Rapid Cycle Quality Improvement in Healthcare: Davies Award Success Stories

Providers looking at patient data

Jonathan French, CPHIMS, SHIMSS

Entering its 25th year, the HIMSS Davies Award recognizes healthcare organizations that demonstrate sustainable improvements in patient quality outcomes, while sharing replicable model practices that other health systems can learn from and leverage.

Davies Award recipients have included hospitals, academic medical centers, community health organizations, behavioral health facilities, pediatric hospitals, primary care residency programs and even a state prison health system.

Many organizations are in the early stages of using clinical quality data as a tool to change standard practice and workflow. Rapid cycle quality improvement in healthcare makes them uncomfortable. Organizations that successfully leverage quality measurement data to identify gaps in care, review workflows and interventions, and can be nimble to make the changes that the data suggests, position themselves to significantly improve care and lower costs.

Two 2018 Davies recipients have fascinating stories about make significant changes in how they practices in order to enhance care outcomes and become more cost efficient. Sparrow Health System in Michigan and University of North Carolina Health embraced the benefits of leveraging data to drive rapid cycle quality improvement in healthcare and resilient workflow and information technology redesign to improve patient quality.

“Failing” Fast and Changing Course to Battle CAUTI

2018 HIMSS Davies Award recipient Sparrow Health System had no formal program in place to address catheter associated urinary tract infections (CAUTIs) within the organization when they implemented their enterprise-wide EHR. Sparrow looked to the Davies Award program for guidance on designing an IT-enabled CAUTI reduction program with clinical decision support to standardize processes and documentation paired with analytics to monitor performance. Sparrow modeled their program after 2013 HIMSS Davies Award recipient Texas Health Resources CAUTI program.

Unfortunately, CAUTI rates didn’t improve. Sparrow worked with a resilient clinical team using a Comprehensive Unit-Based Safety Program model approach to reevaluate the process, people and technology needed to revamp this clinical program for success.

The team identified that their clinical decision support for documentation and tasks related to CAUTI was facing Sparrow’s physicians (like the Texas Health Resources model), while most of the tasks related to CAUTI prevention were conducted by Sparrow’s nurses. Particularly, catheter management and timely removal were high nursing priorities. The clinical team worked with IT to redesign the CAUTI best practice alerts to face the nurses, and then added a mandatory nursing action to the Foley catheter order set. Model practices were established in policies, reinforced with professional reviews driven by the processes and outcomes focused quality measures, and Sparrow made it easier for the nurses to deliver the right care with alerts and standard orders.

As a result, Sparrow cut the number of CAUTIs from 52 in 2014 (the last year before the nurse-facing BPA was created) to three consecutive years of 20 or fewer CAUTIs since 2015 and cost avoidance of over $1 million.

RELATED: Congratulations to the 2018 HIMSS Davies Award Winners

Analytics Instead of Clinical Decision Support to Change Prescribing Behavior

A critical component to driving value-based care is changing prescribing behavior, particularly when a less expensive and equally clinically effective medication option exists. Physicians will often prescribe out of habit, even if the medication isn’t more effective and is more costly. Most organizations combat this issue through developing clinical decision support with lower cost medications featured first in structured data fields for the formulary. UNC Health System decided to use analytics to change practice rather than utilize disruptive clinical decision support.

Two kinds of blood thinners used to treat patients receiving a percutaneous coronary intervention (PCI) are heparin and bivalirudin. Bivalirudin costs about 310 times as much as heparin for each administration. UNC Health wanted to determine if heparin was a more cost effective treatment option.

The UNC Health interventional cardiologists piloted first using heparin, rather than bivalirudin, for patients undergoing a PCI to identify if there was a way of reducing costs without impacting care quality. Despite the pilot demonstrating that heparin is safe in most cases (with bivalirudin reserved for patients with the greatest bleeding risk) UNC health launched a cost-cutting initiative to reduce bivalirudin usage. However, adoption was slow, primarily because UNC did not incorporate any kind of data visualization to share with providers and promote accountability.

In response, UNC Health created a centralized PCI reporting dashboard. The dashboard, includes quality measures and outcome benchmarking, clinical data from disparate systems, and cost data for supplies and medications from purchasing and inventory management systems.

This initial rollout of the dashboard technology created shared accountability for providers across the enterprise and bivalirudin usage during PCI over time due to the initial cost-reduction efforts. However, when drilling down to individual physician data, it was clear that some providers at UNC Health’s Rex Hospital in Raleigh had not changed their practice of using bivalirudin. UNC Health’s physician champions and cath lab leadership presented their findings to the non-compliant physicians and demonstrated that heparin was clinically appropriate for the vast majority of the patients which had continued to be prescribed bivalirudin.

By leveraging the data to demonstrate that heparin usage was a model practice for PCI patients, UNC Health reinforced their analytics dashboard as a reliable source of truth. Bilvalirudin usage, especially amongst the initial group of resistant physicians, dropped significantly and resulted in a cost savings of more than $400,000 in 2017 for UNC Health. By leveraging data and making changes through education, UNC Health added significant value for their patients.

HIMSS Davies Awards: Learn from Award-Winning Health Systems

Davies Award recipients will be presenting their use cases in a series of education sessions on model practices for using health information and technology to improve care on Friday, Feb. 15 during the 2019 HIMSS Global Conference & Exhibition. HIMSS19 attendees are encouraged to attend these educational sessions to learn more and ask questions about optimizing clinical outcomes using health information and technology. The awards recipients will highlight their achievements in these sessions, while showing the barriers and breakthroughs experienced in their journey to improve care.

Learn more about the Davies Awards program and how to apply.
View the full schedule and attend awardee educational sessions at HIMSS19.
Read about 2018 Davies Award recipients on HIMSS Value Suite News.

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