2014 Project Archive

Safety, Access and Efficiency Cluster Projects

Project 1

Characterizing and Reducing Avoidable Outside Utilization

Description

Outside referrals or out-of-network “leakage” is  a ubiquitous problem for many health systems,  especially accountable care organizations and  other health systems with risk-sharing insurance  contracts. Leakage occurs when patients within  a health system’s population are referred to or  otherwise receive care outside that system, with both  cost and care continuity implications. Frequently,  for various reasons, an index referral leads to a  chain of additional referrals with unclear patterns  and causality and with poor visibility in billing data  as to how, why, and for whom these referrals are  occurring (e.g. typically just the visit date, specialist,  and original primary care provider are known).  This project consists of two objectives, (1) to explore  the utility of a variety of analytic methods to help  understand, characterize, and describe referrals and  leakage patterns, and (2) to help reduce, disrupt, or  prevent leakage. Phase 1 will mostly focus on the first  objective with a variety of methods tested for their  feasibility and utility on pilot data from one or more ACOs. Potential approaches include data mining,  classifiers, predictive modeling, and social network  analysis. We also will investigate potential approaches  to detect, prevent, or mitigate avoidable out-of-system  referrals, using methods such as network cuts, agent-based  simulation, or systems dynamics models.

How is this different from related research?

Most approaches to managing outside utilization  have focused on methods to identify referrals that  were appropriate or not, education within a network,  and contract mechanisms. The current approach  complements this work with data analytic and  operations research methods to better understand,  prevent, and intervene/minimize leakage.

Member Benefits

  • Better understanding of how and why leakage  occurs
  • Identification of potential sources and patterns of  avoidable leakage
  • Approaches to detect, prevent, and mitigate  avoidable out-of-network referrals

Project 2

Identifying Emergency Department Efficiency Frontiers and  their Performance Factors

Description

Emergency department (ED) crowding has been  recognized as a serious concern in hospitals  nationwide. In response, healthcare organizations  have pushed EDs to tackle the issues that result  from crowding and to improve the efficiency of  care. However, there exists no single standardized  metric to assess hospital performance. As a result,  hospitals and external organizations have used  many different performance metrics to assess the  operational efficiency in EDs. Although the metrics  can play a role in representing the efficiency of each  ED in a quantitative way, a simple comparison of the  numbers can lead to inaccurate conclusions because  inputs consumed for the outcomes were not taken  into account. Data Envelopment Analysis (DEA) can  be a useful tool to evaluate the efficiency of each  ED among a set of peer groups and compare their  performance. This study aims to develop a datadriven  framework for benchmarking efficient EDs  and determining appropriate stratifications of all  decision making units into peer groups.

How is this different from related research?

Many studies have used time intervals (e.g., door to  doctor, door to bed, and length of stay) to measure  efficiency of EDs. However, a simple comparison of  the numbers can lead to inaccurate conclusions when  the definitions of the metrics are not the same and  when other significant factors affecting the efficiency  are not considered. By using a DEA and statistical  methods, this study will develop a framework to  define appropriate peer groups in which efficiency  of EDs are compared and identify profiles of efficient  EDs in each peer group.

Member Benefits

Our industry partnership with Verizon has led to an  understanding that for patients, insurance companies  and hospitals, gamification will transform the  manner in which wellness management is designed  and advanced. IT industries can benefit largely from  the software platforms developed under this project  and a better understanding of the data acquisition,  transfer and management needs.

Project  3

Predictive Models for System Utilization, Capacity, and Flow Optimization

Description

This is a phase-1 pilot project to scope and initiate  a subsequent portfolio of work in the general area  of predictive modeling to improve real-time ability  to manage patient flow, system utilization, and  care pathways. The value of predictive information  in healthcare is increasingly appreciated, such as  for patient risk identification but less explored in  other potentially useful logistics contexts. This  project investigates four specific potential general  applications, with the objective of obtaining  preliminary results and viability vetting in order  to influence the focus and direction of subsequent  phase-2 projects. In each case preliminary results  will be generated and evaluated in order to assess  decision making utility and specifics of future  projects. Applications include predicting:

  1. Bed  demand in intensive and critical care units one-through-seven days in advance on a rolling basis,
  2. System wide patient flow similar to above,
  3. Long  outlier lengths of stay, such as earlier identification  of long-term acute care (LTAC) patients
  4. Patients appropriate for palliative care discussions.

