1
Pursuing
High Value
Healthcare
Optimizing Laboratory Testing
Webinar
November 19, 2015
Agenda
2
 Welcome
 Update Collaborative Year 2
 Team Survey Results
 Year 2 Lab Global Aim
 COPD Global Aim
 Data update
 Team Updates
● Next Steps
 Action Period to Kick of Year 2
Our Collaborative Journey
YEAR
2!
ALLEN REPP
Year 1 Successes
 Engaging broad collaborative group - 90% of hospital beds in region
 Fostering communication within hospitals and between hospitals
 Identifying opportunities for clinically meaningful improvement – from the
front line
 Lab collaborative website
 Building the foundation for comparing performance across hospitals
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Trust
Legal hurdles: business associate agreements
Technical hurdles: standards and processes for data uploads to central database
 Began to implement real changes in laboratory ordering practices and
processes
 Began to see the impact of those changes
Year 1 - Challenges
 Lack of time & competing priorities for all team members
 Yet, incredible engagement and enthusiasm
 Sense of the potential impact on region
 Performance improvement infrastructure and support varies widely
 Value of collaborative process and central data analysis and reporting clear
 Hospital data definition, collection and storage processes differ enormously
 Refining data reports, cleaning data to be able to compare “apples to apples”
 Technical solutions for housing and analyzing protected health information are limited
 NORC fills a niche, but isn’t user friendly
 Performance improvement requires measures of performance
 Keep inching closer to timely reports
 Systems changes take time
 e.g., committee processes, changes to computerized provider order entry
 There are so many opportunities – where to start and go next?
Survey Results – Year 1
Item
Weighted Mn
The 1st year of the Collaborative met my expectations
3.6
The Collaborative has helped our team begin to accomplish the aim of reducing harm to patients
3.3
The Collaborative has provided an opportunity for our team to cross departmental lines and improve
communication around systems of care.
3.7
The Face to Face Collaborative sessions were valuable in helping to move our team’s improvement
efforts forward.
3.9
The monthly Webinars were valuable in helping to move our team’s improvement efforts forward.
3.0
Openly sharing the data and reports across the collaborative teams is helpful to our improvement
work.
3.9
The changes we have made in optimizing laboratory testing is starting to preserve system resources.
3.1
I plan to participate in the 2nd year of the Optimizing Laboratory Testing collaborative.
4.1
I would be interested in participating in future collaborative quality improvement, patient safety,
and/or high value care projects.
4.0
Survey Results
 Comments:
 Collaborative data availability
 Level of detail on data analysis
 Communication about data management process
 Inter-facility involvement & opportunities to share experiences
Survey Results
 Preferences for a 2nd high value care project:
Proposed Project
Mean Score
Reduce unnecessary lab ordering in COPD patients
3.4
Develop and implement a best practice care pathway for COPD
(to guide testing and treatment in patients with COPD)
4.0
Reduce unnecessary pre-operative lab and/or radiographic
testing
3.0
Reduce use of low utility inpatient labs such as PTT in patients
who are not receiving heparin or hypercoagulable workup in
setting of acute venous thromboembolism
1.7
Develop and implement a protocol for telemetry utilization
2.9
Year 2
 Continue work on lab optimization
 Pick next step(s) in reducing unnecessary testing for each institution
 Address use of daily lab orders, if applicable
 Data / monthly reports
Optimizing Lab Testing Global Aim
We aim to reduce harm to patients and conserve system resources by using a collaborative
approach and the best medical evidence and quality improvement science to optimize the use
of laboratory tests for patients cared for in our region’s hospitals.
It begins with an evaluation of current test ordering profiles and patterns at each institution as
well as the creation of a centralized collaborative data base and reporting process followed by
an organized plan to optimize testing and ends with a plan to sustain these practices.
By doing this we expect to reduce cost and improve satisfaction and quality of care for patients
and the health system and provide ongoing data support to our participating teams.
It is important to work on this now because as health care professionals we can play an
important role in health care reform by designing more patient-centered, efficient and high
value inpatient care.
Year 2 – COPD Pathway
 Longstanding availability of clinical guidelines
 BUT…persistence of large gaps in care quality and substantial variation across hospitals in the
management of patients with COPD
 Approx. 60% of patients with severe COPD are not prescribed maintenance bronchodilator
therapy
 25% of patients with AECOPD are discharged without any bronchodilator therapy
 New evidence over past years about steroid dose and therapies, nebulizers vs MDIs, antibiotic
duration

ATS/ACCP Proposed CW Recommendation: “Do not routinely administer IV steroids for patients hospitalized for
acute exacerbations of asthma and COPD”
Year 2 – COPD Pathway
 Assess and share current state
 Current practices and rationale
 Add to team, if needed
 Nursing, RT, Pharmacy, Pulmonary
 Map future state – create best practice pathway / order set
 Risk stratification
 Pharmacologic mgmt.: steroids, nebs/MDIs, antibiotics
 Non-pharmacologic mgmt.: smoking cessation, immunizations, rehab, device
education
 Transition to outpatient care – identification of local resources
 Core elements of order sets/pathways standard across region
Year 2 – COPD Pathway
 Measures
 Local implementation data
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Lab data from collaborative
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e.g., % patients with COPD exacerbation with COPD order set
e.g., hemograms per patient day in patients admitted with COPD exacerbation
Decide on other data to collect (and sources of data): LOS, mortality, incidence of
hyperglycemia, aggregate pharmacy charges
 Resources:

Chronic Obstructive Pulmonary Disease Program Implementation Guide – SHM Center for Hospital Innovation &
Improvement:
http://www.hospitalmedicine.org/Web/Quality___Innovation/Implementation_Toolkit/COPD/copd_home.aspx
COPD Exacerbation Global Aim
We aim to improve the care provided to patients with COPD exacerbations by using a
collaborative approach and the best evidence based knowledge and quality improvement
science to create a standardized COPD care pathway and/or order set in the participating
regional hospitals.
