Using Data to Spotlight Variation and Transform Total Joint Care

Total Hip (THA) and Total Knee (TKA) Arthroplasty are the most prevalent surgeries for Medicare patients, numbering over 400,000 cases in 2014, costing more than seven billion dollars annually for the hospitalization alone. Today, more than seven million Americans have hip or knee implants, and the number is rising. Furthermore, substantial variation in the cost per case has raised questions about the quality of care. At Thibodaux Regional Medical Center, total joint replacement for hips and knees emerged as one of the top two cost-driving clinical areas with variation in care processes.

To address this, Thibodaux Regional maintained its focus on the IHI Triple Aim while developing organizational and clinical strategies to transform the care of patients undergoing THA and TKA. It commissioned a Care Transformation Orthopedic Team that set multiple outcome goals. Among its many efforts, the team established standard care processes, created an educational program, redesigned order sets and workflows, and deployed a joint replacement analytics application.

Thibodaux Regional reduced variability and decreased costs significantly while maintaining high levels of patient satisfaction:

• 76.5 percent relative reduction in complication rate for total hip and total knee replacement.
• 38.5 percent relative reduction in LOS for patients with total hip replacements.
• 23.3 percent relative reduction in LOS for patients with total knee replacement.
• $815,103 cost savings, achieved in less than two years.

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.

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.

How Allina and Minnesota Perinatal Physicians Lowered Stress and Raised Satisfaction for High Risk Maternal Patients

Assuring patient satisfaction can be challenging, particularly when providing care to pregnant women with high-risk pregnancy conditions. As one of the foremost perinatal practices in the country, Minnesota Perinatal Physicians (MPP) acted swiftly to end a significant delay in scheduling ultrasound appointments, and reduced wait times for other visits.

With an aim to improve patient care and experience, the maternal fetal medicine (MFM) specialists at MPP, employees of Allina Health, leveraged Allina’s “Improving Clinical Value” Program—an initiative that has elevated the patient care experience for numerous other patient populations while simultaneously lowering the per capita cost of care for each one.

Results:

• $210,000 in increased revenue because of improved access, projected to be $280,000 within 12 months.
• 20.8 percent relative improvement in no-show rate.
• 20 percent increase in available ultrasound appointments and an 18.2 percent increase in utilization.

How to Significantly Reduce Inpatient Admission Times and Improve Patient Satisfaction

Admitting a patient to inpatient care is a complex process that, unless carefully managed, can lead to long delays in service and a poor patient experience.

Thibodaux Regional Medical Center’s consistent focus on patient satisfaction has earned the 185-bed community hospital, located one hour southwest of New Orleans, the Healthgrades® Outstanding Patient Experience Award™ every year since 1998. Not surprisingly, when Thibodaux leadership recently analyzed the hospital’s inpatient admit process, they did so from their patients’ point of view and determined to cut admission wait times. Using focused process improvement methodologies, areas of waste were uncovered, exposing problems such as redundant data collection, and inconsistent processes, which would require innovative solutions.

Integrating concepts from the Health Catalyst improvement methodology into its own Lean Six Sigma processes, and with the support of professional services from Health Catalyst, Thibodaux deployed a systematic set of solutions to significantly improve the admission process.

Thibodaux’s efforts are driving measurable improvements in the hospital’s inpatient admission process, including:

• 55 percent reduction in average inpatient admission time
• Ranked 99^th percentile for patient experience