HBI Awards 2018: Value-driven outcomes tool that increases quality and cuts cost

Academic health sciences system comprised of hospitals and clinics with an annual budget of $3.3billion and 744 inpatient beds.

In 2012, Utah introduced its Value Driven Outcomes (VDO) tool in both inpatient and ambulatory care, which has resulted in increased quality outcomes and more than $2.5m in cost savings. Providers can engage with the VDO tool to compare themselves to their peers and to identify standard care pathways and supplies that lower the cost of care while providing the best possible outcomes.

Full application

1. Briefly describe the organisation giving number of facilities, staff, revenue numbers.

With an annual budget of $3.3 billion, University of Utah Health is an academic health sciences system comprised of hospitals and clinics; University of Utah Medical Group; Huntsman Cancer Institute; the Schools of Medicine and Dentistry; Colleges of Health, Nursing, and Pharmacy; Eccles Health Sciences Library; the Cardiovascular Research and Training Institute; and Associated Regional and University Pathologists (ARUP). Excellence in patient care, education, and research is vital to the overall mission of the organization.

Staffed by more than 18,000 employees, University of Utah Health has evolved to be recognized nationally as a highly innovative and transformative health care system. University of Utah Health serves as a training ground for most of Utah’s health care providers and professionals. It is the Mountain West’s only academic health care system, providing leading-edge and compassionate medicine for the people of Utah and a referral area encompassing five states and more than 10 percent of the continental United States.

The system includes 12 community clinic locations and four hospitals – University of Utah Hospital; the University of Utah Orthopaedic Center; University Neuropsychiatric Institute; and Huntsman Cancer Hospital. More than 1,300 physicians practice more than 150 medical specialties, and University of Utah Health employs an additional 8,100 staff. In fiscal year 2016, University of Utah Health had 744 inpatient beds and 1.7 million total patient visits. In 2016, University of Utah Health was named No. 1 in the nation for quality among university hospitals by the Vizient, Inc. Quality and Accountability study, and has ranked in the top 10 university hospitals for eight years running.

2. Please briefly describe the medical service, which the organisation is delivering in which it has deployed the best quality data model

University of Utah Health deployed its quality data model – known as the Value Driven Outcomes (VDO) tool – in both inpatient and ambulatory care with pilot programs that began in 2012 and has numerous projects that have demonstrated significant savings and quality improvement, the most impactful showing more than $2.5 million in cost savings while increasing quality outcomes.

VDO is rolling out to individual providers and targeting the top common medical conditions with a focus on improving outcomes. To date, there are more than 400 people in the organization who have access to and training for VDO.

3. Please describe the way the organisation has deployed and used the best quality data model

How has it changed the way it collects and manages data?

VDO is a transformative data modeling tool created in 2012 to lower costs while optimizing health outcomes. It integrates cost of care, quality, and outcomes data to individual patient encounters.

VDO collects information from:

• University of Utah Health’s enterprise data warehouse, which includes data on patient encounters from our EMR
• National quality metrics
• Clinician-defined metrics
• Supply, pharmacy, imaging, and laboratory utilization
• Human resource utilization
• University of Utah Health’s general ledger

Anyone in University of Utah Health who has completed training can view this data by department, physician, diagnosis, and procedure. VDO is being used to identify case types that have the highest cost variants across providers, provide customized data dashboards, and implement scorecards for the most common medical conditions. Providers can engage with the VDO tool to compare themselves to their peers and to identify standard care pathways and supplies that lower the cost of care while providing the best possible outcomes.

VDO is not punitive, but empowers providers to drive individual, department-level, and system-level improvement in quality and cost simultaneously.

4. What new quality data has the organisation created?

VDO has facilitated the creation of University of Utah Health’s “Perfect Care Index” for projects using the tool. This index is a single binary measure reported as the percentage of perfect care for encounters per period of measurement.

