LWW/JACM

JACM-D-14-00014

May 20, 2014

17:4

J Ambulatory Care Manage Vol. 37, No. 3, pp. 199–205 C 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright 

Leveraging Data to Systematically Improve Care Coronary Artery Disease Management at Geisinger Thomas Graf, MD; Alistair Erskine, MD; Glenn D. Steele, Jr, MD, PhD Abstract: Coronary artery disease is complex chronic disease best managed by a team empowered by actionable data and a comprehensive approach, the ability to improve intermediate outcomes was dramatically enhanced after Geisinger created a system of care to do so. Continuous measurement of critical data elements of process and intermediate outcome measures allows the delivery of actionable information to the most appropriate team member, including the patients and family as team members. Continuous monitoring of the overall program looking for trends and opportunities across sites and regions allows for program enhancements. The comprehensive “all-or-none” bundled approach to care, which has already realized a 300% improvement, will be further enhanced by incorporating additional “Big Data” flows. Key words: big data, CAD, coronary artery disease, disease management, Geisinger

C

ORONARY ARTERY DISEASE (CAD) is a common, complex, and critical chronic disease that necessitates a team approach to optimize the care of patients by comprehensively measuring and improving care and a systematic team approach to care delivery. Engaging “Big Data” solutions carries the promise of even more improvement by moving beyond personalized care goals to personalized care processes and a more comprehensive view of patients through active and passive means. All of this should further enhance our success and allow even more patients to achieve all elements of the “all-ornothing” care bundle.

Author Affiliation: Geisinger Health System, Danville, Pennsylvania. T.G. is on the Merck Medical Home Speaker’s Bureau. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Thomas Graf, MD, Geisinger Health System, 100 N Academy Ave, Danville, PA 17822 ([email protected]). DOI: 10.1097/JAC.0000000000000038

METHODS Designing a model to reliably deliver better care to a population involves individual and population data, physician leadership, an in-depth understanding of the evidence base for optimal care, engagement of all elements of the care team including advanced analytics and the patient as part of the team, continuous measurement and improvement, support for those challenged by the change, and attention to systematic delivery through feedback and compensation (Casale et al., 2007; Graf et al., 2012). Physician-directed teams work to provide all aspects of care in a consistent and reliable manner based on comprehensive data actively pushed to the most appropriate team member when actionable. To do this, the workflow must not rely on the heroic efforts of diligent individuals. The redesign is incorporated into the standard workflow using charting tools, checklists, reminders, and alerts. The electronic health record (EHR) can be a valuable tool in creating a standard workflow, but having an EHR by itself does not accomplish the necessary workflow redesign. 199

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

LWW/JACM

200

JACM-D-14-00014

May 20, 2014

17:4

JOURNAL OF AMBULATORY CARE MANAGEMENT/JULY–SEPTEMBER 2014

We recognized the need to comprehensively redesign the care we delivered to patients with coronary artery disease in 2006. We established a CAD team to review all CADassociated guidelines including: The American Heart Association and American College of Cardiology guidelines for “Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Disease” and for “Chronic Stable Angina”; The National Cholesterol Foundation Adult Treatment Panel III guideline; The Center for Disease Control and Prevention adult immunization schedule; and The National Quality Forum standards for ambulatory care. On the basis of these, we developed a system of care to reliably address 9 patient-oriented goals for improving the health of nearly 17 000 of our patients with CAD. These 9 goals are measured in an “all or none” fashion to encourage team-based workflows, addressing all measures in all patients with CAD, not only at each encounter, but continuously. The measures include appropriate blood pressure control (designated at

Leveraging data to systematically improve care: coronary artery disease management at Geisinger.

Coronary artery disease is complex chronic disease best managed by a team empowered by actionable data and a comprehensive approach, the ability to im...
88KB Sizes 0 Downloads 3 Views

Recommend Documents


Management of coronary artery disease in a Tertiary Care Hospital.
The objective of the study was to study the prescribing patterns of drugs used in the coronary artery disease (CAD) and to identify, which drug is mostly prescribed at that hospital.

Using data to improve care.
We look at the role of data in improving the quality of care for children and young people: how they can help to identify a problem; guide design of solutions; and evaluate changes in practice. We introduce some principles for measurement in the fiel

Quantification of myocardial blood flow using PET to improve the management of patients with stable ischemic coronary artery disease.
Cardiac PET has been evolving over the past 30 years. Today, it is accepted as a valuable imaging modality for the noninvasive assessment of coronary artery disease. PET has demonstrated superior diagnostic accuracy for the detection of coronary arte

Leveraging position bias to improve peer recommendation.
With the advent of social media and peer production, the amount of new online content has grown dramatically. To identify interesting items in the vast stream of new content, providers must rely on peer recommendation to aggregate opinions of their m

Optimizing the leveraging of real-world data to improve the development and use of medicines.
Health research, including health outcomes and comparative effectiveness research, is on the cusp of a golden era of access to digitized real-world data, catalyzed by the adoption of electronic health records and the integration of clinical and biolo

Leveraging Big Data to Improve Health Awareness Campaigns: A Novel Evaluation of the Great American Smokeout.
Awareness campaigns are ubiquitous, but little is known about their potential effectiveness because traditional evaluations are often unfeasible. For 40 years, the "Great American Smokeout" (GASO) has encouraged media coverage and popular engagement

The louisiana clinical data research network: leveraging regional and national resources to improve clinical research efficiency.
Mapping of the human genome and technological advancements allowing storage and rapid retrieval of healthcare data have heralded a new phase in clinical medicine and have served as a catalyst for the advent of personalized medicine. The use of health

Exercise in the Management of Coronary Artery Disease.
Disability adjusted life years (DALYs) lost can be thought of as "healthy years of life lost". DALYs combine years of potential life lost due to premature death with years of productive life lost due to disability. They indicate the total burden of a