Rhodes Moxley, MPA - National Director, Clinical Improvemen PowerPoint Presentation, PPT - DocSlides

Rhodes Moxley, MPA - National Director, Clinical Improvemen PowerPoint Presentation, PPT - DocSlides

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13 August 2015. Improving Outcomes through Clinical Benchmarking. Truven Health Analytics. Clinical Performance Improvement Solutions. Patient Centric. . Provider Driven. Outcomes & Process of Patient Care. ID: 548850

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Rhodes Moxley, MPA - National Director, Clinical Improvement 13 August 2015

Improving Outcomes through Clinical Benchmarking

Slide2

Truven Health AnalyticsClinical Performance Improvement Solutions

Patient Centric

Provider Driven

Outcomes & Process of Patient Care

*

Slide3

For participants to understand: The characteristics of the database that support the development of clinical adjustment methods and benchmarks;The need to incorporate severity and risk adjustment methods in quality improvement programs;Benchmarking considerations and the identification of opportunities;How evidence based medicine can be deployed to identify gaps in the process of patient care;

Improving Outcomes through Clinical Benchmarking

Objectives

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Performance Improvement

So, I am called eccentric for saying in public that hospitals, if they wish to be sure of improvement:They must find out what their results are Must analyze their results, to find their strong and weak pointsMust compare their results with those ofother hospitalsMust welcome publicity not only for their successes, but for their errorsSuch opinions will not be eccentric a few years from hence.

Source: Codman 1917

Ernest A. Codman, MD, FACS (1869-1940)

Known more than anything else for his advocacy of the “End Result Idea.” The “Idea” was simply the premise that hospital staffs would follow every patient they treat long enough to determine whether or not the treatment was successful, then learn from any failures, and how to avoid those situations in the future

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Performance Improvement

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Performance Improvement

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Mortality Percent in The PrincipalHospital of England—1861

Number of Special Inmates of The 4/8/61

Average Number of Inmates in Each Hospital

Number of Deaths Registered in 1861

Mortality Percent on Inmates

In 106 Principal Hospital of England

12,709

120

7,227

56.87

24 London Hospitals

4,214

176

3,828

90.84

12 Hospitals in Large Towns

1,870

156

1,555

83.16

25 County And Important Provincial

Hospitals

2,248

90

886

39.41

30 Other Hospitals

1,136

38

457

40.23

13 Naval And Military Hospitals

3,000

231

470

15.67

1 Royal Sea Bathing Infirmary (Margate)

133

133

17

12.78

1 Dane Hill Metropolitan Infirmary (Margate)

108

108

14

12.96

Source: Nightingale, 1863

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Hospitals cannot legitimately compare

LOS

,

Mortality and Quality Outcomes without clinically adjusting for severity/risk at the patient level.

Performance Improvement

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Start with YOUR needs:

Is severity and risk adjusted data important to your physicians and quality improvement program? Is benchmarking your performance an important feature to support your clinical quality improvement operations?Do you have the ability to identify the best opportunities to improve complications, mortality, readmissions and LOS outcomes?

Characteristics of a clinical benchmarking solution

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Accurate Evaluation of Clinical Performance is Dependant on the Data Sources Driving the Methods & Benchmarking

Risk-adjusted Outcomes of Patient Care & Benchmarks

Over 70% of US discharges

3,700 hospitals23M all-payer discharges

Projected Inpatient Database

Methods Engine

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Truven Health Analytics Projected Inpatient Data Base (PIDB)

Combines data from both public and proprietary state data as well as individual and group hospital contractsThe construction of the PIDB involves the application of sophisticated data screens to ensure qualityContains more than 23 million all-payer discharges throughout the U.S. from over 3,700 acute care hospitalsThe PIDB has been used for many peer-reviewed publicationsModel Specifications, Exclusions and Performance Fully Documented

Methods & Benchmarking Data Source

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Severity & Risk Adjusted Outcomes of Care: Length of Stay Charges/Costs & Departments Complications: 46 Complication Categories Mortality Risk Adjusted Expected Readmissions (RAER: Replicates CMS)

Access to Industry Leading Risk & Severity Adjustment Methodologies*

* Source: Projected Inpatient Data Base

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13

Risk Adjusted Mortality IndexExample

Predictive Accuracy

&

Precision of Performance

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Top 10% & 25% Peer Groups, 100 Top and US Average performance benchmarks :1. All Hospitals2. Major Teaching Hospitals3. Teaching Hospitals4. Large Community Hospitals 250 or more acute-care beds in service 5. Medium Community Hospitals100-249 acute-care beds in service 6. Small Community Hospitals25-99 acute-care beds in serviceU.S. National Average (Mean)100 Top (average)

Best Practice & Norm Comparative Benchmarks*

* Source: Projected Inpatient Data Base

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Ease of Interpretation & Identification of Opportunities

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Higher predictive accuracyMore information is used for prediction, such as admission source and typeHospital characteristic adjustments are applied: facility type, bed size category, teaching status, and urban/rural community settingDesigned to be independent of DRG or other groupers, thereby avoiding DRG-caused trend breaks due to version changesMore accurate than grouper methods for severity adjustment

Truven Health uses its proprietary Model-based Resource Demand Score for LOS.

