Successfully Sustaining Elective Colon Surgery Outcome Improvements

For healthcare organizations, sustaining improvements that have been adopted in more than one part of an organization remains a serious challenge. After improvement initiatives have been successfully implemented, it is estimated that less than 40 percent of gains are sustained in the long term. Because improvement initiatives are necessary to maintain a high standard of care, sustaining them so that further improvements can be made remains a top priority for health systems.
MultiCare Health System, a not-for-profit healthcare system serving Washington state, successfully implemented improvement efforts for patients undergoing elective colon surgery, which resulted in significant reductions in 30-day readmission, LOS, and surgical site infections (SSIs). However, without ensuring ongoing engagement, accountability, and visibility into performance, MultiCare was concerned improvements could slip away. By supporting continued monitoring powered by insights gained from relevant data, and by closely listening to provider feedback, MultiCare was able to sustain previous improvements while identifying new opportunities.
Results:

32.7 percent relative reduction in 30-day readmission rate for patients having elective colon surgery.
3.4-day median LOS for patients having elective colon surgery, sustaining previous improvement.
Among patients who had the complete enhanced recovery after surgery protocol implemented for elective colon surgery, there were no surgical site infections—for an entire year.

Activity-Based Costing and Clinical Service Lines Team up to Improve Financial and Clinical Outcomes

Healthcare costs continue to increase at a disproportionate rate relative to gross domestic product, and Americans are becoming increasingly aware that they aren’t getting their money’s worth. To build a sustainable healthcare system, healthcare organizations must identify and address waste and reduce the total cost of care.
UPMC recognized that the common denominator to addressing threats to sustainability is to fully understand and effectively manage costs. It implemented activity-based costing (ABC), facilitated by the Health Catalyst CORUS™ Suite, to deliver detailed and actionable cost data across the analytics environment, and support service line reporting, contract modeling, and clinical process improvement. UPMC has used this approach to effectively drive cost savings and improve clinical outcomes in many of its service lines, including Surgical Services, Women’s Health, Orthopedics, and Cardiovascular. For example:

$3M cost savings/avoidance over 2 years through the implementation of the ERAS program.
Increased insight into cost variation and drivers of inefficiency in the operating room setting.
Improved patient outcomes and quality (readmissions, complications, patient reported outcomes, patient satisfaction, etc.) for patients undergoing joint replacement.

Enhanced Recovery Program Improves Elective Colorectal Surgical Outcomes

Contemporary colorectal surgery is often associated with long LOS, high costs, and surgical site infections (SSI) approaching 20 percent. Much of the LOS variation is not attributable to patient illness or complications, but most likely represents differences in practice style. Successfully reducing SSI requires a multimodal strategy under the supervision of numerous providers with high compliance across the spectrum.
Allina Health was using established, evidence-based clinical guidelines, yet clinical variation remained high across pre-arrival, preoperative, intraoperative, and postoperative care areas, leading to substantial variation in LOS, cost of care, and the patient experience. To ensure greater consistency, Allina Health developed an enhanced recovery program (ERP) for patients undergoing elective colorectal surgery, which built standard protocols into the EHR to address elements of care from pre-arrival through post-discharge.
To facilitate the program and monitor performance, Allina Health developed an ERP analytics application with an administrative dashboard to easily visualize first-year results:

78 percent relative reduction in elective colorectal SSI rate.
19 percent relative reduction in LOS for patients with elective colorectal surgery.
82.4 percent utilization of preoperative and postoperative order sets, increasing the consistency of care and reducing unwarranted variation.

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.

Evidence-Based Care Process Model Reduces SSIs and Readmissions

The consequences of poor-quality surgical care are significant for both hospitals and patients. Consider the following: One in four patients having a colon re-section is readmitted within 90 days, costing U.S. healthcare approximately $300 million a year and negatively affecting the lives of tens of thousands of patients and their families.
In 2013, Mission Health, North Carolina’s sixth-largest health system, identified opportunities to improve clinical outcomes for its bowel surgery patients. With a vision of achieving the best outcome for each patient, Mission set goals to reduce length of stay (LOS), decrease readmissions, and reduce surgical site infections (SSIs) for its bowel surgery patients.
Mission recognized that care process models (CPMs) were key to making it easier for clinicians to deliver the best care to patients by doing the right thing consistently. The health system therefore organized a multidisciplinary improvement team charged with developing and implementing an evidence-based CPM for bowel surgery. In support of this effort, Mission leveraged technology and analytics to encourage clinician adoption of the CPM and to deliver performance insights.
Through these efforts, Mission has achieved impressive improvements in bowel surgery care:

92 percent reduction in colorectal surgery SSI rates
28.5 percent reduction in mortality
10.6 percent reduction in 30-day readmissions
4.4 percent reduction in LOS
8.5 percent reduction in cost per case

How Allina Health Improved Spine Care Variation and Outcomes

Low back pain (LBP) is a common and expensive problem. The annual cost to patients, employers, and insurers collectively exceeds $100 billion in the U.S. alone. Additionally, LBP care treatment variations, impact outcomes. In 2011, Allina Health created the Spine Institute to deliver care that supports the IHI Triple Aim in the treatment of spine disorders and LBP. All clinical disciplines involved in spine care are part of the program, and care providers follow standard spine care and management evidence-based models. Access to quality data enables Allina to measure performance across providers. With this successful spine care coordination program and advanced clinical analytics, Allina has reduced length of stay by 16 percent and post-op complications by 3.6 percent, while projecting $2.7 million in savings.

Operating Room Excellence: How One Hospital System is Driving Improvements with the Use of Advanced Analytics

Mission Health in North Carolina has always been dedicated to expanding access to care. To preserve this commitment in an era of declining reimbursement rates, Mission needed better access to data for quick and flexible decision-making. As at most hospitals, operating rooms are Mission’s biggest revenue generator, but they also represent a significant cost center. So, leveraging their new analytics capabilities to drive operational improvements across their system of operating rooms was a strategic opportunity. Mission now has improved ability to drive care and operational improvements with integrated data and analytic tools like their OR Dashboard—resulting in dramatic improvements including a 20% increase in first-case on-time surgical starts.

The Problem of Measuring Spinal Surgery Outcomes and How Analytics Can Help

Spinal problems are a common issue with a profound impact on healthcare costs. Faced with the high cost of surgical spine care in an industry transitioning to value-based payments, health systems need analytic solutions to evaluate the effectiveness of surgical interventions. Read how this medical center: 1) built a Spine Registry, 2) drove patient engagement through patient portal usage, 3) integrated data from a multitude of quality of life surveys, and 4) developed a healthcare analytics platform to measure spinal surgery outcomes.