Clinical Programs Purpose and Structure October 7, 2014
Our Vision
Crossing the Quality Chasm
What are Intermountain Clinical Programs? The major vehicle to address the delivery and support of high quality, cost effec<ve health care Organiza<on based on integra<on of medical providers and opera<onal leadership
Clinical Management Infrastructure Regional and system wide physician, and clinical administra/ve opera/ons leaders needed to implement best pracdce CLINICAL PROGRAM INFRASTRUCTURE InformaDon Management Infrastructure Measurement System ImplementaDon Support Staff support personnel and systems necessary to measure clinical, financial and sa/sfac/on outcomes for key clinical processes Staff and systems necessary to develop, disseminate, support and maintain the clinical knowledge base necessary to implement best pracdce INFORMATION TECHNOLOGY
Clinical Programs and Services Working Together Nursing Imaging Respiratory Pharmacy Rehab NutriDon Behavioral Health Oncology Primary Care Musculoskeletal Cardiovascular Women & Newborns Surgical Services Intensive Medicine Pediatrics Neurosciences
How Intermountain Clinical Programs Work Define best prac<ce based on literature and expert consensus Objec<ves and specific goals established Provide resources to achieve goals Compara<ve repor<ng, system- wide Develop local infrastructure to implement clinical programs approach
Why Do We Need Clinical Programs?
The PracDce of Medicine One physician, one pa<ent expert model o o Care craged by individual physician Uses knowledge from training & experience Changing professional model o o o Shared baselines Prospec<ve design of care delivery Judgment at individual physician level
PracDce of Medicine (ConDnued) So much informa<on! o US Na<onal Library of Medicine Added ~ 10,000 ar<cles/ week to on- line archives, (40% of total) o 2005 > 14,000 RCT (1 st in 1952) Personal experience can be misleading Memory limited to 7 + 2
PracDce of Medicine (ConDnued) THE RESULT IS WIDE VARIATION IN HOW WE PRACTICE AND THE OUTCOMES WE ACHIEVE
Reducing process varia<on improves processes, and thus improves outcomes Categorically
Old and Acute New Paradigms Myocardial Infarction OLD PARADIGM Care is given in compartmentalized sezngs. Outcomes are measured in a segmented fashion. The focus is on treatment of complicadons and disease. Quality is defined in the provider context. Care is experience based. NEW PARADIGM Care is organized along the condnuum. Outcomes are measured beyond care compartment boundaries. The focus will shi` to prevendon and management. Quality is defined in the padent context. Care is evidence- based old ways constantly quesdoned.
Intermountain Clinical Programs OrganizaDon Grouping of related clinical services Key concept administra<ve/clinical partnerships Goal: Improved clinical processes and outcome consistency Central leadership support, unique in its scope
Clinical Program Structure System- wide Guidance Council Medical Director Operations Director Data Management Finance IS SelectHealth Education Regional Management Team Regional Management Team Regional Management Team Operations Officer Medical Director Nursing Admin. Operations Officer Medical Director Nursing Admin. Operations Officer Medical Director Nursing Admin. Development Team Development Team Development Team
System- wide Guidance Council Roles Set goals Track implementa<on progress and goal achievement Func<on as system resource for peer review, pa<ent safety, compliance, charging, etc., in area of clinical exper<se
Clinical Program Structure System- wide Development Team Physician Lead CP Operations Director Support Staff Hospital A Physician Lead Hospital B Physician Lead Hospital C Physician Lead Hospital D Physician Lead Hospital E Physician Lead Nursing Lead Nursing Lead Nursing Lead Nursing Lead Nursing Lead Operations Officer Operations Officer Operations Officer Operations Officer Operations Officer
System- wide Development Team Roles Set goals specific to the development team Track implementadon progress and goal achievement Develop and Maintain Clinical Content o o o Care Process Model content Workspace content Report content Review and approve clinical operadons standards (e.g., CPGs) and other protocols Conduct case reviews (QA/QI and risk management)
SeZng and ImplemenDng Clinical Program Goals Determine a poten<al goal with clinical leadership Assess gaps between current and new workflows Determine metrics that will demonstrate progress on goal Measure baseline performance Submit recommended goal for Board approval Select implementa<on date and educate staff Con<nuously measure progress using agreed upon metrics and share with leadership
Care Process Models In simplest form may be standing orders o Heparin, DKA, AMI and thromboly<cs, etc. Or as complex as vent management Varia<on reduc<on o o o Provide benefit of best prac<ce from literature and expert opinion Improve care delivery by repe<<on More readily expose errors
Care Process Models (ConDnued) Improve pa<ent outcomes o o Increase pa<ent focus as opposed to what do I do now orienta<on Facilitate professional judgment Overall, clinicians life is easier
Examples of Results
Severe Sepsis/Septic Shock (ER/OR to ICU) Sepsis Bundle Compliance and Inpatient Mortality Bundle Compliance Rate 90% 80% 70% 60% 50% 40% 30% Baseline Tracking Period Board Goal Period 30% 25% 20% 15% 10% Mortality Rate 20% 10% 5% 0% 0% Average Compliance LCL UCL Mortality
Severe Sepsis/Septic Shock (ER/OR to ICU) Sepsis Bundle Compliance and Inpatient Mortality 0.30 0.80 0.25 0.70 0.60 Mortality Rate 0.20 0.15 0.10 0.50 0.40 0.30 Compliance Rate 0.20 0.05 0.10 0.00 2004(n=325) 2005(n=394) 2006(n=331) 2007(n=623) 2008(n=757) 2009(n=934) 2010(n=965) Mortality rate 95%LCL 95%UCL Total bundle rate 0.00
Asthma Admissions: 6 months Prior vs. 6 months post e-at use 35% 32.1% 30% 26.7% 25% 20% 15% 14.3% 18.1% 17.3% 17.7% 19.8% 10% 5% 5.1% 0% Users* NonUsers (Control) FrequentUsers* InfrequentUsers* Prior Post Significant change (*) Frequent users: used the tool >= 60% of time Infrequent users: used the tool < 60% of time
Asthma Admissions: Medicaid Patients 35% 33.3% 30% 25% 28.4% 26.7% 29.3% 25.9% 22.2% 20% 15% 16.0% 10% 5% 0% 3.7% Users NonUsers (Control) FrequentUsers* InfrequentUsers Prior Post
Asthma Admissions: Hispanic Patients 50% 45.5% 45% 40% 38.6% 35% 33.3% 30% 25.9% 25% 20% 20.0% 15% 10% 8.3% 3.7% 5% 0% 0.0% Users* NonUsers (Control) FrequentUsers* InfrequentUsers* Prior Post
QUESTIONS?