The presentation will begin shortly.. AnMed Health Disparities Dashboard Keeping it REaL: An...

21
The presentation will begin shortly.

Transcript of The presentation will begin shortly.. AnMed Health Disparities Dashboard Keeping it REaL: An...

The presentation will begin shortly.

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

Why this….why now?

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 ….

Our Project Disparities Leadership Program 2011-2012AnMed Health: Disparities Dashboard

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

Questions

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