Strange bedfellows improve care for islanders
Strange bedfellows improve care for islanders
New program facilitating unique collaboration
Sandra Sperry, senior vice president of clinical resources at Sisters of Charity Health Care System in Staten Island, NY, says a new cardiac program will open there soon. The collaboration between Sisters of Charity and Staten Island University Hospital will provide open-heart surgery and a range of other services to Staten Island residents.
People who live there now go off-island for some cardiac procedures. Rare as it is for competitors to cooperate in a program like this, the facilities are taking the challenge and coming together to improve patient services, and their decision-support software is smoothing the way.
"We used the market share analysis component of HealthShare's program to facilitate much of our internal discussion and develop strategies to make this collaboration happen," says Sperry. The decision-support software program targets the millions of people who live in the Staten Island and Brooklyn communities and pinpoints those who have left the island for their coronary artery bypass graft (CABG) procedures in recent years.
"Sisters of Charity now does cardiac caths but with the new joint program, also open-heart surgery and angioplasty," She says. "Because of our new software, we're able to determine community needs by looking at the number of people who leave our island for those procedures."
Focusing PI activities via the best feedback
The 866-bed Sisters of Charity integrated health care delivery system has a new focus on cardiac wellness and prevention in the community. "We're looking at a whole range of ambulatory services that will help prevent stroke through early and better management - educational programs on how cardiac arrhythmias can contribute to stroke, for example," says Sperry. For that project, the facility will be accessing outpatient and ambulatory data, as well as inpatient data via their decision-support software system. (See sample computer graphics, p. 48.)
"And in terms of our own performance standards evolution," she explains, "we can look at where we are as compared to our competitors and other benchmarks and see how our practices are reflected in the community."
For example, the health system can link congestive heart failure (CHF) benchmarks within the state, those external to New York, and their own internal performance - physician to physician and program to program - and see where opportunities for improvement are.
"We've had several hospitals look at theircardiac programs and benchmark themselves against their peers," says Richard B. Siegrist Jr., founder and CEO of HealthShare Technology in Acton, MA.
"They then pull together teams of administrators and clinicians to address weaknesses. One institution that was looking at resources being used in cardiology and cardiothoracic surgery saved millions using these programs."
"Over the years," says Sperry, "our approach toward utilization [management] and performance improvement has been too punitive, and both require a positive attitude. This system allows us to talk through the data with our clinicians and those providing service to our clinicians in a collegial, collaborative fashion." They discuss the data's impact. Before this, physicians couldn't really know how they did in comparison with the rest of the industry, other than through anecdotal evidence, and that was often inaccurate. The system fosters cooperation and a positive attitude.
Sisters of Charity generated several decision reports on CHF. "When we thought our costs were high as compared to SPARCS data, and our ICU lengths of stay were longer than that of benchmark hospitals, we drilled down and got more details," says Sperry. Various physicians asked her to run reports on their individual performances so they could see where they fell among their peers.
"Nothing is more powerful than having solid timely information and data to help clinicians look at opportunities for improvement and start to shift behavior. It's the best kind of feedback," she says. "We have seen a significant change in physician response to the information." Physicians look at most data with some degree of suspicion, especially when statistics are not as up to date as they should be and not severity-adjusted.
"The industry is moving forward so fast in the area of CHF, anything I used to take to the physicians was probably three years old, and I got a `been there, done that' kind of response," Sperry says. The data provided by the decision-support software are current - within six months to a year - and severity-adjusted. You can ask your own questions, then reformat them to delve deeper for different levels of detail, such as comparative data on expenditures on EKGs and holter monitoring.
Sisters of Charity leases the software from HealthShare; data are updated every six months. The 1996 data alone required nine gigabytes of memory.
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