Session #27:
Quality Improvement in Healthcare:
An ACO Palliative Care Case Study
Dr. Robert Sawicki
Linda Fehr, RN
Roopa Foulger
Senior Vice President,
Supportive Care
Division Director,
Supportive Care
Executive Director,
Data Delivery
Pre-Session Poll Question
How would you describe your
organization’s progress on
achieving the Triple Aim and the
IOM Six Aims for Improvement?
a)
b)
c)
d)
e)
f)
Not evident
Beginning
Effective
Mature
Advanced
Unsure or not applicable
93
667
Locations
Providers
Visits
About The Organization
1.5M Patients annually
185K Home Health annually
267 Hospice daily census (avg)
2
Palliative (Supportive) Care
Palliative
Care
3
Why Palliative Care Is Important
What does
advance care
planning (ACP)
mean to
patients?
 To understand,
discuss, and
record plans for
a future scenario
when they
cannot make
their own
medical
decisions
 To feel confident
that their end-oflife care
preferences will
be honored
Who is ACP
appropriate
for?
 All of us, ideally,
but especially
chronically ill
patients
Why is ACP
important?
 To provide
higher quality
end-of-life care
that honors
patients' values,
goals, and
preferences
What are the
components of
ACP?
 Advance care
plan
 Advanced
directive
 Durable power of
attorneyhealthcare
(DPOA-HC)
Prior to this, only patients in imminent need for advanced
care planning were the focus
4
Pain Points

Financial incentives are misaligned
with patient desires

Major reform is needed to ensure
higher quality, affordable, and
sustainable end-of-life care

Chronic conditions and functional
limitations are key drivers of high
healthcare costs

Increased healthcare spending is not
associated with higher-quality care
*Source:
13%
An estimated 13% of
$1.6 T in healthcare costs
is for the care of
individuals in their
last year of life*
Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life © 2014
5
Poll Question #2
Does your healthcare organization have a palliative
(supportive) care program?
a) Yes
b) No
c) Unsure or not applicable
6
Our Approach
And
Results
7
Goals

Understand and align patients’ value
system with their healthcare goals

Leverage the OSF supportive care
program in a community-wide initiative

Dramatically increase the number of
patients completing advance care
planning

Drive the engagement of all patient care
providers

Provide optimized care coordination for
patients

Quickly deploy a solution that could be
used by all individuals

Provide real-time customized reporting
8
Care Coordination
Inpatient
Skilled
nursing
facility
Outpatient
Care
Coordination
Community outreach
and education
Home
Home health
care
Clinic care
Hospice
9
Technology-Enabled Solutions
Identification of
high-risk patients
 Community enters data into an
easy-to-use, accessible
database
 Supports heterogeneous EHR
environments
 Deployable in days
EDW
Platform
Advance care planning
information is integrated
into the OSF patient EHR
 Supportive care dashboard
 Custom reporting (supportive care
team, clinicians, executives)
10
Supportive Care Dashboard
11
Driving Engagement
 Trained physicians and patient care providers:
Initiate
the conversation
Identify
the patients’ values
Translate
the patients’ values
into medical
decision
Document
the patients’ stated
preferences for
care
 Co-sponsored “considering the conversation” screening with two large
hospital systems
 Developed a healthy competition with accessible, customized reports
12
Results/Measurable Analytics
1,761
High-risk patients
who have completed
advance care
planning
Target: 1,200
18,655
Total number of
patients who have
completed advance
care planning to date
980
Engaged physicians,
nurses, parish nurse
facilitators, and
employees
 One common database to enable tracking and reporting: Easy-to-use
interface; supports heterogeneous EHR environment; deployed in days
 Timely, customizable reporting: Facilitator reporting; identified high-risk
patients; customized reports (supportive care, clinicians, and executives)
13
Future Plans
Evaluate the number of
referrals to patients with
advance care plans who
are referred to hospice
Analyze readmissions
rates for patients with
advance care plans,
versus those without
advance care plans
Correlate how well the
patients’ care goals were met
and the timing of the
advance care planning
discussion
Expand advance care
planning discussion
targets to non-high-risk
patients
Continue to drive
employee and
employee family
member engagement
Ensuring patients’ wishes
are met, then compare
results
14
Lessons Learned
 Palliative care requires a team approach
to care that addresses the patient’s and
family’s physical, emotional, and spiritual
needs
 Look beyond just your healthcare system
and engage in a community-wide
initiative with considerable focus on
training
 Establishing targets and providing real-
time visibility to results across the
organization helps build healthy
competition and drive outcomes
15
Analytic
Insights
Questions &
Answers
A
16
Choose one thing…
Write down one thing will you do differently
after hearing this presentation
17
Thank
You
18
Session Feedback Survey
1. On a scale of 1-5, how satisfied were you overall with this session?
1)
Not at all satisfied
2)
Somewhat satisfied
3)
Moderately satisfied
4)
Very satisfied
5)
Extremely satisfied
2. What feedback or suggestions do you have?
19
Upcoming Sessions
Breakout Sessions – Wave 5 (2:20 PM – 3:05 PM)
Location
31) Panel – Data Governance in Healthcare
Grand Salon
32) How One ACO Is Using Analytics to Position Itself for Population
Health Management and Shared Savings
Imperial Ballroom A
James J. Dearing, DO, FACOFP, FAAFP, Vice President, Chief Medical Officer, Honor
Health
33) Panel – Best Practices in Achieving Physician Engagement
34) Panel – Precision Medicine and Embracing Variability
35) Improving Analytics and Processes to Ease Hospital Crowding
Wes Elfman, Visualization Developer, Clinical and Business Analytics, Stanford Health Care
Terrill Wolf, Manager, Data Architecture, Clinical and Business Analytics, Stanford Health
Care
Imperial Ballroom B
Murano
Venezia