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©2017 Dimensional Insight, Inc.
Merry BassiBusiness Intelligence Architect
UnityPoint Health - Methodist Peoria
(Insert Organization Logo)
©2017 Dimensional Insight, Inc.
Introduction
Background– Started as a Clinical Chemist in the Lab
• Taught Clinical Chemistry • Participated in lab Research &
Development• Moved into Quality Improvement
– This led to the need for data….. – Access, Excel, SQL lists – back to Access &
Excel and then we discovered Diver
I love clinical data!
©2017 Dimensional Insight, Inc.
Quality Metrics – Converting 6.4 to 7.0 SpectrecBase, cPlan, Divefiles
History
AGENDA
Pharmacy Medication- Medication Reconciliation Project
Readmission Rate – Converting to 6.4 Model to 7.0 Spectre cBase
©2017 Dimensional Insight, Inc.
©2017 Dimensional Insight, Inc.
Peoria Region
Employed Physicians: 194 Volunteers: 686 Employees: 4,418 Licensed Beds: 654 Births: 2,264 Admissions: 23,148 Surgeries: 18,764 Emergency Visits: 96,358 Hospital Outpatient Visits: 366,616 Clinic Visits: 534,444
©2017 Dimensional Insight, Inc.
Our history with Diver
2008– How do we integrate data from multiple McKesson
medical record systems to improve reporting & analytics?
Started out slow – hourly census and built from there– One person - 10% of time to 100% of time – once we
discovered clinical data– Two dedicate FTEs
©2017 Dimensional Insight, Inc.
New Pilot Project: Medication Reconciliation by Pharmacist Prior to Discharge
Medication Reconciliation Prior to Discharge– Attending provider must review all medications and clarify
medications to add, modified, or discontinued prior to the patient discharge
– What makes it hard• Medications added for acute reasons only…. need to be discontinued
before discharge• Medication names similarities• Duplicate medication – but totally different names• Documentation system • Multiple providers: attending, current PCP, surgeon, consultants
©2017 Dimensional Insight, Inc.
New Pilot Project: Medication Reconciliation by Pharmacist Prior to Discharge
How the problem was presenting– Literature suggests a 50% defect rate– Medication errors and patient complaints regarding medication
issues were trending upwards– Admission medication reconciliation repeatedly surfaced medication
reconciliation problems– Zone pharmacist were identifying problems– Acute Care Medical Director & Hospitalists were requesting further
pharmacist coverage & assistance– JCAHO & National Patient Safety Goals– Mini pharmacy pilot: – Pharmacist reviewed 200 patients’ discharge medication
• Results: 46% error rate
©2017 Dimensional Insight, Inc.
New Pilot Project: Medication Reconciliation by Pharmacist Prior to Discharge
Requested resources for medication reconciliation:– 6 pharmacy techs for admission med rec Approved: 4– 2 pharmacists for discharge med rec Approved: 1
March 2017 – focused pilot– Pilot Group:
• Next Generation ACO & Bundle DRGs (COPD, Heart Failure, Pneumonia) patient
• Pharmacist to review all discharge medication prior to patient discharge• Monday-Friday 7am-4pm
– Daily patient lists to pharmacists with admitted Next Gen ACO patients and possible bundle DRGs (based on admitting diagnosis)
©2017 Dimensional Insight, Inc.
New Pilot Project: Medication Reconciliation by Pharmacist Prior to Discharge
Process Measures– % of discharges with medication reviewed by pharmacist prior
to discharge– % of medication reviews with interventions– Interventions per provider
Outcome Measures– 7 day & 30 day return to ED– 7 day & 30 day readmission rate– Med Rec Events – staff reported
©2017 Dimensional Insight, Inc.
Process Measures
Process Measures were built with an– Integrator script to Cbase using
• Epic Hospitalized Encounters• IP Flowsheet Measures – Pharmacist Med Rec & Interventions• Patient FYI Flags (Next Gen Patients)
©2017 Dimensional Insight, Inc.
Initial Result: Pilot Population% Patients with Med Rec by Pharmacist Prior to Discharge
12
©2017 Dimensional Insight, Inc.
Initial Results: Pilot Population% Patients with Med Rec by Pharmacist Prior to Discharge and With Recommended Changes
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©2017 Dimensional Insight, Inc.
Review by Discharge Day of Week – April 2017
©2017 Dimensional Insight, Inc.
Review by Discharge Day of Week – May 2017
©2017 Dimensional Insight, Inc.
But Then…….
Outcome Measures– 7 Day & 30 Day Readmission Rate
• Already had 32 dimensions & 4 different versions of the model
Converted 6.4 Readmission model to 7.0 Spectre cBase– Set up Aliases – data files from other projects– Re-established all input file paths to Spectre project data or
aliases– Convert model to cBase– Convert markers & diveplans from models to cBase – using
text editor
©2017 Dimensional Insight, Inc.
