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Transcript of The presentation will begin shortly.. AnMed Health Disparities Dashboard Keeping it REaL: An...
AnMed Health Disparities DashboardKeeping it REaL: An Analysis of Health Care Quality Among
Priority Patient Populations
Juana Slade, CDM, CCFDirector, Diversity and Language Services
Suzanne Wilson, RN, MBADirector, Medical Resource Management
Presented in partnership with theInstitute for Diversity in Health Management
Health Research Education TrustAffiliates of the American Hospital Association
May 30, 2012
AnMed Health• 578 Bed Acute Care System
– 461 AnMed Health Medical Center– 72 AnMed Health Women’s and
Children's Hospital– 45 AnMed Health Rehabilitation
Hospital• 24,054 Inpatient admissions• 205,400 Outpatient procedures• 107,818 ED visits• 400 Admitting physicians • 2800 Employees
to passionately blend the art of caring with the science of medicine to optimize the health of our patients, staff
and community.
Our Mission
Our Vision
to be recognized and celebrated as the gold standard for healthcare quality and community
health improvement.
The Joint Commission’s Stroke Center of Excellence
The Joint Commission’s “Top Performer” on Key Quality Measures
IHI Mentor Hospital for Acute Myocardial Infarction
Healthgrades® Clinical Excellence and Patient Safety Awards
100 Most Wired Hospitals in Health Networks Magazine
Institute for Diversity in Healthcare’s “Best in Class” and a “Promising Practices”
Gold Standard Celebrations
Healthgrades® America’s 100 Best Hospitals Award
Pursuit of Equitable Care National Direction:• Culturally and Linguistically Appropriate Service
Standards (CLAS)• Joint Commission’s Roadmap Advancing Effective
Communication, Cultural Competence and Patient- and Family-Centered Communication Standards
• American Hospital Association’s National ‘Call to Action’
Applicable law or comprehensive vision
Executive authorization or executive leadership
Language access policy or cultural and linguistic competence
Functional accountability or system integration
Regulatory compliance or equitable care
A Few Historical Realities ….
GoalThe goal of our project is to research and develop a disparities dashboard to identify and strategically address AnMed Health’s most vulnerable, underserved and costly patient populations. The disparities dashboard will be adjunct to our system-wide quality management strategies.
Project Objectives
I. Establish dashboard implementation team
II. Establish dashboard frameworkIII. Establish priority populationsIV. System engagementV. Project Evaluation & Phase II
Assessment
Project Status– Administrative /Executive Support– Competing organizational priorities
• Moving disparities ‘conversations’ forward
– Established dashboard framework• Methodology and Data Set
– Physician Sponsor• Matt Cline, MD, Assoc. Program Director, Family Medicine
– Resources / Implementation Team Talent
Quality & Disparities Dashboard Components
Quality • Appropriate Care Scores
– HF; AMI; CAP; SCIP• Patient Satisfaction
