September All Hands Meeting - Dimensional Insight€¦ · Medication Reconciliation project is...

©2017 Dimensional Insight, Inc.

Merry BassiBusiness Intelligence Architect

UnityPoint Health - Methodist Peoria

(Insert Organization Logo)


Introduction

Background– Started as a Clinical Chemist in the Lab

• Taught Clinical Chemistry • Participated in lab Research &

Development• Moved into Quality Improvement

– This led to the need for data….. – Access, Excel, SQL lists – back to Access &

Excel and then we discovered Diver

I love clinical data!


Quality Metrics – Converting 6.4 to 7.0 SpectrecBase, cPlan, Divefiles

History

AGENDA

Pharmacy Medication- Medication Reconciliation Project

Readmission Rate – Converting to 6.4 Model to 7.0 Spectre cBase



Peoria Region

Employed Physicians: 194 Volunteers: 686 Employees: 4,418 Licensed Beds: 654 Births: 2,264 Admissions: 23,148 Surgeries: 18,764 Emergency Visits: 96,358 Hospital Outpatient Visits: 366,616 Clinic Visits: 534,444


Our history with Diver

2008– How do we integrate data from multiple McKesson

medical record systems to improve reporting & analytics?

Started out slow – hourly census and built from there– One person - 10% of time to 100% of time – once we

discovered clinical data– Two dedicate FTEs


New Pilot Project: Medication Reconciliation by Pharmacist Prior to Discharge

Medication Reconciliation Prior to Discharge– Attending provider must review all medications and clarify

medications to add, modified, or discontinued prior to the patient discharge

– What makes it hard• Medications added for acute reasons only…. need to be discontinued

before discharge• Medication names similarities• Duplicate medication – but totally different names• Documentation system • Multiple providers: attending, current PCP, surgeon, consultants



How the problem was presenting– Literature suggests a 50% defect rate– Medication errors and patient complaints regarding medication

issues were trending upwards– Admission medication reconciliation repeatedly surfaced medication

reconciliation problems– Zone pharmacist were identifying problems– Acute Care Medical Director & Hospitalists were requesting further

pharmacist coverage & assistance– JCAHO & National Patient Safety Goals– Mini pharmacy pilot: – Pharmacist reviewed 200 patients’ discharge medication

• Results: 46% error rate



Requested resources for medication reconciliation:– 6 pharmacy techs for admission med rec Approved: 4– 2 pharmacists for discharge med rec Approved: 1

March 2017 – focused pilot– Pilot Group:

• Next Generation ACO & Bundle DRGs (COPD, Heart Failure, Pneumonia) patient

• Pharmacist to review all discharge medication prior to patient discharge• Monday-Friday 7am-4pm

– Daily patient lists to pharmacists with admitted Next Gen ACO patients and possible bundle DRGs (based on admitting diagnosis)



Process Measures– % of discharges with medication reviewed by pharmacist prior

to discharge– % of medication reviews with interventions– Interventions per provider

Outcome Measures– 7 day & 30 day return to ED– 7 day & 30 day readmission rate– Med Rec Events – staff reported


Process Measures

Process Measures were built with an– Integrator script to Cbase using

• Epic Hospitalized Encounters• IP Flowsheet Measures – Pharmacist Med Rec & Interventions• Patient FYI Flags (Next Gen Patients)


Initial Result: Pilot Population% Patients with Med Rec by Pharmacist Prior to Discharge

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Initial Results: Pilot Population% Patients with Med Rec by Pharmacist Prior to Discharge and With Recommended Changes

13


Review by Discharge Day of Week – April 2017


Review by Discharge Day of Week – May 2017


But Then…….

Outcome Measures– 7 Day & 30 Day Readmission Rate

• Already had 32 dimensions & 4 different versions of the model

Converted 6.4 Readmission model to 7.0 Spectre cBase– Set up Aliases – data files from other projects– Re-established all input file paths to Spectre project data or

aliases– Convert model to cBase– Convert markers & diveplans from models to cBase – using

text editor


Easy to convert to 7.0 Spectre…. But does take time


Readmissions had many integrator scripts & input files


Most common problem


Current 30 Day Readmission Diveport with Quickviews


30 Day Readmission RateMedicare Traditional Age 65yrs Plus

Care Navigator Pilot Starts

Pre Care Navigator Readmission Rate: 13.9 Care Navigator Pilot Readmission Rate: 12.0


30 Day Readmission Rate – Med Rec Pilot PopulationConverted to cBase – Added Dimensions

Care Navigator Pilot Med Rec Pilot Start

Pre Care Navigator Readmission Rate: 13.9 Care Navigator Pilot Readmission Rate: 12.4


30 Day Readmission Rate – Pre Med Rec - Pilot PopulationPatient Age Range: 80-94 yrs


Next Steps

Add in additional dimensions – further stratification– Discharging provider– Zip code– Abnormal vital signs– High risk med flag


Model to cBase Conversion

Advantage of cBase– Faster (17 seconds to 11 seconds)– Smaller (23,148 Kb to 4,165 Kb)– Unlimited dimensions (32 plus 2 info fields to 39 dimensions)– Define column data types

Diveplans, Marker & Diveport conversion from model to cBase worked well

Medication Reconciliation project is ready for further modification


Quality Metrics: Results of converting 6.4 models to 7.0 Spectre cBase

6.4 Quality Metric Models

File size: 9 GB, 57 metrics

Models: Split into 5 models to run all the metrics

Model Build Time: 4-6 hours each

Model Sizes: 80-100 GB each

Multi-tab marker: 2 minutes

7.0 Spectre cBase

File size: 9 GB, 57 metrics

cBase: One – for all metrics

cBase build elapse time: 0:15:01

cBase size: <1 GB

Multi-tab marker: 3 seconds. Once opened, is instantaneous.

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Quality Metrics – Family & Internal Medicine


Quality Metrics – Family & Internal Medicine - Medicare


Quality Measures – Converted to Measures PortletsUsing cPlans, dive files & qvsets Measure timeseries.cplan

– Multilevel cBase inputs: quality measure cBase & target cBase– Timeseries: rolling current month & rolling 24 months

Dive files– Dive file for each measure

• Using measures_timeseries.cplan• With calcs to address

– Measure “good” direction, – Measure colors (green, yellowish, red)– Measure # formatting


Measures_timeseries.cplan


Example Dive file


Quality Metrics Core Set - Filtered to Methodist Clinics- Medicare


Quality Metrics – Core Set - Filtered to Methodist Clinics-Next Gen ACO


Quality Metrics Core Set – Filtered to Methodist-Family Medicine – Next Gen ACO


Quality Metrics Core Set – Filtered to Methodist-Internal Medicine – Next Gen ACO


Benefit of cPlan, Divefiles

Easy to build out cplan-divefiles for each additional metrics (copy, paste, change measure name)

Fast and can set production script to build memory cache

Quick for end user to view report for each provider along with trending history


Next Steps – Quality Metrics

Adding Patient volume – Is the gap 5 patients of 500 patients?

Info pop ups? Build out remaining quality metrics into “snapshot

views” Create “gap” reports

– Easy views of which clinics/providers have the biggest gaps. Gain better understanding of cplans & divefiles Can we change the timeframe?


Summary

Models to cBase– Timesaver

• Unlimited dimensions• Projects with multiple models now go to 1 cBase• cBases run much faster• Improves our ability to generate actionable level information quickly

– Uses less disk space Struggled with

– Learning curve– Time to make the conversion

Consulting time – did help us move forward at a much faster clip

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September All Hands Meeting - Dimensional Insight€¦ · Medication Reconciliation project is...

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