Primary modeling approaches are envisioned  to include Monte Carlo simulation, probability  convolutions, logistic regression, and time series  analysis. Each application also will be evaluated  for the usefulness of predictive information to  decision making, via direct analysis and stakeholder  interviews.

How is this different from related research?

While predictive models per se are used in many  healthcare contexts, most uses tend to focus more on  patient risk, changes, or health status than on system  status and rates of change. Each above application is  of significant interest to a number of health systems  in order to better manage the delivery system and its  most effective utilization. Additionally, our approach  to system flow and bed demand uses a recently  developed new probability model, resulting in a fairly  large and previously intractable convolution, and  a novel generating function approach to its rapid  computation.

Member Benefits

  • Understanding how to use predictive modeling  for bed demand, system utilization, and patient  management
  • Identification of challenges and opportunities
  • Improved system utilization, costs, flow, and  outcomes

Project  4

Shared Commons Game Theory Models to Improve Antibiotic Stewardship

Description

Antibiotic resistance remains a growing problem  of broad health and cost concern, with significant  focus on antimicrobial stewardship as one important  intervention. This project develops and uses  game theoretic models of stewardship policies,  participation rates, and intervention design to help  understand resistance spatial-temporal dynamics and  how to best limit resistance locally and regionally.  In behavioral economics, stewardship can be viewed  as a “tragedy of the commons”, Hardin’s analogy  of a shared town pasture for which each individual  herder has incentive to graze their sheep without  concern for the others, thereby reducing the longterm  value to everyone. For antibiotic stewardship,  this equates to over-use reducing their effectiveness,  where short-term incentives exist to use antibiotics for  individual care episodes but at the consequence of  reducing long-term effectiveness across a community.  Results will help analyze regional spread and growth  of antibiotic resistance over time as a function of  stewardship participation percentages, distribution,  and compliance, which will be used to help inform  policies and influence awareness, participation, and  cooperation in such programs.

How is this different from related research?

While antibiotic stewardship has been promoted by  numerous patient safety, epidemiology, and infection  control organizations, to our knowledge little-to-no  work has been conducted to model the impact of such  programs to help understand and inform policy and  interventions.

Member Benefits

  • Improved understanding of how stewardship  policies, participation rates, and consistency  impact resistance

  • Methodology to identify the most effective  interventions to reduce the extent and spread  of resistance

Project  5

Understanding the Dual Effect of Hospital Safety Culture on Patients and Care Providers; Optimizing Hospital Safety Culture and Reducing Safety Events

Description

The healthcare industry in the United States  continues to report among the highest rates of  workplace injury and illness of all industries. Many  studies examine care provider personal safety  perceptions and have found these perceptions  influence care provider health and wellness. With  respect to patient safety, hospitals continue to  struggle with effective tools and processes to reduce  patient safety events. Retrospective data shows that  many of the facets that promote a safe environment  for care providers are the same facets as those that  promote a safe environment for patient care. This  project will identify and assess the facets of safety  culture that influence both care provider and patients  safety events and determine how safety events may  influence patient satisfaction scores (as measured by  the Hospital Consumer Assessment of Healthcare  Providers and Systems”“HCAHPS).

How is this different from related research?

While there are substantive literature bases in both  employee and patient safety, there is a dearth of  studies that examine both patient safety and care  provider safety in tandem. Further, safety culture  studies have yet to include the influence of poor  safety culture on patient and family satisfaction with  their care experience. The inclusion of HCAHPS  patient satisfaction scores presents the financial  imperative for hospitals to optimize their safety  culture, a relatively unexplored imperative in safety  research.

Member Benefits

The results of this research will assist all hospitals in  developing a better understanding of the relationship  between patient and care provider safety and  the effect of safety events on HCAHPS scores. By  identifying the patient/provider commonalities in  safety, these relationships will provide hospitals with  critical areas of focus to improve the hospital’s safety  culture and reduce safety events for both providers  and patients and help improve patient satisfaction.

