Determining value in health care can be an elusive equation.
“We know that more expensive health care isn’t necessarily better health care,” says Sharon L. Anderson, RN, BSN, MS, FACHE, senior vice president for Quality and Patient Safety. “But how do you define value in health care?”
Christiana Care is working to demystify value through Focus on Excellence measurement reports, a dynamic and innovative initiative that examines performance in seven high-volume populations. A value score trend is calculated through a 50/50 equation of quality metrics and cost and utilization metrics.
Quality metrics include mortality, morbidity, readmission within 30 days, patient satisfaction and guideline compliance. Cost and utilization metrics are length of stay and estimated direct costs.
Performance in each metric is denoted by a symbol. A green circle indicates a better-than-expected performance; a yellow triangle denotes coming within 10 percent of the target; and a red diamond indicates that performance is more than 10 percent below the goal.
Scores are calculated on a 100-point scale, which translates to a letter grade.
“The letter grade sparks lively discussion among the doctors, who are used to getting all A’s,” says Patty Resnik, corporate director, Performance Improvement/Utilization Management. “It inspires everyone to do better in a very positive way.”
The heart failure and stroke teams were the first to report on their progress to senior leaders in the President’s Cabinet.
“Doctors need accurate information about their medical care, including the patients’ outcomes and the cost of the care,” says Timothy Gardner, M.D., medical director of the Center for Heart & Vascular Health. “We welcome this program and look forward to having such data available to our doctors so that they can judge for themselves the value of the care they are providing.”
Gathering ideas was an inclusive, comprehensive process.
“Our team sat down and looked at the way we cared for patients, from admission to discharge,” says Mitchell Saltzberg, M.D., medical director of Heart Failure. “Are we ordering more tests than are recommended? What more can we do to better comply with guidelines?”
Team-based rounds with physicians, advanced practice nurses, case managers and social workers provide a comprehensive approach to care and patient education, a strategy to help reduce readmissions.
“If they are coming back for a new problem, that’s understandable,” Dr. Saltzberg says. “But if they are coming back because they didn’t understand their meds or didn’t have adequate support at home, that is something we need to work on.”
Cohorting patients with similar conditions enables nurses to work more efficiently and help improve compliance with guidelines on stroke care .
“Working to improve value to the patient and improve patient outcomes goes hand-in-hand,” says Anthony E. Munson, M.D., medical director, Stroke Program. “The benefits of a dedicated stroke program are realized in patient satisfaction, safety and more efficient movement of the patients to their next step to recovery.”
The program also focuses on three OB/GYN populations: vaginal delivery, Caesarean section and hysterectomy, as well as pneumonia and knee replacement.
“We are breaking new ground,” Anderson says. “This is an exciting opportunity to learn more about ways to improve both patient care and efficiency.”