Easy to convert to 7.0 Spectre…. But does take time
©2017 Dimensional Insight, Inc.
Readmissions had many integrator scripts & input files
©2017 Dimensional Insight, Inc.
Most common problem
©2017 Dimensional Insight, Inc.
Current 30 Day Readmission Diveport with Quickviews
©2017 Dimensional Insight, Inc.
30 Day Readmission RateMedicare Traditional Age 65yrs Plus
Care Navigator Pilot Starts
Pre Care Navigator Readmission Rate: 13.9 Care Navigator Pilot Readmission Rate: 12.0
©2017 Dimensional Insight, Inc.
30 Day Readmission Rate – Med Rec Pilot PopulationConverted to cBase – Added Dimensions
Care Navigator Pilot Med Rec Pilot Start
Pre Care Navigator Readmission Rate: 13.9 Care Navigator Pilot Readmission Rate: 12.4
©2017 Dimensional Insight, Inc.
30 Day Readmission Rate – Pre Med Rec - Pilot PopulationPatient Age Range: 80-94 yrs
©2017 Dimensional Insight, Inc.
Next Steps
Add in additional dimensions – further stratification– Discharging provider– Zip code– Abnormal vital signs– High risk med flag
©2017 Dimensional Insight, Inc.
Model to cBase Conversion
Advantage of cBase– Faster (17 seconds to 11 seconds)– Smaller (23,148 Kb to 4,165 Kb)– Unlimited dimensions (32 plus 2 info fields to 39 dimensions)– Define column data types
Diveplans, Marker & Diveport conversion from model to cBase worked well
Medication Reconciliation project is ready for further modification
©2017 Dimensional Insight, Inc.
Quality Metrics: Results of converting 6.4 models to 7.0 Spectre cBase
6.4 Quality Metric Models
File size: 9 GB, 57 metrics
Models: Split into 5 models to run all the metrics
Model Build Time: 4-6 hours each
Model Sizes: 80-100 GB each
Multi-tab marker: 2 minutes
7.0 Spectre cBase
File size: 9 GB, 57 metrics
cBase: One – for all metrics
cBase build elapse time: 0:15:01
cBase size: <1 GB
Multi-tab marker: 3 seconds. Once opened, is instantaneous.
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©2017 Dimensional Insight, Inc.
Quality Metrics – Family & Internal Medicine
©2017 Dimensional Insight, Inc.
Quality Metrics – Family & Internal Medicine - Medicare
©2017 Dimensional Insight, Inc.
Quality Measures – Converted to Measures PortletsUsing cPlans, dive files & qvsets Measure timeseries.cplan
– Multilevel cBase inputs: quality measure cBase & target cBase– Timeseries: rolling current month & rolling 24 months
Dive files– Dive file for each measure
• Using measures_timeseries.cplan• With calcs to address
– Measure “good” direction, – Measure colors (green, yellowish, red)– Measure # formatting
©2017 Dimensional Insight, Inc.
Measures_timeseries.cplan
©2017 Dimensional Insight, Inc.
Example Dive file
©2017 Dimensional Insight, Inc.
Quality Metrics Core Set - Filtered to Methodist Clinics- Medicare
©2017 Dimensional Insight, Inc.
Quality Metrics – Core Set - Filtered to Methodist Clinics-Next Gen ACO
©2017 Dimensional Insight, Inc.
Quality Metrics Core Set – Filtered to Methodist-Family Medicine – Next Gen ACO
©2017 Dimensional Insight, Inc.
Quality Metrics Core Set – Filtered to Methodist-Internal Medicine – Next Gen ACO
©2017 Dimensional Insight, Inc.
Benefit of cPlan, Divefiles
Easy to build out cplan-divefiles for each additional metrics (copy, paste, change measure name)
Fast and can set production script to build memory cache
Quick for end user to view report for each provider along with trending history
©2017 Dimensional Insight, Inc.
Next Steps – Quality Metrics
Adding Patient volume – Is the gap 5 patients of 500 patients?
Info pop ups? Build out remaining quality metrics into “snapshot
views” Create “gap” reports
– Easy views of which clinics/providers have the biggest gaps. Gain better understanding of cplans & divefiles Can we change the timeframe?
©2017 Dimensional Insight, Inc.
Summary
Models to cBase– Timesaver
• Unlimited dimensions• Projects with multiple models now go to 1 cBase• cBases run much faster• Improves our ability to generate actionable level information quickly
– Uses less disk space Struggled with
– Learning curve– Time to make the conversion
Consulting time – did help us move forward at a much faster clip
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