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.

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.

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.

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.

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.

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.

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.

Care Management: A Critical Component of Effective Population Health Management

Unprecedented changes in the healthcare payment system have resulted in health organizations across the country investing in the pursuit of the Institute for Healthcare Improvement’s (IHI’s) Triple Aim to improve population health, improve patient experience and outcomes, and reduce costs per capita. Health organizations must develop effective population health management strategies, and they need the right data and analytics to inform their initiatives.
Once armed with the information to make data-driven decisions, leading healthcare providers are implementing care management programs, which have proven to be helpful mechanisms for achieving the Triple Aim. Many healthcare organizations have identified specific patient cohorts to monitor the impact of care management interventions on individual and population health outcomes.
Data-driven care management programs that target high-risk and rising-risk patients can achieve impressive results, including:

Up to 20 percent lower rates of hospitalization in mature care management programs.
Lower rates of emergency department utilization.
Decreased costs.

How to Reduce Clinical Variation and Improve Outcomes While Demonstrating a Positive ROI

Clinical variation can be frustrating for patients and their families, often leaving the impression that healthcare team members are not on the same page and don’t agree on the plan for the patient’s diagnosis or treatment. It is also costly—the Institute of Medicine estimates that $265 billion (30 percent) of healthcare spending is waste that directly results from clinical variation.
To reduce unwanted variation, Texas Children’s Hospital invested considerable resources to develop clinical standards tools, including evidence-based order sets; however, demonstrating the effectiveness and utilization of those guidelines, pathways, and order sets had been daunting. To that end, Texas Children’s deployed an analytics platform from Health Catalyst to aggregate and analyze the data needed to perform both of these critical functions.
Results:

$2,401 reduction in cost per patient with order set utilization, and an 8.4-day difference in average length of stay (LOS).
$15 million reduction in total direct variable costs in Fiscal Year 2015, $32 million anticipated reduction in Fiscal Year 2016 at the current order set usage rate, and a potential $64 million annual reduction with a hypothetical 80 percent order set usage rate.
1,629 percent return on investment (ROI).

Reducing HAC Rates to Keep Kids Safe and Healthy

Hospital-acquired conditions (HACs)—such as central line-associated blood stream infections (CLASBIs) and pressure ulcers (PUs)—cause harm and adversely affect patients’ lives, while also increasing hospital length of stay (LOS) and total hospital costs. In fact, each case of CLABSI alone costs up to $55,000 to treat and makes health systems vulnerable to reimbursement penalties.1
Children’s Hospital of Wisconsin (CHW), a nationally ranked pediatric center with two hospitals and a surgery center, recognized that reducing the rate of HACs in its facilities would require major systematic changes. CHW’s approach to transforming care to prevent HACs included cultural changes with an emphasis on staff education and engagement and a new governance structure to support the initiative. These changes were powered by high-tech tools and quicker access to new types of data that CHW didn’t have in the past.
The hospital’s implementation of its comprehensive and collaborative HAC reduction plan has resulted in measurable quality of care improvements and cost reductions, including:

$1.6 million savings realized to date as a result of a 30 percent reduction in the overall number of HACs
23 percent reduction in central line-associated blood stream infections (CLABSIs)
74 percent reduction of pressure ulcers (PUs)
68 percent reduction in venous thromboembolisms (VTEs)

Calculating the ROI of Diabetes Care Improvement

Texas Children’s Hospital has dedicated itself not only to successfully improving diabetes mellitus (DM) outcomes, but also to developing a framework for measuring the ROI of its performance improvement efforts. Texas Children’s tackled its DM initiative with a combination of technology investments and new organizational models, including an enterprise data warehouse (EDW) and analytics platform, a clinical care process team model for improving the quality and cost of care, and a diabetic care unit (DCU) staffed by a highly specialized, highly trained group of providers. Health system leaders also worked with the business school at Rice University to develop a model for measuring ROI that focused on easily quantifiable drivers. The results of this effort include substantially improved quality of care for DM patients, an increase in net revenue by a projected $232,000 annually, and an estimated ROI of 53 percent.

How Hospital Financial Transparency Drives Operational and Bottom Line Improvements

In an era of steadily declining operating margins, hospitals are seeking ways to increase their profitability. Learn how one hospital system integrated financial and operational data in near real-time, giving their leaders visibility into how their decisions are impacting the bottom line. Leadership is now making more informed decisions and they are addressing problems as they arise. Budgets are consistently being managed close to target and variances for each cost center are readily explained with drill-down capabilities into the general ledger. A significant manual effort associated with over 1,000 cost center spreadsheets has been eliminated and the organization has saved $12 million in labor savings.

Effective Practice Management Results in Quality Care for More Patients

Effective practice management can help provide quality patient care, increase revenues— and enhance patient and employee satisfaction. Ineffective practice management may cause patients to seek care elsewhere. As the healthcare industry transitions to value-based care, clinics must align provider scheduling as tightly as possible with patient demand while maintaining a high level of physician and patient satisfaction. Learn how practice managers, clinicians and operational executives are improving practice management, patient access and provider productivity, which has contributed to an estimated $20 million in savings.

$74M in Healthcare Operational Improvements: How Texas Children’s Hospital Is Delivering on Its Vision

Federal and state funding reductions, along with increased competition, are the latest profitability challenges facing healthcare organizations. Texas Children’s recently faced this challenge head-on when projections indicated they would fall $50 million short of what was needed to build capital reserves and to maintain their bond rating. To improve financial performance and prepare for the future, the leadership team launched a system-wide performance improvement project called “Delivering on the Vision” (DOTV). DOTV would involve increasing accessibility for patients as well as driving healthcare operation savings. Texas Children’s goal, of increasing operating margins over 18 months by achieving $60 million in savings, has been surpassed — realizing $74 million in cost savings to date.

