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

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100

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Number of Inpatient Visits with Palliative Care Consultations

aveCRDMFDIHSWT

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Consultation Volume

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100

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200

Number of Inpatient Visits with Initial Palliative Care Consultations

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Consultation Volume

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Number of Inpatient Visits with Previous Palliative Care Consultations

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Consultation Rate

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Rate of Palliative Care Consultations per 100 Inpatient Admissions

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Length of Stay

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10

Preconsult ALOS for Visits with Consult

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Length of Stay

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Postconsult ALOS for Visits with Consult

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Length of Stay

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Total ALOS for Visits with Consult

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Length of Stay

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All Hospital ALOS

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Cost Savings on Impact Days

-$50,000$0

$50,000$100,000$150,000$200,000$250,000$300,000$350,000$400,000

Cost Savings on Impact Days for Visits with Consults

aveCRDMFDIHSWT

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Cost Savings on Impact Days

-$50,000$0

$50,000$100,000$150,000$200,000$250,000$300,000

Cost Savings on Impact Days for Visits with Initial Consults

aveCRDMFDIHSWT

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Cost Savings on Impact Days

-$25,000$0

$25,000$50,000$75,000

$100,000$125,000$150,000

Cost Savings on Impact Days for Visits with Previous Consults

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IHS

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Billable Revenue

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$10,000

$20,000

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Provider Charges Billed for Palliative Care Services

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Billable Revenue

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$5,000

$10,000

$15,000

$20,000

$25,000

Provider Charges Collected for Palliative Care Services

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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 DomainsOperational

• 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 scoresCustomer

• 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 Developmentconvert data and information into knowledge

• Translate ‘word’ definitions into technical specifications

• Visually present what is happening• Trust and be confident with the results

Report Developmentconvert data and information into knowledge

• Data characteristics must be understood – necessary to define exact specifications

• Data must be accurate• Data must be complete

Report Developmentconvert 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 Developmentconvert data and information into knowledge

Report Developmentconvert 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)