Macro/Policy Cluster Projects

Project 1

Bundle Science Statistical Models and Analysis

Description

Use of evidence-based bundles has become common  for monitoring evidence base compliance in many  patient safety contexts. Examples include surgical site  infections, ventilator pneumonia, acute myocardial  infarction, total joint replacement, coronary artery  bypass graft surgery, and others. Despite becoming  part of routine improvement projects, the evidence  base on evidence based bundles is limited at best.  Little actually is known about the best way to form  bundles, relationships between care elements,  individual and combined adverse events (AE)  predictive ability and efficacy, or how to use them as  intervention triggers. This project therefore addresses  several important questions and needs, using data  from two or more health systems:

  1. Statistical  Process Control (SPC) methods for monitoring  bundle compliance, including self-starting methods  and prototyping an automated surveillance systems
  2. Regression analysis of bundle elements, including  quantification of interaction terms and the so-called  culture-of-safety “bundle effect”
  3. How to best  use these results as an intervention trigger

How is this different from related research?

Bundles are used increasingly to measure and  motivate patient safety improvement activities,  typically defined by expert consensus and literature  review. Little-to-no statistical work, however, has been  conducted on the science of creating and validating  bundles themselves, nor using them for prediction  and surveillance. Our prior work, additionally,  developed new control charts for bundles, with  significant detection improvements but also  highlighting several limitations and research needs  (weighting, start-up, parameter estimation).

Member Benefits

  • Increased understanding of how to create and use  bundles for patient safety quality improvement
  • Validated statistical methods for comparing  and monitoring bundle compliance over time,  manually or in an automated surveillance or  triggering system
  • Understanding of the relative importance and  interaction terms of different bundle elements  and, more broadly, development of a general  bundle science framework

Project  2

Economics and Potential Financial Model of the Perioperative Surgical Home: Developing a Framework for PSH Design and Action

Description

The “perioperative surgical home” (PSH) is a  relatively new concept that is based, at least in part,  upon the patient-centric characteristics of the  medical home combined with foci on team science,  micro-systems, service line management, carecoordination,  and bundled payment. The purpose  of this study is to continue to define the “surgical  home” conceptually and to identify and describe  the economics and detailed financial model of one  selected PSH model in the United States.

How is this different from related research?

Unlike the related concept of patient-centered  medical home that dates back over 50 years, the PSH  is a product of a new environment of care concerned  with improved safety, effectiveness, timeliness, and  efficiency of surgical care. This research is heavily  driven by both theory and practice to more clearly  define the financial model of the PSH and its variants  across the health care industry. Furthermore, it  requires close collaboration with professionals  associated with the selected PSH at all stages of the  research.

Member Benefits

The sponsor as well as other associations, hospitals,  and policy makers will benefit from a clear understanding  of the nature, operational design, and  financial model for leading PSH programs in the U.S.  Specific attention will be given to characteristics of a  viable PSH financial model starting with one specific  surgical specialty.

Project  3

Healthcare Improvement Spread Models

Description

This is a continuation project of a current phase-1  project in response to our industrial advisory board  request for proposals looking at the slow spread of  improvement in healthcare. The focus is to develop  analytic models of the spread of innovations and  improvement knowledge across healthcare systems  and healthcare quality improvement networks.  Phase-1 consisted of two activities:

  1. Applying  social network analysis tools to “map” the structure  of several healthcare quality improvement networks  to investigate their interconnectedness relating to  spread
  2. Developing two proof-of-concept  agent-based simulation models of the spread of  improvements across such networks.

Phase-2 now will  continue this work and apply results to two specific  applications to:

  1. Validate our simulation model  using real data from two identified networks
  2. Develop an optimization framework to maximize the  spread of innovations across the network. We will also  generalize knowledge and explore how to bridge the  gap between our theoretical work and practical use.

How is this different from related research?

While a significant amount of work by others has  focused on project management and the challenge  of improvement implementation (e.g. Mayo Clinic  Model for Diffusion, IHI Framework for Spread, etc.),  less is known about how such projects and innovations  actually spread across quality improvement networks,  resulting in a need to better understand and  accelerate the spread of good ideas across healthcare  improvement communities.

Member Benefits

  • Better understanding of the evolution and  structure of effective and ineffective quality  improvement networks
  • Identification of ideal network structures to  promote effective spread of ideas and innovation

Project  4

Healthcare System Redesign: Advancing Delivery Quality and Effectiveness

Description

Individual health systems provide various services  and allocate different resources for patient care.  Healthcare resources including professional and  staff time are constrained. Patients are “˜sicker’ often  with a combination of chronic diseases. It would  already take 16″“18 hours daily to do everything the  guidelines recommend that primary care provide for  their patients. Patient lifestyle patterns are mostly  suboptimal with adherence with pharmacotherapy  is often limited. This study aims to:

  1. Identify  critical variables that impact outcomes (e.g.  control of risk factors and prevention of hospital/ED admission) and inform allocation of limited  time and resources for greater effect
  2. Address  realistically modifiable social determinants of health  that will improve community health
  3. Seek  greater use of treatment evidence (e.g. secondary  EMR usage, “OMICs” data) to advance quality  and effective of care delivery.