– H-CAHPS• Readmissions
Disparities • Diversity Snapshot
– Service Volumes – Business Line Analysis
• Language Services
FY2011 Diversity Snapshot
Diversity Snapshot White HispanicAfrican
AmericanAmerican
IndianAsian
Unknown/ Other
Setting Percent
Inpatient Discharges 78.63% 0.91% 19.83% 0.25% 0.31% 0.08%
Emergency Department 70.64% 1.17% 23.59% 0.01% 0.12% 4.47%
Child Health 42.23% 7.52% 27.09% 0.00% 0.01% 23.14%
Family Medicine 65.26% 1.85% 20.97% 0.00% 0.00% 11.91%
Type of Care White HispanicAfrican
AmericanAmerican
IndianAsian
Unknown/ Other
Service Percent of Admissions
Inpatient Adult 59.61% 0.72% 19.36% 0.19% 0.24% 0.09%
Inpatient Pediatrics (<17) 73.33% 2.19% 23.04% 0.63% 0.78% 0.04%
AnMed Health Business Line 78.63% 0.91% 19.83% 0.25% 0.31% 0.08%
Cardiac Surgery 88.68% 0.75% 9.43% 0.75% 0.38% 0.00%
Cardiology 74.71% 0.40% 24.55% 0.00% 0.27% 0.07%
Cath & EP 83.37% 0.59% 15.32% 0.13% 0.53% 0.07%
Dentistry 53.85% 7.69% 38.46% 0.00% 0.00% 0.00%
ENT 77.25% 1.20% 20.96% 0.00% 0.60% 0.00%
Gastroenterology 79.93% 0.88% 18.85% 0.20% 0.14% 0.00%
General Surgery 81.05% 1.24% 17.22% 0.33% 0.08% 0.08%
Gynecology 72.18% 0.70% 26.06% 1.06% 0.00% 0.00%
Internal Medicine 78.48% 0.54% 20.43% 0.23% 0.27% 0.05%
Medical Oncology 69.39% 0.00% 30.16% 0.23% 0.23% 0.00%
Neonatology 73.16% 2.25% 23.77% 0.41% 0.41% 0.00%
Nephrology 76.10% 0.73% 22.96% 0.10% 0.00% 0.10%
Neurology 77.02% 0.62% 21.49% 0.00% 0.25% 0.62%
Neurosurgery 85.63% 0.00% 13.22% 0.57% 0.57% 0.00%
Normal Newborn 73.34% 2.04% 22.98% 0.72% 0.85% 0.07%
Obstetrics 72.67% 2.10% 23.75% 0.62% 0.72% 0.14%
Opthalmology 25.00% 0.00% 75.00% 0.00% 0.00% 0.00%
Orthopaedics 87.27% 0.29% 12.22% 0.00% 0.22% 0.00%
Psychiatric 84.08% 0.57% 15.06% 0.00% 0.10% 0.19%
Pulmonary 81.03% 0.55% 18.19% 0.08% 0.12% 0.04%
Thoracic Surgery 82.70% 0.00% 17.30% 0.00% 0.00% 0.00%
Trauma & Burns 82.54% 0.79% 15.08% 0.79% 0.79% 0.00%
Urology 85.27% 0.63% 14.11% 0.00% 0.00% 0.00%
Vascular Surgery 68.69% 1.22% 29.79% 0.30% 0.00% 0.00%
Diversity Snapshot White HispanicAfrican
AmericanAmerican
IndianAsian
Unknown/ Other
Setting Percent
Inpatient Discharges 78.63% 0.91% 19.83% 0.25% 0.31% 0.08%
Emergency Department 70.64% 1.17% 23.59% 0.01% 0.12% 4.47%
Child Health 42.23% 7.52% 27.09% 0.00% 0.01% 23.14%
Family Medicine 65.26% 1.85% 20.97% 0.00% 0.00% 11.91%
Type of Care White HispanicAfrican
AmericanAmerican
IndianAsian
Unknown/ Other
Service Percent of Admissions
Inpatient Adult 59.61% 0.72% 19.36% 0.19% 0.24% 0.09%
Inpatient Pediatrics (<17) 73.33% 2.19% 23.04% 0.63% 0.78% 0.04%
AnMed Health Business Line 78.63% 0.91% 19.83% 0.25% 0.31% 0.08%
Cardiac Surgery 88.68% 0.75% 9.43% 0.75% 0.38% 0.00%
Cardiology 74.71% 0.40% 24.55% 0.00% 0.27% 0.07%
Cath & EP 83.37% 0.59% 15.32% 0.13% 0.53% 0.07%
National Hospital Quality Measures
1-White 1-Hispanic 2-Black3-American
Indian4-Asian 7-UTD Total
Heart Failure
Discharge instructions 97.71% 100.00% 96.90% 0.00% 0.00% 100.00% 97.51%
Evaluation of LVS Function 100.00% 100.00% 100.00% 100.00% 0.00% 100.00% 100.00%
ACEI or ARB for LVSD 99.29% 0.00% 100.00% 0.00% 0.00% 0.00% 99.51%