Improving Healthcare Provider Productivity with Advanced Analytics

Improving provider productivity to enhance access to care and positively impact the bottom line is one of the most important tasks facing healthcare organization today. Historically the approach to evaluating provider productivity was complicated, time-consuming and inconsistent. This left providers struggling to effectively manage in their areas of responsibility. Learn how section chiefs, providers and operational leaders at one healthcare organization now have access to near real-time data, a single source of truth, and national benchmarks that enable them to optimize productivity—which resulted in their ability to see more patients and increase revenue per clinical FTE, contributing $20M in organizational savings.

How to Reduce Preventable Healthcare Associated Conditions in Children Using Best Practice Bundles and Analytics

Despite the preventability of healthcare associated conditions (HACs), rates continue to be unacceptably high throughout the country. Developing and implementing best-practice bundles—and tracking providers’ compliance with these bundles—has proven to be highly effective in preventing HACs. However, tracking HAC rates and bundle compliance can present a significant reporting burden. Learn how this healthcare organization has streamlined reporting and is able to identify vulnerable patients sooner, monitor clinicians’ compliance with best-practice bundles, and minimize manual chart reviews to calculate the HAC rates. With increased bundle compliance, their overall HAC rate has decreased by 35% and their CAUTI rate by 50%.

How to Integrate Patient Satisfaction Data to Deliver Quality Healthcare and Improve Operational Efficiency

Patient Satisfaction Explorer has enabled Texas Children’s Hospital to trend key performance indicators for patient satisfaction by service unit. Clinicians, executives, and operational leaders can easily drill down into the granular data to analyze patient satisfaction in more detail, including individual survey responses. Their current results include: improved operational efficiencies with integrated data and analytics – which is helping the healthcare system achieve its system-wide initiative to eliminate the use of vendor portals; increased system-side transparency across 3 campuses, 28 survey units and 145 locations with all levels of the organization having full transparency into how their performance is being measured; full empowerment to discover how to improve their patients’ experience, integrated patient satisfaction data into quality improvement initiatives; reduced custom reporting requests by 15%.

How to Improve Appendectomy Care Outcomes Using Advanced Analytics in Healthcare

Quality and efficiency have become even more important to hospitals amid the impending transformation of the reimbursement system from fee-for-service to value-based payments. Learn how this hospital used using analytics technology, team-based processes and evidence-based best practices to drive cultural transformation, improve appendectomy outcomes and reduce costs, and deploy end-to-end workflow optimization. The results are impressive: they reduced postoperative length of stay by 36 percent; they reduced average variable direct costs by 19 percent; they increased order set adoption rates by 36 percent; they increased the percentage of patients receiving recommended antibiotic as first antibiotic by 53 percent.

Measuring and Reporting The Joint Commission’s Perinatal Core Measures using Clinical Analytics

Addressing The Joint Commission (TJC) core measures is a challenge for healthcare organizations. Hospital EMR data issues are well known by quality and patient safety, and clinical quality improvement clinicians. Read how this healthcare organization is using their healthcare enterprise data warehouse and clinical analytics to establish accurate baseline measures and ongoing near real time performance tracking for their TJC perinatal core measures.

Streamlining Radiology Operations and Care Delivery through Analytics

Texas Children’s Hospital radiology practice administrators used to dedicate several hours each week performing manual report reviews for weekly reporting — interfering with time they could be spending on streamlining their operations and delivering patient care. They are improving their operations and increasing patient satisfaction through health analytics while reducing costs by an estimated $400K. Texas Children’s established an analytics platform that enables near-real time reporting to track key performance measures such as average procedure duration, results turnaround time to providers, anesthesia utilization, patient flow cycle times and more.

Launching an EDW to Rapidly Reduce Waste in Asthma Care

See how one children’s hospital used its enterprise data warehouse and related analysis tools to uncover a faulty order set in an EHR that was resulting in too many chest xrays. End result? A 49% reduction in x-rays ordered in the first six months. And the numbers just keep getting better.

Population Registries Kick-start Rapid-cycle Clinical Process Improvement

What do you get when you combine an enterprise data warehouse with analytics applications? Texas Children’s Hospital used this dynamic duo to help them identify and implement improvement programs that drive measurable — and sustainable — results.

Texas Children's Hospital Significantly Reduces Reporting Costs Using a Clinical Data Warehouse

Clinical data can be difficult to extract from an EMR, particularly when you want to combine it with other data and use it in a timely manner. But when Texas Children’s Hospital adopted an enterprise data warehouse, they found they were able to extract the data and create near real-time reports that came with an added bonus: a 67% cost savings.

How to Reduce Healthcare Labor Costs by Using an EDW and Analytics

In the shift to value-based care, Texas Children’s Hospital began to see its bottom line decline and needed an immediate solution to address labor and productivity challenges. The hospital set out to develop a methodology to help them allocate labor resources appropriately to the demand for services.

How to Improve Clinical Quality Improvement with an EDW

While the staff at Texas Children’s Hospital hoped that EHRs would be the data goldmine they were hoping for, shortly after implementation, they discovered they needed something more. The answer? A data-driven clinical culture coupled with an enterprise data warehouse.