We aim to increase  quality and timeliness of care, maximize financial  performance, and decrease practice variability  the organization.

How is this different from related research?

This study attempts to combine social-economic  and demographics demands, hospital resources,  and evidence of treatment (including EMR, Omics,  and other laboratory data) to redesign the delivery  process for quality and effectiveness of healthcare  delivery. While efficiency is often performed via  process improvement, patient risk factors, disease  patterns and treatment characteristics may shed lights  on resource needs and care requirement, and provide  holistic health systems redesign opportunities for  improving care quality and effectiveness.

Member Benefits

  • Improve quality and efficiency of care
  • Reduce waste
  • Serve more needed patients
  • Improve demand-resource alignment
  • Reduce prolonged LOS (and thus reduce hospital  acquired conditions)
  • Improve capability in the event of pandemic or  disaster response.

From the patient standpoint, it offers timeliness  and personalized evidence-based care, and reduces  unnecessary hospital stays and the associated risks  and costs. This work has the potential to reduce  healthcare delivery disparities.

Patient-Centered Care Cluster Projects

Project 1

A Data Mining Methodology for Patient Adherence to Home-Based Therapies

Description

Patient non-adherence to physician-prescribed  disease and wellness management protocols is a major  challenge in the healthcare industry and has led to  an increase in hospital visits, health risks and medical  costs. For example, the non-adherence to prescribed  medication results in over 125,000 deaths per year  and a financial burden to the healthcare system  exceeding $100 billion in direct costs. This project  will explore patient adherence for those who adopt a  proposed sensor and visualization system for remote  wellness management and feedback.

How is this different from related research?

Systems such as AutoCITE reveal that remote  patient supervision has tangible impact on patient  health outcomes. The main limitations of existing  techniques are that they are physically invasive, often  requiring patients to wear some digitally connected  device for an extended period of time. Furthermore,  these systems do not provide an integrated healthcare  delivery strategy that connects the sensing results to  the patients and healthcare officials in a seamless,  visually straightforward manner. The proposed  project aims to not only predict patient adherence,  but also provide feedback to both patients and  physicians, which can then help physicians prescribe  alternative solutions if a patient is non-adherent.

Member Benefits

Our industry partnership with Verizon has led to an  understanding that for patients, insurance companies  and hospitals, a convenient and automated technique  to monitor treatment progress can lead to large  time and money savings. In particular, industries  can benefit largely from the research into sensor  placement and data management and transfer. This  will be an increasingly important field, as low cost  sensors we use in our homes become more prevalent.

Project  2

Applying the Studer Group Evidence Based Leadership Principles to Improve Physician Engagement and Performance

Description

Studer Group, an outcomes-based firm dedicated  to improving the patient experience, has been  developing its Evidence-Based Leadership technology  to help address the issues faced by both health  systems, physician practices, and individual physicians  successfully integrate. This project proposes the  evaluation of the Studer Physician Feedback  System (SPFS), (referred to as the intervention),  recently developed to assist health system leaders  and physicians with hospital/physician integration  initiatives. The integration of physicians from  independent practice into health systems has proved  challenging over the past several decades, and has  been met with mixed financial, economic, and  physician engagement results.

How is this different from related research?

Current research regarding hospital and physician  integration tends to focus on distal outcomes (e.g.  financial performance). Further, there is a paucity  of evidence regarding tools and methods for health  system leaders to guide these efforts, and provide  real-time feedback across a variety of dimensions,  including clinical, safety, engagement and  experience.

Member Benefits

This study offers a unique opportunity to assess  such a comprehensive intervention, and disseminate  important findings to a practitioner-oriented  audience, thus impacting the quality and nature of  care in a variety of settings.

Project  3

Can ‘Visiting Specialists’ Coverage Agreements Return a Positive ROI for Sponsoring Institutions?

