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 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 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.
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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.
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Combatting Opioid Abuse with Data-Driven Prescription Reduction

Each day, 91 Americans die from an opioid overdose. Historically, illegal opioids, such as heroin, were the primary contributing factor to overdoses. Today, it is well understood that a driving force for opioid abuse is prescriptions, which contribute significantly to the overdose epidemic.

Following a series of adverse outcomes related to opioid misuse within the community, Allina Health sought to evaluate how it managed acute non-cancer pain in the outpatient setting, particularly among opioid-naïve patients. By leveraging the Health Catalyst Analytics Platform, including the Late-Binding™ Data Warehouse and broad suite of analytics applications, Allina Health obtained data on prescribing patterns and identified several opportunities to reduce the number of opioids prescribed.

Results:

  • 980,527 fewer opioid pills prescribed in the outpatient setting in 2016, a 12 percent relative reduction.
  • 1,079 fewer patients (with acute or chronic pain) receiving eight or more opioid pill prescriptions over 12 months, a 10.3 percent relative reduction.
  • 13,391 fewer patients receiving opioid prescriptions for more than 20 pills, a 13 percent relative reduction.
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Successfully Sustaining Sepsis Outcomes

Increasingly, high-functioning healthcare organizations are recognizing the challenge of sustaining results following successful clinical improvement initiatives. Sepsis is a major driver of mortality in the U.S. In fact, it is estimated that up to half of all hospital deaths are linked to sepsis. After executing a successful strategy to improve outcomes for patients with sepsis, Piedmont Healthcare was determined to sustain those critical reductions in mortality, length of stay, and cost.

The health system “hardwired” process changes into the EHR, monitored performance compliance via a well-developed analytics application, and fostered strong leadership on the frontlines to champion a culture of continuous improvement. In the second year of its latest sepsis improvement effort, Piedmont was able to not only sustain, but also to further improve upon its first-year improvement results.

Second-year results:

  • 14.2 percent reduction in mortality for severe sepsis and septic shock translating to 68 lives saved in one year.
  • 30.7 percent improvement in number of patients receiving calculated fluid target.
  • $1.2 million saved in one year from decreased variable cost.
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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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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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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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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 99th percentile for patient experience
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From the Boardroom to the Bedside—Using Analytics to Drive a Culture of Continuous Improvement

Tracing its roots back nearly 120 years, Mission Health has a vision to provide world-class care to western North Carolina and beyond—even as the entire healthcare profession experiences a disruptive upheaval. Mission determined to meet these external changes by making a big change of its own: embracing a culture of continuous improvement.

Mission subsequently engaged physicians and other clinicians to increase process improvement skills, while expanding access to meaningful data via an analytics platform from Health Catalyst.

Results:

  • 20 percent improvement in compliance with severe sepsis; 32 percent reduction in mortality rates; 58 percent increase in sepsis detection.
  • 7 percent reduction in LOS for bowel surgery patients.
  • 34 percent improvement in heart failure LVEF assessment rates.
  • 20 percent increase in “on time” starts as result of OR dashboard.

 

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The Improvement Methodology From Thibodaux That TJC Calls “Best Practice”

Thibodaux Regional Medical Center has always excelled in delivering quality care to its patients, but a fundamental tenet of its culture is continuous improvement.

Driving that continuous improvement is a methodology The Joint Commission called “best practice in how to use data and get physicians engaged.” This quality improvement methodology centers around a three-systems care transformation model that includes best-practice care protocols, analytics, and rapid time-to-value analytics application development and frontline clinician adoption.

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How Allina Health Deployed Evidence-Based Decision Making and Reduced Variation

To tackle the variation and waste that can arise from different treatment decisions, Allina Health developed a solid framework to establish and deploy standard, evidence-based practices across the enterprise. The transition to a standard evidence-based decision-making process required collaboration and buy-in from multiple stakeholders and physicians. Allina’s established quality governance structure reviewed and approved system-wide clinical practice guidelines for Stage 1 lung cancer treatment and IV heparin treatment. To sustain and improve on this new model of care, a comprehensive checklist was developed to ensure that all future guidelines are based on patient subgroups and preferences, available evidence, stakeholder review, and other important criteria including IOM standards. Adherence to guidelines is monitored with metrics based on data extracted from Allina’s enterprise data warehouse and from the electronic health record. Results to date already indicate notable improvements in variation and cost, including the following: the establishment of a system-wide EBDM model and policy, 20 system-wide approved evidence-based guidelines developed months faster, a 5 percent decrease in Stage 1 lung cancer treatment variation, and a 20 percent decrease in the number of heparin protocols.