It begins with an evaluation of the current COPD care pathways and processes of care and a
review of the latest evidence based information on COPD. It ends with the development and
implementation of a common COPD care pathway and/or order set.
By doing this we expect to reduce cost and improve patient satisfaction and quality of care for
patients and the health system.
It is important to work on this now because as health care professionals we can play an
important role in health care reform by designing more patient-centered, efficient and high
value inpatient care.
Year 2
 Faculty liaisons- connections for all teams
Institution
Team lead
Contact information
Faculty Liaison
Liaison Contact
Justin.StinnettJustin Stinnett-Donnelly
Donnelly@cvmc.org
CVMC
Don Weinberg
tchcdon@gmail.com
DHMC
Alden Hall
Mark Cervinski
alden.w.hall@hitchcock.org
Mark.A.Cervinski@hitchcock.org
Allen Repp
Allen.Repp@uvmhealth.org
Brattleboro
Aida Avdic
aavdic@bmhvt.org
Mark Pasanen
Mark.Pasanen@uvmhealth.org
Porter
David Rand
davearand@gmail.com
Jill Warrington
Jill.Warrington@uvmhealth.org
Rutland
Denise Simpson
dsimpson@rrmc.org
Virginia Hood
Virginia.Hood@uvmhealth.org
SWMC
Jim Poole
pooj@phin.org
Bonnie and Randy
bonniewalker@tupelogroup.com
RandyMessier@tupelogroup.com
North Country
Oren Martin
omartin@NCHSI.org
Mark Fung
Mark.Fung@uvmhealth.org
NVRH
Mike Rousse
m.rousse@nvrh.org
Cy Jordan
cjordan@vtmd.org
Year 2 Continued
 Webinars – more inter-hospital discussion
 Learning sessions
 Split between Lab Testing and COPD pathway
 Visits to sites and teams
 Share experience – presentations
 Template presentation on website
 Share experience – manuscript(s)
Data Update
ABBY AND STEVE
Status of Current Data 11.18.15
Current Data Timeline
November 30th: collaborative data report
All data submitted by the 15th of the month* will be included in the
monthly collaborative report
Monthly collaborative reports will be distributed on the 30th of each
month
*How can we help you get your data up to date?
Data Collaborative Reports
Measure set #1
November 30th
 Current month individual hospital # discharges
 Characteristics of current month individual hospital discharges: distributions of gender, age, and
length of stay in CDC patient days. 15 most frequent DRG codes.
 Run charts with lab rates for all participating institutions over time: lab rates will be defined as
“total # labs” / “total # CDC patient days” associated with monthly hospital discharges. Lab rates will be
calculated for visits with a DRG code (inpatient) and those without DRG codes (observation) separately.
Lab values included in monthly report:
 These are the categories of lab tests to be for monthly lab rate reporting. Those specific tests in bold are
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used to represent the category for use in reporting across the collaborative:
CBC (HCT, HGB, PLT, WBC)
CHEM (BUN, CREA, CAL, IONCAL, NA, K, CO2, CL, MG, PHOS)
CARDIAC BIOMARKERS (CK, CKMB, TROP)
LIVER FUNCTION (ALT, AST, BIL)
COAGULANTS (PTT, INR)
Data Collaborative Reports
Measure set #2
December 30th
Focus will be on including lab rates by day of hospital stay:
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
Day of admission
Day +1, +2, +3, etc.
Day of discharge
Data Collaborative Reports
Measure set #3
January 30th
Focus will be on lab values
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Normal values
Change in values over time
Data Collaborative Reports
Measure set #3
January 30th
Focus will be on lab values
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Normal values
Change in value
Data Collaborative Reports - timeline
 Measure set #1
November 30th
 Support all sites to submit up to date data
 Establish a streamlined data mgmt. and cleaning process
 Measure set #2
December 30th
 Variable and measures definitions
 Incorporate measures into data reports
 Measure set #3
January 30th
 Variable and measures definitions
 Incorporate measures into data reports
Please help us with this timeline!
Team Progress Reports
4
 RRMC
 Brattleboro
 NVRH
 Bennington
 Porter
 DHMC
 CVMC
 UVMMC
 NCH
 Team membership and frequency
of team meetings.
 Changes and improvements tried.
 Success/accepted changes.
 Barriers?
 Interest in COPD pathway
development.
 Current COPD pathway or current
COPD work if appropriate.
Kick-Off
Week 1
Collaborative Timeline
Sept 10, 2PM
Action Period
5-6 weeks
Learning
Session 1
Oct. 15
8:30 to 3:30
Continuous Coaching/Faculty Support
Conference
Call /
Webinar
Nov 19, 2PM
Conference
Call /
Webinar
Dec 17, 2PM
Learning
Session 2
Jan.14, CVH
8:30 to 3:30
Learning
Session 4
Jun. 9 UVM
8:30 to 3:30
26
Conference
Call/
Webinar
Feb. 18, 2PM
Conference
Call /
Webinar
May 12, 2PM
Conference
Call /
Webinar
Mar 24, 2PM
Learning
Session 3
Apr. 14 DHMC
8:30 to 3:30
Next Steps
 Action Period
 Continue to review and submit data
 Test change ideas
 Measure results
 Adjust as needed
 Test again or try new change idea
10
 Support
 Liaisons/Faculty and Data Team are here to support you!
 Next Webinar December 17th 2PM.