The Most Appropriate Care Initiative

Julia Slininger, RN, BS, CPHQ

VP, Quality & Patient Safety, HASC

4/29/16

Doing Important Work

Together

Valuing our • Patients and Families

• Physicians

• Administrators

• Inter-professional staff

• Collective Accountability for the

Triple Aim

Choosing Wisely

www.choosingwisely.org

An initiative of the ABIM Foundation

Aims to promote conversations between

clinicians and patients, helping patients

choose care that is:

Supported by evidence

Not duplicative of other tests or

procedures already received

Free from harm

Truly necessary

Dr. Leo Lopez, PIH Health

• PIH Health physicians support the Choosing Wisely campaign

• Since April 2013, the medical staff has made great progress in implementing nearly all the recommendations

• We are continuously reassessing our results and work with patients on shared decision-making to optimize care for every patient

An attempt by doctor’s groups to determine their own cuts rather than wait for the government or insurance companies to mandate them

Choosing Wisely

Choosing Wisely

Over seventy specialty societies representing more than 1,000,000 physicians developed agreements of “Five things physicians and patients should question”. They aim to promote conversations between physicians and patients by helping patients choose care that is: • Supported by evidence • Not duplicative • Free from harm • Truly necessary

• PIH Health neurologists follow these guidelines

– However, since we are consults many patients with stable migraine headaches are imaged before we even see the patient

PIH Health Hospital – Headache

White Memorial Key Utilization Initiatives

Blood Utilization

Urinary Catheterization

Antibiotic Stewardship

Diagnostic Imaging

Daily/Serial Labs

End of Life / Palliative Care

White Memorial Organizational Performance Matrix

Clinical and Cost Improvement for Population

Health

•Governance

•Education

•Clinical decision support

•Monthly individual physician Choosing Wisely adherence

feedback

Approach

12

17% reduction

in blood

utilization

while CMI

increased by

14%

* 2015 is projected from 6 months of data

** 2015 Case Mix Index (CMI) value is from January-June data

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Deployment of CDS at point-of-care, RBC transfusions among patients with high hemoglobin levels declined by 46%

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HGB VALUE

Pre-transfusion Hemoglobin 2012-2014

"Before"

After

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CDS alerts

14

Objectives for the Initiative We are better TOGETHER

• Provide an interactive and open sharing

environment for peer hospitals to learn

from each other

• Collaborate with our physicians, as

partners in pursuing the Triple Aim and

surviving healthcare reform

• Select and Implement changes in each

hospital to address one or two MAC

objectives

• Discover ways to quantify and qualify the

value we expect to enhance

What are we trying to accomplish?

How will we know that a

change is an improvement?

What changes can we make that

will result in improvement?

IHI Model for Improvement

Act Plan

Study Do

© 2003 Institute for Healthcare Improvement

17

Use of the PDSA Cycle to Test Changes

Ideas,

Theories,

Hunches

Changes that

Result in

Improvement

A P

S D

A P

S D

© 2003 Institute for Healthcare Improvement

Cycle #1

Cycle #2

Cycle #3

Cycle #4

Use Existing Structures

1. Utilization/Case Management

Committee

2. QI Committee

3. Pharmacy and Therapeutics

4. Medical Staff Committees

5. Board of Directors

Telling our own “Story”

Thank YOU

To all who have brought

Storyboards

Sharing your progress in this

journey!

Rough estimate of our MAC

Initiative hospitals’ focus areas

Areas being addressed # of hospitals

Blood Utilization

Urinary Catheterization

Antibiotic Stewardship

CT Scans

Daily/Serial Labs

End of Life/ Palliative Care

Continuous Telemetry

Nebulizer Therapy

Other

4

4

11

4

9

16

12

2

3

Statewide Workgoup on Overuse of

Ineffective or Unnecessary Medical Care

Co-chaired by CalPERS, DHCS and

Covered California Addressing 3 selected targets (Opioid overuse,

NTSV C- Section, and Imaging for low back pain)

to help implement change across the continuum

With a variety of participants from stakeholder and

provider organizations, including Julie Morath,

President and CEO of the Hospital Quality

Institute (HQI), and David Perrott, SVP/CMO for

the California Hospital Association

Integrated Healthcare Association

ABIM announced on 6/18/15 “IHA has been selected as a grantee in the

Choosing Wisely campaign to reduce the use of

tests and treatments in CA that national medical

societies have said are often overused and may

be unnecessary.”

Partners include the Robert Wood Johnson

Foundation, Sharp Rees-Stealy Medical Group,

Sutter Health, the CA chapter of the ACP, the

Center for Healthcare Decisions, and Blue Shield

of CA

HASC MAC Initiative Resources

HASC’s Most Appropriate Care

Initiative Webpage resources

http://www.hasc.org/education-

event/most-appropriate-care-

initiative