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Moving Healthcare Outcomes Improvement Projects to the Finish Line

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There are many ways to approach outcomes improvement in healthcare. Health Catalyst advocates the three-systems methodology whose individual components remain firm: best practices, adoption, and analytics. There are also various ways to interpret the three systems and this article uncovers nuances in how they are defined. With this unique perspective, organizations may be better able to understand how to develop outcomes improvement projects that not only launch with enthusiasm, but sustain energy over the long-term. Furthermore, outcomes improvement done right is scalable so that small firms, those with fewer resources, can adapt the methodology to improve their performance.

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Moving Healthcare Outcomes Improvement Projects to the Finish Line

  1. 1. Moving Healthcare Outcomes Improvement Projects to the Finish Line ̶ Dr. Bill Knowles
  2. 2. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Simple Example of Best Practices In the late eighties I was involved with the Grant Fitness Center firefighter program in Columbus, Ohio, overseen by Grant Medical Center. We discovered long-term health risks for firefighters and the potential benefits of a multidisciplinary, team- based fitness program. Over a decade later a 2001 article in Occupational Medicine, cited “increasing attention over the last several years” to occupational health programs for firefighters.
  3. 3. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Simple Example of Best Practices A primary challenge of implementing the firefighter program was the accumulation of sufficient data that would appropriately address the healthcare risks. I developed software that could store and report on dozens of parameters in different areas ̶ clinical and lab values, and physical data, such as body fat measurements. The initial results generated much optimism among clinical staff and firefighters alike.
  4. 4. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Simple Example of Best Practices This experience provides a simple example of how to improve outcomes in patient care. The medical center identified a cohort (firefighters) with potential health risks and involved a small team of health- care professionals with subject matter expertise in different areas. The data system I developed could then be used for analysis by the team for advising them on improvements needed at both the individual patient and program levels.
  5. 5. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Methodology for Improving Patient Outcomes While the firefighter program is an over-simplification of the process, we can see three basic systems that can provide a systematic approach to improving patient outcomes: • Best practices • Adoption • Analytics This same pattern can be followed in any sized healthcare organization, simply adjusting to the needs and resources of the organization and its patients.
  6. 6. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Methodology for Improving Patient Outcomes Best practices is represented by the various professionals who leveraged their experience and knowledge, and standardize processes in the program. The adoption system is represented by the multidisciplinary team’s carrying out the program. The analytics system is represented by the software system that was developed to store, analyze, and report on the firefighters’ related healthcare data.
  7. 7. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement in Action at TCH Our Health Catalyst team partnered with Texas Children’s Hospital (TCH) in outcomes improvement endeavors using the methodology found in Part 2 of Dr. John Haughom’s book, Healthcare: A Better Way. TCH uses a series of care process teams (for different specialty areas) consisting of healthcare professionals who take ownership of quality, cost, and patient satisfaction measures associated with healthcare delivery.
  8. 8. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement in Action at TCH These care process teams design their own solutions to targeted improvement objectives, also called aim statements. These are permanent teams with integrated clinical and technical members, who also have the support of their respective leadership team and the executive team. An underlying principle for the teams is that of continuous improvement that ultimately benefits the patients and their families.
  9. 9. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement in Action at TCH As one aim is completed, they move on to the next targeted objective for outcomes improvement. This effort is guided by evidence- based medicine principles, leveraging both best practices and data analytics to determine and move forward on opportunities meeting the Triple Aim. Teams are guided by best practices and analytics (data dashboards) in the adoption of these projects/programs.
  10. 10. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement in Action at TCH This methodology has improved the lives of patients at TCH as the organization focused its improvement initiatives on care processes with high costs and variability. One of these target areas was the management of patients with diabetic ketoacidosis (DKA), which was noticed to have a measurable degree of variation, and thus some gaps in quality of care.
