Saving Money, Saving Lives Population-Based Quality Improvement

19
Saving Money, Saving Lives Population-Based Quality Improvement Edward F. Donovan Child Health Services Research Meeting June 24, 2006

description

Saving Money, Saving Lives Population-Based Quality Improvement. Edward F. Donovan Child Health Services Research Meeting June 24, 2006. Regional Systems of Perinatal Care The Investment Case for Quality Improvement. Economic resources spent for perinatal care - PowerPoint PPT Presentation

Transcript of Saving Money, Saving Lives Population-Based Quality Improvement

Page 1: Saving Money, Saving Lives Population-Based Quality Improvement

Saving Money, Saving LivesPopulation-Based Quality

Improvement

Edward F. DonovanChild Health Services Research Meeting

June 24, 2006

Page 2: Saving Money, Saving Lives Population-Based Quality Improvement

Regional Systems of Perinatal CareThe Investment Case for Quality

Improvement

Economic resources spent for perinatal care - taxes/charity (public health & gov’t sponsored

insurance) - after-tax wages (employment-sponsored insurance)

Potential savings - avoid preterm births and consequent lifelong

handicaps

Because many individuals receive a mix of tax-supported and employment-supported services, quality improvement should occur at the health system level

Page 3: Saving Money, Saving Lives Population-Based Quality Improvement

Population-based quality improvement to save lives and money

Geographically defined systems of perinatal care

Individuals receive care from different parts of the system

Test population-based QI: - caregiver/policy teams - data systems operational - QI collaborative

Investment case for population-based QI

Regionalized Perinatal Care in Ohio

Page 4: Saving Money, Saving Lives Population-Based Quality Improvement

Gestation for All Ohio Births 1995 - 2001Singletons only, fetal deaths excluded

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

Gestation - Weeks

Per

cen

t S

till

Pre

gn

ant

Region 1 Region 2 Region 3 Region 4 Region 5 Region 6

Page 5: Saving Money, Saving Lives Population-Based Quality Improvement

EXTREME PREMATURITY[birth at less than 29 weeks gestational age]

• 60-70% of deaths in the first year of life are associated with EXTREME PREMATURITY

• 50% of lifelong handicapping conditions with onset in infancy are associated with EXTREME PREMATURITY

• 1% of births are EXTREMELY PREMATURE, but 25% of spending for perinatal care

Page 6: Saving Money, Saving Lives Population-Based Quality Improvement

Gestation for All Ohio Births 1995 - 2001Singletons only, fetal deaths excluded

white mothers

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

Gestation - Weeks

Per

cen

t S

till

Pre

gn

ant

Region 1 Region 2 Region 3 Region 4 Region 5 Region 6

99.40%

99.45%

99.50%

99.55%

99.60%

99.65%

99.70%

99.75%

99.80%

25 26 27 28

Gestation - Weeks

Pe

rce

nt

Sti

ll P

reg

nan

t

Region 1 Region 2 Region 3 Region 4 Region 5 Region 6

Page 7: Saving Money, Saving Lives Population-Based Quality Improvement

Gestation at Birth for All Ohio Births 1995 - 2001Singletons only, fetal deaths excluded

African American mothers

97.5%

98.0%

98.5%

99.0%

99.5%

25 26 27 28

Gestation - Weeks

Per

cen

t N

ot

Del

iver

ed

Region 1 Region 2 Region 3 Region 4 Region 5 Region 6

Page 8: Saving Money, Saving Lives Population-Based Quality Improvement

Population-based QI to improve perinatal care in Ohio

Outcome: Extreme prematurity

QI Methods:

Real-time, longitudinal measures of outcomes: e-birth-certificates

Improvement collaboratives: PDUC

Benchmarking

Transparent tests of change

Page 9: Saving Money, Saving Lives Population-Based Quality Improvement

Benchmarking• If whites (83% of births) in less well performing

regions had the same proportions of births 25-28 weeks GA as the best performing region, there would be roughly 135 fewer infants in this category per year in Ohio

• If African Americans (17% of births) in less well performing regions had the same proportions of 25-28 weeks GA as African Americans in the best performing region, there would be approximately 175 fewer infants in this category per year

135 + 175 = 310 fewer extremely preterm infants per year

Page 10: Saving Money, Saving Lives Population-Based Quality Improvement

Return on Investment Saving a few lives and a lot of money

80 fewer deaths per year100 fewer children per year with life long disability

Total annual savings in birth spending: $ 78 million[5% of total birth spending in Ohio]

Total savings in Medicaid birth spending: $ 24 million

Ohio Medicaid budget for families and children= $ 2 billion (5% of Ohio’s annual spending)

Medicaid savings = 1% per year [not counting cost of lifelong handicap]

Ohio Medicaid budget for children has been increasing 3.6% per year

Page 11: Saving Money, Saving Lives Population-Based Quality Improvement
Page 12: Saving Money, Saving Lives Population-Based Quality Improvement

Improving quality of perinatal care for geographic regions

• Outcomes depend on multiple sources of care• Optimal care depends on linkages among care

sources• Processes of care are readily identifiable• Population-based outcome measures are

available in existing administrative data sets (birth and death certificates)

• In many areas, perinatal care is “regionalized”• Benchmarking and learning collaboratives are

possible within jurisdictions (e.g. states)

Page 13: Saving Money, Saving Lives Population-Based Quality Improvement

Opportunities to Improve

• Identify best evidence

• Highly reliable use of best evidence

• Identify best practices

• Highly reliable implementation of best practices

Page 14: Saving Money, Saving Lives Population-Based Quality Improvement

Quality of Care Improvement

• Real-time measurement of processes and outcomes

• Small tests of change• Benchmarking• Improvement collaboratives: constituency

determined from the users perspective• Transparency

Page 15: Saving Money, Saving Lives Population-Based Quality Improvement

Country Infant mortality 1998

[deaths/1000 births]

GDP per capita 1992

[1985 U.S. $]

Health expenditures

1995[% GDP]

Public health expenditures

1995[% total health $]

Japan 4 15,105 7.2 78

Germany 5 10.5 78

UK 6 12,724 6.9 84

USA 7 17,945 14.0 47

Infant Mortality

U.S. international rank in 2002 24th

African American IM = 14.4

White IM = 5.8

U.S. international rank in 2002 for low risk infants 7th

Page 16: Saving Money, Saving Lives Population-Based Quality Improvement

Improving the perinatal care system: Users’ perspectives’

What types of care do I need?

Prevention- Care in the public sector: nutrition, housing, social services, immunizations,

primary care Care in the private sector:

primary care (pre-conception, prenatal)

Page 17: Saving Money, Saving Lives Population-Based Quality Improvement

Improving the perinatal care system: The users perspectiveWhat types of care do I need?

Treatment- Care in the public sector: Public health clinics,

‘public’ hospitals Care in the private sector:

Offices, birthing centers, hospitals

Page 18: Saving Money, Saving Lives Population-Based Quality Improvement

OHIO

Page 19: Saving Money, Saving Lives Population-Based Quality Improvement