accelerating & scaling learning healthcare: hca and ......2008 2010 2012 2014 2016 2018 2020...

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1 | Clinical Services GroupCONFIDENTIAL – Contains proprietary information.

Not intended for external distribution.

Accelerating & Scaling Learning Healthcare:HCA and Harvard Pilgrim PartnershipJonathan B. Perlin, MD, PhD, MSHA, MACP, FACMIPresident, Clinical Services Group and Chief Medical Officer HCA / Hospital Corporation of America

Clinical Professor of Medicine & Biomedical Informatics, Vanderbilt UniversityAdjunct Professor of Health Administration, Virginia Commonwealth University

Contact: [email protected]



Thank You & Congratulations!A Remarkable Team of Collaborators

• Richard Platt, Professor and Chair of the Department of Population Medicine

• Sheila Fireman, Director of Institute Administration

• Dennis Ross-Degnan, Associate Professor and Director of Research

• Susan Huang, Professor, Infectious Disease, University of California, Irvine School of Medicine Medical Director, Epidemiology and Infection Prevention

• Grace Lee, Clinical Instructor, Pediatrics; Associate Chief Medical Office for Practice Innovation; Stanford University

• Clayton Huntley, Antibacterial Resistance Program Officer, Division of Microbiology and Infectious Diseases, NIAID/NIH/DHHS

• John Jernigan, Director of the Office of HAI Prevention Research and Evaluation, Division of Healthcare Quality Promotion (DHQP), CDC

• Taliser R. Avery, Ken Kleinman, Mary K. Hayden . . . and numerous other faculty and staff at HPHCI, and collaborators at CDC, AHRQ, NIH, UCI, Rush, Stanford and beyond . . .

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HCA & Harvard Pilgrim Partnership Pragmatic TrialsAccelerating Learning Healthcare, at-Speed and at-Scale

20

40

60

80

100

120

140

REDUCE MRSAREDUCE MRSA

HC

A H

osp

itals

2008 2010 2012 2014 2016 2018 2020Study Timeline

74,256 339,904

44%

28%

Cum

ulative Patients (x B

aseline)1M

2M

165,000

3,210,500

266,0003M

4M



• Size: 33,000 Patients (vs. 75,000)

• Efficiency: ALLHAT $80M (vs. $3M, including supplies)

• Length of Study: 10 years (vs. 1½ years)

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HCA & Harvard Pilgrim PartnershipOther Collaborations

2008 2010 2012 2014 2016 2018 2020Years

SentinelMini Sentinel

Universal Decolonizationon Clusters of HAIs

Clusters MediatedBy Universal Decolonization

PAICAP

Multicenter Evaluation& Comparison of SepsisDefinitions

Impact of Vent SedationRegimens on Outcomes

Sepsis K08 Career Development Award

Evaluating Hospital VariationIn Sepsis Coding Using Objective Clinical Data

CMS Case MixAdjustment for Colorectal Surgeries

Studies in total represent more than >23,000,000 patient encounters

HCA: A Platform for Learning Healthcare

InternationalAnchorage

NW GA

NortheastC

Terre Haute

Idaho Falls

ColumbusAtlanta

Panhandle**

Orleans

Idaho Falls

Tallahassee

WW

W

Las VegasWW

W

San JoseW

WesternIdaho

Utah

SouthernCalifornia

Utah

W

Denver

W

WSan Antonio

Austin

Dallas/FW

Houston

Kansas City

Oklahoma City

W

W

Corpus Christi

Brownsville

W

Wichita

W

W

San Antonio

Austin

Dallas/FtW

Wichita

El Paso

New

CentralLouisiana

Lafayette

CNo. VA

C

RichmondCSW VAC

FrankfortC

SW VAFrankfortFrankfort

Tampa

North Central Florida

Treasure Coast

E

E

Palm Beach

Dade

Broward

Jacksonville

Columbus

Panhandle

TerreHaute

Middle GATrident/Charleston

Grand StrandAugustaChattanooga

SW VA

American Group

National Group

Central London

WesternIdaho

San Jose

Houston

Kansas City

NW GAAtlanta

Oklahoma City

Nashville

28 million patient episodes annually

Approximately 5% of major hospital services in U.S.:

• Admissions > 1.65 million• Patient Days > 7.6 million

• Deliveries > 0.25 million• Total Surgeries > 1.3 million• ED Visits > 8.5 million

176 Hospitals, 120 Freestanding Surgery Centers, > 850 Physician Practices, >200 Urgent Care Centers in 23 states and London

Hospitals range from complex tertiary referral and academic medical centers to urban and suburban community medical centers

~ 233,000 employees, including ~ 80,000 nurses and 30,000 allied health professionals

> 40,000 affiliated physicians, including > 4,500 employed physicians and practitioners

More than 43,000 licensed beds

• Largest provider of uncompensated care, Medicaid services to a population more diverse than U.S. pop.

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Number of Units 1-2

3-4

5-6

7-8

>8

Arm 1 Routine CareArm 2 Decolonization

Trial Sites



26 Hospitals (90 units)

N = 156,887

Intervention: 339,904 patients (+ ~327,000 baseline)

1,294,153 attributable patient days (intervention)

Routine Care Decolonization

27 Hospitals (104 units)

N = 183,017

24 Hospitals(88 units)

N = 152,596

24 Hospitals(98 units)

N = 177,076

3 Hospitals (6 units) withdraw

As Randomized

As Treated

2 Hospitals (2 units) withdraw

HCA: Scaling Learning, by Cluster Randomization

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Care Informs Care: A Learning Healthcare System

SystemImprovement

Care Data

Afferent

Efferent

KnowledgeWisdom

Care Changes Care: An Improving Healthcare System



CARE

Enterprise Data Services

Enterprise Application Services(Ecosystem for Innovation)

WISDOM

DATA

KNOWLEDGE

INFORMATION

Care Systems:

EBCD

Transaction Systems:Growth Efficiency Patient

ExperienceQuality Provider

Engagement

LEARNING

Big Data

CE

CDW(Teradata)

Analytics/Data Science

HCA Clinical Informatics FrameworkThe Clinical Informatics (CI) framework supports the collection and analysis of data; leading to improved understanding of our patients’ conditions and to timely and precise interventions and treatments.

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Partnership Expansion Areas

BehavioralHealth

Women’s & Children’s

Patient Experience

PredictiveModeling

Endocrinology



First Principles, Lasting Wisdom . . .

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SystemImprovement

Care Data

Afferent

Efferent

KnowledgeWisdom



Accelerating & Scaling Learning Healthcare:HCA and Harvard Pilgrim PartnershipJonathan B. Perlin, MD, PhD, MSHA, MACP, FACMIPresident, Clinical Services Group and Chief Medical Officer HCA / Hospital Corporation of America

Clinical Professor of Medicine & Biomedical Informatics, Vanderbilt UniversityAdjunct Professor of Health Administration, Virginia Commonwealth University

Contact: [email protected]

. . . Thank you!. . . Thank you!

Above all else, we share commitment to the

care and improvementof human life

accelerating & scaling learning healthcare: hca and ......2008 2010 2012 2014 2016 2018 2020...

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