice care routines and interventions that would benefit this population. By using the information in the Enterprise Data Warehouse and analytics applications to monitor clinical outcomes and compliance, and leveraging technology in the EHR to provide decision support and order sets at the point of care, MultiCare was able to significantly improve the clinical outcomes for these patients.

Results:

• 19 percent reduction in readmission rates.
• 22 percent reduction in length of stay.
• 85 percent reduction in infections related to colorectal surgery.

Clinical Data Abstraction as a Service Improves Accuracy and Efficiency

Allina Health needed to ensure the data it reported to regulatory agencies was timely and accurate. The integrated health system sees 100,000 inpatient hospital admissions annually, 340,000 emergency care visits, and 6,000 physicians and 1,600 nurses providing and documenting care. Due to the sheer volume of patients and employees, clinical data abstraction at Allina Health is not a small undertaking.

Looking to stay compliant while reducing resource utilization, Allina Health sought to change its workflow procedures for faster, more accurate clinical data abstraction. A large amount of clinical data required for compliance with CMS performance measures and Joint Commission Core Measure resides in unstructured data, such as narrative notes, which require manual data abstraction. With the help of data analytics, Allina Health was able to develop evidence-based standardized processes for clinical reporting and automate some clinical data abstraction.

Results:

• 76 percent relative improvement in time to data availability at each site. Data is typically available within 14 days of discharge, far exceeding the 30-day target.
• 95.5 percent accuracy for CMS validation.