Adult smoking cessation advice/counseling 100.00% 0.00% 100.00% 0.00% 0.00% 0.00% 100.00%
HF Appropriate Care Score (ACS) 98.06% 0.00% 97.37% 100.00% 0.00% 0.00% 97.90%
AMI
Aspirin at arrival 100.00% 100.00% 100.00% 100.00% 100.00%
Aspirin Prescribed at discharge 100.00% 100.00% 100.00% 100.00% 100.00%
ACEI or ARB for LVSD 100.00% 0.00% 100.00% 0.00% 100.00%
Adult smoking cessation advice / Counseling 100.00% 0.00% 100.00% 100.00% 100.00%
Beta Blocker prescribed at Discharge 100.00% 100.00% 100.00% 100.00% 100.00% Inpatient Mortality *Not tracked in 2011 4.76% 0.00% 6.67% 0.00% 5.06%
Primary PCI Received Within 90 Minutes of Hospital Arrival 100.00% 0.00% 100.00% 100.00% 100.00%
AMI Appropriate Care Score (ACS) 100.00% 100.00% 98.04% 100.00% 99.67%
AMI-T1a LDL Cholesterol Assessment
AMI-T2 Lipid-Lowering Therapy at Discharge (Test)
Pneumonia
Pneumococcal vaccination 99.79% 100.00% 100.00% 0.00% 100.00% 0.00% 99.81% Blood Cultures Performed in the ED Prior to Initial Abx Received in Hospital 99.62% 100.00% 98.68% 100.00% 100.00% 0.00% 99.50%
Adult smoking cessation advice / counseling 100.00% 0.00% 100.00% 0.00% 100.00% 0.00% 100.00% Influenza vaccination 100.00% 100.00% 100.00% 0.00% 100.00% 0.00% 100.00%
Blood cultures w/i 24 hours of hosp arrival-pts transferred/admitted to the ICU 100.00% 0.00% 100.00% 100.00% 0.00% 0.00% 100.00% Initial antibiotic received within 8 hours of hospital arrival 96.89% 100.00% 97.14% 100.00% 100.00% 0.00% 96.98%
Initial antibiotic selection for CAP in immunocompetent - ICU patient 95.65% 0.00% 100.00% 0.00% 0.00% 0.00% 96.08% Initial antibiotic selection for CAP in immunocompetent - Non ICU patient 97.58% 100.00% 97.06% 0.00% 0.00% 0.00% 97.52%
Initial Antibiotic Received Within 6 Hours of Hospital Arrival 96.89% 100.00% 97.14% 100.00% 100.00% 0.00% 96.94%
PN Appropriate Care Score (ACS) 96.78% 100.00% 96.40% 100.00% 100.00% 0.00% 96.75%
Surgical Care
Prophylactic abx within 1 hr prior to surgical incision-Overall Rate 98.35% 100.00% 99.19% 0.00% 98.49%
Prophylactic abx selection surgical patients-Overall Rate 98.22% 100.00% 97.58% 0.00% 98.13%
Prophylactic abx discontinued within 24 hrs after surgery end time-Overall Rate 98.41% 100.00% 99.17% 0.00% 98.54%
Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Serum Glucose 99.15% 100.00% 93.33% 0.00% 98.52%
Surgery Patients with Appropriate Hair Removal 100.00% 100.00% 100.00% 100.00% 100.00%
Surgery Pt on BB Therapy Received BB During Perioperative Period 96.23% 100.00% 97.67% 100.00% 96.53%
Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered 99.18% 100.00% 100.00% 0.00% 99.32% Rcvd Appropriate VTE Prophylaxis w/n 24 Hrs Prior to thru 24 hrs after Surg 98.57% 100.00% 97.94% 0.00% 98.47% SCIP Appropriate Care Score (ACS) 91.99% 100.00% 91.98% 100.00% 92.05% Urinary Catheter Removed on POD 1 or POD 2 With Day of Surgery Being Day Zero 93.75% 100.00% 95.45% 0.00% 94.09%
Surgery Patients with Perioperative Temperature Management 100.00% 100.00% 100.00% 0.00% 100.00%
Appropriate Care Score Populations:
