As the fee-for-service model of health care transforms into a quality-based system, Christiana Care is at the leading-edge of this change and is using the research of the Value Institute to align with this important shift in care.
“The Value Institute’s real-world research is putting patients first and demonstrating tangible improvements so that quality and safety are front and center in everything that we do,” said Christiana Care president and CEO Janice E. Nevin, M.D., MPH.
To build on the application of evidence-based care, the Value Institute centered its 2017 Spring Symposium, June 12, on the keynote address by Brent James, M.D., MStat: “We Count Our Successes in Lives: Quality as a Core Business Strategy.” Dr. James is the chief quality officer and executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare, a Utah-based system of more than 20 hospitals. He told those gathered for the semi-annual symposium that he’s impressed with Christiana Care’s commitment to excellence in bedside and outpatient care.
“You understand that quality improvement is a process, not an event,” said Dr. James, who pointed out that the federal government’s unfunded health care obligations will mean more and more value-based payments. In his view, this will be a revenue opportunity for hospitals devoted to quality, given that “waste” in the health care system accounts for 35 to 50 percent of expenditures.
Dr. James is often called the nation’s foremost expert in the application of quality-improvement ideas in health care because of the transformation that he’s helped to implement at Intermountain through the creation of almost 60 clinical data registries that have brought about improved care. Typically, said Dr. James, a successful data registry:
- Identifies a high-priority clinical process.
- Builds evidence-based best-practice protocols.
- Blends new protocols into the clinical workflow.
- Embeds data systems to track patient outcomes.
These include protocol variations, as well as short-term and long-term outcomes, while insisting clinicians vary treatments based on patient needs.
“Over time we’ve seen that better clinical results produce lower costs and drive waste from the system,” he said.
He estimates that by focusing on quality, Intermountain has realized a cumulative savings of $688 million, much of it due to cutting unnecessary costs. And he says that the movement to collect and analyze treatment data is not only an advance in the standardization of excellence, but one of the most dramatic medical transformations of the last 100 years. Under this model, “the best way to improve your financial performance is to improve the quality of care,” he said.
“Dr. James, I am most inspired by your talk and intensely inspired by the people here at Christiana Care, who show a curiosity and an openness to learning every day,” said Ken Silverstein, M.D., MBA, chief clinical officer.
In remarks titled “Measuring Outcomes that Matter to Patients,” Eric V. Jackson Jr., M.D., MBA, associate director, Value Institute, and director of health care delivery science, highlighted new Value Institute quality improvement projects, including:
- Exploring a relationship with the International Consortium for Health Outcomes Management, which is measuring patient outcomes from around the world with a goal of categorizing all diseases and developing standard sets of treatments along with outcomes that matter most for patients. Most importantly, this approach will leverage patient-reported outcome measures that will direct collection of information from patients regarding symptoms, functional status and mental health. The data sets include clinical interventions for diseases common in Delaware such as heart disease, diabetes and stroke. Harnessing the analytic power of the Value Institute on this global data set, researchers are promoting methods that will advance evidence-based decision making at the administrative level.
- Launching the Christiana Care Early Warning System (CEWS) this summer as a critical tool to facilitate awareness of patient health. In the electronic record, CEWS involves a nursing assessment paired with a patient’s physiological parameters to generate a risk score – low, medium, high and critical. By evaluating the score and how it has changed over an eight-hour period, clinicians can identify deteriorating patients so they can receive timely care before an adverse event occurs. The system uses advanced analytics as well as clinical expertise to provide evidence-based recommendations for interventions.
“This is the kind of work we want to champion,” said Dr. Jackson, adding that the creation of CEWS is the result of a Value Institute partnership with Nursing, Information Technology and Acute Medicine.
A panel discussion moderated by Dr. Jackson looked at how evidence-based medicine is being advanced at Christiana Care. On the panel were Dr. James and Sharon Anderson, RN, BSN, MS, FACHE, senior vice president of Quality and Patient Safety and chief population health officer; Ed Ewen, M.D., FACP, director of clinical data and analytics in the Center for Strategic Information Management; and Ken Silverstein, M.D., MBA, chief clinical officer.
Anderson said that Carelink CareNow, launched about five years ago, is a truly data-driven project that involves predictive analytic software and a clinician-led care patient management service combining a team of health professionals. Carelink CareNow identifies patients at highest risk of an adverse event so a clinical team can consult in real-time and manage issues before they become more serious medical problems. More than 100,000 people are in the Carelink CareNow system.
Dr. Ewen discussed the Center for Strategic Information Management, which started a year ago to develop strategies for managing data as a key strategic asset. The Center for Strategic Information Management is focused initially on gathering data on sepsis, heart failure and Clostridium difficile infection, given the potential for evidence-based interventions to have a high clinical impact in these areas and hold down costs.
In addition to the panel, Mia Papas, Ph.D., director of clinical research and health outcomes for the Value Institute, announced the first two recipients of the annual Seema Sonnad Distinguished Scholar Award. The honor is named for the late Seema Sonnad, Ph.D., director of Health Services Research, and was established with a generous gift from Sonnad’s family and friends to memorialize her dedication to mentorship and research.
One recipient is Neal D. Goldstein, Ph.D., MBI, an epidemiologist and a post-doctoral fellow in the Department of Pediatrics whose work has transformed thinking about infectious disease in the neonatal care unit and led to improved outcomes for this vulnerable population.
The second recipient is Vinay Maheshwari, M.D., MHCDS, FCCP, vice chair of the Department of Medicine. In addition to his clinical role as a critical care physician, he has served in various leadership roles, including medical director of Respiratory Care, director of Medical Critical Care, and clinical practice leader of the medical intensivists. Dr. Maheshwari’s decade of visionary leadership has led to the implementation of practices that have improved patient outcomes and care delivery.