Transcript IHS Palliative Care Project

IHS Palliative Care Project
A collaboration to develop palliative
care metrics across the care
continuum
Objectives
• Describe the PC Metric Report
• Discuss the value of metrics
• Identify the outcome measurement system
developed by the Iowa Health System PC
Affinity Group
• Identify next steps for PC Metrics expansion
Inpatient Palliative Care Metrics
•
•
•
•
•
•
Consultation Volume
Palliative Care Consultation Rate
Length of Stay
Length of Stay Outliers
Cost Savings on Impact Days
Billable Revenue
Consultation Volume
Number of Inpatient Visits with Palliative Care
Consultations
250
200
150
Lo...
av e
CR
DM
100
FD
50
IHS
0
WT
Consultation Volume
Number of Inpatient Visits with Initial Palliative
Care Consultations
200
150
L...
av e
CR
100
DM
FD
50
IHS
WT
0
Consultation Volume
100
80
60
40
20
0
Number of Inpatient Visits with Previous
Palliative Care Consultations
L...
av e
CR
DM
FD
IHS
WT
Consultation Rate
Rate of Palliative Care Consultations
per 100 Inpatient Admissions
15
Lo...
10
5
0
av e
CR
DM
FD
IHS
WT
Length of Stay
Preconsult ALOS for Visits with Consult
10
8
L...
av e
CR
6
DM
4
FD
2
0
IHS
WT
Length of Stay
Postconsult ALOS for Visits with Consult
10
8
6
4
2
0
L...
av e
CR
DM
FD
IHS
WT
Length of Stay
Total ALOS for Visits with Consult
20
15
L...
ave
CR
10
5
0
DM
FD
IHS
WT
Length of Stay
All Hospital ALOS
10
8
6
4
2
0
L...
av e
CR
DM
FD
IHS
WT
Cost Savings on Impact Days
Cost Savings on Impact Days for Visits with
Consults
$400,000
$350,000
$300,000
$250,000
$200,000
$150,000
$100,000
$50,000
$0
-$50,000
L...
ave
CR
DM
FD
IHS
WT
Cost Savings on Impact Days
Cost Savings on Impact Days for Visits with
Initial Consults
$300,000
$250,000
$200,000
$150,000
$100,000
$50,000
$0
-$50,000
L...
ave
CR
DM
FD
IHS
WT
Cost Savings on Impact Days
Cost Savings on Impact Days for Visits with
Previous Consults
$150,000
$125,000
Lo...
$100,000
ave
$75,000
CR
$50,000
DM
$25,000
FD
$0
-$25,000
IHS
WT
Billable Revenue
Provider Charges Billed for Palliative Care
Services
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
$0
L...
ave
CR
DM
IHS
Billable Revenue
Provider Charges Collected for Palliative Care Services
$25,000
$20,000
L...
ave
$15,000
CR
$10,000
DM
IHS
$5,000
$0
Outpatient Palliative Care Metrics
• Consultation Volume
• Discharge Distribution/DC Reason
• Readmission to Acute Inpatient Care
– Referred from IPPC
• Readmission to Acute Inpatient Care
– Without IPPC
Getting started
• Created the Palliative Care Affinity Group
which includes inpatient and outpatient
providers.
• Identified basic standards for PC programs
– Definition
– Interdisciplinary Team
– Policies (based on National Consensus Project:
Clinical Practice Guidelines)
PC Metrics – Why?
• Internal quality assessment
• External quality assessment (TJC
Accreditation, public reporting, value based
contracting)
• Research/Exploratory Quality Improvement
Initiatives
Determining Metrics
• Identified PC metrics based on national
standards
– series of articles in Journal of Palliative Medicine
by Dr. David Weissman and Dr. Diane Meier from
Center to Advance Palliative Care)
• www.capc.org
Metric Domains
Operational
• Does my program have the features required to provide high
quality palliative care?
