Value-Based Care and the Art of Improving Outcomes

The transition to value-based care is redefining not only how quality care is delivered, but the patient experience as a whole. Moving away from a fee-for-service world, providers are expected to deliver care more proactively rather than reactively and place more focus on prevention of chronic disease. By increasing provider accountability, patients are more empowered to take a more active role in their health and wellness.

Here are three success stories from organizations that have earned the HIMSS seal of approval in improving outcomes that contribute to an overall improvement in care delivery: the HIMSS Davies Award of Excellence and HIMSS Analytics Stage 7 Electronic Medical Record Validation.

Duke Health: Reducing Surgical Readmissions

Duke Health of North Carolina recognized a pattern of higher than desired readmission rates and post-surgical urinary tract infections (UTIs) among their patients that had colectomies—removal of part of the large intestine.

The health system also recognized that decreasing readmissions meant standardizing care processes that emphasized patient safety and quality of care: key tenants of value-based care.

A colorectal surgeon and her team set out to tackle the readmissions challenges through the development and implementation of Enhanced Recovery After Surgery (ERAS) protocol. The ERAS protocol improved how patients were physically managed before, during and after surgery in regards to nutrition, activity and pain control.

“While the surgeon would initially identify the patient [for ERAS protocol], there wasn’t a discreet data point in the EHR,” said Genie McPeak Hinz, MD, chief medical information officer at Duke Health. So the team added a data point in the EHR to note the patient was a candidate for ERAS protocol, and this information could travel in real time. “That discreet data point was subsequently made visible in the pre-anesthesia testing area, so that the anesthesiology group that was doing the evaluation for the patient could recognize that the surgeon had identified this patient for enhanced recovery.”

STEPS to Value Podcast | Lessons Learned from a Davies Award Winner: How Smart Use of Data Improves Patient Care and Outcomes

Tune in to this STEPS to Value episode to learn more about how Davies Award winner Duke Health used technology to improve care and outcomes, including a 50% reduction in readmission rates for colorectal patients. | Listen now 

Getting surgery can be stressful, and protocol like ERAS helps keep patients in the know, Dr. McPeak Hinz explained. “We gave patients education on their [smartphones] so they could have a better understanding as well. It’s really important that you give it to them in a format that they can go back to over and over again. When you are having surgery, the first time you hear about these things, it’s sometimes hard to take in. So you need to give it to patients in a format that makes sense.”

In addition to cutting readmissions in half for colectomy patients, these standardized changes resulted in reduced length of stay (LOS) and decreased secondary complications of UTIs, greatly improving patient experience as a whole.

St. Stephen’s Hospital: Improving Efficiencies in Care Through Integration

Enhancements in the EMR can be a critical step in delivering value-based care effectively and improving the patient experience. That’s why St. Stephen’s Hospital of Hervey Bay, Australia strategized to design a newly integrated environment where medical devices and other technologies could work in sync while moving to paperless workflows. The hospital also set goals to improve access to data and images in near real time and improve the efficiencies of image documentation for the management of pressure injuries.

After implementing their EMR, St. Stephen’s created a scalable platform that enabled device connectivity available in workflows and at the point of care. The platform helped decrease infection rates, which have remained consistent over the last four years. Additionally, biomedical device integration helped nurses spend more time at the bedside to improve care efficiency over 58%. Hospital-acquired injuries have also reduced.

St. Stephen’s is the first Stage 7 validated hospital in Australia, and like the HIMSS Davies Award, HIMSS Analytics Stage 7 validation focuses on many key areas in value-based care models and demonstrates an organization’s dedication to improving outcomes through the best use of information and technology.

“Everyone involved with St. Stephen’s is both pleased and proud to accept the HIMSS Davies Award of Excellence,” said Madonna Bowers, acting general manager and director of clinical services at St. Stephen’s Hospital. “As the first fully integrated digital hospital in Australia, health information and technology has been a cornerstone to our success in providing excellent and safe care to our patients and the community.

TriHealth: Collaborating for Success in Advanced Quality Outcome Initiative

With consistent focus on improving the patient experience, population health and reducing costs, TriHealth of Ohio prioritizes collaboration inside and outside their own walls to accomplish organizational goals with their Advanced Quality Outcome Initiative. This collaboration is integral in ensuring a seamless transition to value-based care. Improving patient experience, population health and reducing costs are also fundamental in achieving the Triple Aim—a framework developed by the Institute for Healthcare Improvement.

TriHealth wrestled with the time-consuming challenge of capturing skilled nursing facility (SNF) performance data. Selection of an SNF at discharge was based on perceived quality versus actual quality metrics, adding to the challenge at hand.

 

In this HIMSS TV interview, watch Lori Baker, director, ambulatory care management and post-acute care at TriHealth, and Donna Peters, director, applications center, information systems at TriHealth, share stories about the health system’s move to accountable care and how they advanced quality care for SNFs.

 

To address this, TriHealth worked to find an automated methodology to report quality performance of SNFs to develop a preferred provider network. Reporting quality metrics with automation and consistency required a standard and scalable documentation solution by the SNFs. The health system worked to implement new processes and solutions that would:

  • Create a preferred provider SNF network
  • Increase communication with SNF partners
  • Decrease readmissions from SNFs
  • Improve utilization of their preferred providers, demonstrating better quality outcomes and increasing shared savings

As a result, Trihealth was able to reduce LOS and readmissions in key service lines for patients going to a preferred SNF provider. For instance, in orthopedic providers, LOS averaged nearly two days less following implementation. In addition, wound care providers observed an approximate 19% decrease in readmission rates. The health system recognized a reduction of over $2 million in SNF expenditures, nearly $500,000 in cost avoidance (due to reduced cost per case) and an overall $2,578,123 return on investment. Additionally, the organization was also able to redeploy full-time equivalent resources from manual data collection, entry and reporting to the education of their SNFs and TriHealth team members, improving overall team member satisfaction.

Though there’s no one-size-fits-all solution when it comes to providing quality care, these success stories show that the thoughtful application of health information and technology holds immense power to transform health outcomes and adapt to workforce changes while keeping patients at the center.

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