Driving Down Costly COPD-related Readmissions with NOREADMITS Bundle

Nationally, approximately 700,000 hospitalizations occur each year with the principle diagnosis of Chronic Obstructive Pulmonary Disease (COPD), with one in five patients being readmitted within 30 days. Even with a national cost for each COPD readmission costing between $9,000 and $12,000, evidence-based measures that improve patient outcomes and decrease COPD readmissions are largely lacking.

When reviewing organizational performance for 30-day all cause readmission, MultiCare Health System identified COPD as one of the top two readmission diagnoses, along with a rate higher than expected. This prompted the organization to take action. MultiCare implemented a NOREADMITS bundle, using the Health Catalyst Analytics Platform and integrating performance measures for each element of the bundle, resulting in:

  • 16.5 percent reduction in readmission rate.
    • Approximately 34 fewer patients with COPD readmitted each year, saving an estimated $360,000 annually based on national benchmarks.
  • 95 percent of COPD patients were assessed for readmission risk.
  • Two-fold increase in COPD order set utilization.
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Collaborative Partnerships and a Three-System Approach to Driving Healthcare Transformation

Healthcare organizations are among the most complex forms of human organization ever attempted to be managed, making transformation a daunting task. Despite the challenges associated with change, Texas Children’s Hospital identified that it needed to evolve into a data-driven outcomes improvement organization.

Texas Children’s embarked on a journey to transform care, building a three-systems approach—analytics, best practice, and adoption—designed to develop a data-driven quality improvement organization that could achieve outcomes improvement expediently and at scale across the entire organization. Texas Children’s leadership knew that the foundation for clinical systems integration would be meaningful, actionable data. That realization prompted the organization to implement the Health Catalyst Analytics Platform including a Late-Binding™ Data Warehouse (EDW) and a broad suite of analytics applications.

After deploying the analytics platform supported by multidisciplinary quality improvement teams, Texas Children’s was able to improve patient outcomes related to the following:

  • 35 percent relative decrease in hospital-acquired conditions (HACs).
  • 44 percent relative decrease in LOS for patients with Diabetic ketoacidosis (DKA).
  • 30.9 percent relative reduction in recurrent DKA admissions per fiscal year.

 

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Data-Driven Clinical Documentation Improvement Program Increases Revenue and Improves Accuracy of Risk Adjusted Quality Metrics

Allina Health, an integrated delivery system throughout Minnesota and western Wisconsin, has long understood the value of clinical documentation improvement (CDI), and its growing importance in recent years. With the implementation of ICD-10, the specificity needed for accurate coding has increased, and reimbursement shifts have occurred as well, creating sizeable payment disparity for some clinical conditions. Leaders at Allina wanted to understand where their CDI program would have the greatest return on investment. However, data from the EHR was not sufficient to inform their strategy. CDI specialists still lacked the ability to perform a comprehensive assessment of the accuracy of clinical documentation, and were unable to confidently target improvement efforts in areas that would generate the greatest return on investment. To take a more data-driven approach, team members leveraged the Health Catalyst Analytics Platform, including their Late-Binding™ Data Warehouse and broad suite of analytics applications to develop a CDI analytics application. With the application, the team identified opportunities and thoroughly vetted them, before collaborating with physicians and service line leaders to educate providers on documentation improvements.

They achieved the following results:

  • 12.1 percent improvement in CV surgical cardiology CC/MCC capture rate.
  • 6.3 percent increase in medical cardiology CC/MCC capture rate.
  • Increased accuracy in publically reported risk adjusted quality metrics
  • Revenue capture improvement across the system – resulting in millions of dollars of additional reimbursements.
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Mission Health Receives 100 Percent of At-Risk Dollars in Payer Incentive Program

Since 2004, the US healthcare system has annually ranked last relative to 10 other developed nations in quality, access, efficiency, equity, and health outcomes. In an effort to improve the quality of care and patient outcomes in the U.S., the Center for Medicare and Medicaid (CMS) launched a series of quality incentive programs designed to generate a shift from volume to value-based reimbursement.  The health insurance industry soon followed their lead, and started writing contracts with hospitals in which a percentage of payment was based on performance on selected quality metrics.

Faced with the challenge of reporting on numerous incentive programs with differing expectations, Mission Health leveraged their enterprise data warehouse to aggregate the data needed to track the quality measures. With millions of dollars on the line with one particular payer, Mission developed an analytics application to monitor performance on the metrics in that contract.  The application was used to analyze whether performance feedback and workflow changes would lead to improved performance on the metrics, thus ensuring that they would maximize reimbursement, while improving care for patients.

Results:

  • Achieved 100 percent of all at risk dollars.
  • 100 percent of the ambulatory metric targets were exceeded, some by as much as 19 percent.
  • All five hospitals exceeded targets for 80 percent or more of their inpatient metrics.
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How Texas Children’s Turned Child Diabetes Management into a Community Cause

Patients with diabetes are at a high risk for infections and substantial complications, including the risk of death from infections. Further, social determinants in these patients’ communities have a tremendous influence on their health.

Texas Children’s Hospital, ranked as one of the top four Best Children’s Hospitals by U.S. News & World Report, recognized that there were gaps in diabetes care coordination in the community—where the majority of a child’s diabetes management takes place. The hospital initiated a coordinated community response, aided with an analytics platform, which is setting the standard for community management of pediatric diabetes.