• What metrics do I need to measure in order to demonstrate my
program has these cores features?
Clinical
• Am I improving the clinical care of patients?
Symptom assessment scores, psychosocial assessment scores
Customer
• Am I meeting the needs of patients and families?
Satisfaction survey data: patient, family, referring clinician
Financial
• Is my program fiscally responsible?
Project Manager
• Committee Team
• Formal Metric Documents (K. Routson)
• Data Development
• Finalized Data Elements
• Identifying IT Resources
• DB Development
• Analytics and Reporting
• Finalized
• Audit Process
• Physicians Group (K. Routson)
Project Manager
Live Demonstration
http://cpi.ihs.org/valuebasedcontracting/Hospice_PalliativeCare
Project Technology
• Two established programs at Cedar Rapids and
Des Moines
• Two Microsoft Access Databases
– One backed by Microsoft Access
– One backed by SQL Server
• Need for one Statewide Database across the
Continuum of Care
Project Technology
• Involvement in Metric Development
• Consolidation of Databases
– Entry screens of one
– Overall structure (SQL Server) of the other
• Security Issues with Statewide Database
Project Technology
• Involvement in Metric Development
– Ensure database and entry screens are configured
properly
– Work through what data needs pulled from other
sources versus entered manually
Project Technology
• Consolidation of Databases
– Entry screens of one and structure of the other
– TSI/EPSi Data
• Hospitalizations and Costs
• Monthly Feed until all EPSi and Epic conversion is complete
– Horizons
• Outpatient Metrics
• Nightly feed
• Medical Record Numbers are entered into Horizons for
linking
Project Technology
• Security Issues
– Multiple Affiliates in one database
– Both Inpatient and Outpatient in one database
– Not an ACE (Affiliated Covered Entity)
– Affiliate Personnel was developing and
maintaining the database
– Need to be able to handle
• Addition of affiliates - Peoria Methodist
• Partners external to HIS - Hospice of Siouxland
Project Technology
• First Iteration
– SQL Server data stored on the IHDM SQL Server
– Access database in Network folder
• Issues
– Data stored at one affiliate for multiple affiliates
– Additional lock down of Access database wanted
Project Technology
• Second Iteration
– SQL Server database that is maintained by IT
– Access database accessed via Citrix
– Utilized Access Runtime via Citrix to limit ability to
access design functions
• Issues
– Support model being worked through as IHS IT to
support Database
– Need for Reporting Support
Project Technology
• Final
– SQL Server database that is maintained by IT
– Access database accessed via Citrix
– Utilized Access Runtime via Citrix to limit ability to
access design functions
– Patients can be viewed across the continuum
– New Analytics Department in IT to support
Database
– Center for Clinical Transformations (CCT) to
support reporting
Report Development
convert data and information into knowledge
• Translate ‘word’ definitions into technical
specifications
• Visually present what is happening
• Trust and be confident with the results
Report Development
convert data and information into knowledge
• Data characteristics must be understood –
necessary to define exact specifications
• Data must be accurate
• Data must be complete
Report Development
convert data and information into knowledge
• Data are linked across tables or files by
common fields.
• If data are wrong or missing, knowledge is
lost.
Report Development
convert data and information into knowledge
Report Development
convert data and information into knowledge
• Provide reports that users can easily run to
detect missing or inaccurate data
• Report staff run reports or conduct
reasonableness check on data
• Design review/audit steps earlier, rather than
later, in overall process
• Automate as much as possible – moving data
introduces opportunity for error
Future Plans
• Automate metric report so it can be created
internal to the system or via the new EDW and BI
tools being developed.
• Look at alternatives to Access for entry (i.e. IQ4)
• Add tabs in PC Report for PC Clinic, PC LTC, and
Hospice
• Add clinical metrics in 2012 (pain, dyspnea,
advanced care planning)
• Add customer satisfaction metric (patient/family,
referring provider)