Harnessing the Power of DataVision Toolpacks Barbara Schork, DataVision Product Specialist and Brenda Pettyjohn, Solutions Advisor
A Story About Tools
DataVision Users Have Many Tools in Their Arsenal
Why Use DataVision Toolpacks? Offer both graphical and tabular displays of a wide variety of data. Enable you to review outcomes and events to improve processes and quality of care. Allow you to view both high level data and patient level detail Can be easily modified to focus on clinical subpopulations.
Where to Start Pneumonia is one of three key clinical topics tied to reimbursement (along with AMI & CHF). Pneumonia patients are especially prone to readmissions and comorbid conditions. We know this is a particularly problematic population at our hospital. What process changes might we make to improve outcomes and reduce readmissions?
Examining the Pneumonia Population High Volume
Very High LOS
High Mortality
Very High Readmission Rate
Many of the Readmissions Could Be Prevented
Average Costs for Pneumonia MS-DRGs 193, 194, 195 Above the Median
Let s Take a Deeper Dive into the Data
What Issues Do We Find?
Top Principal Diagnoses Is there an opportunity to improve clinical documentation?
Top Principal Procedures Two-thirds of procedures were either a Level 5 ED Visit or a Closed bronchial biopsy.
Admits by Day of Week Nearly 25% of patients are admitted on Saturday or Sunday, when access to physicians and other care providers may be limited.
Admits by Time of Day Nearly half of all Pneumonia admissions occur between 6 PM and 7 AM.
Discharge Status The vast majority of patients were discharged home.
Major Complications of Care 100 of 478 adult pneumonia patients had one or more NPOA diagnoses, with the most common being Acute Pulmonary Failure.
Drill-down to Major Complication Detail
Provider Utilization This analysis enables you to compare costs and charges among attending physicians
Provider APR-DRG LOS Use this report to examine Severity of Illness (SOI) and LOS O/E ratios by Discharge APR DRG for each provider, as well as average charges and costs.
APR DRG Severity by Attending Looking at the aggregate of all providers, 82% of patients had a severity level of 2 or 3, most of whom were in APR DRG 139 (Other pneumonia)
APR DRG Mortality by Attending Here again, we see the vast majority of encounters in APR DRG 139, with ROM levels clustering around 2 or 3.
LOS Outliers Patients with LOS >2 SD from your hospital s ALOS are most likely to have adverse events.
A Few Areas for Further Investigation Review clinical documentation practices to optimize specificity where possible. (451 of 478 patients had a diagnosis labeled as NOS.) Examine LOS outliers to determine if patients may have been kept too long or sent home too soon or perhaps not admitted at all. Expected LOS averaged 4.80 but observed LOS averaged 5.99. Drill down into mortalities to determine risk vs. outcomes. For example, one of our mortalities had a risk of 2, and two had an SOI of 2.
DataVision Risk Management Toolpack
Were Risk Events a Contributing Factor to Pneumonia Outcomes? Since we know that respiratory patients account for the most falls in our hospital, let s start there.
Focus in on Falls Among Respiratory Patients
One Unit Is Not Specific About Falls
Types of Falls
Falls by Location MDC 4
Falls by Time of Day
Falls by Day of Week
Falls by Principal Diagnosis
Falls by Outcomes
Days Between Admit and Event
Falls are Reported Promptly
High Readmissions
DataVision Readmission Toolpack
What does the DataVision Readmission Toolpack do? The Readmission Toolpack can be used to evaluate readmissions DataVision measures/clinical populations All inpatients/acute care inpatients Acute care excludes: - Rehabilitation, skilled nursing, behavioral health/psychiatric, and hospice - Inpatient delivery encounters with ICD-9 V codes V27.0 V27.9 - Inpatient newborn encounters with ICD-9 V codes V30.00 V39.01 Your encounter-based custom Midas+ Indicators
Things You Need to Know Midas+ reports readmissions in pairs. The pair consists of the initial (index, or #1) encounter and a readmission (#2) encounter. Events that might have precipitated the readmission encounter likely occurred in the index encounter. However, a causal relationship might not exist between events in the two encounters. The index encounter qualifies for an Indicator based on its discharge date.
