Solutions for South Floridas Healthcare System Trends in Healthcare: Looking Ahead

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Solutions for South Floridas Healthcare
SystemTrends in Healthcare Looking Ahead

• South Florida Hospital and Healthcare Association
• Ft. Lauderdale, Florida
• Paul H. Keckley, Ph.D.
• Vanderbilt Medical Center
• May 12, 2006

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ADMINISTRATORS/WATCHDOGS
Regulators
Media
Professional Societies/ Special Interests
BIOTECH
INNOVATORS
Insurers
Academic Medicine
Pharma
BioTech
Accrediting Agencies
Employers
HCIT
SERVICE PROVIDERS
Device
Hospitals
Outpatient Facilities
Long Term Care
Allied Health Professionals
Disease Management
CAM
Physicians
CONSUMERS
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6320 per person in the U.S.!
8.8 GDP
12.0 GDP
13.3 GDP
15.7 GDP(projected)
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The quality of care we get is far from the care
we should be getting Don Berwick, IHI

• Acute care deficiencies
• Antibiotic misuse 30-70
• Prenatal care 74

• Preventive care deficiencies
• Child immunizations 76
• Influenza vaccine 52
• Pap smear 82

Quality of Care Safe Effective Patient-centered
Timely Efficient Equitable

• Chronic care deficiencies
• Beta blockers 50
• Diabetes eye exam 53

• Surgery care deficiencies
• Inappropriate
• hysterectomy 16
• Inappropriate
• CABG surgeries 14

• Hospital care deficiencies
• Proper CHF care 50
• Preventable deaths 14
• Preventable ADEs 1.8/100 admits
• Life threatening 20
• Serious 43

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What the evidence says is what you get (half the
time)
McGlynn et al The Quality of Health Care
Delivered to Adults in the United States NEJM
June 26, 2003
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Variation is widespread..
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Source Center for the Evaluative Clinical
Sciences at Dartmouth
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Source Center for the Evaluative Clinical
Sciences at Dartmouth
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Source Center for the Evaluative Clinical
Sciences at Dartmouth
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Source Center for the Evaluative Clinical
Sciences at Dartmouth
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The quality you get depends on where you live
Quartile Rank
First
Second
Third
Note State ranking based on 22 Medicare
performance measures.
Fourth
Source S.F. Jencks, E.D. Huff, and T. Cuerdon,
Change in the Quality of Care Delivered to
Medicare Beneficiaries, 19981999 to 20002001,
Journal of the American Medical Association 289,
no. 3 (Jan. 15, 2003) 305312.
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So what do we know from these data?

• The system is expensive
• Delivery is uneven
• Quality is variable
• More is not better
• Where you live matters
• Its unsustainable!

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Our challenges are many
CHANGE
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The framework for health system transformation
Improve quality Evidence-based medicine
Standardize processes and information Information
technology
Manage demand Chronic care management
Engage consumers Financial participation
Change incentives Pay for performance
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Quality will be a major focus

• Evidence Based Care
• Patient Centered Approach
• System Orientation

Its the basis for our Purpose, Worthwhile Work,
and Making a Difference
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Quality has three key dimensions clinical
processes are fundamental

• Service Delivery Processes
• Satisfaction with care management processes
• Amenities to reduce anxiety, increase comfort

• Structural Processes
• Access to needed services in appropriate settings
• Paperwork/administrative procedures to access
  services
• and document transactions

• Clinical Processes
• Adherence to evidence-based pathways in the
• diagnosis and intervention planning with patients
• Safe, effective, timely, patient-centered care
• Collaborative care management

Supportive
Primary
Clinical Excellence!
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Clinical processes evolve from adherence to
evidence-based practices
Evidence-based medicine is the judicious
application of relevant scientific studies to
patient preferences and values.
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Guidelines The Framework for Evidence-based
Medicine

• Systematically developed statements to assist
  practitioner and patient decisions about
  appropriate health care for specific clinical
  circumstances
• IOM 92

• Derived from
• 20,000 RCTs annually
• 4,000 guidelines since 1989
• 2,500 periodicals in NLS
• Every guideline is not evidence-based, and some
• guidelines are about who, what should be done

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The data correlates adherence to evidence-based
practice with

• Improved outcomes
• Reduced variation
• Improved patient adherence
• Improved efficiency
• So why isnt evidence-based practice more
  consistently provided?

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For most, its a journey they choose to take!
Its cookbook Medicine
we dont have the tools
we never did it that way before
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Quality is the basis for how well be paid, how
well attract and keep good people, and how well
build our organizations
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CUT
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The cat is out of the bag!!
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Results from CMS Hospital Compare April 2005
(4203 hospitals reporting)
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Payers are shifting incentives pay for
performance is not a fad, its a trend!-
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For a hospital, there are six key areas for
action
Pathway Management Building and updating
pathways, order sets and guidelines for care
teams
Risk Management Avoiding error, conducting root
cause analysis
Care Team Management Recruiting, equipping and
holding accountable care teams
Outcome Management Measuring what works best
and why
Admissions Management Evaluating appropriately,
directing resources effectively
Discharge Management Teaching, equipping patients
for guided self-care, follow-up
Physician leadership is essential!
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Must Haves for Clinical Excellence
Evidence-based Personalized Care
Process
Tools
Leadership
The gap between the care we deliver and the care
we should deliver
Vision
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The essentials for hospitals

• Leadership with fact-based vision
• Advocacy.. They dont know what they dont know
• Integration doctors and hospitals in care
  management organizations
• Information systems clinical knowledge
  management tools, real-time decision support
• Process change.. Avoid work-arounds, adapt to new
  rules

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As Yogi says

• The future aint what it
• used to be!!

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Contact

• Paul H. Keckley, Ph.D.
• Executive Director
• Vanderbilt Center for Evidence-based Medicine
• Associate Professor
• Vanderbilt University School of Medicine
• D-3300 Medical Center North
• Nashville, TN 37232-2104
• paul.keckley_at_vanderbilt.edu
• 615-343-3922
• www.ebm.vanderbilt.edu