Below are the latest developments from various clinical performance and work groups.
May 2018 updates
Cancer
- Quality/Cost: There is a lot of work being done around ED visits by patients undergoing chemotherapy treatment. A “high risk” clinic has opened at Kadlec for patients who might be having complications, a Triage Nurse has been implemented at St. Mary’s, Swedish has formed a multi-departmental team to do an in depth analysis of this issue and Covenant Health has established a pilot where paramedics will visit cancer patients in their home to help look for signs of distress.
- Quality/Growth: Hoag Health has implemented Syapse into their Epic build as a part of the PSJH Genomics Program. Syapse is a software interface that provides information on genetic composition and has the potential to match appropriate clinical trials for clinicians.
Digestive Health
- Affordable Care/Improve Quality: Efforts have been ongoing to socialize both the GI bleed pathway and GI bleed Glasgow-Blatchford scoring tool regionally in support of the 2018 DHI executive metric to reduce GI bleed cost per case system-wide by 10%. There are still several sites which have not launched improvement teams locally. Tool kits have been developed along with detailed data reports. Also the ED has not widely adopted the Blatchford scoring tool. A manuscript is being developed for publication which should help with ED compliance.
- Improve Quality: The first in-person summit for the recently formed LA Digestive Health Advisory Council will be held May 30 in Burbank. This meeting will bring thought leaders and expert faculty together to provide updates on the latest advances and best practices in the medical, endoscopic and surgical treatment of common GI conditions, treatment of cancer of the digestive system with a focus on affordability, improvement and collaborative processes.
Heart
- Improve Quality: Over the last 12-month period, the Heart Institute has seen a general improvement in key TAVR quality metrics, including mortality, significant cardiac events, stroke, bleeding, and pacemaker utilization. This is concurrent to the operational efficiency work that reduced the cost per case of TAVR and improved the direct margin.
- Affordable Care: The Ischemic Heart Disease focus group analyzed Impella utilization in PCI, as well as appropriate treatment of chronic total occlusion. These are two high cost areas that support cost reduction for PCI. The group agreed to develop criteria to facilitate more consistent utilization/treatment.
Laboratory
- Genomics: Decision to have one system lab will improve quality and affordability; quality will be enhanced by having one lab CAP/CLIA certified that will provide consistent data outcomes, well connected to Syapse. Affordability will be improved since volumes drive down marginal costs in a sequencing lab. Decision has generated planning regarding staffing, resources and messaging.
Neurosciences
- Improve Care/Making Care Affordable: At the end of March, the system pre-op smoking rate had decreased from a baseline of 10.2% to 9.4%, nearing the 2018 target of 9.2%. Reduction in this rate ensures that patients who undergo elective fusions are less likely to develop complications and experience failed fusions, avoiding extended length of stay and/or reoperation thereby avoiding unnecessary cost and CMS penalties.
- Making Care Affordable: Obtained $2.1M YTD supply chain contract savings at the end of March, on track to exceed the 2018 Executive Metric target of $5M across all Neuroscience contracts, including current spine RFE, shunts/EVD catheter, Osteobiologics, and spinal cord stimulator contracts. Anticipate additional savings from Cochlear Implant contracts (signed 4/1/18), and the upcoming thrombectomy RFP and new spine RFP (this fall).
Orthopedics & Sports Medicine
- Improve Quality: The O&SM Institute team has been convening a Readmission workgroup this year to focus in on the reduction of preventable readmissions. Initial results from January 2018 have been calculated, and 31/40 ministries are displaying a Readmission O/E below 1.0. This performance exceeds the threshold performance level of 75%.
- Improve Quality: Our clinicians and stakeholders are partnering with clinicians from OrthoCarolina, Stanford, and UT Health to research “Bundle Buster” patients. This study will hopefully allow the participating organizations to better identify those patients whose episodic spend under a bundled arrangement will be far above budgeted amounts. The results will be submitted as an abstract but will be used immediately to improve performance against the targets in alternative payment models.
- SJH Integration: Many SJH/Covenant clinicians and administrators took part in the selection of the new PSJH Large Joint Implant agreements on May 9. The O&SM Institute team, in partnership with REH, have worked with the local teams in these regions and at these ministries to be inclusive and transparent as PSJH works to reduce the cost of care through the first large-scale RFP impacting all 50 ministries within PSJH.
Perioperative
- Making Care Affordable: With the guidance of plastic and general surgeons, the Clinical Program Group completed the contract enhancement with LifeCell (Allergan) for biologic mesh (human and porcine acellular dermal matrix), resulting in a projected annual savings of almost $900k while maintaining current use volume.
- Improve Quality: Two hospitals (St. Joseph Orange and Everett) have joined the next cohort of the ASA’s Periop Surgical Home Learning Collaborative, a two-year commitment to develop local PSH programs aiming to improve post op outcomes and reduce costs by optimizing and coordinating a seamless evidence-based perioperative care pathway. Successes at other hospitals so far include reduced LOS, opiate use, mortality, and SSIs.
Throughput
- Growth & Quality: Providence St. Vincent Medical Center is currently expanding the Transfer Center to improve patient flow within the hospital, as well as management of external transfers from the region, particularly the Obstetric and Neonatal populations, to standardize workflows and streamline transfers through a centralized hub. Providence St. Vincent is also implementing a standard tool to support transfer center workflow and reports known as Central Logic, which is currently in place at Swedish Medical Center & Providence Sacred Heart Medical Center.
- Growth & Quality: Currently there are 31 Providence ministries live with MSHN EDQ ED dashboard with 90% utilization.
Women & Children’s
- Improve Quality: The Women’s Health Focus Group presented the Benign Hysterectomy Pathway to the Regional CMOs. This pathway uses an algorithm based on best practices to determine which surgical modality should be used; with the goal of completing the surgery using a minimally invasive approach when indicated, leading to better patient outcomes and shortened length of stay. The system target is to have an open rate of <15%. The rate is has dropped to 18% from a high of 25.1%.
- Making Care Affordable: Representatives from each region met in person to launch the Vaginal Delivery Value Improvement Project. This meeting featured best practice presentations; Reducing Time to Delivery in Labor and Delivery, Creating a Value Based Maternity Bundle, Induction of Labor, and The Midwife Model. Other work included an overview of the Value Oriented Architecture tool and finance. These representatives will work locally to implement key value changes and come together quarterly for sharing. This group has a savings target of $3.3M in 2018.
See past updates