Moving Healthcare Outcomes Improvement Projects to the Finish Line

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outcomes improvement finish lineOver the years, I have come to appreciate that using best practices to inform patient care is key to increasing healthcare outcomes improvements. My passion for combining medical knowledge and its respective best practices, software engineering solutions, and project management tools and techniques, has led to wonderful opportunities and experiences in addressing healthcare challenges.

A Simple Example of Best Practices

In the late eighties I was involved with the Grant Fitness Center firefighter program in Columbus, Ohio, overseen by Grant Medical Center. At the time, more and more evidence was accumulating to indicate significant long-term health risks for firefighters, and the potential benefits of a multidisciplinary, team-based fitness program. In retrospect, this program reflected great vision ahead of its time, as evidenced more than 10 years later in a 2001 article in Occupational Medicine, which cited “increasing attention over the last several years” to occupational health programs for firefighters. I have seen the concept and frequency of multidisciplinary and collaborative teams expand significantly since that time.

However, a primary challenge of implementing that program was the accumulation of sufficient data, both at an individual and a collective level, to address the healthcare risks appropriately. Because of this challenge, I was asked to develop a software system that could store and report on dozens of parameters in different areas, including clinical and lab values, as well as information collected by a nutritionist, such as body fat measurements. My internship finished early into the program, so I only saw initial results, but they were already generating optimism among the clinical staff and firefighters alike.

I share this experience because it provides a simple example of how to improve outcomes in patient care. The medical center identified a cohort (firefighters) with potential health risks and involved a small team of healthcare professionals with subject matter expertise in different areas (primarily, a physician, nurse, and nutritionist, with some support staff). This team was aware of current best practices and was responsible for standardizing and carrying out the program. The data system I developed could then be used for analysis by the team for advising them on improvements needed at both the individual patient and program levels.

The Methodology for Improving Patient Outcomes

While this is an over-simplification of the process, we can see described here three basic systems that can provide a systematic approach to improving patient outcomes: best practices, adoption, and analytics. The best practices system in this case is represented by the various professionals involved, who could leverage their experience and knowledge, and standardize processes in the program. The adoption system is represented by the multidisciplinary team’s carrying out the program. And, the analytics system is represented by the software system that was developed to store, analyze, and report on the firefighters’ related healthcare data. This same pattern can be followed in large and small healthcare organizations alike, simply adjusting to the needs and resources of the organization and its patients.

Outcomes Improvement in Action at Texas Children’s Hospital

An in-depth description of this methodology can be found in Part 2 of Dr. John Haughom’s book, Healthcare: A Better Way. And it has been put into action as our Health Catalyst team has partnered with Texas Children’s Hospital in outcomes improvement endeavors.

Texas Children’s Hospital uses a series of care process teams (for different specialty areas) consisting of healthcare professionals who take ownership of quality, cost, and patient satisfaction measures associated with healthcare delivery, and design their own solutions to targeted improvement objectives, also called aim statements. These are permanent teams with integrated clinical and technical members, who also have the support of their respective leadership team and the executive team. An underlying principle for the teams is that of continuous improvement that ultimately benefits the patients and their families. As one aim is completed, they move on to the next targeted objective for outcomes improvement. As mentioned previously, this is guided by evidence-based medicine principles, leveraging both best practices and data analytics (using dashboards that bring together data from disparate databases) to determine and move forward on opportunities that dovetail with the IHI Triple Aim. Again, we see teams guided by best practices and analytics (data dashboards) in the adoption of these projects and programs.

This methodology has improved the lives of patients at Texas Children’s as the organization has focused its improvement initiatives on care processes with high costs and variability. One of these target areas was the management of patients with diabetic ketoacidosis (DKA), which was noticed to have a measurable degree of variation, and thus some gaps in quality of care. With a care improvement team and measurable goals in place, supported by an enterprise data warehouse (EDW) and a pediatrics diabetes analytics application, Texas Children’s made significant strides in improving diabetes care, especially for DKA patients. Results included having 81 percent of DKA patients assigned to a diabetic care unit and Core Diabetic Nurse, with a 17 percent relative increase in DKA patients receiving an evidence-based evaluation and order sets, and a 19 percent relative increase in DKA patients receiving IV insulin within one hour of order. In addition, there was a 33 percent relative decrease in length-of-stay for DKA patients. For those also interested in the ROI, it was calculated at about 53 percent. These, by the way, are not atypical results for these outcomes improvement programs… and that to me is exciting!

Relentlessly Focus on Outcomes Improvement

It has been rewarding for our Health Catalyst teams to partner with such exemplary healthcare organizations as Texas Children’s, and to do the work that we do. To see our efforts in outcomes improvement filter down to the patient level is especially gratifying. In the words of Dan Lowder, a Technical Director at Health Catalyst and associate on these projects:

“Health Catalyst is unique from any other organization I’ve worked for because they are outcomes focused. In other roles (in the past) as a Business Intelligence Engineer and Data Architect, I have been given technical requirements for a project and asked to execute. At Health Catalyst, I’m given a situation related to patient care or patient costs and asked to build a solution to measure outcomes. By a relentless focus on outcomes in everything we do, we are ensuring that the end result is ultimately saving the patient either time or money, or improving his/her health. In most cases, this focus results in improvements in all three of these areas.”

These outcomes improvement results described by Dan can be achieved by anyone in any size organization.

Outcomes Improvement Is Scalable

The key to continuous quality improvement in healthcare, or in any area, is to follow a systematic approach, such as that described above. While it is easy to understand how an organization the size of Texas Children’s Hospital could harness resources and organize their staff to do so, it might be more challenging to contemplate how a very small organization could implement such a system. However, just as with the firefighter program example, it is very possible to adapt this methodology to virtually any size organization.

Especially nowadays, there are numerous sources to inform an organization on best practices and standardization guidelines, including a discretionary search of the Internet. Numerous data software systems also are available with their respective tools for analysis and reporting. Then one or more permanent clinical teams can be formed with the existing staff to carry out the outcomes improvement program. Time constraints sometimes are given as a challenge to forming these permanent teams, however, experience shows that the time savings from reducing redundancies, as well as eliminating other types of waste, more than compensates for the time invested.

An Effort that Reaps Exponential Rewards

It is very rewarding to be involved with people and organizations that know how to do the right thing for the patient the first time, and every time, using best practices to inform patient care. As one progresses with these outcomes improvement efforts, the rewards become more and more obvious. A primary motivator for me to become a physician was to positively impact the lives of patients and their families. I originally had thought that my contributions could help improve the lives of thousands of people over my lifetime. Now I wake up each day excited about the prospect that what I am doing along with others potentially will benefit not thousands, but millions of people!

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