  11. 11. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement in Action at TCH With a care improvement team and measurable goals in place, supported by an enterprise data warehouse (EDW) and a pediatrics diabetes analytics application, TCH made significant strides in improving diabetes care, especially for DKA patients. RESULTS 81% of DKA patients assigned to a diabetic care unit and Core Diabetic Nurse 17% relative increase in DKA patients receiving evidence-based evaluation and order sets 19% relative increase in DKA patients receiving IV insulin within one hour of order 33% relative decrease in length-of-stay for DKA patients ROI approximately 33%
  12. 12. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Relentlessly Focus on Outcomes Improvement It has been rewarding for our Health Catalyst teams to partner with such exemplary healthcare organizations as Texas Children’s, and to do the work that we do. To see our efforts in outcomes improvement filter down to the patient level is especially gratifying. DAN LOWDER Health Catalyst Technical Director At Health Catalyst, I’m given a situation related to patient care or patient costs and asked to build a solution to measure outcomes. By a relentless focus on outcomes in everything we do, we are ensuring that the end result is ultimately saving the patient either time or money, or improving his/her health. In most cases, this focus results in improvements in all three of these areas.”
  13. 13. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement Is Scalable The key to continuous quality improvement is to follow a systematic approach. While it is easy to see how an organization the size of TCH could harness the resources and staff to do so, you may not easily see how a small organization could implement such a system. As the firefighter example proved, it is possible to adapt this method- ology to any size organization.
  14. 14. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement Is Scalable Today there are numerous sources to inform an organization on best practices and standardization guidelines, including a discretionary search of the Internet. Numerous data software systems are available with their respective tools for analysis and reporting.
  15. 15. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcomes Improvement Is Scalable Then one or more permanent clinical teams can be formed with the existing staff to carry out the outcomes improvement program. Time constraints sometimes are given as a challenge to forming these permanent teams, however, experience shows that the time savings from reducing redundancies and eliminating other types of waste, more than compensates for the time invested.
  16. 16. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. An Effort that Reaps Exponential Rewards It is very rewarding to be involved with people and organizations that know how to do the right thing for the patient the first time, and every time, using best practices to inform patient care. As one progresses with these outcomes improvement efforts, the rewards become more and more obvious.
  17. 17. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. An Effort that Reaps Exponential Rewards A primary motivator for me to become a physician was to positively impact the lives of patients and their families. I originally had thought that my contributions could help improve the lives of thousands of people over my lifetime. Now I wake up each day excited about the prospect that what I am doing along with others potentially will benefit not thousands, but millions of people!
  18. 18. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
  19. 19. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Link to original article for a more in-depth discussion. Moving Healthcare Outcomes Improvement Projects to the Finish Line 7 Features of Highly Effective Outcomes Improvement Projects Brant Avondet, VP of Client Operations Successfully Rolling Out Healthcare Improvement Initiatives with Key Influencers Tom Burton, Co-founder and Executive VP The 4 Clinical Teams Needed to Drive Sustainable Improvement Susan Easton, Engagement Executive, VP; Kathleen Merkley, Clinical Improvement – VP Tracy Vayo, VP of Knowledge Services; Kirstin Scott, Senior Medical Writer Keys to a Successful Health Catalyst Data Warehouse Platform and Analytics Implementation Jared Crapo, Sales, VP; Eric Just Eric Just, Technology, VP; Dan Lidgard 6 Steps for Implementing Successful Performance Improvement Initiatives in Healthcare Bobbi Brown, VP of Financial Engagement; Leslie Hough Falk, Customer Engagement, VP
  20. 20. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Dr. Bill Knowles has a unique background to support the vision to transform healthcare through the application of relevant experience, processes, and technology. His certifications as a physician, certified Oracle developer, and project management professional (PMP), combined with the years of experience he has working in these areas, have formed a strong foundation for achieving success in Life Science programs and projects. Bill has established and been the director of several project management offices, in addition to being a project management team lead and senior technical consultant. He has travelled to domestic and international client sites to lead software implementations, and has years of experience providing program and project management, as well as technical and clinical registry guidance, mentoring, and training to healthcare professionals and support staff. Bill has been a senior director of client engagement at Health Catalyst since 2014, and he is fully bilingual in English and Spanish. He also is a graduate of the accredited Health Catalyst University Accelerated Practices Program, which trains professionals in the acceleration of outcomes improvement. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com

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