WILLMAR - When hospitals undertake a project to improve patient care, how do they know they’re actually making a difference?
Rice Memorial Hospital harnessed the data to take an in-depth look this past year at the care of patients diagnosed with pneumonia and how it stacked up on measures of cost and quality.
The multidisciplinary team in charge of the project found the hospital’s efforts indeed were paying off. Their analysis uncovered improvements in most areas, from fewer deaths among pneumonia patients to shorter hospital stays and even lower costs.
Rice has been working since the late 1990s to continually improve its care of pneumonia, a common reason for patients to be admitted to the hospital, said Kathy Dillon, director of information management.
Improvement has not historically been easy to measure, she said. “You make a change because you believe it’s the right thing to do, but did you really have an impact on cost and quality?”
Better data collection and more sophisticated ways of mining the information are changing this, however.
Late in 2012 a Rice Hospital team began looking more deeply at the hospital’s pneumonia data to assess the key indicators and to incorporate newer initiatives such as antibiotic selection.
The following year, Rice had an opportunity to join a pilot project by Voluntary Hospitals of America to test new tools for making better use of data.
The project involved compiling the data and tracking for changes and improvements, said Nathan Goracke, a Rice Hospital pharmacist. He and Dillon, team leaders of the project, shared their findings recently with the hospital board of directors.
“It’s almost a report card,” Goracke said. “This is a unique project. We do a lot of these things in the hospital, but we don’t always grab the data to compare before and after.”
The data covered 139 patients admitted to Rice Hospital with pneumonia in 2012-13 and 127 admitted in 2013-14. The team studied and compared indicators ranging from appropriate use of testing and antibiotics to rates of complications and readmissions.
Over the time period that was studied, the rate of pneumonia patients who were readmitted to the hospital within 30 days remained unchanged at 10 percent. But there were fewer deaths and pneumonia patients spent less time in the hospital.
The average length of stay dropped from 4.3 days to 3.83, Goracke said. “A third of a day is a very large decrease.”
The cost also fell, from $11,225 to $9,575.
At the same time, the team found that doctors were using standardized orders 80 percent of the time, and this percentage had gone up 10 points.
The process gave the team a detailed look at what Rice is doing well in the care of pneumonia and where there’s room for improvement.
The use of standard orders, for instance, can be a hurdle with physicians who might see it as “cookbook medicine,” said Ken Flowe, chief medical officer.
But as more doctors begin using well-designed standard orders, it increases the likelihood that best practices in care will be followed more consistently, he said. “It’s the right thing to do for most patients. Some patients may need something else.”
The team’s analysis also identified areas for further work, such as readmissions. Hospitals are coming under increasing pressure to reduce the number of patients who end up being readmitted within 30 days. Organizations that don’t meet national benchmarks are now being penalized with reductions in Medicare payments.
“That is one thing that is an opportunity for us, to decrease those readmission rates,” Goracke said.
Dillon said the project showed that Rice Hospital can learn from the data it collects and use the information to improve hospital care and processes.
Work is underway to develop in-house data experts “so we have the right people pulling the information and analyzing the data,” she said. “We continue to use the data tools that are available and measure our care against our peers as well as internally.”