Things You Need to Know (continued) The readmission encounter qualifies for an Indicator based on its admission date. The readmission encounter does not require a discharge date; an active (nondischarged) encounter qualifies as a readmission encounter. An index encounter can also be a readmission encounter if it has a qualifying admission. In some cases, a single encounter qualifies as an index encounter and a readmission
Choosing Parameters
What trends do we see?
Since most patients are discharged to home, do we need to evaluate discharge planning?
More reason to look at discharge planning
Continued example of non-specific diagnosis Most patients returning with pneumonia, but note other diagnoses that are likely related.
Continued indication that patients returning for reasons related care during initial encounter Was discharge planning adequate for support at home and understanding of ongoing treatment? Were some of the early returns because of a missed diagnosis during the first encounter?
Is there a trend amongst the attending physicians for this population?
Trends that could have financial impact?
What have we learned and what questions were raised that need further investigation? High percentage of returning population are elderly and were discharged to home There is continued evidence of a significant documentation improvement opportunity Attending physicians with the low admitting volume have high readmission rates Many or returning patients are in the self-pay or Medicare categories for payment How many of the readmissions were potentially preventable?
DataVision 3M PPR Toolpack
What does the 3M PPR Toolpack Do? The DataVision 3M PPR Toolpack can be used to evaluate potentially preventable readmissions (PPRs) at your facility. The report generates an Excel workbook with several worksheets that provide details about various aspects of the selected population. Because it includes only admissions that might be preventable, the 3M PPR methodology helps you identify case areas where clinical or care management processes might be less than optimal. To better understand the selected population, review APR DRG comparative data along with the PPR data.
Things You Need to Know PPR methodology links clinically related admissions within a selected readmission time interval (15 or 30 days). To be clinically related, the readmission must be reasonably linked to the care given during or immediately after a previous admission, and not due to unrelated events. Readmissions are reviewed in chains which contain an initial admission and all clinically related PPRs. Within a chain, the number of days between the discharge date of an earlier admission and the admit date of a subsequent admission determines the number of days between those contiguous admissions.
Things You Need to Know (continued) The chain is broken when a subsequent admission exceeds the selected readmission interval. The readmission interval applies to contiguous encounters within the chain, so the time span of the entire chain can exceed the readmission interval. In a corporate group, where multiple facilities share a single server, PPR data is based only on encounters that are readmitted to the same facility as the initial encounter. PPR calculations include behavioral health admissions. So if a patient is discharged from a medical service and then returns 3 days later for a behavioral health (BH) admission, the BH admission could be included in an All Inpatient PPR readmission chain.
Even More Things You Need to Know Some same-day transfers within a hospital are considered nonevents if the discharge disposition of the first encounter is mapped Discharge to Rehabilitation, Discharge to Skilled Nursing Facility, Psych, Discharge to Acute Care, or Hospice. The subsequent encounter is treated as a nonevent if its admission date is the same as the discharge date of the previous encounter. In this way, patients who are discharged from a medical unit and readmitted on the same day to a psychiatric unit (or vice versa) are excluded from the PPR calculation. Encounters are ignored if classified as a nonevent during the interval between an Initial Admission and a readmission.
Generating the Toolpack
Easy Access to Definitions
Focusing on Trends Previously Noted
High percentage returning with non-specific pneumonia diagnosis
Attending Physician Trends Validated
Further Analysis of Attending Physicians with Highest Volumes and/or Charges Filtered by chosen physician
Clinical Relationships
Evaluate Possible Losses for Potentially Preventable Readmits
Wrap Up By using DataVision Toolpacks we were able to confirm possible issues with the pneumonia population DataVision Toolpacks allow you to look at several levels of data going from a general overview of the population down to risk adjusted specificity The Toolpacks output provides you with multiple data points to bring to your peers for validation of issues and provide recommendations for improvement activities
And One More Thing. Don t forget to utilize the DataVision Comparative reports to support your Analysis
References Quick Start Guides are available from www.midasplus.com. After logging in, select User Documentation, select DataVision (or CPMS) from the Category list, click Search, and then double-click the Quick Start Guides entry in the table. Self-paced e-learning is available from www.midasplus.com After logging in, select Training, select DataVision/CPMS and choose from the list in the appropriate folder
Thanks for attending. Are there any questions? Barbara Schork, DataVision Product Specialist barbara.schork@xerox.com Brenda Pettyjohn, Solutions Advisor brenda.pettyjohn@xerox.com