Case Study: Using IDS as a Tool to Support Data Quality Improvements and Decision Making for Funding

Transcription

1 Case Study: Using IDS as a Tool to Support Data Quality Improvements and Decision Making for Funding

2 Overview What is the Integrated Decision Support Business Intelligence Tool (IDS) HHS Quality Based Procedure (QBP) Process and Teams Case Study: Using IDS to support QBP data quality, timely volume and metrics monitoring, and provide support for decision making

3 HNHB LHIN Integrated Decision Support (IDS) Business Intelligence Tool Hosted by Hamilton Health Sciences as an Initiative of the HNHB LHIN

4 The IDS BI Solution and Features Mulit LHIN solution, built with ability to link patient level data across multiple data sources, multiple episodes, and multiple sectors to track flow of patients Authorized role-based access through secure web-based portal (ehealth network) providing consolidated (regional/lhin) view down to an encounter level Extensive library of 250+ on-demand reports, analyses, dashboards, visualizations and export capabilities- solution based on the Microsoft Business Intelligence Reporting and Analysis and Sharepoint stack Data Sharing Agreement (DSA), Service level Agreement (SLA), Privacy Impact Assessment and Threat Risk Assessment (PIA/TRA) completed

5 Rich Set of Data Sources IDS supports current patient level data, linked by a unique identifier per patient, for all hospitals, CCAC, and CHC (HNHB LHIN) only 9 Data sources supported for HNHB, 8 sources for Toronto Central, South West, and Cambridge from Waterloo Wellington LHIN: CIHI Acute Inpatients (DAD) CIHI ER, SDS, MDC (NACRS) CCAC CHRIS Client Referral and Visits (from April HNHB) CCAC RAI Assessments (from April ) MIS Trial Balances from Participants and CAHO Teaching Hospitals 7 Community Health Centres (CHC) client events and provider data (EMR upload) CIHI Inpatient Rehabilitation (NRS) CIHI Acute Mental Health (OMHRS) CIHI Complex Continuing Care (CCRS) Stats Canada 2006 Census data tables at FSA level/2010 Census Tract Level Tables HAY Level of Care Tables (Primary, Secondary, Tertiary/Quaternary) HNHB LHIN real time ALC-IS cube level data and reports HNHB LHIN BSO Project flag with CCAC and Hospital Behavioral record level data *HNHB LHIN includes early adopter WW LHIN Cambridge Memorial

6 IDS Benefits & Value Linked data at cube (aggregate level without identifying details) for all participants Linked data can be drilled down to record level for shared custodians of patients (PHIPPA 39 (1)(d)) Allows view into patient populations across regions that can be tied back to the HSP s internal databases (Patient Journey) Complement to HSP s existing information management systems. Another Tool in the toolkit for decision makers. Rich and timely data sets, depending on submission timing (currently cube uploads and data repository done weekly) Promotes and fosters evidence based planning & collaboration through data sharing Information and Metrics support to Health Links

7

8 HHS QBP Process and Teams QBP Steering Committee meets monthly Executive Level and Program Level Reports through to HHS Strategic Goal #4: Attract and Steward Resources QBP Specific Implementation Teams for each Reports to QBP Steering Project Charter governs the process Mulit Disciplinary Team led by Administrative Director and Medical Lead Representatives from Decision Support/Case Costing, Quality, and Health Records Overview of Clinical Expert Panel Handbooks, Pricing and Costing Current State assessed and compared to pathway, Value Stream Mapping completed and GAP analysis done Future State developed to decrease variation and increase efficiency Working on implementing, monitoring and adjusting through PDSA cycles

9 Non Cardiac Vascular QBP Case Study

10 SETTING THE STAGE QBP Non Cardiac Vascular Aortic Aneurysm (AA) Process Mapping

11 QBP Non Cardiac Vascular Aortic Aneurysm (AA) Non Cardiac Vascular Aortic Aneurysm (AA) for Hamilton Health Sciences Carve Out Cases ARIW TWgt Cases Unit Cost Carve Out $5,014 $2,348,820 Funding Cases ARIW TWgt Cases OCCI Avg Adj Total CPWC Funding Total Cost per Case $5,334 $2,498,888 $17,723 Variance $150, % At the time of Funding Announcement HHS FY11/12 OCCI was total avg $21,946 When FY12/13 was available HHS OCCI costs were total average $23,297

12 QBP Non Cardiac Vascular Aortic Aneurysm (AA) Avg HIG ELOS Days Avg Pat Spec Supplies Avg HIG Avg Avg Gen Avg Direct Avg Avg Total MIS Group Cases Avg LOS Weight Labour Supplies Cost Overhead Cost Allied Health 151 $378 $32 $1 $2 $412 $85 $497 2% Cardiac Catherterization Lab 3 $19 $8 $0 $1 $28 $10 $38 0% Cardiac Stepdown 143 $2,874 $0 $167 $88 $3,129 $706 $3,835 16% Day Surgery 148 $182 $0 $15 $4 $200 $62 $262 1% Diagnostic Services 150 $764 $23 $19 $251 $1,057 $429 $1,487 6% Endoscopy 3 $2 $0 $1 $1 $4 $2 $6 0% Food Services 149 $83 $0 $31 $2 $116 $28 $144 1% Laboratory 151 $260 $0 $52 $25 $338 $78 $416 2% Medical Diagnostics 47 $24 $0 $1 $3 $28 $7 $35 0% Operating Room 151 $1,325 $9,902 $371 $317 $11,915 $1,747 $13,662 59% PACU 144 $492 $0 $22 $26 $539 $124 $663 3% Pharmacy 151 $189 $120 $4 $9 $322 $66 $388 2% SCU 20 $996 $0 $86 $29 $1,111 $252 $1,362 6% Ward 43 $357 $0 $18 $11 $386 $115 $501 2% $7,945 $10,085 $789 $768 $19,586 $3,710 $23, % Avg Other Direct % of Total Costs FY13/14 decreased variation and improved costs as part of the QBP working group efforts and work with Ministry and Clinical Expert Panel as it relates to the standard, moderate, and advanced clinical grouping, which are significantly different in costs

13

14

15

16

17

18 QBP Implementation Team Questions Immediately, when looking at the volumes there were concerns that we were not capturing all the cases from the physicians Re-reviewed Clinical Expert Panel Documents for Technical Specification Definitions Re-reviewed IDS Data Definitions Reports Concluded the query was picking up all the cases under the definition so.. Obtained a list from physicians of their patient s MRN and cross referenced to IDS MRN Missing a number of cases When going into IDS patient details very clear the case was done as a Same Day Surgery and then admitted subsequently under non AA Codes or as a short stay Handbook specifies all cases defined as planned/elective admissions, assigned to an inpatient bed, Estimate 8 cases done as Day Surgery with no admission and 20 cases done as day surgery with subsequent admission to an inpatient bed Length of stay, average RIW, and other quality metrics captured in IDS were reasonable but there did exist some variability and room for improvement Questions around Standard, Moderate, Advanced case definition groupings and comparisons with other centres doing AA Significant cost differentiation between the categories

19

20

21 PHI information blanked out for Presentation purposes

22 PHI information blanked out for Presentation purposes The cost of a AA is about $22,000 and we were only getting paid out of the global budget for an SDC case. Because these cases were not in the inpatient side they were not being counted as an AA at all in the QBP funding.

23 Thank You