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Advanced Analytics in Clinical Operations: Framework and ROI

Srinivasan Suresh MD, MBAVice-President, CIO & CMIO

UPMC Children’s Hospital of PittsburghSession # 224, February 14, 2019

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Srinivasan Suresh MD, MBA

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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• Background/Care setting

• Explanation of Problem: Variation in Clinical Care

• Outline of solution: Standardized Clinical Pathways

– Step 1: Clinical Effectiveness Guideline (Intranet)

– Step 2: Hardwiring into the EHR

– Step 3: Measure usage & compliance; Share outcomes

• High Value Care: Desired Outcomes

• Challenges- How did we address those?

• A data-driven culture to sustain excellence

• Next Steps

• Q & A

Agenda

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1. Describe the emphasis placed on standardization of care, and

on elimination of avoidable variances

2. Illustrate the critical nature of delivering actionable data in a

timely, accurate and user-friendly manner

3. Explain the focus on data-driven observations to change

physician behavior

4. Demonstrate how to implement technology to enhance

processes and how to improve the availability of information to

guide operational decision-making

5. Recognize the importance of transparency of financial and

quality metrics in a care improvement project

Learning Objectives

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Background- Children’s Hospital of Pittsburgh

Annual Stats

Outpatient visits

1,000,000+

Admissions

22,000

Emergency visits

80,000

Surgeries

25,000+

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Evolution of Analytics

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• Clinical Effectiveness Guideline

• Evidence-Based

• Typically associated with Limited

Education

• Variable interdisciplinary

collaboration

• Aimed at Focused settings of Care

Guidelines vs Pathways• Clinical Pathway

• Evidence and consensus-based

• Formal education and rollout

• Inter- and Multi-disciplinary collaboration

• Across the Continuum - prehospital, ambulatory and inpatient

• Component of Real-time measurement & feedback loop

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Impact of Clinical PathwaysHigh-Value Care Desired Outcomes

Evidence-based and technology-enabled Clinical Pathways

Pre, during, and post-admission

High-cost and high-volume pediatric conditions

• Reduce

– Unnecessary variation in care

– Unplanned Readmissions

– Length of stay

• Improve

– Outcomes (Quality, Safety & Financial metrics)

– Continuity of care (pre and post admission)

– Patient, Family & Provider Satisfaction

• Eliminate

– Non-value added testing

– Waste

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• Most common abdominal surgical emergency in children

• #1 cause of surgical site infections

• Relatively high treatment-associated resource utilization due to case volume and morbidity of perforated disease*

• Evidence-base remains poor and variation in care extreme*

• Tremendous opportunity for collaborative QI*

• Clinical Effectiveness Guide available on intranet

• Lack of access to real-time data

Why Appendicitis?

(* American College of Surgeons – National Surgical

Quality Improvement Program, Pediatric)

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Throughput Metric – Length of Stay

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Process Measures in Appendicitis Care

QUALITY FINANCE

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Appendicitis - Outcome Measures

MetricPre-

Pathway

Post-

Pathway

Mean Length of stay (Uncomplicated) 36 hours 31 hours

Mean Length of stay (Complicated) 155 hours 110 hours

Controllable per-case cost (Uncomplicated) $5,779 $5,495

Controllable per-case cost (Complicated) $15,262 $13,935

Realized Cost Savings of $157,576 in 6 months

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Appendicitis - Outcome Measures

Metric CY 17 CY 18

LOS – Complicated Appendicitis 94 hours 84 hours

LOS – Uncomplicated Appendicitis 27 hours 26 hours

Controllable cost/patient – Complicated Appendicitis $10,015 $9,538

Controllable cost/patient – Uncomplicated Appendicitis $3,438 $3,461

30-day Readmission Rate – Complicated Appendicitis 11% 8%

30-day Readmission Rate – Uncomplicated Appendicitis 1.8% 0.6%

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Impact of Clinical Pathways

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Impact of Clinical Pathways• Appendicitis

• Introduction of regular diet and ambulation in the early post-operative phase

• Eliminated ‘repeat labs’

• Promoted judicious antibiotic use

• Reduced IV opiate use

• Hyperbilirubinemia (Newborn Jaundice)

• Reduced unnecessary IV fluid use

• Cellulitis/Abscess

• Eliminates unnecessary blood cultures

• Eliminates non-standard tests (ESR, CRP)

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Impact of Clinical Pathways

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Value Equation in Healthcare

Making the case to improve quality and

reduce costs in pediatric health care

Sachdeva & Jain.

Pediatric Clinics of North America

Aug 2009

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Health Informatics – Technical Assets

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1. Collection, analysis and timely dissemination of accurate clinical and throughput data changes physician behavior, and improves care outcomes.

2. Our ‘living, breathing template’ to transform appendicitis care (reduce costs per capita, apply existing and new technology to guide operational decision making) can be expanded to various disease management states, not only across children's hospitals, but across other academic medical centers as well.

3. Creating and implementing care pathways is primarily a clinical project, with the physician and nursing champions as the leaders, and information technology (IT) experts as the enablers, and not the other way around.

Lessons Learned & Takeaways

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1. Gabriella Butler (Director, Healthcare Analytics & Strategy)

2. Ariane Alcorn (Senior Financial Analyst)

3. Christopher Myers (Systems Analyst)

4. Dr. Andrew Buchert (Clinical Resource Management)

5. Cecilia Verner (Clinical Pathways Coordinator)

6. CHP Data Warehouse Team

7. CHP Executive Team

Acknowledgements

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Thank You Q & A

suresh@chp.edu

@SureshKidsDoc