Data included in the Perfect Care Index are defined by physicians, nurses, administrators, and quality improvement staff. This includes:

• Risk-adjusted mortality
• Patient safety measures
• Clinical process measure
• Unplanned hospital readmissions or emergency
• Patient satisfaction data
• Patient-reported outcomes

VDO has also allowed the creation of scorecards that track cost and outcomes for the most common medical conditions. These scorecards are being continually refined as the health system continues to organize itself around value.

VDO infrastructure is expanding with efforts to serve central services such as the Operating Room Cost Accountability (ORCA) dashboard. Launched in the spring of 2016 and driven by physician leaders inspired to find cost savings and quality improvements, ORCA is allowing providers to examine and compare the costs of procedures. Central service dashboards are also being developed for pharmacy, lab, and imaging. While VDO data is available on a monthly basis, University of Utah Health is exploring ways to integrate it into the electronic medical record for real-time data.

5. How has that new quality data been used to change the way that health care services are delivered?

VDO has created a comprehensive quality and utilization data source that allows for full transparency to users, giving the University of Utah Health to power identify areas for improvement by showing the highest variability in cost and quality. Three areas identified for initial improvement work were sepsis, total joint replacement, and reducing unnecessary lab costs. This work took place in the form of pilot programs conducted between 2012 and 2016.

• Sepsis: A multifaceted educational campaign targeting improved recognition and treatment of sepsis was developed and implemented for all clinical staff. A Modified Early Warning System trigger was embedded into the electronic health record, along with corresponding sepsis order sets and real-time Modified Early Warning System scores on patient lists. After four months of implementation on the acute internal medicine service, the time from meeting SIRS criteria to administration of antiinfective agents for 76 patients was reduced to a median time of 2.2 hours and a mean time of 3.6 hours.

• Total Joint Replacement: A multidisciplinary team defined a Perfect Care Index for joint replacement comprising six nationally and locally defined quality indicators, including a new care practice of early mobility (out of bed on day of surgery). Compared with the baseline year, mean direct costs were 7% lower in the implementation year and 11% lower in the post implementation year. After modifying the schedules of in-house physical therapists to ensure same-day mobility, the mean length of stay declined from 3.50 days during the baseline year to 3.17 days during the first evaluation year. This decrease in facility utilization and length of stay accounted for 34% of the cost reduction between the baseline year and the post implementation year (second evaluation year).

• Hospitalist Lab Usage: In February 2013, hospitalists launched a quality improvement project to reduce unnecessary inpatient laboratory testing. The project included:

(1) clinician education

(2) a rounding checklist including discussion of all laboratory testing plans

(3) monthly value-driven outcomes feedback via in-person group review of current and year-to-date comparative individual and peer laboratory utilization data

(4) a financial incentive program that shared 50% of hospital cost savings with the department to support future quality improvement projects.

The result: a reduction in mean cost per day from $138 to $123 during the intervention period, and the risk of 30-day readmission was reduced from 14 percent to 11 percent. Annual cost savings associated with this project were greater than $250,000 per year. Additionally, VDO has contributed to the development of new care pathways for the top 50 most common medical conditions. For example, a care pathway for pneumonia was implemented in 2017.

Since the success of these pilots, VDO has spread throughout the institution as we have worked to grant transparency around quality and the utilization of hospital resources. For example, in the Department of Surgery, surgeons receive regular reports with their quality measures compared to peers, the supply cost for each case compared to their historical supply cost for similar cases, along with their peer comparison for supply and lab utilization.

6. When did the quality data model start affecting service delivery?
Month : April
Year : 2012

7. What are the main key performance indicators? How does the organisation measure the success of the project?

Performance indicators for improvement work utilizing VDO include cost savings and improved patient outcomes and quality of care. All University of Utah Health value improvement work is described, tracked, and available to anyone in the organization through a Value Summaries internal database.

We measure the success of this project by verified improvements in quality, as well as cost savings through redesign of care or improvements in utilization of resources. Only with exceptional data quality and governance for the access of data can improvements in care be systematically driven forward.

8. Additional Information
Case study 1
Case study 2

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