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A Data-Driven Systems Approach to Improving Emergency Care

Health systems can directly impact the quality of emergency department (ED) care by reducing the time patients wait between arrival and seeing a qualified medical professional. Long ED wait times can reduce patient satisfaction and put patients at risk.

Mission Health determined that patients in its ED often waited more than 50 minutes to receive qualified medical care. To decrease this wait time, the hospital system sought to improve its ED patient flow. Using data-driven insights provided by use of its analytics platform, Mission could visualize each portion of the ED patient flow, enabling the improvement team to identify and respond to opportunities for process improvement.

Using this strategy, Mission achieved the following:

  • 89 percent relative reduction in the rate of patients who left without being seen (LWBS), resulting in the current performance of 0.4 percent.
  • 29 percent relative reduction in the time from discharge order to ED departure time.
  • 24 percent relative reduction in the median length of stay (LOS) for patients who are discharged.
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Clinical Data Abstraction as a Service Improves Accuracy and Efficiency

Allina Health needed to ensure the data it reported to regulatory agencies was timely and accurate. The integrated health system sees 100,000 inpatient hospital admissions annually, 340,000 emergency care visits, and 6,000 physicians and 1,600 nurses providing and documenting care. Due to the sheer volume of patients and employees, clinical data abstraction at Allina Health is not a small undertaking.

Looking to stay compliant while reducing resource utilization, Allina Health sought to change its workflow procedures for faster, more accurate clinical data abstraction. A large amount of clinical data required for compliance with CMS performance measures and Joint Commission Core Measure resides in unstructured data, such as narrative notes, which require manual data abstraction. With the help of data analytics, Allina Health was able to develop evidence-based standardized processes for clinical reporting and automate some clinical data abstraction.

Results:

  • 76 percent relative improvement in time to data availability at each site. Data is typically available within 14 days of discharge, far exceeding the 30-day target.
  • 95.5 percent accuracy for CMS validation.
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How Allina Engaged Clinicians and Analytics to Improve Influenza Vaccination Rate

Influenza, a contagious respiratory illness spread by droplets, can lead to hospitalization and even death. Millions of people get influenza each year, hundreds of thousands are hospitalized, and thousands to tens of thousands die from influenza related causes each year. The key to preventing a devastating outbreak is vaccinating enough people that an outbreak is unlikely.

When Allina Health identified that its own rates for influenza vaccination were lower than desired, the health system studied data gleaned from its EHR and an Analytics Platform from Health Catalyst, which includes a Late-Binding™ Enterprise Data Warehouse and broad suite of analytics applications, to understand its true current vaccination performance. The data revealed that changes were in order, which Allina put in place through clinician feedback, engagement, and education.

Results:

  • 4.8 percentage point improvement in influenza vaccination rate, exceeding the Healthy People 2020 goals for vaccination.
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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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40,000 Covered Lives: Improving Performance on ACO MSSP Metrics

The U.S. healthcare system is the most expensive in the world, but data consistently shows the U.S. underperforming relative to other countries on most dimensions of performance. The Centers for Medicare & Medicaid Services’ (CMS’s) accountable care organization (ACO) model is aimed at addressing that issue by offering financial incentives for providers to improve the health of populations and reduce costs through greater efficiencies and a focus on preventive care.

Mission Health formed a Medicare Shared Savings Program (MSSP) ACO called Mission Health Partners (MHP), which is responsible for 40,000 patient lives. MHP knew that its manual approach to data collection and reporting would not be sufficient for the required ACO quality metrics. By leveraging a previously implemented enterprise data warehouse platform and implementing an ACO MSSP analytics application, MHP was able to automate the processes of data-gathering and analysis and align the data with ACO quality reporting measures. The visibility and transparency of near real-time, online performance data coupled with focused process improvement has resulted in subsequent improvement in all 33 of the ACO performance metrics. Specifically, improvements have included:

  • 9.6 percent increase in compliance over all reported ACO metrics, with 23,000 more patients receiving recommended treatment or screenings.
  • 98.9 percent of eligible patients received screenings for clinical depression and follow up.
  • 40 percent increase in number of patients receiving any cancer screening; 46 percent improvement in the number of patients receiving colorectal cancer screening.
  • 456 percent increase in the number of patients getting fall risk screening.
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Allina Health: A Successful Approach to Improving VTE Care and Prevention across a Large Health System

An estimated 1 million cases of venous thromboembolism (VTE) occur each year in the United States—with approximately 300,000 of these cases resulting in death. These sobering statistics led Allina Health to embark on a journey to address prevention and improved care for its VTE patients—one of the most common causes of hospital-related death in the United States—and one of the most preventable. Supported with analytics, Allina implemented a physician-led, multidisciplinary workgroup to standardize order sets and engage clinicians in improvement efforts. To date, their system-wide efforts have generated measurable improvements including an 11 percent increase in VTE bundle compliance rate, a 96.9 percent compliance with VTE prophylaxis, and a 41 percent increase in compliance with VTE warfarin therapy discharge instructions.

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Standardizing Labor and Delivery Best Practices to Improve Outcomes

Advancing women’s health is a key part of the nation’s healthcare quality improvement and population health management agenda. Mission Health has embarked on a journey to standardize its best practices and develop a more systematic method for collecting and analyzing data related to perinatal care. With an EDW serving as its analytics platform, and a newly implemented clinical improvement model, Mission is able to monitor performance on several evidence-based practices designed to improve maternal and newborn care. Learn how they have sustained a zero elective delivery rate, and how they have reduced the time they spend manually collecting data and calculating rates.

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How to Avoid PQRS Penalties and Earn Potential Incentives with Accurate Submission of Quality Measures

CMS has recently transitioned its Physician Quality Reporting System (PQRS) program from a pay-for-reporting program to a program that will now apply a negative payment adjustment to providers who do not satisfactorily report data on quality measures. Memorial Hospital faced a significant problem when its PQRS reporting process was hampered by its transition to a new EHR system. They needed a solution. Learn how Memorial successfully used their enterprise data warehouse to submit the necessary data to a certified registry, avoiding a four percent Medicare reimbursement adjustment, and providing them with the potential to earn an incentive payment. They also now have several patient registries that can be used for quality improvement initiatives in clinical care, patient safety, and care coordination.

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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.

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