• Heart Failure (HF)• Acute Myocardial Infarction (AMI)• Pneumonia (CAP)• Surgical Care (SCIP)
National Hospital Quality Measures
1-White 1-Hispanic 2-Black3-American
Indian4-Asian 7-UTD Total
Heart Failure Discharge instructions 97.71% 100.00% 96.90% 0.00% 0.00% 100.00% 97.51%
Evaluation of LVS Function 100.00% 100.00% 100.00% 100.00% 0.00% 100.00% 100.00%
ACEI or ARB for LVSD 99.29% 0.00% 100.00% 0.00% 0.00% 0.00% 99.51%
Adult smoking cessation advice/counseling 100.00% 0.00% 100.00% 0.00% 0.00% 0.00% 100.00%
HF Appropriate Care Score (ACS) 98.06% 0.00% 97.37% 100.00% 0.00% 0.00% 97.90%
AMI
Aspirin at arrival 100.00% 100.00% 100.00% 100.00% 100.00%
Aspirin Prescribed at discharge 100.00% 100.00% 100.00% 100.00% 100.00%
ACEI or ARB for LVSD 100.00% 0.00% 100.00% 0.00% 100.00%
Adult smoking cessation advice / Counseling 100.00% 0.00% 100.00% 100.00% 100.00%
Beta Blocker prescribed at Discharge 100.00% 100.00% 100.00% 100.00% 100.00%
Inpatient Mortality *Not tracked in 2011 4.76% 0.00% 6.67% 0.00% 5.06%
Primary PCI Received Within 90 Minutes of Hospital Arrival 100.00% 0.00% 100.00% 100.00% 100.00%
AMI Appropriate Care Score (ACS) 100.00% 100.00% 98.04% 100.00% 99.67%
AMI-T1a LDL Cholesterol Assessment
AMI-T2 Lipid-Lowering Therapy at Discharge (Test)
Pneumonia
Pneumococcal vaccination 99.79% 100.00% 100.00% 0.00% 100.00% 0.00% 99.81%
Blood Cultures Performed in the ED Prior to Initial Abx Received in Hospital 99.62% 100.00% 98.68% 100.00% 100.00% 0.00% 99.50%
Adult smoking cessation advice / counseling 100.00% 0.00% 100.00% 0.00% 100.00% 0.00% 100.00%
Influenza vaccination 100.00% 100.00% 100.00% 0.00% 100.00% 0.00% 100.00%
Blood cultures w/i 24 hours of hosp arrival-pts transferred/admitted to the ICU 100.00% 0.00% 100.00% 100.00% 0.00% 0.00% 100.00%
Initial antibiotic received within 8 hours of hospital arrival 96.89% 100.00% 97.14% 100.00% 100.00% 0.00% 96.98%
Initial antibiotic selection for CAP in immunocompetent - ICU patient 95.65% 0.00% 100.00% 0.00% 0.00% 0.00% 96.08%
Initial antibiotic selection for CAP in immunocompetent - Non ICU patient 97.58% 100.00% 97.06% 0.00% 0.00% 0.00% 97.52%
Initial Antibiotic Received Within 6 Hours of Hospital Arrival 96.89% 100.00% 97.14% 100.00% 100.00% 0.00% 96.94%
PN Appropriate Care Score (ACS) 96.78% 100.00% 96.40% 100.00% 100.00% 0.00% 96.75%
Surgical Care Prophylactic abx within 1 hr prior to surgical incision-Overall Rate 98.35% 100.00% 99.19% 0.00% 98.49%
Prophylactic abx selection surgical patients-Overall Rate 98.22% 100.00% 97.58% 0.00% 98.13%
Prophylactic abx discontinued within 24 hrs after surgery end time-Overall Rate 98.41% 100.00% 99.17% 0.00% 98.54%
Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Serum Glucose 99.15% 100.00% 93.33% 0.00% 98.52%
Surgery Patients with Appropriate Hair Removal 100.00% 100.00% 100.00% 100.00% 100.00%
Surgery Pt on BB Therapy Received BB During Perioperative Period 96.23% 100.00% 97.67% 100.00% 96.53%
Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered 99.18% 100.00% 100.00% 0.00% 99.32%