Description

Access to specialty care has been and continues  to be a pressing issue for rural patients. While it  has always been desirable to push care back to  these smaller, underserved markets, volume is not  typically sufficient to support specialty physician  coverage. This problem has been compounded by  a reimbursement system that pays physicians on  volume rather than value basis. Thus, health systems  have begun to spend large amounts of money by  subsidizing employed and independent specialists  to offer clinics in rural areas. Sponsor systems  stand to benefit from offering such subsidies by  potentially reducing unnecessary hospitalizations  and rehospitalizations for patients who would have  otherwise not been seen by a specialist. However,  little if any research has been conducted to date to  determine if this ‘visiting specialist’ model yields  a positive return on investment (ROI) for  sponsoring health system.

How is this different from related research?

Little research has been conducted to measure the  visiting specialist model’s impact on quality and  costs. None of this research was conducted in light of  new CMS penalties on 30-day readmissions, stricter  community needs assessment requirements, or more  generally on the recent shift towards population  health management.

Member Benefits

  • Determine if the system’s CHF 30-day re-admission  rate for patients in targeted rural markets is  affected by the visiting specialist model
  • Determine if the ROI for the sponsor is system is  positive or negative
  • Identify local factors (e.g., physician-population  ratio, frequency of service offerings, mean patient  severity index, distance to system etc.) with the  biggest impact on the sponsor system’s ROI
  • Results should also allow researchers to  calculate the value of physician impact on the  community-a key requirement for community  needs assessments

Project  4

Chronic Disease Management: Clinical, Community, and Patient-Centered Approaches

Description

Sixty-eight percent of Medicare spending goes to  people with five or more chronic diseases. Reports  found that between 44% – 57% of older patients take  more than one unnecessary drug. The management  of multiple diseases is complicated and offers  daunting challenges to healthcare providers. More  drugs are prescribed for treatment, which causes  reduced adherence of patient to drug therapy, higher  possibility of drug-drug interactions, more side effects  observed on patients, less effective treatment, and  more frequent changes in drug therapies. This results  in more hospital visits, heavier burden on the use of  health resources and higher medical expenses. The  objective of this study covers both the clinical visits,  and a patient-home-centric approach to optimize the  outcome and sustained health of patients.

How is this different from related research?

First, the project focuses on co-existing multiple  conditions, rather than a single disease. Thus, it is  more challenging, interesting, and clinically relevant.  The project will bring together a multi-team of  providers to identify guidelines of multiple disease  treatment. It will reduce the time pressure of doctors  on unnecessary patient visits, and assists doctors to  manage complex treatments. Chronic disease also  requires pro-active patient participation as well as  fostering a community and culture for healthy living.  Active home and community engagement provides a  supporting environment. Remote sensors can be fun  and offers unique opportunity for health engagement  and communication between providers and for sustained health improvement.

Member Benefits

The study attempts to deal with chronic disease  from both clinical as well as home-community  levels. The study will return optimal outcome-driven  treatment for multiple conditions with lower cost and  better control of disease symptoms. The resulting  treatment will also use a minimum amount of drugs,  thus reducing the risk of adverse/side effects and  increasing the efficacy of the treatment (more drugs  mean high risk of non-compliance). This all will  translate to improve the quality of care and quality  of life of patients. Positive and healthy home and  community environments facilitate pro-active patient  health engagement, and promote healthy eating.  Remote sensors offer care continuation (outside  clinic), promote active engagement to sustain broader  health improvement.

Quality and Safety Cluster Projects

Project 1

Analysis of Practice Variance: Outcome and Evidence-Driven Clinical Practice Re-Design

Description

Numerous studies have shown that surgical  outcomes differ among hospitals. Why do some  sites achieve better outcomes? This is a complex  question with many contributing elements. A large  factor is the variability in patient characteristics  and risk factors. With regard to non-patient factors,  it is likely that outcomes are affected by a host of  factors broadly related to experience, resources, and  experimentation. For example, some centers may  commit greater resources to certain procedures.  Other centers may encourage experimentation,  resulting in adoption of changes in surgical and  medical care that appear promising and divergence  in management practices from those at other  institutions. Practice variance is an important issue to  analyze as a means to optimize care delivery (quality  and efficiency) and to encourage collaborative  learning for broad quality improvement.

How is this different from related research?

Collaboration has the added potential of stimulating  new ideas for investigation or new management  techniques, and increases our ability to conduct  prospective research in a highly specialized  clinical setting. Experimentation and discussion  among colleagues can lead to the rapid adoption  of innovations and avoid the replication of  disadvantageous techniques. Collaboration and site  visits have not yet been applied to pediatric cardiac  surgery. Collaborative learning in pediatric cardiac  surgery requires a multi-institutional approach due  to relatively low volumes. A national structure for  collaborative site visits has never been tried, to our  knowledge, in any field.