Results

  • 4 percent relative improvement in the percentage of patients with diabetes who received the influenza vaccine.
  • 3 percent relative improvement in pediatric provider diabetes knowledge.
  • 90 percent of patients now have individualized school packets developed and available in the EHR.
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Systematic Improvement of Diabetes Care in the Inpatient Setting

Texas Children’s Hospital is improving the care delivery of its patients with diabetes, one of the most common diseases in school-aged children. How? Powered by dedicated improvement teams and analytics, they have focused on order utilization, timeliness of IV and subcutaneous insulin administration, length of stay (LOS), establishing a diabetic care unit (DCU), educating core diabetic nurses (CDNs), frontline staff adoption, and more.

Care delivery improvements include the following:

  • 94 percent of patients with diabetic ketoacidosis (DKA) are assigned to diabetic care unit.
  • 17 percent relative increase in patients with DKA receiving an evidence-based evaluation and order sets.
  • 19 percent relative increase in patients with DKA receiving IV insulin within one hour of order.
  • 50 percentage point improvement in the percentage of patients transitioning to SubQ insulin in less than four hours after medical readiness.
  • 44 percent relative decrease in LOS for patients with DKA.

 

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DKA Risk Prediction Tool Helps Reduce Hospitalizations

Each year, more than 12,700 pediatric patients are diagnosed with diabetic ketoacidosis (DKA), a life threatening complication of diabetes. Texas Children’s Hospital sought a way to accurately predict risk of DKA in time for care team members to intervene before these patients suffered a severe episode.

The health system ultimately formed a multidisciplinary high risk diabetes team to devise pre- and post-discharge strategies, and DKA risk prediction tools aided by the Health Catalyst Analytics Platform built using the Late-BindingTM Data Warehouse.

Results:

  • 30.9 percent relative reduction in recurrent DKA admissions per fiscal year.
  • 90 percent of all patients with new onset type 1 diabetes at the Medical Center Campus have a documented RIPGC in their medical chart.
  • 100 percent of patients with type 1 diabetes have a risk index for DKA documented every 6 months.
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Improving Population Health for Children with Diabetes

Diabetes is the most common chronic illness for children living in developed countries. Leaders at Texas Children’s Hospital wanted to take a more data-driven approach to population health management for children with diabetes. They created a Care Process Team (CPT) to pursue outcomes improvements related to diabetic ketoacidosis (DKA) since data from the EDW revealed that 64% of diabetes patients discharged had this life-threatening condition.

After the CPT achieved their initial goal of improving care for patients admitted to the hospital with DKA, they set out to implement larger improvements that would benefit the entire population of diabetes patients.

By empowering CPT members, leveraging data to drive decisions, and implementing new interventions effectively, the Diabetes CPT members have improved population health for patients with diabetes across all settings of care. Below are a few of the most significant results.

  • 44 percent relative decrease in LOS for patients with DKA.
  • 30.9 percent relative reduction in recurrent DKA admissions per fiscal year.
  • 34.4 percent relative improvement in the percentage of patients with diabetes who receive the influenza vaccine.
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Analytics Support the Delivery of Effective Diabetes Self-Management Education

Effectively educating pediatric and adolescent patients and families to self-manage diabetes is a critical part of diabetes care. Leaders at Texas Children’s Hospital, one of the top four children’s hospitals in the country, recognized that diabetes self-management education that incorporates national standards and empowers patients can improve clinical outcomes and quality of life. While diabetes education has always been important to Texas Children’s, the education provided to patients was varied, no organizational standards existed, and tracking the effectiveness was not possible.

To address these challenges, Texas Children’s created an Education Care Process Team (CPT) that focused on: developing a standard education curriculum based on national guidelines, creating consistent education materials, leveraging powerful analytics to identify potential learning gaps and customize patient goals, and investing in the professionals who deliver education.

As a result of these efforts, Texas Children’s achieved the following:

  • Implementation of a standard diabetes education curriculum.
  • 100 percent of diabetes educators are now CDEs.
  • 70.7 percent of patients with diabetes have had an education visit with a CDE, and the hospital is on track to achieve its goal of 80 percent within the year.
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Improving Diabetic Care in the Ambulatory Environment

Diabetes is the most common life-threatening, chronic illness in children who live in developed countries. With effective management of diabetes, children with diabetes can live long, healthy, and active lives.

Texas Children’s Hospital believes that diabetes patients and their families are most successful in managing their disease if they receive standardized, family-centered, multidisciplinary care in both inpatient and outpatient settings.

Texas Children’s created a new Clinic Care Process Team (CPT) which developed a comprehensive approach to standardizing diabetes care by automating best practice alerts that help clinicians recognize the need for testing, so they order labs more quickly.

Within one month of implementation Texas Children’s saw measurable improvements:

  • Screening percentages for each test improved to >80 percent.
  • 28.2 percent relative improvement in the percentage of patients receiving recommended annual thyroid-stimulating hormone (TSH) testing, with current performance greater than 90 percent.
  • 23 percent relative improvement in the percentage of patients receiving recommended annual lipid testing, with current performance greater than 90 percent.
  • 54.1 percent relative improvement in the percentage of patients receiving annual retinal examinations, with current performance at 94 percent.
  • Patient satisfaction is on an upward trend.
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