Rcvd Appropriate VTE Prophylaxis w/n 24 Hrs Prior to thru 24 hrs after Surg 98.57% 100.00% 97.94% 0.00% 98.47%
SCIP Appropriate Care Score (ACS) 91.99% 100.00% 91.98% 100.00% 92.05%
Urinary Catheter Removed on POD 1 or POD 2 With Day of Surgery Being Day Zero 93.75% 100.00% 95.45% 0.00% 94.09%
Surgery Patients with Perioperative Temperature Management 100.00% 100.00% 100.00% 0.00% 100.00%
National Hospital Quality Measures
1-White 1-Hispanic 2-Black
Heart Failure
Discharge instructions 97.71% 100.00% 96.90%
Evaluation of LVS Function 100.00% 100.00% 100.00%
ACEI or ARB for LVSD 99.29% 0.00% 100.00%
Adult smoking cessation advice/counseling 100.00% 0.00% 100.00%
HF Appropriate Care Score (ACS) 98.06% 0.00% 97.37%
AMI
Aspirin at arrival 100.00% 100.00% 100.00%
Aspirin Prescribed at discharge 100.00% 100.00% 100.00%
ACEI or ARB for LVSD 100.00% 0.00% 100.00%
Adult smoking cessation advice / Counseling 100.00% 0.00% 100.00%
Beta Blocker prescribed at Discharge 100.00% 100.00% 100.00%
Inpatient Mortality *Not tracked in 2011 4.76% 0.00% 6.67%
Primary PCI Received Within 90 Minutes of Hospital Arrival 100.00% 0.00% 100.00%
AMI Appropriate Care Score (ACS) 100.00% 100.00% 98.04%
FY2011 Appropriate Care
Scores
FY2011
H-CAHPS
Readmissions
Language Services
Language Services Outpatient Services Inpatient Services Total
Spanish 92.73% 86.31% 91.21%
Russian 1.66% 1.34% 1.58%
Sign Language 2.05% 2.17% 2.08%
Other 1.78% 6.62% 2.92%
Chinese / Mandarin 1.21% 2.84% 1.59%
Arabic 0.12% 0.45% 0.20%
Vietnamese 0.38% 0.17% 0.33%
Polish 0.03% 0.03%
Farsi (Persian) 0.03% 0.03%
German 0.00% 0.00%
Greek 0.11% 0.03%
Patient Experiences with Care WhiteAfrican
AmericanAmerican
IndianHispanic Mexican
Puerto Rican
Hawaiian/Pacific Islander
Asian
% of Responses in Best Category (9-10 Rating) H-CAHPS (Inpatient) Overall Rating 78.70% 74.50% 80.11% 71.43% 70.00% 71.43% 53.85% 50.00%
30-Day Readmissions White HispanicAfrican
AmericanAmerican Indian Asian Unknown/ Other Overall
Overall Rate 10.85% 5.76% 11.54% 3.85% 6.15% 5.88% 10.90%
Overall Volume 1796 11 482 2 4 1 2296
Heart Failure Rate 22.08% 33.33% 22.09% 0.00% 0.00% 0.00% 21.94%
Heart Failure Volume 106 1 38 0 0 0 145
AMI Rate 11.76% 0.00% 37.04% 0.00% 0.00% 0.00% 15.65%
AMI Volume 34 0 20 0 0 0 54
Pneumonia Rate 14.18% 0.00% 13.61% 0.00% 0.00% 0.00% 14.02%
Pneumonia Volume 133 0 20 0 0 0 153
Progress and Challenges
– Strategic alignment• Family Medicine Residency Program • REaL data collection at registration
– Trending and Data Analysis– Intervention Team
• Inpatient Focus– Collaborative and Benchmark Opportunities
Interventions
• Case Management Involvement– Real Time Patient Alerts– Readmission Interview– Post Discharge Phone Calls
• Cultural Competency Education– Skills Fair – Ongoing Relevance Training– Dashboard Presentations
Contact Information
Pamela J. Janniere, MBASenior Membership Specialist
Institute for Diversity in Health [email protected]
312-422-2691
Barrett Ludley, [email protected]
864-512-1846
Juana Slade, CDM, [email protected]
864-512-2361
Suzanne Wilson, RN, [email protected]
864-512-1767