In-depth data report identifies 10 diagnoses with the highest levels
of unjustified variation within the ICU; cardiac procedures and sepsis
are biggest opportunity areas
CHARLOTTE, N.C.--(BUSINESS WIRE)--
Premier Inc. (NASDAQ: PINC), a leading healthcare improvement company,
has identified 10 diagnoses with the biggest opportunity to curb
variation within the intensive care unit (ICU) and reduce unnecessary
length-of-stay. The analysis was published in Premier’s
latest Margin of Excellence report, which provides unparalleled,
data-driven, evidence-based insights on cost and quality improvement
opportunities.
The
Premier report focuses on evidence-based improvement steps in the
ICU based on an analysis of 20 million patient discharges across 786
hospitals over a five-year period (2011-2016). According to the
analysis, Premier found opportunities to reduce ICU days by 988,111 days
overall or nearly 200,000 annually. Overall, patients treated at
top-performing hospitals spent 24 percent less time in the ICU.
Opportunities were identified by comparing all hospitals in the analysis
to peers that utilized the ICU for the same populations in the most
efficient manner without compromising quality (metrics examined included
inpatient mortality rates and unplanned 30-day readmissions).
The findings underscore the value of identifying evidence-based
improvement opportunities that healthcare leaders are focused on. For
instance, a recent Premier C-Suite survey found respondents
overwhelmingly ranked reducing clinical variation and standardizing the
use of products, resources and services as a top cost management
priority (96 percent), with more than half ranking it as the top
priority when tackling cost inefficiencies. The ICU report can help
providers pinpoint areas with the most opportunity to reduce variation.
10 ICU Diagnoses with Highest Variation in ICU
Stays over a Five-Year Period
1. Sepsis patients with major complications or comorbidities: Represents
19 percent of the ICU reduction opportunity
2. Infectious and parasitic diseases associated with operating room
procedures, and major complications or comorbidities: Represents 15
percent of the ICU reduction opportunity
3. Cardiac valve and other major cardiothoracic procedures without
cardiac catheterization, but with major complications or comorbidities:
Represents 12 percent of the ICU reduction opportunity
4. Coronary bypass without cardiac catheterization, but with major
complications or comorbidities: Represents 9.8 percent of the ICU
reduction opportunity
5. Respiratory system diagnosis with ventilator support for up to 96
hours: Represents 9.5 percent of the ICU reduction opportunity
6. Craniotomy and endovascular intracranial procedures with major
complications or comorbidities: Represents 8.9 percent of the ICU
reduction opportunity
7. Sepsis patients using a mechanical ventilator >96 hours: Represents
6.8 percent of the ICU reduction opportunity
8. Cardiac valve and other major cardiothoracic procedure with cardiac
catheterization and major complications or comorbidities: Represents 6.8
percent of the ICU reduction opportunity
9. Cardiac valve and other major cardiothoracic procedure without a
cardiac catheterization, but with complications or comorbidities:
Represents 6.1 percent of the ICU reduction opportunity
10. Heart failure and shock with major complications or comorbidities:
Represents 6 percent of the ICU reduction opportunity
“Spending too much time in the ICU can negatively impact patients and
the bottom line, particularly in this era of value-based care payment
models,” said Robin Czajka, RN, service line vice president of cost
management at Premier. “Decisions around admitting patients to the ICU
and how they are treated can often be subjective calls, rather than
guided by evidence. While ICU optimization is no easy task, robust data
and analytics can help unveil opportunities to improve care delivery and
quality within this setting – ranging from identifying diagnoses with
the greatest variation in outcomes to monitoring patients who no longer
need ICU-level care within newly-created intermediate care settings.”
Premier also found that providers in the analysis are making progress in
optimizing care, identifying a 13 percent decrease in patient days spent
in the ICU across the top 10 diagnoses over the five year period.
Improvements were associated with the following key best practices:
-
Using evidence-based practices performed collectively to tackle
healthcare-associated infections (HAIs) and delirium;
-
Creating intermediate care settings to seamlessly provide an effective
transition unit for patients who no longer require ICU-level care;
-
Leveraging checklists to monitor patient progress and goals; and
-
Multidisciplinary care team collaboration with physicians, nurses,
pharmacists, residents and other members of the ICU staff.
Premier’s
analysis provides a deep understanding of cost and quality trends so
that providers can compare performance against peers and identify
unjustified variation, as well as drill down to contributing
institution-, service line- and physician-level sources.
“Data is the foundation for our optimization efforts – helping transform
the delivery of care within our ICUs,” said Dr. Pinckney McIlwain, chief
medical officer of Charleston Area Medical Center (CAMC) in West
Virginia. “Focusing on unnecessary ICU days has the potential to improve
patient outcomes, reduce payment penalties, create additional bed
capacity, decrease patient holding time within the emergency department,
optimize workflow and increase patient satisfaction – all while reducing
cost pressures and creating additional savings. As we continue on this
journey, data is fueling this initiative to understand our performance
and ability to improve ICU and critical care delivery.”
Examples of success at Premier member health
systems
-
CAMC (Charleston, WV) has seen an overall reduction in
length-of-stay within the ICU and Medical Intensive Care Unit by 1.15
days over a 21-month period and deferrals have decreased dramatically.
-
Mercy Health (Cincinnati, Ohio) streamlined changes
across institutions and departments that touch ICU and critical care
that would continue to enhance quality care. As a result, the system
also generated $6.7 million in savings over a two-year period.
-
Inova Fairfax (Falls Church, Va.) launched a 90-Day Clinical
Effectiveness Sprint focused on craniotomy patients and in a 10-month
period, the team has seen patient readmissions to the ICU decrease by
54 percent, and the average length-of-stay for its neurological ICU
reduce from 5.2 days to 2.1 days.
Premier’s Margin of Excellence reports provide a detailed view on cost
and quality trends across the continuum, as well as share insights on
evidence-based strategies and tools designed to tackle inefficiencies in
healthcare, ranging from variation in clinical practices to resource
utilization. The analyses tap Premier’s robust integrated database,
PremierConnect®, linking clinical, financial and supply chain
data. Results are leveraged by providers seeking to pinpoint areas of
improvement by comparing their performance to national peer data.
Methodology
The ICU utilization analysis included data from 786 facilities based in
45 states, representing more than 20 million discharges over a five-year
period (2011- 2016). Researchers reviewed charges within this data for
ICU stays from within 128 MS-DRGs, which account for 80 percent of ICU
use at these facilities.
About Premier Inc.
Premier Inc. (NASDAQ: PINC) is a leading healthcare improvement company,
uniting an alliance of approximately 3,900 U.S. hospitals and health
systems and approximately 150,000 other providers and organizations.
With integrated data and analytics, collaboratives, supply chain
solutions, and advisory and other services, Premier enables better care
and outcomes at a lower cost. Premier, a Malcolm Baldrige National
Quality Award recipient, plays a critical role in the rapidly evolving
healthcare industry, collaborating with members to co-develop long-term
innovations that reinvent and improve the way care is delivered to
patients nationwide. Headquartered in Charlotte, N.C., Premier is
passionate about transforming American healthcare. Please visit
Premier’s news and investor sites on www.premierinc.com;
as well as Twitter,
Facebook,
LinkedIn,
YouTube,
Instagram
and Premier’s
blog for more information about the company.
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Source: Premier Inc.