Speakers at a BioBreakfast hosted in July by the Value Institute at Christiana Care Health System and the Delaware Bioscience Association offered a peek into some of the changes ahead — and some that are already being put into action at Christiana Care.
Sharon Anderson, MS, BSN, RN, FACHE, senior vice president, Quality, Patient Safety and Population Health Management and director of the Center for Quality and Safety in the Value Institute, described the reorganization of the Quality and Safety Program, including unit-based value improvement teams, which began three years ago at Christiana Care. To reinforce a culture focused on patient safety, staff were given extra training, technology and resources to improve patient care, and units were graded on outcomes. The result: reductions in mortality and morbidity, a drop in the number and rate of medical errors and cost savings of more than $55 million. Quality indicators jumped from 43 percent to 68 percent.
“It’s a testament that shows how seriously we take our mission to improve the quality and safety of care that we deliver,’’ Anderson told about 190 attendees at the John H. Ammon Medical Education Center. “Our strategy is founded in The Christiana Care Way — creating innovative, effective, affordable systems of care that our neighbors value. Much is changing in health care, including payment reform, which also will help support our work to improve care and the health of our community.”
The current fee-for-service system in place in health care is based on volume — the more services provided, the more revenue one receives with less focus on the quality of care provided, Anderson said. That is starting to change.
Starting in 2015, Christiana Care will be participating in a Centers for Medicare and Medicaid Services 90-day bundled-payment project, in which a single payment will be allocated for care that begins up to three days before hospitalization through 90 days after discharge. It provides one payment for the range of health services needed. In other words, said Anderson, “Christiana Care will now be able to focus on better supporting our patients after discharge and helping them stay healthy by working with them outside of the hospital setting after a hospitalization.”
To move forward, “we have to change the way we do the things we do, starting with ourselves,’’ she said. That is why Christiana Care employees now receive health care through Christiana Care Quality Partners, a network of physicians who are working to develop models of care aimed at delivering better care for individuals, better health for populations and lower costs.
“We’re going to see if we can improve our own outcomes, keep our employees well and improve their health status,’’ Anderson said. “It’s not just about hospital care but also improving the continuum of care. Ultimately, it’s back to The Christiana Care Way.”
That mission extends even to neighbors far away. Richard J. Derman, M.D., MPH, FACOG, the Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology at Christiana Care, described his work to improve maternal and infant health in India, where each year, 309,000 babies die on the day of birth, and there are 56,000 maternal deaths. “It’s like three jumbo jets going down every day,’’ he said.
Derman and colleagues have published results of the successful use of misoprostol to reduce maternal death due to postpartum hemorrhage, and a program, Helping Babies Breathe, that provides life-saving neonatal resuscitation training. “We have data on 99 percent follow-up on over 400,000 women,’’ he said, and “we continue to follow those mothers.’’
It is that kind of data gathering, whether in India or closer to home, that is fueling a revolution in information technology that will improve the ability to deliver the right care to the right person at the right time, said Randall Gaboriault, chief information officer at Christiana Care.
“We’re doing innovative things here in Delaware that are not happening across the nation,’’ he said, citing the Delaware Health Information Network, a partnership that allows instant access by physicians to a patient’s records from hospitalizations, as well as outpatient lab results and imaging studies.
“We also are actively creating the next generation of electronic care systems, building and integrating algorithms as members of the care team,” Gaboriault said. “These algorithms, based on data from sources across the patient care journey and our best-known science, can aid the provider in predicting patient risks, which in turn can be used to build value-driven, evidence-based interventions. We’re developing intelligent clinical management built on evidence and delivered through information technology.”
Christiana Care co-hosts health care-related programs with the Delaware BioScience Association to share new knowledge and ideas with Delaware’s life-sciences community. The association brings together hospitals and other medical institutions, pharmaceutical and biotechnology firms, medical device manufacturers, agricultural biotech and chemical companies, research entities and others with the shared goal of expanding Delaware’s bioscience economy.
“These kinds of connections enable these important sectors to individually and collectively help Delawareans live healthier, more productive lives,” said Timothy Gardner, M.D., executive director of the Value Institute and medical director of Christiana Care’s Center for Heart & Vascular Health.