Member Benefits

  • Improve quality and efficiency of care
  • Successful dissemination of best practice
  • Reduce length-of-stay through early extubation  and improving care coordination and management
  • Establishment of important CPG for broad  national dissemination.

Project  2

Hospital Acquired Conditions – Systematic Analysis and Adaptive Approach

Description

A Hospital Acquired Condition (HAC) is a medical  condition or complication that a patient develops  during a hospital stay, which was not present at  admission. About one in 25 U.S. patients has at  least one infection contracted during the course  of their hospital care, according to a 2104 study  released by the U.S. Centers for Disease Control  and Prevention (CDC), resulting in about 75,000  patients with healthcare-associated infections (HAI)  died during their hospitalizations. Hospitals have  worked to mitigate HAC as unnecessary resources  tied up, and outcome of patients are compromised.  The progress and urgency have been  as the Affordable Care Act imposes HAI penalty.  The challenges here are multiple folds, including  suboptimal adherence to current prevention  recommendations; limitations in surveillance  strategies; lack of efficient mechanism for reporting  adverse events; inconsistent metrics of measurement;  and at times, lack of system-wide research. Most  studies are site-specific, e.g., ICU-focus, antibiotics focus,  etc. The interdependencies and multi-faceted  potential personnel and process contribution to  HACs make it difficult to pinpoint sources for early  detection and intervention. Our team has previously  made good SSI advances in open heart surgery  through system advances.

How is this different from related research?

This large-scale system-wide study involves multiple  hospitals, units, and services, including OR, ICU,  NICU, MRSA, ED, and environmental service, and  multiple stakeholders (care givers and providers,  patients, and facility/cleaning workers). Terminal  cleaning tools and processes will also be observed.  Our study is designed to uncover susceptible areas/processes/procedures over the entire hospital stay  period where infection/conditions are acquired with  the objective to cultivate a pro-active system of awareness of infection-prone situations.  The team will completely immerse in the day-to-day  processes and will map out the multi-faceted interdependencies  across processes and systems. Multi-site  comparison will be performed.

Member Benefits

  • Improve quality of care and treatment outcome  for patients
  • Reduce unnecessary length of stay and extra  medical care
  • Improve provider and patient compliance
  • Improve hospital surveillance
  • Improve hospital resource utilization
  • Improve providers’ morale and confidence
  • Establish a conducive atmosphere for sustainable  process and change transformation where HAC  awareness is integral and second nature to service  process.

Project  3

Quantifying the Impact of Pay-for-Performance Financial Incentives to Reduce Healthcare-Associated Infections

Description

Healthcare-associated infections (HAIs) are  infections that patients contract while receiving  treatment for medical or surgical conditions,  which impose a considerable economic burden  on the U.S. healthcare system. According to the  Centers for Disease Control and Prevention (CDC),  approximately 1 out of every 20 hospitalized patients  contract some form of HAI. Further, the estimated  medical costs of HAIs to U.S. hospitals range  from $30-45 billion. As a result, HAIs have greatly  contributed to the escalating costs of hospital care  as well as both morbidity and mortality. Pay-for-performance  (P4P) initiatives are increasingly used  to incentivize providers to improve both care quality  and performance. The system-wide implementation  of P4P models may help drive down HAIs for  participating hospitals, but what are the incentives  for hospitals to participate? In this project, we seek  to quantify the economic benefit of participating  hospitals in Highmark’s P4P financial incentive  program in terms of return-on-investment (ROI). We  aim to evaluate the effects of hospital P4P program  participation on existing levels of care quality and  whether there is a decline in the HAI incidence rates  for these participating hospitals.

How is this different from related research?

Previous research on the impact of P4P models have  focused on improved hospital quality, efficiency,  patient care and safety, but a critical gap remains  with measuring the actual ROI associated  hospital participation in such P4P financial  programs. The objective of our research is to  measure the true economic benefit of these financial  incentives for both Highmark and  hospitals, while evaluating the extent to which  QB program may help reduce HAI incidence rates;  thereby, serving as a motivator for system-wide  implementation.

Member Benefits

Highmark, as a NSF-CHOT partner, has identified  the strategic priority around a better understanding  of financial incentives for HAI. This project  is potentially significant for all NSF-CHOT  hospital partners, and we expect to leverage their  participation in the effort as appropriate.