These are state of the art methods for measuring

and adjusting for severity

Advantages include:

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Severity-Adjusted Length of Stay Assignment

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Start with YOUR needs:

What clinical populations are you particularly focused on this year?What do you consider to be your most challenging clinical quality issue are you facing today? Specifically, what patient care outcomes are you most worried about?What metrics do you require to support the application (ALOS, Mortality, PSI’s, Core Measures)?

Well Defined Applications Determines the Measures, Analytics & Data Sources

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Target ANY Patient Population

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TARGET ANY PATIENT POPULATION

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Access to Industry Leading Methodologies, Benchmarks & Measures/Indicators

Severity Adjusted: Length of Stay Charges/CostsRisk Adjusted: Mortality ---- (RAMI) - Risk Adjusted Mortality Index Complications --- (ECRI) Expected Complication Rate IndexRisk-Adjusted Expected Readmissons (RAER: replicates CMS method)Agency for Healthcare Research and Quality: (PSI) Patient Safety Indicators (IQI) Inpatient Quality Indicators(PDI) Pediatric Quality IndicatorsHospital Acquired Conditions (HAC): Core Measures

21

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How aligned are your physicians with your quality goals?

 How are you addressing the higher utilization that are associated with practice pattern variation? How do you determine who to partner with or the “high value” physicians to support your initiatives? Are you having any issues responding to physician reporting requirements (The Joint Commission)?

Performance Improvement & Physician Quality Reporting

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Supports Provider Profiling Initiatives

Step-by-step

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Use thresholds to set case volume minimums View top performers by setting thresholds for specific metricsUse thresholds to set thresholds/triggers for further review

Thresholds Identifies Physicians of Interest

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25

Dedicated Module To Support Provider Profiling Initiatives

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Ability to customize

outcome metrics and method of deployment

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Do you have the ability to identify the gaps in patient care centered on evidence based medicine (EBM)?Do you have the ability to identify the processes of care driving the undesirable outcomes?

Evaluate the process of care to identify gaps that drive outcome opportunities

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Enabling Process of Care Comparisons

Access Line Item Detail Standard Transaction Codes (STCs)

28

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29

CONDITION INSIGHTS

Guidance Based on the Highest Quality Referential Content

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X

Using Data to Identify Process of Care Gaps

12 Clinical Population Monitoring Groups with

process measures aligned with Micromedex

Clinical Checklist

ACE Inhibitors/ ARBs

Beta blockerNSAIDs excluding Cox-2 InhAspirinCOX-2 inhibitorEKGNitroglycerinStatinTroponin

AMI Process Measure Name

“Clinical checklist” of

evidence-based guidelines applied with adherence results (met/not met) assigned at the patient level

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AMI Process Measure Performance Summary

Analytics to Identify Gaps in Patient Care

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Identify the Gaps in the Care Process & the impact on Outcomes

“Checklist” results are aggregated across the clinical population to identify process failures and impact on risk adjusted outcomes

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Clinical Performance Benchmarking Delivery Options

Custom Analytic OptionDesigned to meet unique reporting needs of the system

CareDiscovery® OptionWeb-based solution designed for standard and ad hoc reporting needs

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Improving Outcomes through Clinical Benchmarking Today’s Take Away Points

A critical characteristic of a database that supports the development of clinical methodologies and benchmarks is....

.the size matters!

When evaluating severity & r

isk

adjustment methods:

performance of a model

vs

grouper approach

clinically based and

imperically

driven

fully documented (not a black box)

a proven track record (case studies)

Compare performance

against

clinically valid benchmarks:

ability to compare performance to similar hospitals,

facilitates multiple benchmarks (10%, 25% Mean),

supports establishing outcome goals that are objective and quantifiable

supports the identification of opportunities

Have a strategy :

determine p

atient

populations,

meaningful

measures, top down

analytics system/hospital wide, physician to patient level

evaluate the process of patient care driving the variations in patient care

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35

Take Action!!

Truven’s

Clinical Performance Improvement Solutions & Services

Taking Action on Identified Opportunities

Readmissions

1-30 days

Complications/HACs/Pt Safety:

incidence of DVT/PE & Sepsis

LOS

Top 10% : 4 days US Norm: 5.8 days

Process of care Gaps

Statin

: AMI

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Truven’s

Clinical Solutions Supports the Performance Improvement Process

DEFINE

& MEASURE

ANALYZE

& ACTION

IMPROVE

CONTROL

CareDiscovery

CareDiscovery

CareDiscovery

360 Care Insights

36

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Thank you.


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