A percutaneous coronary intervention (PCI) is a non-surgical procedure that uses a catheter to place a small tube, called a stent, in the heart to open blood vessels narrowed by plaque buildup. During these procedures, blood thinners can be used to avoid blood clots. Two kinds of blood thinners, or anticoagulants, are heparin and bivalirudin.
Recognizing that bivalirudin costs about 310 times as much as heparin for each administration, the University of North Carolina (UNC) Health Care System’s interventional cardiologists piloted first using heparin, rather than bivalirudin, for patients undergoing a PCI.
Following the pilot’s completion, UNC determined that heparin is safe in most cases and that bivalirudin can be reserved for patients with the greatest bleeding risk. UNC then launched a cost-cutting initiative to reduce the amount of bivalirudin used. UNC Medical Center in Chapel Hill shared these findings with UNC REX Hospital in Raleigh, which followed suit in efforts to reduce costs associated with the use of bivalirudin. However, there was no formalized mechanism for monitoring the progress and tracking results. This lack of monitoring spurred the creation of an initiative to centralize PCI reporting.
Centralizing PCI Reporting: The Process
During implementation, data from multiple sources was integrated into a dashboard, including external data from the National Cardiovascular Data Registry Cath-PCI registry for quality measures and outcome benchmarking, clinical data (including equipment usage, timestamps, vitals, medications and hemodynamics) from disparate systems, and cost data for supplies and medications from purchasing and inventory management systems.
On a macro level, the data showed an overall reduction of 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 UNC REX providers had not changed their practice of using bivalirudin. Affecting these remaining physicians’ behaviors required additional data. Given that varying patient populations and patient complexities are common reasons cited for the lack of a uniform standard of care, statistical clustering was used to break cases into high complexity versus low complexity. This allowed providers to be easily benchmarked against each other based on common criteria – confirming outliers weren’t justified due to differences in case types and patient populations.
With data in hand, physician champions and cath lab leadership took the dashboard to the cardiologists to review findings and discuss opportunities. The latest data showed that bivalirudin usage dropped significantly for all of the outlier providers. After empowering these physicians with additional information, bivalirudin use has dropped further and both groups have maintained consistently low levels since the program launched in 2015. The bivalirudin reduction initiative resulted in a savings of more than $400,000 in 2017.
“The cardiologists received the information in an extremely positive fashion. After training, most doctors and us interventional cardiologists work independently during cases and patient care with limited exposure to our partners,” said Joel Schneider, MD, FACC, a UNC REX interventional cardiologist. “Being able to share practice patterns and understand cost/quality among peers resulted in positive change in behavior.”
HIMSS Davies Award of Excellence
The HIMSS Davies Award of Excellence recognizes outstanding achievement of organizations that have utilized health information technology to substantially improve patient outcomes and value. As the pinnacle of the HIMSS Value Recognition Program, this award highlights organizations promoting health information and technology-enabled improvements in patient and business outcomes through sharing evidence-driven best practices on implementation strategies, workflow design, change management and patient engagement.
“It is an honor to again be recognized as national leaders in health IT,” said Tracy Parham, RN, UNC Health Care’s Chief Information Officer. “I’m incredibly proud of our team and their work that the Davies award symbolizes. This award also recognizes the operational and clinical partners we work with across UNC Health Care to ensure our IT efforts allow our clinicians to provide the best, safest care for our patients across North Carolina.”
“UNC Health Care leverages information and technology to take an iterative approach to change care delivery focused on easing the documentation burden on providers while improving quality,” said Jonathan French, senior director of Quality and Patient Safety Initiatives at HIMSS. “For UNC Health Care’s use of data and analytics to find innovative ways to improve care delivery in settings as diverse as academic medical centers to community hospitals, HIMSS is proud to recognize UNC Health Care as a 2018 Davies Enterprise Health Award winner.”
UNC Health Care will be recognized during the 2019 HIMSS Global Conference & Exhibition, taking place Feb. 11-15 in Orlando, Florida.
Learn more about how the University of North Carolina Health Care System has embraced the value of health information and technology: explore three award-winning use cases.