Project  4

Reinventing the Pediatric Primary Care Model

Description

Pediatric primary care has evolved from a reactive  delivery model to a more coordinated and proactive  model of care over the past 40 years. Today,  advancements in pediatric practice guidelines,  chronic disease prevention, diagnostic and  treatment technologies, and an increasingly engaged  parent population present this field with a unique  opportunity to reinvent itself. Modern pediatric  care networks are now pursuing strategies to engage  patients and parents earlier and more often by using  innovative technologies and approaches. Further,  pediatric primary care networks stand to benefit  from improved integration with obstetrics in order  to create a continuous stream of healthy parents  and children. Finally, pediatric care networks are  becoming increasingly proactive with their high  acuity patients through the use of remote monitoring  technologies and mobile health. In designing these  new care models it is important to make informed  judgments on what is best suited for well-defined  customer segments and existing organization  infrastructure. The purpose of this study is to  identify best practices of innovative pediatric primary  care models (IPCM) and to define operational  and financial details of relevant models for future  implementation.

How is this different from related research?

As suggested in our initial description, the IPCM is a  product of a new environment of care concerned with  improved access, effectiveness, timeliness, patient/parent engagement, and efficiency of pediatric care.  IPCM calls for evolving care teams and professional  leadership in the reengineering of work processes  from obstetrics (when the patient first enters the  model) all the way through their transition into  adult-oriented care. Thus, this research is heavily  driven by both theory and practice to more clearly  define IPCMs and their variants across the healthcare industry. Results of this research will provide a  model for IPCM and guide CHOT members in IPCM  planning and implementation.

Member Benefits

The sponsor as well as other associations,  hospitals, and policy makers will benefit from  a clear understanding of the nature, evolution,  design components and role of the IPCM in the  healthcare industry. Specific attention will be given  to characteristics of the IPCM and its contributions  to improved, patient/parent engagement, and access  to coordinated care models of practice for IPCM  programs.

Enabling HIT and Care Coordination Cluster Projects

Project 1

A Combined Human-Factors and Quality Improvement Approach to Assess Health Information Technology Usability

Description

Electronic Health Records (EHR) play a major role  in the efficiency of clinical operations. Although  the main objective of EHR is to provide support  on clinical activities, several studies have reported  that usability issues have caused inefficiencies and  dissatisfaction of clinicians. As a result, EHR systems  have suffered from lack of acceptance and adoption.  The American Recovery and Reinvestment Act  (ARRA) of 2009 put the “meaningful use” of EHR  as a central priority for the Centers of Medicare &  Medicaid Services (CMS) with the main objective of  effective use of EHRs to achieve health and efficiency.  As a way to support this priority, a three-phase EHR  incentive program was developed to implement in a meaningful way to improve quality and safety  of the U.S. healthcare systems. After 2015, financial  penalties will be imposed on Medicaid eligible  professionals that do not meet all the criteria for  meaningful use.

How is this different from related research?

Although the ARRA claimed for a meaningful use  of certified EHR technologies, only a few studies  have investigated the impact of EHR usability issues  on efficiency and satisfaction of clinical users. In  addition, most of those studies discuss the EHR  usability problem without providing details on  how they could be addressed and quantified. Our  combined HF-QI framework provides a  of EHR usability at the task level and a more detailed  mapping of usability issues. Therefore, informed  recommendations can be made to improve usability  and as a consequence, improve efficiency in clinical  settings.

Member Benefits

Identifying and quantifying EHR usability issues  at the task level represent a huge opportunity to  inform EHR interface designers and identify areas  of opportunity for EHR training programs. This  will address the efficiency of clinical operations  and clinician satisfaction. Therefore, it will have a  positive impact not only on people’s health but also in  healthcare costs.

Project  2

Automated Language Translation for Improving Care Management

Description

Language barriers pose problems for communication  and interaction among patients and healthcare  providers. Yet, proper communication is critical  for optimal health management and outcomes. To  improve patient-provider communication for patients  with limited English proficiency (LEP), it is necessary  to interpret spoken language and translate written  clinical documents to the patient’s primary language  of communication. There is mounting evidence  that LEP is a risk factor for reduced healthcare  accessibility, reduced quality of care, decreased  patient satisfaction, poor understanding of provider’s  instructions, increased length of hospital stay and  increased adverse events and misdiagnoses. Thus,  limited patient”“provider communication due to the  language barrier is a burden to payers, providers  the community as a whole.