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Other Content in Best Practices

Posts

Reducing Unwanted Variation in Healthcare Clears the Way for Outcomes Improvement

According to statistician W. Edwards Deming, “Uncontrolled variation is the enemy of quality.” The statement is particularly true of outcomes improvement in healthcare, where variation threatens quality across processes and outcomes. To improve outcomes, health systems must recognize where and how inconsistency impacts their outcomes and reduce unwanted variation.

There are three key steps to reducing unwanted variation:

  1. Remove obstacles to success on a communitywide level.
  2. Maintain open lines of communication and share lessons learned.
  3. Decrease the magnitude of variation.
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Three Essential Systems for Effective Population Health Management

An effective population health management program must include three systems: Healthcare Analytics, Best Practice, and Adoption. Organizations with only one or two of these systems often display symptoms of weak and ineffective capability for population health management.  But when you have a analytics foundation based upon a data warehouse, combined with evidence-based practices contained in a best practice system, and the ability to deploy and implement systematic changes to healthcare processes, health systems are truly prepared to manage population of patients.

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Improving Patient Safety and Quality through Culture, Clinical Analytics, Evidence-Based Practices, and Adoption

According to the Centers of Disease Control (CDC), an estimated 70,000 patients die each year from hospital-associated infections (HAIs): contrast the CDC statistic with the fact that only 35,000 people die each year in the U.S. from motor vehicle accidents.  Learn key best practices in patient safety and quality including:  patient safety as a team sport, the added challenges of healthcare being the most complex, adaptive system, and how culture, analytics, and content contribute to improve outcomes and lower costs.

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The Clinical Integration Hierarchy: A Primer on the Backbone of Data-driven Quality and Cost Improvement

Healthcare delivery is typically siloed into departments and care settings. But accountable care and value-based payment models require organizations to coordinate care across the continuum. To accomplish this, the Clinical Integration Hierarchy groups healthcare into work process that reflect how care is actually delivered. At the most granular level are care processes such as AMI and Cardiac Rehab (some of which are further divided into sub-care processes such as when AMI is divided into PCI and CABG). Next, care process families form the link between care processes through common pathologic conditions. Finally, the care process families comprise clinical programs such as Cardiovascular and Behavioral Health. The Clinical Integration Hierarchy forms the foundation for systematically tackling quality and cost improvement.

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How to Develop a Robust Clinical Content System

On average it takes seventeen years for medical research findings to make their way into standard clinical practice. Healthcare organizations are being challenged to find much faster ways to implement evidence-based best practices into everyday care delivery. Successful implementation of a robust content system is critical for hospitals to drive clinical integration more quickly and efficiently across the organization to achieve improved, sustainable outcomes. There are 5 major steps including:. 1. Performing key process analysis; 2. Understanding the population; 3. Understanding best practices and current state; 4. Identifying key metrics; and 5. Defining specific goals

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Webinars

The Content System: Making the Best Medical Knowledge Standard Practice

In previous webinars, Dr. Haughom discussed the first two systems care delivery organizations need to adopt in order to excel; the analytic and deployment systems.

During the session attendees will:

  • Learn to identify cohorts of patients for quality improvement initiatives
  • Understand levels of evidence to determine which is the most veritable
  • Discover how to utilize evidence to identify and eliminate waste
  • Apply standardized care delivery through shared common baselines
  • Employ tools to accelerate waste identification and elimination

The combination of a strong analytic, deployment, and content system enables healthcare organizations to ignite change and deliver evidence-based care and drive scalable, sustainable improvements in cost and quality.

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