It may sound obvious on the surface, but you can’t do good end-of-life care if you wait until the end of a patient’s life.
Yet, many healthcare organizations struggle with palliative care. Studies have proven that an established end-of-life program, helping reduce visits to the emergency room and 30-day readmissions, can prove to be incredibly cost-effective for providers. More importantly, it helps ensure a patient and their family’s goals are delivered in the final days of their terminal illness.
OSF Healthcare, a Catholic-based health system in Peoria, Ill., is not one of those organizations finding its feet in this emerging area. Bob Sawicki, M.D., the senior vice president of supportive care at OSF, says the organization formed a palliative care initiative back in 2006. With nine acute-care facilities, an employed medical group, and home-care and hospice units, OSF developed a systemwide care planning process across the continuum. Later, when they were admitted as a Medicare Pioneer accountable care organization (ACO), they recognized the importance of planning risk beyond the walls of their health system.
Integrating Different Datasets
It was then the organization invested in an enterprise wide data warehouse, with an analytics platform that sits on top. The technology, (from the Salt Lake City-based Health Catalyst) integrates numerous datasets, within and outside of OSF, including clinical, claims, patient satisfaction, enterprise resource planning (ERP) information. It also allows for unique, specific-to-palliative care data to be integrated as well after input from the palliative care teams.
“Having our own internal EMR data, having the claims data, having the unique palliative care information, we’re able to provide better risk assessment and stratification of the patient for that population and for the palliative care admissions. We’re able to provide reports and analytics to support [the palliative care team’s] work,” says Mark Hohulin, senior vice president of healthcare analytics at OSF.
Moreover, Roopa Foulger, executive director of analytics at OSF, says that the advanced care planning information documented by Dr. Sawicki’s team is integrated into the warehouse. She says having all of this information in one place pushed out to the masses, including the leaders of the organization, sped everything up by increasing engagement of different levels.
Mark Hohulin Roopa Foulger
The timing aspect, attempting to use this data as quickly as possible, is vital. It allowed them be more coordinated in their proactive approach to treating these patients. “Most of them are older,” Sawicki says. “The last thing they want is multiple people calling them multiple times about what they perceive is the same thing. Having the ability in real-time to figure out who has been reached out to and the response from that is helpful.”
Furthermore, he notes that real-time feedback is motivational, for all those involved in the process. This includes the frontline facilitators, typically made up of nurses or social workers, who are working directly with the patients on advanced care directives.
Thus far, OSF has found success in using analytics to coordinate advance care planning directives across the continuum. To Foulger’s point, it’s raised awareness. “It’s provided visibility and transparency not just to Dr. Sawicki’s team, but we’ve shown all clinicians that this really is a priority,” says Hohulin.
In the first nine months, they completed the advance care planning process for more than 1,200 high-risk patients. Their original goal was to do that within the year. Overall, the number of patients that have completed this process has increased by 64 percent. They have completed it for more than 12,000 patients total, many of whom were likely to become high risk.
Sawicki says that they have yet to look at its impact on 30-day readmissions rates, but they know that it’s there. “We have someone in our organization who is working to identify risk factors for 30-day readmissions. One of the factors that’s been identified is the advanced care planning process. We don’t know the specific impact but we know it does impact it,” he says. “That’s a huge win.”
The trio of leaders at OSF say that there is more to come and lots more data to mine. “A lot of the data we’ve been gathering over the last year, we’re hoping to use for more clinical research purposes,” Foulger says. Sawicki adds they hope to reach out and engage other healthcare systems and get them involved in this process.
They offer two sides of advice: from the clinical and analytics viewpoints. From the clinical side, Sawicki says leaders have to educate providers and keep the patient at the center. From the analytics side, Foulger says the key is to find the right people at the table and have a creative approach.
“This is a team effort. Supportive care teams relied on the IT and administrative teams. Everyone worked together towards the common goal. Everyone was willing to check their egos at the door and look at the results more than anything else,” Sawicki concludes.