In this study, we plan to address the translation  services and plan to test computer-assisted translation  and machine translation (MT), utilizing freely  available open source tools such as Google Translate,  along with our advanced computing machine  translation services to translate discharge summaries  to various other languages to improve the accuracy of  translations. We will use a combination of carefully  customized user dictionaries/templates, based on  correct terminology and fine tuning of MT tools, to  increase the accuracy of machine translation.

How is this different from related research?

The overall objective of this project is to study the  language interpreter/translation services workflows  and find opportunities where advanced informatics  solutions could provide a robust solution to language barriers. Our system is the first attempt  automation where the resulting machine translator  will continue to learn and improve through multilevel  usage.

Member Benefits

Reduced time for language translators to edit the  machine translated summaries, reduced time to  translate documents and improved quality of the  discharge process by providing the documents  in the language the patient understands. It will  also enhance the discharge for patients speaking  languages for which there are no translators. This  allows the hospital to set up a community language  bank. Once successful, these language access tools  could be applied in a variety of settings across the  entire healthcare system where language barriers  pose problems and to materials such as health  education and disease related documents, brochures,  health guides and research briefs.

Project  3

Designing Health Information Technologies to Help Patient Care Teams Identify and Manage Information Problems

Description

Patient-care teams frequently encounter information  problems during their clinical decision making  process. These information problems include  wrong, outdated, conflicting, incomplete, or  missing information. Information problems can  negatively impact the patient-care workflow, lead to  misunderstandings about patient information, and  potentially lead to medical errors. Although these  information problems have existed for some time in  paper records, there is an increasing need to  on them in electronic records due to the tremendous  growth in the use of health information technologies  (HIT). Consequently, we will investigate the role  that HIT plays in supporting or hindering patient  care team members’ ability to identify and  information problems in an inpatient unit of Medical Center (HMC). The goals of the project will  be to:

  1. Identify requirements for HIT features to  better support identification and management of  information problems
  2. Develop low-fidelity  prototypes of these features and get feedback from  users on their usability/usefulness.

How is this different from related research?

Current medical informatics research focuses  primarily what causes information problems and  the impact that the information problems have on  the workflow of the hospital staff. However, there is  little research that examines how these information  problems are identified and managed by patient care  teams and the role that HIT plays in this process. The  intellectual merit of this work lies in addressing an  issue in the medical informatics field for which there  is currently little research. The broader impact of research lies in its ability to potentially improve the  delivery of care and reduce medical errors.

Member Benefits

Our work is relevant to all the industry members of  CHOT. Identifying features that can help reduce  information problems can improve the quality of  healthcare delivery in hospitals, decrease the chances  of medical errors occurring, and lead to the design of health information technologies.

Project  4

Gamification for Self-Monitoring of Patients for Enhanced Wellness Outcomes

Description

The objective of this project is to investigate the  fundamental aspects of gaming (both traditional  hardcore gaming and casual mobile gaming) that  make them engaging, rewarding and and apply those research findings towards a more  immersive healthcare wellness management solution  that can be adopted by patients. The video game  industry has grown to become a ~$100 billion  industry, with the average age of gamers being 30.  The success of mobile games such as angry birds,  candy crush, etc. has extended the definition of a  “gamer” to include a broad range of individuals of  all ages and demographics. The term “gamification”  is an emerging paradigm that aims to employ game  mechanics and game thinking to change behavior.  The current physician-patient relationship is topdown  in nature; a physician provides a patient  with a specific set of instructions that they must  comply with and a patient goes home and is left to  manage their wellness until the next hospital visit.  In the context of healthcare, gamification aims to  transform the patient-physician relationship into  a more collaborative experience, where patients  themselves are motivated to succeed in their wellness  management goals.

How is this different from related research?

The goal of our project is to create the “angry  birds/candy crush” of wellness systems, based on  the gamification paradigm that appeals to a broad  range of individuals (that may not have considered  wellness management systems in the past). This  project will focus on maintaining engagement in  wellness management apps through a theoretical  understanding of how/why the gaming industry is  often successful in maintaining user engagement extended periods of time.

Member Benefits

Our industry partnership with Verizon has led to an  understanding that for patients, insurance  and hospitals, gamification will transform the  manner in which wellness management is designed  and advanced. IT industries can benefit largely the  software platforms developed under this project and a  better understanding of the data acquisition, transfer  and management needs.